The Prevalence and Presumed Etiology of Elevated Aminotransferase Levels in a Pacific Northwest Tribal Community.

American Indians and Alaska Natives (AI/ANs) die from chronic liver disease at high rates, but little data exist on the etiology of liver disease in AI/ANs. Adult participants from a tribal health clinic in the Pacific Northwest completed an alcohol consumption survey and underwent laboratory testing, and anthropometric measurements. Participants with abnormal serum alanine aminotransferase (ALT) levels, positive hepatitis B surface antigen, or hepatitis C antibody were invited for follow-up visit. Then, they received a limited liver ultrasound, additional liver function tests, and confirmatory hepatitis tests. Among 71 participants, 26 (37%) had sustained elevation of ALT over six months. Two patients (8%) had chronic hepatitis C virus and 19 (73%) had ultrasonographic steatosis suggesting nonalcoholic fatty liver disease (NAFLD). Elevated aminotransferase levels were common, with NAFLD and hepatitis C accounting for most cases. Few participants were aware of their liver condition, indicating the need for increased awareness, screening, and intervention.

Clinicians' Implicit and Explicit Attitudes about Weight and Race and Treatment Approaches to Overweight for American Indian Children.

PURPOSE: Obesity is one of the most serious health problems among American Indian/Alaska Native (AI/AN) children. We investigated Indian Health Service (IHS) primary care providers' implicit and explicit attitudes about weight and race and their association with treatment approaches to overweight in children. METHODS: We conducted an online survey of long-term primary care clinicians in two western regions of the IHS. We used the existing Weight Attitude Implicit Association Test (IAT) and developed a new Native American Attitude IAT to measure implicit attitudes. Explicit attitudes about weight and race were assessed through self-report. We assessed self-rated treatment approaches to childhood overweight. We used linear regression models to evaluate the association of attitudes about weight and race with treatment approaches. RESULTS: Our sample included 75 clinicians (56% response rate) who, on average, saw 74 patients per week. Fifty-five percent of clinicians reported that 30-60% of their child and adolescent patients were overweight or obese, and 25% of clinicians reported that 60-100% of their patients were overweight or obese. We found strong implicit bias favoring thin people (Cohen's d=1.44) and weak implicit bias favoring whites (Cohen's d=0.35). We found no association between implicit or explicit bias scores and self-reported treatment of childhood overweight. Continuing education on obesity was associated with self-rated success and competence in weight management. CONCLUSIONS: Weight and race bias exists among long-term IHS clinicians, but may not influence treatment approaches for overweight AI/AN children. Further research should assess the effect of clinicians' attitudes on real-world weight management.