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PubMed2002

Native American women in alcohol and substance abuse treatment.

Alcohol and other drug use is a serious problem among American Indian and Alaska Native women. However, information about their needs for treatment is lacking. In response, a study was conducted to document the life experiences and perceived recovery needs of American Indian and Alaska Native women at nine treatment centers nationwide. The data show that most of these women have experienced various forms of abuse and neglect from childhood into adulthood and have been exposed to alcohol and other drugs from an early point in their lives. Most of these women have made multiple attempts to recover from their addictions, often for the sake of their children. The information derived from this study can be used as the foundation for further research about the treatment needs of American Indian and Alaska Native women.

Adolescent↗
PubMed2000

Northern exposure.

The operators of Alaska's Alyeska pipeline have often claimed an outstanding record in preventing accidents and environmental damage. This article highlights that, contrary to these claims, Alyeska's operations have brought with them a life-threatening gamble with Alaska's fragile environment. The authors document how the operators of Alyeska have misled the public about the company's real safety record, while at the same time preventing employees from speaking out. As the oil companies consolidate globally, territorial entities such as Alaska can literally assume the character of an oil province.

Journal Article↗
PubMed1998

Gonorrhea among drug users: an Alaskan versus a national sample.

The study described here investigates the replicability of gender-specific risk profiles for gonorrhea based on an Alaskan sample compared to a U.S. national sample of drug users at risk for HIV infection. The Alaska sample (interviewed at a field station in Anchorage, Alaska; N=1,049) and the national sample (interviewed at 18 sites other than Alaska; N=17,619) consisted of cocaine smokers and injection drug users not in drug treatment. A history of gonorrhea infection was self-reported and coded as ever or never. The Anchorage and national risk profile for men included the following factors: (a) history of intranasal or parenteral cocaine use, (b) being black versus nonblack, (c) being older, (d) income from illegal activity, and (e) history of amphetamine use. The Anchorage and national risk profiles for women included the following factors: (a) trading sex for money, (b) being Native American versus non-Native American, and (c) trading sex for drugs. The Anchorage model for women included perceived homelessness as a factor, but it was not retained in the national model. The extent of the replicability of these models illustrates the generalizability of Alaskan findings to other U.S. drug-using populations. The authors also discuss the implications of these findings for disease prevention.

Comorbidity↗
PubMed1983

Effects of fusarium cultures, T-2 toxin, and zearalenone on reproduction of turkey females.

Nicholas Large White turkey hens in egg production (10 per treatment) were individually fed cultures of Fusarium roseum 'Gibbosum' to provide 100 ppm zearalenone, Fusarium tricinctum at a level of .1% of the diet, Fusarium roseum Alaska at a level of 2% of the diet, 100 ppm purified zearalenone, and 5 ppm purified T-2 toxin for 8 weeks. The following 4 weeks the birds were fed a control diet. Hens were inseminated every 2 weeks with .05 ml of pooled semen from males fed a control diet. After 30 days of toxin feeding, hens were innoculated with a killed Newcastle disease virus preparation. Blood samples were obtained periodically. Egg fertility and titers to Newcastle disease virus were unaffected by treatment. Egg weight was reduced by F. roseum 'Gibbosum'. F. roseum 'Gibbosum' and F. tricinctum caused decreases in feed consumption, body weight, and egg production. Egg production was decreased by zearalenone and T-2 toxin. Hens fed F. roseum 'Gibbosum', F. tricinctum, and T-2 toxin exhibited mouth lesions that healed rapidly upon withdrawing toxic feed. Hatchability of fertile eggs was reduced by feeding F. roseum 'Gibbosum', F. tricinctum and F. roseum Alaska to 28, 78, and 49%, respectively, of control values by the end of the 8 week test period. Upon removal of toxic feed, hatchability rapidly returned to control levels. Embryo mortality occurred mainly in the first 10 days of incubation for F. roseum Alaska and the last 18 days for F. roseum 'Gibbosum' and F. tricinctum fed hens. It appears that mycotoxins other than zearalenone and T-2 toxin are responsible for reduced hatchability from feeding Fusarium cultures.

Animals↗
PubMed2004

Viral hepatitis in the Arctic.

OBJECTIVES: Summarize research on viral hepatitis in indigenous populations in the Arctic. STUDY DESIGN: Literature review. METHODS: Medline search from 1966-2003. RESULTS: High prevalence rates of total hepatitis A antibody of > 50% and of hepatitis B of between 22% in Alaska and 42% in Greenland for total infection and between 3% in Canada and 12% in Siberia for chronic infection have been reported. Universal childhood vaccination with hepatitis A vaccine beginning at age 2 have stopped epidemics of HAV in Alaska and newborn hepatitis B immunization programs in Alaska and Canada have reduced new infections. However, in all Arctic countries several thousand persons chronically infected with HBV remain at risk for the development of cirrhosis and hepatocellular carcinoma. Prevalence rates of hepatitis C (HCV) reported are <1.4% in the Arctic. Hepatitis D virus, which co-infects with HBV, has been found in 40% of persons with HBV in Greenland. CONCLUSIONS: High rates of viral hepatitis A, B, C, and D are found in the Arctic. Effective vaccines against HAV, HBV and HDV can prevent transmission of these viruses. In addition, new antiviral therapies for HBV and HCV can be used effectively to treat many chronically infected patients.

Arctic Regions↗
PubMed1991

An in-depth investigation into a food poisoning outbreak.

On and shortly after the 6th May 1990, 16 people were affected by food poisoning in an old peoples' residential home, of whom two died. The vehicle of infection was identified as a baked Alaska contaminated by Salmonella enteritidis phage type (PT) 8 and, at an early stage of the investigation, the source was attributed to a single infected egg. A separate investigation by the author, however, revealed that the baked Alaska meringue had been dispensed from an inadequately cleaned piping bag which had been recovered from the kitchen a month after the outbreak. A pure, profuse culture of S. enteritidis PT8 was isolated from it. At least one secondary case may have been attributable to food made with this bag. Ministry of Agriculture Investigations of the flocks suspected of producing the eggs used for the baked Alaska demonstrated an absence of S. enteritidis. On this basis, the author considered a more likely cause of the outbreak to be the piping bag, contaminated from source or sources unknown within the kitchen. Furthermore, the possibility of human carrier transmission cannot be wholly ruled out. The incident underlines the dangers of jumping to conclusions at the outset of food poisoning investigations and emphasises that hypotheses formulated on sources of contamination must be properly tested, the absence of which, in this instance, led the investigators to unwarranted conclusions as to the cause of the outbreak.

Aged↗
PubMed2003

Tribal connections health information outreach: results, evaluation, and challenges.

In 1997, the National Library of Medicine (NLM), a component of the National Institutes of Health (NIH), initiated a program of intensified outreach to Native Americans, initially focusing on the Pacific Northwest in collaboration with the Pacific Northwest Regional Medical Library (PNRML). This initiative, known as the Tribal Connections Project, emphasized the establishment or strengthening of Internet connections at select Indian reservations and Alaska Native villages and related needs assessment and training. The hope was that these efforts would improve tribal access to health information available via the Internet and the Web. Phase I included sixteen tribal sites--eight in Washington, four in Alaska, two in Montana, and one each in Oregon and Idaho. Phase I results indicate that the project was successful in assessing local needs and building awareness of the Internet, forging new partnerships with and between the participating Indian reservations and Alaska Native villages and other organizations, making real improvements in the information technology (IT) infrastructure and Internet connectivity at fifteen of sixteen sites, and conducting training sessions with several hundred tribal participants across thirteen sites. Most importantly, the project demonstrated the key role of tribal community involvement and empowerment and contributed to development of an outreach evaluation field manual and the evolving concept of community-based outreach. The knowledge gained from Tribal Connections Project Phase I is helping refine and enhance subsequent NLM-sponsored tribal connections and similar community outreach efforts.

Community-Institutional Relations↗
PubMedDate not supplied

The expected impact of a smoking cessation program for pregnant women on infant mortality among Native Americans.

To quantify the expected impact of a smoking cessation program for pregnant women on infant mortality among Native Americans, we estimated the proportional reduction (impact fraction) and the absolute reduction (impact risk) in neonatal and postneonatal mortality as a result of the intervention program. The estimated attributable fraction due to maternal smoking was 16.6% of infant deaths in the Aberdeen Indian Health Service (IHS) Area, 16.2% in the Alaska IHS Area, and 5.2% in the Navajo IHS Area. Under the assumptions that 14% of the smokers participating in a smoking cessation program would quit and that the intervention would have 60% relative efficacy in preventing infant deaths attributable to smoking, the impact fraction was estimated to be 0.9% of all infant deaths in the Aberdeen Area, 1.0% in the Alaska Area, and 0.3% in the Navajo Area. Under the "best" model assumptions (28% cessation rate and 90% relative efficacy), 2.6% of all infant deaths, 3.7% of postneonatal deaths, and 1.2% of neonatal deaths would be prevented by a smoking cessation program in the Aberdeen Area. When applied to 1984-1986 infant mortality data, the impact risk per 100,000 live births under the "best" model assumptions was 10 neonatal deaths and 41 postneonatal deaths in the Aberdeen Area, 10 neonatal and 34 postneonatal deaths in Alaska, and 2 neonatal and 8 postneonatal deaths in the Navajo Area. This report points to the need to develop effective smoking cessation programs for Native Americans, targeted in particular to women of reproductive age.

Adult↗
PubMedDate not supplied

Knowledge, intent to use, and use of smokeless tobacco among sixth grade schoolchildren in six selected U.S. sites.

Questionnaires on smokeless tobacco use were completed by 781 sixth grade students in 15 schools at six locations in the United States. The students were both American Indian-Alaska Native and non-American Indian-Alaska Native. The Indian and Alaska Native schoolchildren were experimenting with and regularly using smokeless tobacco at higher rates that non-Indian schoolchildren. At Indian Health Service sites, 28.1 percent of the children reported current use of smokeless tobacco, compared with 3.3 percent of the children elsewhere. For girls reporting smokeless tobacco experimentation, the comparison was 68.9 percent at Indian Health Service sites and 8.7 percent at non-Indian sites; for boys, it was 79.1 percent from the Indian sites and 35.4 percent from the non-Indian sites. For those students who had tried smokeless tobacco, more than half also reported having tried cigarettes. The majority of all sixth grade students surveyed were aware of the health risks of smokeless tobacco use in that it is an increased risk for cancer. Additional research is needed to determine appropriate interventions.

Child↗
PubMedDate not supplied

State variation in rates of cesarean and VBAC delivery: 1989 and 1993.

There is wide variation among states in rates of cesarean and vaginal births after cesarean (VBAC) deliveries. In general, states in the South have the highest cesarean rates, states in the West have the lowest, and states in the Northeast and Midwest are intermediate. Louisiana had the highest overall rate in 1993 (27.7 per 100 births) while Alaska had the lowest rate (15.2). The majority of states had declines in their cesarean rate between 1989 and 1993. Patterns in primary cesarean rates are similar to those of the overall rate-states in the South generally have the highest rates while states in the West have the lowest rates. Primary cesarean rates ranged between a high of 19.6 in Louisiana to a low of 10.6 in Wisconsin. In general, states with low cesarean rates have among the highest rates of VBAC delivery. Alaska had the highest VBAC rate (40.0), which was almost quadruple the rate of Louisiana (11.2), the state with the lowest rate. Most states had substantial increases in VBAC rates between 1989 and 1993. When examining cesarean rates by maternal age and birth order, states with the highest overall rates also have among the highest age/birth order-specific rates. Cesarean rates were lowest for mothers under 25 years of age having a second or higher order birth in Alaska, 10.4, and highest for mothers 35 years of age or over having a first birth in Mississippi, 51.3. Standardized cesarean rates which were adjusted for differences between states in maternal age and birth order distributions did not diminish the variation among areas.

Adolescent↗
PubMed2000

Migration patterns and breast carcinoma.

BACKGROUND: Many American Indian and Alaska Native women have lower incidence rates of breast carcinoma than other racial/ethnic groups in the United States. The rates in most areas, however, have increased in recent years. The author reviews the migration patterns and effects that might contribute to this change. METHODS: A review of the literature on migration and breast carcinoma incidence was conducted. RESULTS: Migration significantly impacts on breast carcinoma incidence in all groups of women studied. CONCLUSIONS: Research must be designed that will explore the components of host, life-styles, and environment on breast carcinoma rates in American Indian and Alaska Native women to elucidate mechanisms of breast carcinoma etiology.

Alaska↗
PubMed2005

Hospitalized nonfatal injuries in the Alaskan construction industry.

BACKGROUND: Construction industry workers are exposed to many hazards leading to fatal and nonfatal injuries. Information for nonfatal work-related injury surveillance may be vague and come from a variety of sources. METHODS: The Alaska Trauma Registry (ATR) is used as an injury surveillance tool to focus on hospitalized nonfatal injuries in the Alaskan construction industry. RESULTS: During 1991-1999, 717 workers in the Alaskan construction industry were hospitalized due to occupational injuries, with an average annual injury rate of 0.39 injuries/100 workers. Leading causes of injury included falls (48%) and machinery (15%). Thirty-four percent of the falls were from a building or structure, followed by falls from a ladder (24%). A fractured bone was the most common type of injury (57%). CONCLUSIONS: Information on hospitalized patients from the ATR focuses on the more severe and debilitating injuries, and provides valuable information for prioritizing injury prevention efforts in Alaska.

Accidental Falls↗
PubMedDate not supplied

Linking public health data using geographic information system techniques: Alaskan community characteristics and infant mortality.

This article identifies geographical contexts important in differentiating infant mortality in Alaska and uses spatial processing models to link and analyse multi-source data. Information characterizing geographical locations are collected from Alaska's vital statistics for the years 1982-91 and the 1990 Census. Geographic information system (GIS) techniques are applied to identify spatially homogeneous regions, assess spatial compatibility across databases, and allocate geographical units across boundaries. A primary goal of this paper is to encourage spatial linkage and analysis techniques for vital statistics and census data. By demonstrating the interplay of tabular, graphical, and mapping techniques on Alaskan infant mortality, this analysis describes procedures for conducting epidemiological research with data spatially defined at distinct geographical levels.

Alaska↗
PubMed2000

Telephone survey of Alaskan pharmacists' nonprescription needle-selling practices.

OBJECTIVES: To determine the availability of nonprescription needles and syringes (NS) through pharmacy sales and to assess the impact of pharmacy policies and municipal paraphernalia laws on pharmacists' selling practices. DESIGN: Telephone survey of all pharmacies in Alaska's four largest cities. SETTING: Anchorage, Fairbanks, Juneau, and Ketchikan, Alaska. SUBJECTS: A single pharmacist from each pharmacy represented in the cities' phone books. MAIN OUTCOME MEASURES: Reports of (1) pharmacies' policies and individual pharmacists' procedures regarding the nonprescription sale of NS, (2) pharmacists' selling practices, and (3) identification of conditions that may affect pharmacists' decisions to sell nonprescription NS. RESULTS: Response rate of 86% (37/43); 77% of pharmacists reported selling at least one nonprescription NS in the last month. Store policy was related to selling practices; however, there was no difference in selling practices between a city with a paraphernalia law and cities without such laws. Logistic regression revealed pharmacists were more likely to sell NS if they worked in chain pharmacies and estimated that a high number of other local pharmacists sell nonprescription NS. CONCLUSION: NS are available through nonprescription sales in Alaskan pharmacies. The majority of pharmacies have store policies that permit pharmacists to sell nonprescription NS, either in all cases or at their discretion. Municipal paraphernalia laws do not determine the selling practices of individual pharmacists.

Alaska↗
PubMed2000

Ingestion of crude oil: effects on digesta retention times and nutrient uptake in captive river otters.

Studies following the Exxon Valdez oil spill in Prince William Sound, Alaska indicated that river otters (Lontra canadensis) from oiled regions displayed symptoms of degraded health, including reduced body weight. We examined the fate of ingested oil in the digestive tract and its effects on gut function in captive river otters. Fifteen wild-caught males were assigned to three groups, two of which were given weathered crude oil in food (i.e., control, 5 ppm day(-1), and 50 ppm day(-1)) under controlled conditions at the Alaska Sealife Center. Using glass beads as non-specific digesta markers and stable isotope analysis, we determined the effects of ingested oil on retention time and nutrient uptake. Our data indicated that oil ingestion reduced marker retention time when we controlled for activity and meal size. Fecal isotope ratios suggested that absorption of lipids in the oiled otters might have been affected by reduced retention time of food. In addition, a dilution model indicated that as much as 80% of ingested oil was not absorbed in high-dose animals. Thus, while the ingestion of large quantities of weathered crude oil appears to reduce absorption of oil hydrocarbons and may alleviate systemic effects, it may concurrently affect body condition by impacting digestive function.

Alaska↗
PubMed1992

Frequency of adverse reactions to hepatitis B vaccine in 43,618 persons.

PURPOSE: To determine the incidence of adverse reactions to hepatitis B plasma-derived vaccine. PATIENTS: Alaska natives (43,618) who received 101,360 doses of hepatitis B vaccine. METHODS: All adverse reactions, excluding transient fever, myalgia, or soreness lasting less than 3 days, were reported. An intradermal skin test was developed to test purported adverse reactions. Records of the entire population were reviewed for Guillain-Barré syndrome (GBS). SETTING: A statewide hepatitis B control program for Alaska natives. RESULTS: Possible adverse reactions occurred in 39 persons. The most frequent adverse reactions were myalgia/arthralgia lasting longer than 3 days (14), followed by skin rashes (eight) and dizziness (seven). Skin tests were performed on 13 persons and were positive in five. Six of the persons with negative skin tests and eight persons who did not undergo skin testing received additional doses of vaccine without any adverse reactions. No increased incidence of GBS was found in the vaccinees. CONCLUSION: Hepatitis B vaccine is safe and most adverse reactions are coincidental.

Adult↗
PubMed1996

A cost-effectiveness evaluation of newborn hemoglobinopathy screening from the perspective of state health care systems.

OBJECTIVE: To determine the most cost-effective strategy for newborn hemoglobinopathy screening from the perspective of state health care systems. STUDY DESIGN: Using Alaska as an example, we used decision analysis to compare a policy of no screening to universal or targeted screening with selective follow-up only of infants who are homozygous or compound heterozygous for an abnormal hemoglobin variant and to universal or targeted screening with complete follow-up, including follow-up of infants with clinically insignificant traits. Probabilities and costs were varied over values that might be expected for other states. RESULTS: Among the selective follow-up options, targeted screening would be the most cost-effective strategy for Alaska at a cost of $206,192 per death averted; by contrast, universal screening would prevent 50% more deaths at an incremental cost of $2,040,000 per death averted. Universal would be more cost-effective than targeted screening for several scenarios expected to occur in other states, including a high sickle cell disease prevalence, a low screening test cost, and a high cost per screen associated with racial targeting. Among the complete follow-up options, both targeted and universal screening would cost at least $200,000 per death averted over the range of all variables tested during sensitivity analysis; the incremental cost of universal versus targeted screening would be at least $600,000 per death averted. CONCLUSIONS: Our data suggest each state should determine the most cost-effective option based on state-specific values for sickle cell disease prevalence, test costs and racial targeting costs.

Alaska↗
PubMed2004

Antifreeze proteins in Alaskan insects and spiders.

Prior to this study, antifreeze proteins (AFPs) had not been identified in terrestrial arthropods from the Arctic or anywhere in Alaska. The hemolymph of 75 species of insects and six spiders from interior and arctic Alaska were screened for thermal hysteresis (a difference between the freezing and melting points), characteristic of the presence of AFPs. Eighteen species of insects and three spiders were shown to have AFPs. Ten of the insects with AFPs were beetles including the first species from the families Chrysomelidae, Pythidae, Silphidae and Carabidae. In addition, the first Neuropteran to have AFPs was identified, the lacewing Hemerobius simulans together with the second and third Diptera (the first Tipulids) and the second and third Hemiptera, the stinkbug Elasmostethus interstinctus (the first Pentatomid), and the water strider Limnoporus dissortis (the first Gerrid). Prior to this study, 33 species of insects and three spiders had been reported to have AFPs. Most AFP-producing terrestrial arthropods are freeze avoiding, and the AFPs function to prevent freezing. However, some of the AFP- producing insects identified in this study are known to be freeze tolerant (able to survive freezing) to very low temperatures (-40 to -70 degrees C).

Acclimatization↗