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2.
Artigo em Inglês | MEDLINE | ID: mdl-33322686

RESUMO

Substantial gaps remain in the evidence base for prenatal tobacco use interventions among Indigenous women. Using a cluster randomized controlled trial (RCT), the Healthy Pregnancies Project evaluated a community-level intervention for Alaska Native (AN) women in rural western Alaska. Sixteen villages were randomly assigned to usual care (control, n = 8 villages) or usual care plus a community-level intervention delivered by local AN "Native Sisters" (n = 8 villages). Outcomes were tobacco use rate at delivery and at 2 and 6 months postpartum, with biochemical confirmation obtained at 6 months. The program had high reach, enrolling 73% of all eligible women screened. Of the 352 participants, 67% used tobacco at baseline. No significant differences emerged between study groups on follow-up in tobacco use rates. More intervention than control participants made a quit attempt at 2 months postpartum (70% vs. 51%, respectively, p = 0.012). Participants in both study groups reported the program helped to raise awareness of healthy pregnancies in the study villages. This trial supports the reach of a community-level intervention, but not its efficacy for reducing tobacco use during pregnancy or postpartum. Efforts to sustain early quit attempts appear warranted. The community involvement, and reported impact on raising awareness of the importance of healthy pregnancies, supports the value of the research program in this community.


Assuntos
Nível de Saúde , Abandono do Hábito de Fumar , Uso de Tabaco , Alaska/epidemiologia , Feminino , Humanos , Gravidez , Cuidado Pré-Natal , Uso de Tabaco/epidemiologia
3.
Int J Circumpolar Health ; 79(1): 1835251, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33074067

RESUMO

Since February 2020 the COVID-19 pandemic has been unfolding in the Arctic, placing many communities at risk due to remoteness, limited healthcare options, underlying health issues and other compounding factors. Preliminary analysis of available COVID-19 data in the Arctic at the regional (subnational) level suggests that COVID-19 infections and mortality were highly variable, but generally remained below respective national levels. Based on the trends and magnitude of the pandemic through July, we classify Arctic regions into four groups: Iceland, Faroe Islands, Northern Norway, and Northern Finland with elevated early incidence rates, but where strict quarantines and other measures promptly curtailed the pandemic; Northern Sweden and Alaska, where the initial wave of infections persisted amid weak (Sweden) or variable (Alaska) quarantine measures; Northern Russia characterised by the late start and subsequent steep growth of COVID-19 cases and fatalities and multiple outbreaks; and Northern Canada and Greenland with no significant proliferation of the pandemic. Despite limitations in available data, further efforts to track and analyse the pandemic at the pan-Arctic, regional and local scales are crucial. This includes understanding of the COVID-19 patterns, mortality and morbidity, the relationships with public-health conditions, socioeconomic characteristics, policies, and experiences of the Indigenous Peoples. Data used in this paper are available at https://arctic.uni.edu/arctic-covid-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Alaska/epidemiologia , Regiões Árticas/epidemiologia , Betacoronavirus , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Europa (Continente)/epidemiologia , Humanos , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Federação Russa/epidemiologia , Análise Espaço-Temporal
4.
Diabetes Res Clin Pract ; 167: 108357, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32745696

RESUMO

AIMS: This study estimates incidence of diabetes (DM) and pre-DM relative to DM risk factors among relatively healthy Alaska Native and American Indian (henceforth AN) adults living in urban south central Alaska. METHODS: Baseline (2004-2006) and follow-up (2014-2017) surveys, blood samples, and medical chart review data were collected from AN adults living in south central Alaska. We analyzed associations between prevalent risk factors and incident DM and pre-DM using Cox proportional hazards and used multivariable models to identify independent predictors for both DM and pre-DM. RESULTS: Among 379 participants with follow-up data, overall DM incidence was 16.5/1,000 PY; overall pre-DM incidence was 77.6/1,000 PY, with marked differences between men and women. Prevalent cardiometabolic risk factors also varied with greater amounts of overweight in men and greater amounts of obesity in women. Controlling for age and sex, obesity, abdominal adiposity, pre-DM, and metabolic syndrome independently increased DM risk. CONCLUSION: Health care providers of AN populations must seize the opportunity to screen, refer, and treat individuals with pre-DM and other modifiable DM risk factors prior to DM diagnosis if we are to alter the epidemiologic course of disease progression in this urban AN population.


Assuntos
Estado Pré-Diabético/diagnóstico , Adulto , Alaska/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Programas de Rastreamento , Fatores de Risco , Autorrelato
5.
Avian Dis ; 64(2): 109-122, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32550610

RESUMO

Alaska represents a globally important region for the ecology of avian-origin influenza A viruses (IAVs) given the expansive wetlands in this region, which serve as habitat for numerous hosts of IAVs that disperse among four continents during the annual cycle. Extensive sampling of wild birds for IAVs in Alaska since 1991 has greatly extended inference regarding intercontinental viral exchange between North America and East Asia and the importance of Beringian endemic species to IAV ecology within this region. Data on IAVs in aquatic birds inhabiting Alaska have also been useful for helping to establish global patterns of prevalence in wild birds and viral dispersal across the landscape. In this review, we summarize the main findings from investigations of IAVs in wild birds and wetlands of Alaska with the aim of providing readers with an understanding of viral ecology within this region. More specifically, we review viral detections, evidence of IAV exposure, and genetic characterization of isolates derived from wild bird samples collected in Alaska by host taxonomy. Additionally, we provide a short overview of wetland complexes within Alaska that may be important to IAV ecology at the continental scale.


Assuntos
Aves , Vírus da Influenza A/isolamento & purificação , Influenza Aviária , Alaska/epidemiologia , Animais , Animais Selvagens , Incidência , Vírus da Influenza A/genética , Vírus da Influenza A/fisiologia , Influenza Aviária/epidemiologia , Influenza Aviária/transmissão , Influenza Aviária/virologia , Prevalência , Áreas Alagadas
6.
J Parasitol ; 106(3): 406-410, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32579665

RESUMO

New World flying squirrels, Glaucomys spp., are nocturnal arboreal sciurid rodents that have been previously surveyed for coccidial parasites. To date, 4 species of Eimeria have been reported from 2 species of Glaucomys. Here we report 2 species of eimerians from southern flying squirrels (Glaucomys volans) and the endemic Prince of Wales flying squirrel (Glaucomys sabrinus griseifrons). Oocysts of Eimeria dorneyi Levine and Ivens were found to be passing in the feces of 4 G. s. griseifrons from Alaska and a new species of Eimeria was present in feces from 6 G. volans from Arkansas. Oocysts of Eimeria hnidai n. sp. are ellipsoidal with a bilayered wall, measure 23.7 × 13.7 µm, and have a length/width (L/W) ratio of 1.7; a micropyle and oocyst residuum are absent but polar granule(s) are present. Sporocysts are ellipsoidal-elongate and measure 11.8 × 4.9 µm, L/W 2.2; Stieda body is present but sub-Stieda and para-Stieda bodies are absent. The sporocyst residuum is composed of small indistinct granules along the edge or in the center of the sporocyst. This is the first coccidian reported from G. volans from Arkansas as well as the initial coccidian (E. dorneyi) reported from G. s. griseifrons from Alaska. We also provide a summation of the coccidia known from North American flying squirrels.


Assuntos
Coccidiose/veterinária , Eimeria/classificação , Doenças dos Roedores/parasitologia , Sciuridae/parasitologia , Alaska/epidemiologia , Animais , Arkansas/epidemiologia , Coccidiose/epidemiologia , Coccidiose/parasitologia , Eimeria/isolamento & purificação , Fezes/parasitologia , Doenças dos Roedores/epidemiologia
7.
Pediatr Pulmonol ; 55(4): 975-985, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32096916

RESUMO

OBJECTIVE: The sole prospective longitudinal study of children with either chronic suppurative lung disease (CSLD) or bronchiectasis published in the current era was limited to a single center. We sought to extend this study by evaluating the longer-term clinical and lung function outcomes and their associated risk factors in Indigenous children of adolescents from Australia, Alaska, and New Zealand who participated in our previous CSLD or bronchiectasis studies during 2004-2010. METHODS: Between 2015 and 2018, we evaluated 131 out of 180 (72.8%) children of adolescents from the original studies at a single follow-up visit. We administered standardized questionnaires, reviewed medical records, undertook clinical examinations, performed spirometry, and scored available chest computed tomography scans. RESULTS: Participants were seen at a mean age of 12.3 years (standard deviation: 2.6) and a median of 9.0 years (range: 5.0-13.0) after their original recruitment. With increasing age, rates of acute lower respiratory infections (ALRI) declined, while lung function was mostly within population norms (median forced expiry volume in one-second = 90% predicted, interquartile range [IQR]: 81-105; forced vital capacity [FVC] = 98% predicted, IQR: 85-114). However, 43 out of 111 (38.7%) reported chronic cough episodes. Their overall global rating judged by symptoms, including ALRI frequency, examination findings, and spirometry was well (20.3%), stable (43.9%), or improved (35.8%). Multivariable regression identified household tobacco exposure and age at first ALRI-episode as independent risk factors associated with lower FVC% predicted values. CONCLUSION: Under our clinical care, the respiratory outcomes in late childhood or early adolescence are encouraging for these patient populations at high-risk of premature mortality. Prospective studies to further inform management throughout the life course into adulthood are now needed.


Assuntos
Bronquiectasia/diagnóstico , Adolescente , Adulto , Alaska/epidemiologia , Alaska/etnologia , Austrália/epidemiologia , Austrália/etnologia , Criança , Doença Crônica , Tosse/etiologia , Feminino , Seguimentos , Humanos , Povos Indígenas , Estudos Longitudinais , Pneumopatias/diagnóstico , Masculino , Nova Zelândia/etnologia , Estudos Prospectivos , Infecções Respiratórias/complicações , Fatores de Risco , Espirometria , Supuração/complicações , Capacidade Vital
8.
Am J Prev Med ; 58(4): e133-e140, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32005593

RESUMO

INTRODUCTION: Measuring and comparing the incidence of child maltreatment is challenging. Linkage of statewide birth cohorts with Child Protective Services reports to study incident child maltreatment over the life course are becoming more common. This study compares the reported incidence between 2 states derived from population-based administrative data linkages. METHODS: Linked births (2009-2011) with Child Protective Services records (2009-2015) and deaths in each state were used to compare the cumulative incidence of a Child Protective Services report before age 7 years. Given differences in population race structure and documented disparities of race groups in Child Protective Services data, variation was adjusted for using direct standardization. Unadjusted cumulative incidence, race cumulative incidence, and race-adjusted cumulative incidence were compared. Analyses were completed in 2018. RESULTS: Before age 7 years, 26.0% of Alaskan children and 19.0% of Californian children were reported to Child Protective Services (RR=1.37, p<0.001). Aside from Asian/Pacific Islanders, the cumulative incidence between states was similar for each race. The race-adjusted cumulative incidence indicated that children born in Alaska were 1.10 times as likely to experience a report before age 7 years compared with children in California. CONCLUSIONS: Much of the difference in risk for child maltreatment observed between Alaska and California is most likely due to variation in the population structure by race as opposed to modifiable factors. Standardization is a simple method to adjust for population structure differences. This study contributes to the growing body of knowledge regarding the use of linked administrative data to study maltreatment and provides insights into considerations for making comparisons or conducting cross-jurisdictional analyses based on commonly aligned data sets.


Assuntos
Demandas Administrativas em Assistência à Saúde , Grupo com Ancestrais Nativos do Continente Americano/estatística & dados numéricos , Declaração de Nascimento , Maus-Tratos Infantis/etnologia , Maus-Tratos Infantis/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Alaska/epidemiologia , California/epidemiologia , Criança , Maus-Tratos Infantis/mortalidade , Serviços de Proteção Infantil , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
10.
Arthritis Care Res (Hoboken) ; 72(8): 1152-1158, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31150159

RESUMO

OBJECTIVE: To determine the prevalence and clinical characteristics of juvenile idiopathic arthritis (JIA) in Alaska Native children. METHODS: Potential cases of JIA were identified by querying administrative data from hospitals and clinics in the Alaska Tribal Health System for codes possibly identifying JIA. Medical record abstraction was performed to confirm criteria met for JIA, demographic and clinical characteristics, and treatment patterns. Individuals age ≤18 years with a confirmed diagnosis of JIA were included. The denominator for prevalence was the 2015 Alaska Area Indian Health Service user population age of ≤18 years. RESULTS: The unadjusted prevalence of JIA in Alaska Native children was 74.6 per 100,000 (age-adjusted 79.0 per 100,000). JIA was more common in females than males (unadjusted prevalence 105.8 versus 45.0 per 100,000). Oligoarthritis was the most common subtype (31% of cases), but polyarthritis and enthesitis-related arthritis were also common (26% and 24% of cases, respectively), with a notably high prevalence of enthesitis-related arthritis. The median age at diagnosis was 9 years. Of the combined cohort with results available, 56% were antinuclear antibody positive, 23% were rheumatoid factor positive, 19% were anti-cyclic citrullinated peptide antibody positive, and 57% had the presence of HLA-B27. Uveitis had been diagnosed in 16% of cases. CONCLUSION: The prevalence of JIA in Alaska Native children may be higher than the general US population. Enthesitis-related arthritis makes up a higher proportion of cases than in other populations described likely because of the high prevalence of HLA-B27 in this population.


Assuntos
/estatística & dados numéricos , Artrite Juvenil/etnologia , Artrite Juvenil/epidemiologia , Adolescente , Alaska/epidemiologia , Anticorpos Anti-Proteína Citrulinada/sangue , Anticorpos Antinucleares/sangue , Artrite Juvenil/sangue , Criança , Pré-Escolar , Feminino , Antígeno HLA-B27/sangue , Humanos , Masculino , Prevalência , Fator Reumatoide/sangue
11.
Obesity (Silver Spring) ; 28(1): 55-64, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31858739

RESUMO

OBJECTIVE: The aim of this study was to examine the association of county-level food access, recreational opportunities, and natural amenities with participant engagement in a weight management program. METHODS: In this cohort study, participants in the Veterans Health Administration MOVE! weight management program between October 1, 2007, and September 30, 2013, were observed for 12 months after enrollment. Engagement was measured as the number of program visits per year at 12 months. Cross-sectional analysis and spatial regression were used to examine county characteristics associated with greater participant engagement at 12 months. RESULTS: A total of 321,624 participants in 2,708 counties were included. Greater engagement was associated with older age, female sex, white race, being married, and being retired. After accounting for similarities between nearby communities, engagement at 12 months was 3.1 visits higher for each additional farmers' market per 1,000 population (P = 0.01). Engagement was highest for participants living in counties with the most natural amenities (P < 0.001). Recreational opportunities had only a small effect on engagement in the program (ß = 0.02 visits at 12 months; P = 0.002). CONCLUSIONS: Consideration of a participant's county characteristics in addition to other known demographics and program factors may help to explain variation in engagement in weight management programs.


Assuntos
Planejamento Ambiental/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Parques Recreativos/provisão & distribução , Recreação/fisiologia , Veteranos/estatística & dados numéricos , Programas de Redução de Peso , Adulto , Idoso , Alaska/epidemiologia , Estudos de Coortes , Estudos Transversais , Feminino , Frutas/provisão & distribução , Hawaii/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Parques Recreativos/estatística & dados numéricos , Filipinas/epidemiologia , Porto Rico/epidemiologia , Características de Residência/estatística & dados numéricos , Verduras/provisão & distribução , Programas de Redução de Peso/estatística & dados numéricos
12.
Lancet Oncol ; 20(10): e590-e600, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31579005

RESUMO

Cancer is a substantial health burden for Inuit populations, an Indigenous peoples who primarily inhabit the circumpolar regions of Alaska, Canada, Greenland, and Russia. Access to radiotherapy is lacking or absent in many of these regions, despite it being an essential component of cancer treatment. This Review presents an overview of factors influencing radiotherapy delivery in each of the four circumpolar Inuit regions, which include population and geography, health-systems infrastructure, and cancer epidemiology. This Review also provides insight into the complex patient pathways needed to access radiotherapy, and on radiotherapy use. The unique challenges in delivering radiotherapy to circumpolar Inuit populations are discussed, which, notably, include geographical and cultural barriers. Recommendations include models of care that have successfully addressed these barriers, and highlight the need for increased collaboration between circumpolar referral centres in Alaska, Canada, Greenland, and Russia to ultimately allow for better delivery of cancer treatment.


Assuntos
Acesso aos Serviços de Saúde , Inuítes , Neoplasias/epidemiologia , Neoplasias/radioterapia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Alaska/epidemiologia , Regiões Árticas/epidemiologia , Canadá/epidemiologia , Groenlândia/epidemiologia , Humanos , Incidência , Prevalência , Federação Russa/epidemiologia
13.
J Prim Care Community Health ; 10: 2150132719884298, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31658872

RESUMO

Introduction: An estimated 2.4 million people in the United States live with hepatitis C. Though there are effective treatments for chronic hepatitis C, many infected individuals remain untreated because 40% to 50% of individuals with chronic hepatitis C are unaware of their hepatitis C status. In 2013, the United States Preventive Services Task Force (USPSTF) recommended that adults born between 1945 and 1965 should be offered one-time hepatitis C screening. The purpose of this study is to describe rates of birth cohort hepatitis C screening across primary care practices in the WWAMI region Practice and Research Network (WPRN). Methods: Cross-sectional observational study of adult patients born between 1945 and 1965 who also had a primary care visit at 1 of 9 participating health systems (22 primary care clinics) between July 31, 2013 and September 30, 2015. Data extracted from the electronic health record systems at each clinic were used to calculate the proportion of birth cohort eligible patients with evidence of hepatitis C screening as well as proportions of screened patients with positive hepatitis C screening test results. Results: Of the 32 139 eligible patients, only 10.9% had evidence of hepatitis C screening in the electronic health record data (range 1.2%-49.1% across organizations). Among the 4 WPRN sites that were able to report data by race and ethnicity, the rate of hepatitis C screening was higher among African Americans (39.9%) and American Indians/Alaska Natives (23.2%) compared with Caucasians (10.7%; P < .001). Discussion: Rates of birth cohort hepatitis C screening are low in primary care practices. Future research to develop and test interventions to increase rates of birth cohort hepatitis C screening in primary care settings are needed.


Assuntos
Hepatite C/epidemiologia , Programas de Rastreamento/métodos , Atenção Primária à Saúde/métodos , Alaska/epidemiologia , Estudos de Coortes , Grupos de Populações Continentais/estatística & dados numéricos , Estudos Transversais , Grupos Étnicos/estatística & dados numéricos , Humanos , Idaho/epidemiologia , Montana/epidemiologia , Washington/epidemiologia , Wyoming/epidemiologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-31581631

RESUMO

Hydroclimatic changes may be particularly pronounced in high-latitude regions and can influence infectious diseases, jeopardizing regional human and animal health. In this study, we consider the example of tularemia, one of the most studied diseases in high-latitude regions, which is likely to be impacted by large regional hydroclimatic changes. For this disease case, we use a validated statistical model and develop a method for quantifying possible hydroclimatically driven shifts in outbreak conditions. The results show high sensitivity of tularemia outbreaks to certain combinations of hydroclimatic variable values. These values are within the range of past regional observations and may represent just mildly shifted conditions from current hydroclimatic averages. The methodology developed also facilitates relatively simple identification of possible critical hydroclimatic thresholds, beyond which unacceptable endemic disease levels may be reached. These results call for further research on how projected hydroclimatic changes may affect future outbreaks of tularemia and other infectious diseases in high-latitude and other world regions, with particular focus on critical thresholds to high-risk conditions. More research is also needed on the generality and spatiotemporal transferability of statistical disease models.


Assuntos
Mudança Climática , Doenças Transmissíveis/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Tularemia/epidemiologia , Alaska/epidemiologia , Animais , Finlândia/epidemiologia , Humanos , Modelos Estatísticos , Federação Russa/epidemiologia , Suécia/epidemiologia
15.
Emerg Infect Dis ; 25(10)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31538562

RESUMO

The risk for invasive streptococcal infection has not been clearly quantified among persons experiencing homelessness (PEH). We compared the incidence of detected cases of invasive group A Streptococcus infection, group B Streptococcus infection, and Streptococcus pneumoniae (pneumococcal) infection among PEH with that among the general population in Anchorage, Alaska, USA, during 2002-2015. We used data from the Centers for Disease Control and Prevention's Arctic Investigations Program surveillance system, the US Census, and the Anchorage Point-in-Time count (a yearly census of PEH). We detected a disproportionately high incidence of invasive streptococcal disease in Anchorage among PEH. Compared with the general population, PEH were 53.3 times as likely to have invasive group A Streptococcus infection, 6.9 times as likely to have invasive group B Streptococcus infection, and 36.3 times as likely to have invasive pneumococcal infection. Infection control in shelters, pneumococcal vaccination, and infection monitoring could help protect the health of this vulnerable group.


Assuntos
Pessoas em Situação de Rua/estatística & dados numéricos , Infecções Estreptocócicas/etiologia , Alaska/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/etiologia , Fatores de Risco , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae , Streptococcus pneumoniae , Streptococcus pyogenes
16.
J Surg Res ; 243: 524-530, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31377493

RESUMO

BACKGROUND: Although colorectal cancer occurs earlier in life and at twice the frequency in Alaska Native (AN) people compared with the general population, the colorectal polyp burden in this group has not been quantified. In addition, an appropriate age for initial screening in ANs has not been defined. MATERIALS AND METHODS: A retrospective chart review of 766 AN people who had screening colonoscopy from 2015 to 2016 was performed. The polyp burden in patients aged 40-49 y was compared with that in those aged 50-59 y in both the AN and the general US populations. RESULTS: In total, 345 adenomas were removed: 121 (35%) from 40- to 49-year-olds and 224 (65%) from 50- to 59-year-olds. Twenty-six percent of AN people aged 40 y to 49 y and 40% of AN people aged 50 to 59 y had at least one adenoma. Low- and high-risk adenomas were significantly less frequent in the younger group (22% versus 29%, P = 0.048; 9.2% versus 15%, P = 0.035; respectively). Advanced adenomas were also less frequent in the younger group, although not statistically significant. Polyp histology, size, location, and morphology did not differ significantly between groups. CONCLUSIONS: The adenoma and advanced adenoma prevalence in 40- to 49-year-old AN people is high, suggesting colorectal cancer screening should begin at age 40 y in ANs.


Assuntos
Pólipos Adenomatosos/epidemiologia , Neoplasias do Colo/epidemiologia , Adulto , Alaska/epidemiologia , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos
17.
Cancer Causes Control ; 30(10): 1067-1074, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31428891

RESUMO

PURPOSE: Cancer is the leading cause of mortality among Alaska Native (AN) people. The Alaska Education and Research Towards Health (EARTH) cohort was established to examine risk and protective factors for chronic diseases, including cancer, among AN people. Here, we describe the cancer experience of the Alaska EARTH cohort in relation to statewide- and region-specific tumor registry data, and assess associations with key cancer risk factors. METHODS: AN participants were recruited into the Alaska EARTH cohort during 2004-2006. Data collected included patient demographic, anthropometric, medical and family history, and lifestyle information. This study linked the Alaska EARTH data with cancer diagnoses recorded by the Alaska Native Tumor Registry (ANTR) through 12/31/15. We compared EARTH incidence to ANTR statewide incidence. We examined independent associations of smoking status, diet, BMI, and physical activity with incident all-site cancers using multivariable-adjusted Cox proportional hazards models. RESULTS: Between study enrollment and 2015, 171 of 3,712 (4.7%) Alaska EARTH study participants were diagnosed with cancer. The leading cancers among Alaska EARTH participants were female breast, lung, and colorectal cancer, which reflected those observed among AN people statewide. Incidence (95% CI) of cancer (all sites) among Alaska EARTH participants was 629.7 (510.9-748.6) per 100,000 person-years; this was comparable to statewide rates [680.5 (660.0-701.5) per 100,000 population]. We observed lower risk of all-sites cancer incidence among never smokers. CONCLUSIONS: Cancer incidence in the Alaska EARTH cohort was similar to incidence observed statewide. Risk and protective factors for leading cancers among AN people mirror those observed among other populations.


Assuntos
Neoplasias/epidemiologia , Adulto , Idoso , Alaska/epidemiologia , Índice de Massa Corporal , Estudos de Coortes , Dieta , Exercício Físico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Proteção , Sistema de Registros , Fatores de Risco , Fumar/epidemiologia
18.
Int J Circumpolar Health ; 78(1): 1653749, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31438808

RESUMO

Despite the importance of indigenous people in the Arctic, there is no accurate estimate of their size and distribution. We defined indigenous people as those groups represented by the "permanent participants" of the Arctic Council. The census in Canada, Russia and the United States records status as an indigenous person. In Greenland, a proxy measure is place of birth supplemented by other information. For the Nordic countries we utilized a variety of sources including registered voters' lists of the various Sami parliaments and research studies that established Sami cohorts. Overall, we estimated that there were about 1.13 million indigenous people in the northern regions of the 8 Member States of the Arctic Council. There were 8,100 Aleuts in Alaska and the Russian North; 32,400 Athabaskans in Alaska and northern Canada; 145,900 Inuit in Alaska, northern Canada and Greenland; 76,300 Sami in northern Norway, Sweden, Finland and Russia; and 866,400 people in northern Russia belonging to other indigenous groups. Different degrees and types of methodological problems are associated with estimates from different regions. Our study highlights the complexity and difficulty of the task and the considerable gaps in knowledge. We hope to spur discussion of this important issue which could ultimately affect strategies to improve the health of circumpolar peoples.


Assuntos
Grupos Populacionais/estatística & dados numéricos , Alaska/epidemiologia , Regiões Antárticas/epidemiologia , Regiões Árticas/epidemiologia , Canadá/epidemiologia , Censos , Medidas em Epidemiologia , Groenlândia/epidemiologia , Humanos , Federação Russa/epidemiologia , Países Escandinavos e Nórdicos/epidemiologia
19.
J Public Health Manag Pract ; 25 Suppl 5, Tribal Epidemiology Centers: Advancing Public Health in Indian Country for Over 20 Years: S54-S60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31348191

RESUMO

Alaska Native (AN) people have among the highest rates of colorectal cancer (CRC) recorded globally. Preventing CRC is an important health priority of AN tribal health leaders and communities. Lifestyle and genetic risk and protective factors for CRC among AN people remain understudied. We have been working to establish a tribally led, community-based, comprehensive investigation of lifestyle and genetic risk and protective factors for CRC among AN people. We describe the process of initiating this research study, including conversations with key tribal health system staff. We discuss themes that arose during these conversations and literature review and describe how those themes were used during the study design and protocol development phase. This description is intended to provide guidance to other researchers working to establish community-based studies of cancer risk, particularly among tribal communities.


Assuntos
/etnologia , Neoplasias Colorretais/diagnóstico , Epidemiologia/instrumentação , Alaska/epidemiologia , Alaska/etnologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etnologia , Detecção Precoce de Câncer/estatística & dados numéricos , Humanos , Fatores de Risco
20.
Am J Community Psychol ; 64(1-2): 34-45, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31343758

RESUMO

This retrospective analysis of a long-term community-based participatory research (CBPR) process spans over two decades of work with Alaska Native communities. A call to action from Alaska Native leadership to create more effective strategies to prevent and treat youth suicide and alcohol misuse risk initiated a response from university researchers. This CBPR process transformed into a collaborative effort to indigenously drive and develop solutions through research. The People Awakening project started our team on this translational and transformational pathway through community intervention science in the Central Yup'ik region of Alaska. We examine more deeply the major episodes and their successes and struggles in maintaining a long-term research relationship between university researchers and members of Yup'ik Alaska Native communities. We explore ways that our CBPR relationship has involved negotiation and engagement with power and praxis, to deepen and focus attention to knowledge systems and relational elements. This paper examines these deeper, transformative elements of our CBPR relationship that spans histories, cultures, and systems. Our discussion shares vignettes from academic and community perspectives to describe process in a unique collaboration, reaching to sometimes touch upon rare ground in emotions, tensions, and triumphs over the course of a dozen grants and twice as many years. We conclude by noting how there are points where, in a long-term CBPR relationship, transition out of emergence into coalescing and transformation can occur.


Assuntos
/psicologia , Pesquisa Participativa Baseada na Comunidade , Suicídio/prevenção & controle , Alaska/epidemiologia , /estatística & dados numéricos , Pesquisa Participativa Baseada na Comunidade/métodos , Cultura , Humanos
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