Health care utilisation changes among Alaska Native adults after participation in an indigenous community programme to address adverse life experiences: a propensity score-matched analysis.

The aim of this study was to investigate whether participation in Family Wellness Warriors Initiative (FWWI), an Alaska Native program that addresses adverse life experiences, is associated with changes in health care utilisation. The study method was a propensity score-matched cohort analysis using retrospective electronic health record data from Southcentral Foundation, a tribal health care system, from 2012 to 2017. Ninety p\articipants in FWWI trainings were identified as the intervention cohort and were propensity matched with 90 people who participated in other emotional wellness-related interventions. The primary outcome was the number of total health system visits. Secondary outcomes included emergency department (ED) visits, substance-use visits and visits with somatisation potential. After adjustment for covariates, FWWI participants showed a 36% reduction in total system visits (incidence rate ratio 0.64, 95% CI 0.49-0.84) and a 70% reduction in substance use visits (incidence rate ratio 0.30, 95% CI 0.10-0.93) when compared to the control. FWWI participants showed a 40% reduction in ED visits (incidence rate ratio 0.60, 95%CI 0.35-1.02) when compared to the control that was borderline significant. No significant differences were found for visits with somatisation potential (incidence rate ratio 1.25, 95% CI 0.79-1.99).

VKORC1 and Novel CYP2C9 Variation Predict Warfarin Response in Alaska Native and American Indian People.

Alaska Native and American Indian (AN/AI) people have unique pharmacogene variation that may affect warfarin disposition and therapeutic response. We performed targeted genotyping for cytochrome P450 (CYP)2C9, vitamin K epoxide oxidase reductase complex subunit 1 (VKORC1), CYP4F2, CYP4F11, and gamma-glutamyl carboxylase (GGCX) variants in AN/AI people receiving warfarin. The primary outcome was stable warfarin dose, defined as one dose, and associated international normalized ratio within the target range, at least 6 months after starting therapy, with two matching doses at least 2 weeks apart. Genotype-phenotype relationships were assessed by multivariate regression analysis, adjusted for self-reported heritage, age, gender, and concurrent statin use. VKORC1 genotype explained 34% of dose variability, with VKORC1 -1639G>A and 1173C>T associated with a 1.7 mg/day (P = 1.4e-05) dose reduction. Additionally, CYP2C9 N218I was suggestively significant (P = 0.077), with heterozygotes requiring 1.1 mg/day less than reference individuals. Self-reported heritage was significantly associated with dose, largely driven by differences in the diagnostic VKORC1 allele frequencies among AN/AI people.

IN VITRO EFFECT OF SUCROSE FEEDING IN THE DIFFERENTIATION OF WOOD ELEMENTS OF PLUMERIA.

Wood with cambium of Plumeria rubra Linn. was cultured in modified Schenk and Hildebrandt medium for 75 days. Change in dimension and frequency of cells was compared with that grown in situ for 75 days. Feeding of 41% sucrose in vitro brought about the same type of differentiation as occurred in situ, where non-reducing sugar percentage increased (from 0.0004 before culture to 0.0032 after 75 days' growth in situ). Sucrose favoured enlargement of axial elements and numerical increase of all lignified elements.