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PubMed2004

End-of-life issues for American Indians/Alaska Natives: insights from one Indian Health Service area.

BACKGROUND: In the United States, the American Indian and Alaska Native (AI/AN) population is aging and the leading causes of death for those 55 and older are chronic diseases such as cancer, heart disease, and the complications of diabetes. Since 1955, the federally directed Indian Health Service, along with Tribal governments has been providing comprehensive health care to over 500 AI/AN communities. OBJECTIVE: This is the first study to examine end-of-life and palliative care issues broadly at selected Indian Health Service facilities in the Albuquerque area. DESIGN: Retrospective medical records review identified from randomized New Mexico Department of Health American Indian resident death certificates, 50 years of age and over, from 1994-1998. Interviews with hospital administrators, medical records personnel, and cultural advisors regarding end-of-life policies and procedures were conducted. RESULTS: The study documents very limited formal palliative care services available to rural and reservation-dwelling American Indians and Alaska Natives. However, new initiatives and training in palliative care are emerging. CONCLUSIONS: Recommendations for fostering expansion of end-of-life and palliative care services for AI/AN persons are discussed.

Aged↗
PubMed1994

Elevated concentrations of plasma omega-3 polyunsaturated fatty acids among Alaskan Eskimos.

Eskimos living in rural southwestern Alaska depend on fish and marine mammals as major sources of subsistence food. Fatty acid concentrations in 80 Yupik Eskimos living in either a coastal or river village of southwestern Alaska were compared with those of non-Native control subjects. Concentrations of total plasma omega-3 fatty acids, eicosapentaenoic acid (20:5 omega-3), and docosahexaenoic acid (22:6 omega-3) were 4.3, 13, and 6.8 times higher, respectively, in Native participants than in non-Native control subjects. Concentrations of these fatty acids were higher in coastal-village than in river-village participants; concentrations paralleled consumption of marine mammal oil and marine fish. The ratios of eicosapentaenoic to arachidonic acid for adult coastal- and river-village participants were 1.16 and 0.70, respectively, 14 and 9 times those of non-Native adults, respectively. There was no increase in the mean bleeding times of Native participants of either village.

Adolescent↗
PubMed1979

Arctic trichinosis: two Alaskan outbreaks from walrus meat.

The arctic form of Trichinella spiralis that infects terrestrial and marine mammals is of importance in public health because persons living in arctic regions still depend on wild animals for economic subsistence. In 1975, an extended common-source epidemic of trichinosis attributed to consumption of walrus meat involved 29 persons in Barrow, Alaska. Of those persons eating this meat, 64% became ill, and the rate of infection of persons eating meat prepared with little or no cooking was four times as great as that of persons eating cooked meat. One year later a second outbreak occurred when a family ate partially cooked meat from an infected walrus. Clinical illness differed little from the disease acquired in temperature climates; however, only 70% had a positive bentonite flocculation titer, whereas 96% had eosinophilia. These epidemics of trichinosis are the first reported in Alaska to be associated with the consumption of walrus meat.

Alaska↗
PubMed1981

Hepatitis B testing in the families and villages of five young eskimos with primary hepatocellular carcinoma.

A 15-year-old female Eskimo and a 22-year-old male Eskimo from a southwestern Alaskan village (population 540) were diagnosed as having primary hepatocellular carcinoma (PHC) in December, 1977. The fathers of both patients also died of PHC. Three additional cases of PHC affecting young Alaskan Eskimos had been diagnosed since 1972, all from neighboring villages. Four of the five young patients were positive for hepatitis B surface antigen (HBsAg), and the family members of three patients were all positive for HBsAg or antibody to this antigen (anti-HBs). The other two families had no members positive for HBsAg. The prevalence of HBsAg in the villages of these patients ranged from 0--5%, and the prevalence of anti-HBs ranged from 3--25%. This part of Alaska has a high rate of infection with hepatitis B virus and an increased incidence of PHC. However, other Alaskan villages of similar ethnic background have considerably higher rates of hepatitis B infection than the four villages described and to date they have no PHC. This suggests that genetic and/or environmental factors in addition to hepatitis B infection may have a role in the etiology of PHC in Alaska.

Adolescent↗
PubMed1985

The control of hepatitis B virus infection with vaccine in Yupik Eskimos. Demonstration of safety, immunogenicity, and efficacy under field conditions.

In 1981, a hepatitis B vaccine demonstration project was initiated among Yupik Eskimos of southwest Alaska to demonstrate that, under field conditions, the vaccine was safe, immunogenic, and efficacious. Laboratory tests for serologic markers of hepatitis B virus infection (HBsAg, anti-HBs, and anti-HBc) performed on sera collected in May 1981 from 3,988 residents of 17 remote Eskimo villages revealed that 2,645 (66.3%) had no evidence of hepatitis B virus infection. Because of a limited supply of vaccine, specific criteria for selection were used so that those at highest risk of infection would be immunized first. In November 1981, the first dose of vaccine was administered to 1,693 carefully selected individuals. The second dose was administered to 1,678 (99.1%) of those who received the first dose, and the final dose was administered to 1,630 persons (96.3%). Serologic follow-up showed the vaccine to be safe (0.4% experienced minor adverse reactions) and immunogenic (97.4% developed antibody). Vaccine-induced antibody levels were significantly higher for persons less than 30 years of age (p less than 0.001) and for females (p less than 0.001). Vaccine recipients were also protected from hepatitis B virus infection (p = 0.002). This public health measure proved to be feasible and effective in this remote arctic population despite difficult conditions for delivery and administration of this temperature-sensitive vaccine. This strategy for immunization is now being applied on a larger scale in Alaska as part of a program for the primary prevention of this infection and its sequelae.

Adolescent↗
PubMed2006

Decline in respiratory syncytial virus hospitalizations in a region with high hospitalization rates and prolonged season.

BACKGROUND: During 1993 to 1996, Alaska Native infants <1 year of age from the Yukon Kuskokwim (YK) Delta in Alaska experienced a respiratory syncytial virus (RSV) hospitalization rate 5 times the U.S. general infant population rate. We describe trends in lower respiratory tract infection (LRTI) and RSV hospitalizations in YK children from 1994 to 2004. METHODS: We abstracted hospital dates, RSV test results and clinical information from the hospital records for YK children <3 years of age hospitalized between July 1994 and June 2004. RESULTS: : The RSV hospitalization rate in YK Delta children <1 year of age decreased from 178 per 1000 infants per year (1994-1997) to 104 per 1000 infants per year (2001-2004) (P < 0.001), and the RSV hospitalization rate for premature infants decreased from 317 to 123 per 1000 infants per year (P < 0.001). The risk reduction for RSV hospitalization was greater in premature (relative risk, 0.39) than in term infants (relative risk, 0.60; P = 0.04). The rate of non-RSV LRTI hospitalizations increased from 153 to 215 per 1000 infants per year (P < 0.001). The median RSV season length was 30.5 weeks. Pneumonia was diagnosed in more than half of RSV admissions. CONCLUSIONS: In YK infants, the RSV hospitalization rate decreased by one-third between 1994 and 2004; however, the overall LRTI hospitalization rate did not change. The median RSV season was twice as long as for the U.S. population. Palivizumab prophylaxis may be responsible for the larger decrease in the RSV hospitalization rate among premature infants; however, the 2001-2004 RSV hospitalization rate among YK infants remained 3 times higher than the U.S. infant rate.

Alaska↗
PubMed1978

Some critical qualitative details of lorica construction in the type species of Calliacantha Leadbeater (Choanoflagellata).

Qualitative structural details, amplifying or correcting previous accounts in the literature on this species have been compiled by means of light and/or electron microscopy of dry whole mounts, prepared in situ from freshly gathered wild material mainly from temperate sources in Denmark, Britain and south Alaska. The more important findings are summarized diagrammatically. These include elaborate and constant details of assembly at the anterior end of the lorica, combined with much greater variability at the hind end. The absence of continuity between the three anterior spines and any of the six longitudinal costae present at the front end of the lorica chamber is confirmed, but a range of conditions involving numerical reduction in costal numbers at the hind end is illustrated. The overall size range encountered in the three temperate localities listed is illustrated photographically, but the large cells characteristic of arctic sources are represented, for a qualitative purpose only, by means of a single photograph recording a specimen collected beneath sea ice in N. Alaska, a source which will be considered more fully on a later occasion.

Alaska↗
PubMed2006

Beringian origins and cryptic speciation events in the fly agaric (Amanita muscaria).

Amanita muscaria sensu lato has a wide geographic distribution, occurring in Europe, Asia, Africa, Australia, New Zealand, and North, Central and South America. Previous phylogenetic work by others indicates three geographic clades (i.e. 'Eurasian', 'Eurasian-alpine' and 'North American' groups) within A. muscaria. However, the historical dispersal patterns of A. muscaria remained unclear. In our project, we collected specimens from arctic, boreal and humid temperate regions in Alaska, and generated DNA sequence data from the protein-coding beta-tubulin gene and the internal transcribed spacer (ITS) and large subunit (LSU) regions of the ribosomal DNA repeat. Homologous sequences from additional A. muscaria isolates were downloaded from GenBank. We conducted phylogenetic and nested clade analyses (NCA) to reveal the phylogeographic history of the species complex. Although phylogenetic analyses confirmed the existence of the three above-mentioned clades, representatives of all three groups were found to occur sympatrically in Alaska, suggesting that they represent cryptic phylogenetic species with partially overlapping geographic distributions rather than being allopatric populations. All phylogenetic species share at least two morphological varieties with other species, suggesting ancestral polymorphism in pileus and wart colour pre-dating their speciations. The ancestral population of A. muscaria likely evolved in the Siberian-Beringian region and underwent fragmentation as inferred from NCA and the coalescent analyses. The data suggest that these populations later evolved into species, expanded their range in North America and Eurasia. In addition to range expansions, populations of all three species remained in Beringia and adapted to the cooling climate.

Alaska↗
PubMed2006

The price of alcohol: a consideration of contextual factors.

BACKGROUND: The current study considers the determinants of prices charged for alcoholic beverages by on-premise and off-premise outlets in Alaska. Alcohol outlet densities, a surrogate measure for local retail competition, are expected to be negatively associated with prices while costs associated with distribution are expected to be positively related to prices. Community demographic and economic characteristics may affect observed local prices via the level of demand, retail costs borne by retailers, or the quality of brands offered for sale. METHODS: The core data for these analyses came from a telephone survey of Alaskan retail establishments licensed to serve alcohol. This survey utilized computer-assisted telephone interviewing (CATI) techniques to collect alcohol-pricing information from on-premise (i.e., establishments where alcohol is consumed at the point of purchase such as bars and restaurants) and off-premise (i.e., establishments such as grocery stores and convenience markets where consumption occurs in other locations) alcohol retailers throughout the state of Alaska. Price estimates were developed for each beverage-type based on alcohol content. Separate regression analyses were used to model each of the 8 price indices (on-premise and off-premise measures for beer, spirits, wine, and the average price across beverage types). All regressions also controlled for a set of zip-code level indicators of community economic and demographic characteristics based on census data. RESULTS: Outlet density per roadway mile was unrelated to price for both on- and off-premise establishments, either across or between beverage types. In contrast, overall distribution costs did appear to be related to alcohol price. The demographic and economic variables, as a group, were significantly related to observed prices. CONCLUSIONS: More attention needs to be directed to the manner in which sellers and buyers behave relative to alcoholic beverages. Alcohol demand remains responsive to prices; yet, consumers have considerable latitude in determining the price that they pay for alcohol.

Alaska↗
PubMed2005

Role of land-surface changes in arctic summer warming.

A major challenge in predicting Earth's future climate state is to understand feedbacks that alter greenhouse-gas forcing. Here we synthesize field data from arctic Alaska, showing that terrestrial changes in summer albedo contribute substantially to recent high-latitude warming trends. Pronounced terrestrial summer warming in arctic Alaska correlates with a lengthening of the snow-free season that has increased atmospheric heating locally by about 3 watts per square meter per decade (similar in magnitude to the regional heating expected over multiple decades from a doubling of atmospheric CO2). The continuation of current trends in shrub and tree expansion could further amplify this atmospheric heating by two to seven times.

Alaska↗
PubMed1981

Delayed development of antibody to hepatitis B surface antigen after symptomatic infection with hepatitis B virus.

During a 2-year period, 38 patients with clinical hepatitis B virus infection were seen at the Public Health Service Alaska Native Hospital in Bethel. This hospital serves an area in southwest Alaska that is hyperendemic for hepatitis B virus. The patients came to the hospital at various times from 15 scattered villages, and 92% were Eskimo. None of the patients had a recent history of hypodermic injection or blood transfusions. Twenty-five patients, all originally positive for hepatitis B surface antigen (HBsAg), were followed for up to 5 years after onset of illness, and 15 were either slow to develop, or never developed, antibody to HBsAg (anti-HBs), although only one patient became a chronic carrier of HBsAg. Six patients had a prolonged "window phase" between the disappearance of HBsAg and the appearance of anti-HBs which lasted for more than 1 year. Three patients had only transient anti-HBs after HBsAg disappeared, and five never developed measurable anti-HBs at all. All patients had antibody to hepatitis B core when both HBsAg and anti-HBs were absent. In contrast to studies in other populations, only 42% had anti-HBs 1 year after onset of illness, 63% had it at 18 months, 70% had it at 2 years, and 80% had it at 5 years. Factors related to ethnicity might account for the differences in the development of anti-HBs after acute symptomatic hepatitis B virus infection seen in Eskimos when compared with whites.

Adolescent↗
PubMed1998

Molecular analysis by pulsed-field gel electrophoresis and antibiogram of Streptococcus pneumoniae serotype 6B isolates from selected areas within the United States.

Fifty-eight clinical isolates of Streptococcus pneumoniae serotype 6B, including 16 from Alaska, 14 from Arizona, 11 from Washington, and 17 from seven additional states, were analyzed. The antibiograms of these isolates were assigned to 10 antibiotic profiles based on their susceptibilities to penicillin, erythromycin, tetracycline, and trimethoprim-sulfamethoxazole. Thirty-two (55%) of these isolates were penicillin nonsusceptible, while 21 (36%) were intermediate or resistant to three or more antibiotics. The restriction endonucleases ApaI and SmaI were used to digest intact chromosomes, and the fragments were resolved by pulsed-field gel electrophoresis (PFGE). The ApaI and SmaI PFGE patterns were combined, and 13 of the 16 Alaskan isolates showed indistinguishable PFGE patterns. One other isolate exhibited highly related ApaI and SmaI PFGE patterns, differing by only one band after restriction with ApaI. Among the 14 isolates from Arizona, 1 was indistinguishable from the predominant ApaI and SmaI PFGE patterns seen in the Alaskan isolates; 5 others were highly related (+/-1 band after cutting with either enzyme) to the Alaskan isolates, suggesting a common ancestral origin. Of the remaining eight isolates, six additional ApaI plus SmaI PFGE patterns were observed. The 28 isolates from the various contiguous states had 22 ApaI plus SmaI PFGE patterns. No correlations were found between specific PFGE patterns, antibiograms, dates of isolation, or geography. The serotype 6B isolates across the contiguous United States were genetically diverse, while the 6B isolates from Alaska appeared to be much less diverse.

Alaska↗
PubMed1988

Antibodies to arboviruses in an Alaskan population at occupational risk of infection.

A total of 435 United States Geological Survey and United States Forest Service workers in Alaska were studied for serologic evidence of past infections with four arboviruses known or suspected to be human pathogens. Of the personnel tested, 36 (8.3%) had the neutralizing antibody to Jamestown Canyon but not snowshoe hare virus, 6 (1.4%) had the antibody to snowshoe hare but not Jamestown Canyon virus, 53 (12.2%) had the antibody to both viruses, 17 (3.9%) had the antibody to Northway virus, and 15 (3.4%) had the antibody to Klamath virus. The indices most significantly correlated with presence of the Jamestown Canyon and snowshoe hare antibodies were the amount of fieldwork (p less than 0.001 for both antibodies) and the duration of employment by the agencies (p less than 0.0001 for Jamestown Canyon and 0.004 for snowshoe hare). The antibody to the four arboviruses also correlated strongly with a history of travel in certain remote or wilderness areas in Alaska (p values ranged from less than 0.001 to 0.086).

Alaska↗
PubMed1993

Community patterns of psychiatric disorders after the Exxon Valdez oil spill.

OBJECTIVE: This study examined the relationship between exposure to the Exxon Valdez oil spill and subsequent cleanup efforts and the prevalence of generalized anxiety disorder, posttraumatic stress disorder (PTSD), and depressive symptoms in 13 Alaska communities. METHOD: A community survey of 599 men and women was conducted approximately 1 year after the spill occurred. Questions from the National Institute of Mental Health Diagnostic Interview Schedule were used to assess symptoms of generalized anxiety disorder and PTSD. The Center for Epidemiologic Studies Depression (CES-D) Scale was used to assess levels of depressive symptoms. RESULTS: The post-spill (i.e., 1-year) prevalence of generalized anxiety disorder and PTSD for the study communities with all degrees of exposure was 20.2% and 9.4%, respectively. The prevalence of respondents with CES-D Scale scores above 16 and 18 was 16.6% and 14.2%, respectively. When compared with the unexposed group, members of the high-exposure group were 3.6 times as likely to have generalized anxiety disorder, 2.9 times as likely to have PTSD, 1.8 times as likely to have a CES-D Scale score of 16 and above, and 2.1 times as likely to have a CES-D Scale score of 18 and above. Women exposed to this event were particularly vulnerable to these conditions, and Alaska Natives were particularly vulnerable to depressive symptoms after the oil spill. CONCLUSIONS: The results suggest that the oil spill's impact on the psychosocial environment was as significant as its impact on the physical environment. The Exxon Valdez experience suggests a number of implications for the mental health needs of disaster victims, particularly in primary care settings.

Accidents↗
PubMed2006

Health services usage by Alaskan injection drug users.

OBJECTIVES: The purpose of this study was to explore health services usage among injection drug users in Anchorage, Alaska. DESIGN: 645 participants were recruited as part of a federally funded study of needle exchanges. They completed a health services usage questionnaire that elicited information on use of a health care provider (physician or nurse) and emergency room services. Chi-square and t-tests were used for the bivariate analyses, and multiple logistic regression was used to develop the final predictive models. RESULTS: The majority of respondents (n = 646) were male (77 percent). Race/ethnicity included 58 percent White, 22 percent Alaska Native, and 20 percent African American. The multivariate model predicting accessing a health care provider (HCP) included ever having had chlamydia (OR 2.7, CI 1.6, 4.5), current income from welfare or public assistance (OR 2.6, CI 1.7, 3.9), current income from disability (OR 5.0, CI 2.2, 11.4), current income from SSI (OR .30, CI .12, .77) and the number of days in the last 30 used opiates other than heroin (OR 1.04, CI 1.002, 1.078). The multivariate model predicting use of an emergency room (ER) was similar to that predicting use of an HCP, with the additional finding of a negative association between being African American and ER use. CONCLUSION: The role of public assistance benefits enabling access to health care for IDUs has policy implications. Large public programs, such as the Indian Health Service, paid for much of the health care received by the IDUs recruited as part of this study.

Adult↗
PubMed2003

Reduction of egg size in natural populations of threespine stickleback infected with a cestode macroparasite.

Manifestations of infectious disease may represent host adaptations to avoid or reduce the effects of infection on host fitness, parasite manipulations that benefit the pathogen's fitness, or nonadaptive side effects of parasitism. Threespine stickleback fish (Gasterosteus aculeatus) from Alaska and the cestode macroparasite Schistocephalus solidus provide an excellent system for study of the effects of parasitism on host egg size because females in populations there are capable of producing clutches of eggs in the face of substantial infection, contrary to the inhibition of reproduction that has been observed in other stickleback populations or other species of fish. A side effect resulting in reduction of mean ovummass among infected females was predicted based on the egg production process in female stickleback, the considerable energy and resource demands of S. solidus, and the chronic and progressive nature of the effects the macroparasite should have on the host fish. In each of 9 populations of G. aculeatus representing replicate natural experiments in lakes scattered across the Matanuska-Susitna Valley and the Kenai Peninsula of south-central Alaska and among all populations combined, the mean ovum mass of infected female fish is significantly reduced in comparison with that of uninfected females taken from the same population at the same time. Reduction in mean female egg mass ranged from 8 to 32% across all populations. To examine whether reduction in mean female ovum mass was a nonadaptive side effect or an adaptation, relatively large data sets from 2 of the populations were used. Mean ovum mass of infected females was predicted to decrease directly in relation to parasite index (PI) if the diminution in mean egg mass were the result of a nonadaptive side effect resulting from host nutrient loss. Alternatively, the absence of a relationship between PI and reduction in ovum mass is predicted if decreases in mean female ovum mass result from host or parasite adaptation (or both) because lightly infected hosts should show a response similar to that of heavily infected ones. In each of the 2 populations, there is a significant, negative relationship between mean female ovum mass and PI, demonstrating a correlation between the decrease in ovum mass and the level of infection. Thus, the results are consistent with the hypothesis that the reductions in mean female egg mass represent side effects of parasitism involving nutrient theft. Moreover, the proportional decline in egg mass with increasing PI apparently differed between the 2 populations, and there was no significant relationship between mean percent decrease in mean female ovum mass and mean PI across populations. These observations suggest that unknown ecological and evolutionary factors influence the degree of reduction in mean ovum mass in a population-specific manner.

Alaska↗
PubMed2005

Confronting oral health disparities among American Indian/Alaska Native children: the pediatric oral health therapist.

American Indian and Alaska Native (AIAN) children are disproportionately affected by oral disease compared with the general population of American children. Additionally, AIAN children have limited access to professional oral health care. The Indian Health Service (IHS) and AIAN tribal leaders face a significant problem in ensuring care for the oral health of these children. We discuss the development and deployment of a new allied oral health professional, a pediatric oral health therapist. This kind of practitioner can effectively extend the ability of dentists to provide for children not receiving care and help to confront the significant oral health disparities existing in AIAN children. Resolving oral health disparities and ensuring access to oral health care for American Indians and Alaska Natives is a moral issue-one of social justice.

Alaska↗
PubMed2002

Rates and sequelae of the coexistence of substance use and other psychiatric disorders.

OBJECTIVES: Despite a growing body of investigations documenting the coexistence of substance use and other psychiatric disorders in a variety of patient populations, no data about comorbidity in the inpatient mental health system in Alaska have been published in scientific journals, and only limited data exist nationwide about coexistence rates in public psychiatric hospitals. METHODS: A retrospective population based study was performed on the entire population of psychiatric patients hospitalized at Alaska Psychiatric Institute (API) between 1993 and 2001. To explore rates of comorbidity, 5,862 patients (who accrued 10,656 visits) were classified according to their diagnostic status; to explore clinical and socio-demographic difference between patients with and without coexisting disorder, univariate analyses were calculated. RESULTS: The study revealed startlingly high rates of comorbidity that have been rising steadily since the early 1990's. In fact, comorbidity has become the rule, not the exception, among patients receiving services at API, with over 60% presenting with coexisting substance use symptoms. Complicating issues even further, these comorbid patients presented with more complex social and interpersonal circumstances, more complex clinical issues, different courses of treatment, and greater symptom complexity than psychiatric-only patients. CONCLUSIONS: 1.) Individual patient level--Providers for psychiatric inpatients must become more prepared to deal with coexisting substance abuse symptoms; policy makers must become more aware of the need for such patients to have smooth transitions from mental health to substance abuse treatment systems. 2.) Systemic-administrative level--Educators must better prepare providers to deal with this challenging clientele.

Adult↗