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1.
Artigo em Inglês | PAHO-IRIS | ID: phr-51901

RESUMO

To the editor: In the United States (US), an estimated 2.4 million persons have chronic infection with hepatitis C virus (HCV). The number of deaths from HCV-related mortality is greater than that of HIV and tuberculosis combined. Treatment with direct-acting antivirals (DAAs), usually 1-3 pills a day for 8 or 12 weeks, can cure over 95% of patients. Successful treatment of HCV has been shown to greatly reduce liver-related as well as all-cause mortality. American Indian and Alaska Native (AI/AN) people have over twice the national rate of HCV-related mortality. The largest health care provider for AI/AN communities is the Indian Health System, a national network of federal (Indian Health Service), tribal, and urban health facilities, comprised mostly of rural primary care clinics. As part of the Indian Health System response to HCV, health facilities have access to tele-mentoring support such as the ECHO (Extension for Community Healthcare Outcomes) model, which has demonstrated excellent outcomes in treating HCV. The program connects rural clinicians (‘spokes’) to a specialist team (‘hub’). These participants meet regularly via low-bandwidth video conference technology. The format of case-based learning, supported by short didactic presentations, aims to scale up clinical capacity across a health network. Patient presentations entail a brief de-identified standardized form with a patient’s clinical history to assess liver disease severity and determine optimal HCV treatment. [...]


Assuntos
Hepatite C , Mortalidade , Doenças Transmissíveis , Nativos do Alasca , Índios Norte-Americanos , Saúde da População Urbana , Serviços Urbanos de Saúde , Hepatite , Telemedicina , Telemedicina para as Zonas Rurais e Remotas , Serviços de Saúde do Indígena , Saúde de Populações Indígenas , Organizações Indígenas
2.
PLoS One ; 15(3): e0229540, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32176704

RESUMO

As genetic testing technology advances, genetic testing will move into standard practice in the primary care setting. Genetic research, testing, and return of results are complex topics that require input from Alaska Native and American Indian (ANAI) communities as policies are developed for implementation. This study employed a day and half long public deliberation with ANAI primary care patients to elicit value-laden views of genetic research, testing, and return of results. Participants emphasized the need for a balance between the potential for genetics research, testing, and return of results to empower individuals and improve health with the potential to expose individuals and communities to privacy breaches, discrimination, and emotional harms. Public deliberation was well received by this group of participants and elicited rich discussion on the complex topic of genetic research, testing, and return of results.


Assuntos
Nativos do Alasca/psicologia , Testes Genéticos/ética , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Adulto , Alaska/etnologia , Feminino , Pesquisa em Genética/ética , Humanos , Masculino
3.
J Med Microbiol ; 69(2): 218-227, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32011229

RESUMO

Introduction. Gastric cancer is a health disparity in the Alaska Native people. The incidence of Helicobacter pylori infection, a risk factor for non-cardia gastric adenocarcinoma, is also high. Gastric cancer is partially associated with the virulence of the infecting strain.Aim. To genotype the vacA s, m and i and cag pathogenicity island (cagPAI) genes in H. pylori from Alaskans and investigate associations with gastropathy.Methodology. We enrolled patients with gastritis, peptic ulcer disease (PUD) and intestinal metaplasia (IM) in 1998-2005 and patients with gastric cancer in 2011-2013. Gastric biopsies were collected and cultured and PCR was performed to detect the presence of the right and left ends of the cagPAI, the cagA, cagE, cagT and virD4 genes and to genotype the vacA s, m and i regions.Results. We recruited 263 people; 22 (8 %) had no/mild gastritis, 121 (46 %) had moderate gastritis, 40 (15%) had severe gastritis, 38 (14 %) had PUD, 30 (11 %) had IM and 12 (5 %) had gastric cancer. H. pylori isolates from 150 (57%) people had an intact cagPAI; those were associated with a more severe gastropathy (P≤0.02 for all comparisons). H. pylori isolates from 77 % of people had either the vacA s1/i1/m1 (40 %; 94/234) or s2/i2/m2 (37 %; 86/234) genotype. vacA s1/i1/m1 was associated with a more severe gastropathy (P≤0.03 for all comparisons).Conclusions. In this population with high rates of gastric cancer, we found that just over half of the H. pylori contained an intact cagPAI and 40 % had the vacA s1/i1/m1 genotype. Infection with these strains was associated with a more severe gastropathy.


Assuntos
Proteínas de Bactérias/genética , Ilhas Genômicas , Infecções por Helicobacter/microbiologia , Helicobacter pylori/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alaska , Nativos do Alasca/estatística & dados numéricos , Proteínas de Bactérias/metabolismo , Feminino , Helicobacter pylori/isolamento & purificação , Helicobacter pylori/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/microbiologia , Neoplasias Gástricas/microbiologia , Fatores de Virulência/genética , Fatores de Virulência/metabolismo , Adulto Jovem
4.
BMC Health Serv Res ; 20(1): 24, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914997

RESUMO

BACKGROUND: Community Health Representatives (CHRs) overcome health disparities in Native communities by delivering home care, health education, and community health promotion. The Navajo CHR Program partners with the non-profit Community Outreach and Patient Empowerment (COPE), to provide home-based outreach to Navajo clients living with diabetes. COPE has created an intervention (COPE intervention) focusing on multiple levels of improved care including trainings for CHRs on Motivational Interviewing and providing CHRs with culturally-appropriate education materials. The objective of this research is to understand the participant perspective of the CHR-COPE collaborative outreach through exploring patient-reported outcomes (PROs) of clients who consent to receiving the COPE intervention (COPE clients) using a qualitative methods evaluation. METHODS: Seven COPE clients were selected to participate in semi-structured interviews one year after finishing COPE to explore their perspective and experiences. Qualitative interviews were recorded, transcribed, and coded to identify themes. RESULTS: Clients revealed that health education delivered by CHRs facilitated lifestyle changes by helping them understand key health indicators and setting achievable goals through the use of accessible material and encouragement. Clients felt comfortable with CHRs who respected traditional practices and made regular visits. Clients also appreciated when CHRs educated their family members, who in turn were better able to support the client in their health management. Finally, CHRs who implemented the COPE intervention helped patients who were unable to regularly see a primary care doctor for critical care and support in their disease management. CONCLUSION: The COPE-CHR collaboration facilitated trusting client-CHR relationships and allowed clients to better understand their diagnoses. Further investment in materials that respect traditional practices and aim to educate clients' families may foster these relationships and improve health outcomes. TRIAL REGISTRATION: clinicaltrials.gov: NCT03326206. Registered 9/26/2017 (retrospectively registered).


Assuntos
Nativos do Alasca/psicologia , Atitude Frente a Saúde/etnologia , Serviços de Saúde Comunitária/organização & administração , Diabetes Mellitus/etnologia , Índios Norte-Americanos/psicologia , Nativos do Alasca/estatística & dados numéricos , Agentes Comunitários de Saúde/psicologia , Relações Comunidade-Instituição , Comportamento Cooperativo , Diabetes Mellitus/terapia , Feminino , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Organizações sem Fins Lucrativos/organização & administração , Participação do Paciente , Relações Profissional-Paciente , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Estados Unidos
5.
BMC Health Serv Res ; 20(1): 34, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931791

RESUMO

BACKGROUND: The purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients. METHODS: Collaborative Care was implemented in three AI/AN serving clinics. Clinic staff participated in training and coaching designed to facilitate practice change. We followed clinics for 2 years to observe improvements in depression treatment and to examine treatment outcomes for enrolled patients. Collaborative Care elements included universal screening for depression, evidence-based treatment to target, use of behavioral health care managers to deliver the intervention, use of psychiatric consultants to provide caseload consultation, and quality improvement tracking to improve and maintain outcomes. We used t-tests to evaluate the main effects of Collaborative Care and used multiple linear regression to better understand the predictors of success. We also collected qualitative data from members of the Collaborative Care clinical team about their experience. RESULTS: The clinics participated in training and practice coaching to implement Collaborative Care for depressed patients. Depression response (50% or greater reduction in depression symptoms as measured by the PHQ-9) and remission (PHQ-9 score less than 5) rates were equivalent in AI/AN patients as compared with White patients in the same clinics. Significant predictors of positive treatment outcome include only one depression treatment episodes during the study and more follow-up visits per patient. Clinicians were overall positive about their experience and the effect on patient care in their clinic. CONCLUSIONS: This project showed that it is possible to deliver Collaborative Care to AI/AN patients via primary care settings in rural areas.


Assuntos
Nativos do Alasca/psicologia , Comportamento Cooperativo , Depressão/etnologia , Índios Norte-Americanos/psicologia , Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , População Rural , Adolescente , Adulto , Idoso , Nativos do Alasca/estatística & dados numéricos , Depressão/prevenção & controle , Feminino , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
6.
Matern Child Health J ; 24(1): 82-89, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31664693

RESUMO

OBJECTIVES: Our objective was to identify preconception and prenatal predictors of early experiences of co-occurring risk and protective factors to help target prevention efforts to the highest-need families prior to the birth of the child. METHODS: Data were from the Alaska Longitudinal Child Abuse and Neglect Linkage project and the 2012-2014 Alaska Child Understanding Behaviors Survey. We used latent class analysis and Vermunt's three-step approach to examine predictors of latent classes of risk and protective factors among Alaska children. RESULTS: Among children of Alaska Native/American Indian mothers, financial (OR 2.02, 95% CI 1.04, 3.90) and partner stress (OR 2.06, 95% CI 1.02, 4.10) prior to childbirth, maternal education < 12 years (OR 2.29, 95% CI 1.05, 4.96), and maternal substance use (OR 2.52, 95% CI 1.30, 4.89) were associated with a higher likelihood of membership in a high risk/moderate protection class as compared to a low socioeconomic status/high protection class. Among children of non-Native mothers, partner stress prior to childbirth (OR 3.92, 95% CI 1.08, 14.19), maternal education < 12 years (OR 2.69, 95% CI 1.24, 5.81), maternal substance use (OR 2.69, 95% CI 1.24, 5.81), younger maternal age (OR 0.87, 95% CI 0.80, 0.95), and a greater number of children (OR 1.62, 95% CI 1.09, 2.41) were associated with a higher likelihood of membership in a moderate risk/high protection class as compared to a low risk/moderate protection class. CONCLUSIONS: Results can inform eligibility criteria for prenatal home visiting programs and prenatal screening in Alaska to ensure prevention programming and referrals are directed to families most in need of additional support.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Maus-Tratos Infantis/prevenção & controle , Índios Norte-Americanos/estatística & dados numéricos , Mães/psicologia , Cuidado Pré-Concepcional , Cuidado Pré-Natal , Alaska , Pré-Escolar , Feminino , Humanos , Recém-Nascido , Idade Materna , Fatores de Proteção , Medição de Risco
7.
Sci Total Environ ; 711: 134450, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31812391

RESUMO

The availability of safe water for potable purposes in Alaska Native communities is limited due to naturally occurring metals and contaminants released from anthropogenic activities, such as drilling and mining. The impacts of climate change are magnified in the arctic and sub-arctic regions and thus have the potential to mobilize contaminants and exacerbate the water contamination problem. Alaska Native communities are vulnerable to such changes in their water quality because of their remote location and limited access to resources. This study initiates an assessment of water quality, including its microbial ecology, in off-the-grid Alaskan water supplies (i.e., primarily groundwater wells). In particular, water quality data were collected from nine communities (22 ground water wells). Water quality analyses included basic water quality parameters, a suite of metals relevant to human health, and microbial community composition. Results revealed location-specific elevated arsenic concentrations based on the underlying geological formation, particularly in the areas located in the geological formation of the McHugh Complex. Diverse microbial communities were observed, and the grouping appeared to be based on elevation. These findings present evidence of compromised water quality in an understudied area in the United States. The results from this study should be considered as a snapshot in time, which highlight the importance for further systematic studies in similar off-the-grid communities.


Assuntos
Nativos do Alasca , Água Subterrânea , Regiões Árticas , Humanos , Estados Unidos , Qualidade da Água , Abastecimento de Água
8.
Cancer Causes Control ; 31(1): 73-82, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31734765

RESUMO

PURPOSE: While smoking prevalence may be declining in the general population, health disparities in tobacco use remain a public health priority. This study examined national, sociodemographic, and geographic trends in American Indians and Alaska Natives (AIs/ANs) smoking prevalence from 1992/1993 to 2014/2015. Additionally, correlates of cigarette smoking were examined among this group. METHODS: Data were drawn from the 1992-2015 Tobacco Use Supplement to the Current Population Survey. Cochran-Armitage tests were used to assess changes in the prevalence of smoking over time in the population, as well by sociodemographic characteristics. Multivariable logistic regression was conducted to examine the correlates of cigarette smoking for AIs/ANs in 2014/2015. RESULTS: The trend analysis indicated that the prevalence of smoking, among AIs/ANs, decreased significantly from 39.1% in the 1992/1993 cycle to 20.9% in the 2014/2015. This decrease was seen in both males and females, with the prevalence of smoking decreasing from 43.6% and 35.4%, respectively, in 2006/2007 to 23.8% and 18.3% in 2014/2015. The decreasing trend was also found for all subgroups, except for the 55+ age group. Multivariable analysis showed higher odds of smoking among males, those with low income compared to those with median or higher income, and those living in non-metropolitan areas. Those aged 25-54 were more likely to be smokers compared with the 55+ age group. CONCLUSIONS: Results indicate a recent decrease in AIs/ANs smoking prevalence, although these populations still experience a high prevalence of smoking compared to the general population. Our findings highlight the need for a comprehensive tobacco control strategy that includes working with stakeholders within the AI/AN community.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Fumar Cigarros/etnologia , Índios Norte-Americanos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Geografia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Classe Social , Estados Unidos/epidemiologia , Adulto Jovem
9.
Public Health Rep ; 135(1): 66-73, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31765285

RESUMO

OBJECTIVE: American Indian and Alaska Native (AI/AN) persons are commonly misclassified in epidemiologic and administrative data sets. The race-corrected hepatitis C virus (HCV)-related mortality rate among AI/AN persons in the Northwest United States (Idaho, Oregon, and Washington State) is unknown. We quantified the disparity in HCV-related mortality between AI/AN persons and non-Hispanic white (NHW) persons in the Northwest during 2006-2012 after correcting misclassified AI/AN race. METHODS: After conducting probabilistic record linkage between death records and the Northwest Tribal Registry, we calculated HCV-related mortality rates for AI/AN and NHW persons by using National Center for Health Statistics bridged-race estimates standardized to the US 2000 standard population. RESULTS: The 2006-2012 aggregate age-adjusted HCV-related mortality rate per 100 000 population in the Northwest was 19.6 (95% confidence interval [CI], 17.3-22.2) for AI/AN persons and 5.9 (95% CI, 5.7-6.1) for NHW persons (rate ratio [RR] = 3.3; 95% CI, 3.0-3.8). The disparity was larger among females (RR = 4.6; 95% CI, 3.8-5.5) than among males (RR = 2.9; 95% CI, 2.5-3.4). CONCLUSION: The disproportionate rate of HCV-related mortality among AI/AN persons in the Northwest highlights the need to expand HCV education, screening, and treatment among this population.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Hepatite C/etnologia , Hepatite C/mortalidade , Índios Norte-Americanos/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noroeste dos Estados Unidos/epidemiologia , Fatores Sexuais
10.
Am J Clin Nutr ; 111(2): 406-419, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31851298

RESUMO

BACKGROUND: Alaska Native (AN) people have the world's highest recorded incidence of sporadic colorectal cancer (CRC) (∼91:100,000), whereas rural African (RA) people have the lowest risk (<5:100,000). Previous data supported the hypothesis that diet affected CRC risk through its effects on the colonic microbiota that produce tumor-suppressive or -promoting metabolites. OBJECTIVES: We investigated whether differences in these metabolites may contribute to the high risk of CRC in AN people. METHODS: A cross-sectional observational study assessed dietary intake from 32 AN and 21 RA healthy middle-aged volunteers before screening colonoscopy. Analysis of fecal microbiota composition by 16S ribosomal RNA gene sequencing and fecal/urinary metabolites by 1H-NMR spectroscopy was complemented with targeted quantification of fecal SCFAs, bile acids, and functional microbial genes. RESULTS: Adenomatous polyps were detected in 16 of 32 AN participants, but not found in RA participants. The AN diet contained higher proportions of fat and animal protein and less fiber. AN fecal microbiota showed a compositional predominance of Blautia and Lachnoclostridium, higher microbial capacity for bile acid conversion, and low abundance of some species involved in saccharolytic fermentation (e.g., Prevotellaceae, Ruminococcaceae), but no significant lack of butyrogenic bacteria. Significantly lower concentrations of tumor-suppressive butyrate (22.5 ± 3.1 compared with 47.2 ± 7.3 SEM µmol/g) coincided with significantly higher concentrations of tumor-promoting deoxycholic acid (26.7 ± 4.2 compared with 11 ± 1.9 µmol/g) in AN fecal samples. AN participants had lower quantities of fecal/urinary metabolites than RA participants and metabolite profiles correlated with the abundance of distinct microbial genera in feces. The main microbial and metabolic CRC-associated markers were not significantly altered in AN participants with adenomatous polyps. CONCLUSIONS: The low-fiber, high-fat diet of AN people and exposure to carcinogens derived from diet or environment are associated with a tumor-promoting colonic milieu as reflected by the high rates of adenomatous polyps in AN participants.


Assuntos
Grupo com Ancestrais do Continente Africano , Nativos do Alasca , Bactérias/metabolismo , Neoplasias Colorretais/microbiologia , Microbioma Gastrointestinal/fisiologia , Adulto , Bactérias/classificação , Estudos de Coortes , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/genética , Estudos Transversais , Dieta , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , População Rural
11.
J Safety Res ; 71: 315-318, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31862042

RESUMO

INTRODUCTION: Despite progress, injury remains the leading cause of preventable death for American Indian and Alaska Natives (AI/AN), aged 1 to 44. There are few publications on injuries among the AI/AN population, especially those on traumatic brain injury (TBI). A TBI can cause short- or long-term changes in cognition, communication, and/or emotion. METHODS: To describe changes over time in TBI incidence by mechanism of injury, injury intent, and age group among AI/ANs, the CDC analyzed hospitalization and death data from the 2008-2014 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and the National Vital Statistics System (NVSS), respectively. RESULTS: From 2008-2014, the incidence of TBI-related hospitalizations increased by 32% (1,477 in 2008 to 1,945 in 2014) and resulted in a 21% increase in age-adjusted rates of people hospitalized with TBI. TBI-related deaths increased in number (569 in 2008 to 644 in 2014) and age-adjusted rate (22.7 in 2008 to 25.4 in 2014) by approximately 13% and 12%, respectively. Motor-vehicle crashes were the leading cause of TBI-related deaths among AI/ANs aged 0-54 years. Practical application: Prevention efforts should focus on increasing motor-vehicle safety and advancing prevention strategies for other leading causes of TBI, including: falls, intentional self-harm, and assaults.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Lesões Encefálicas Traumáticas/epidemiologia , Hospitalização/estatística & dados numéricos , Índios Norte-Americanos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/etiologia , Criança , Pré-Escolar , Humanos , Incidência , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
13.
Nurs Res ; 68(6): 488-493, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693555

RESUMO

BACKGROUND: Certain research principles, framed within an indigenous context, are helpful guideposts to practice ethical, relevant, and sensitive inquiries. It is essential to further adapt research approaches based on the unique geographical, sociopolitical, and cultural attributes of partnering tribal communities. These adaptations are largely shaped by trial and error. OBJECTIVES: The purpose of this article is to offer the prospective novice nurse researcher lessons that we learned when entering Indian country to conduct research for the first time. As indigenous and nonindigenous researchers, we are not seeking to set down a methodology but rather offer a list of processes, environments, timelines, and barriers that we never learned in didactic, seminar, clinical, practicum, or any other academic setting. METHODS: We organized a set of memories and thoughts through a series of semistructured iterative sessions specific to our first encounters as researchers in Indian country. We compiled our written responses and field notes from our dialogue, interpreted these data, and organized them into themes. We have reported what we felt would be the most surprising, frequent, or important information to note. RESULTS: We identified three overarching themes in our collective experience: orientation and negotiation, situating ourselves and our work, and navigating our way. Subthemes included perceiving ourselves as outsiders, negotiating distance and time realities, relying on the goodness of gatekeepers, shaping research questions per community priorities, honing our cross-cultural and intercultural communication skills, discovering the many layers of tribal approval processes, and developing sensibilities and intuition. DISCUSSION: Our previous experiences as novices leading research projects in Indian country have produced unique sensibilities that may serve to guide nurse researchers who seek to partner with tribal communities.


Assuntos
Pesquisa sobre Serviços de Saúde/organização & administração , Índios Norte-Americanos , Pesquisa em Enfermagem/organização & administração , Nativos do Alasca , Humanos
14.
Transl Behav Med ; 9(5): 952-961, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31570921

RESUMO

In remote Alaska Native communities, traditional foods are inextricably linked to health and food security. Degradation of the traditional food system over the past several decades has resulted in a shift in dietary patterns that have contributed to increased rates of chronic diseases and food insecurity among Alaska Native People. Interventions are needed to address this. Our objectives were to evaluate the preliminary efficacy of a school-based intervention-Neqa Elicarvigmun or the Fish-to-School Program-on diet quality, fish intake, and attitudes and beliefs around traditional foods (specifically fish) using a pre-post comparison group design with data collection occurring at three time points. Study participants were 76 middle and high school students in two remote Alaska Native communities (population <900) in southwestern Alaska. We used a participatory approach to design the school-based, multilevel intervention that included activities in the cafeteria, classroom, and community. Multilevel analyses showed that students in the experimental community showed significant improvements in diet quality compared to the comparison community (Beta = 4.57; p < .05). Fish intake, measured using the stable nitrogen isotope ratio of hair, a validated biomarker, also increased significantly in the experimental community (Beta = 0.16; p < .05). Leveraging the cultural and physical resources of the traditional food system for the Neqa Elicarvigmun program represents a strength-based approach that improves diet quality, increases adolescents' connection to their traditional culture, and by promoting the local food system supports food security. Embedding the program into the local culture may result in faster adoption and greater sustainability of the program.


Assuntos
Nativos do Alasca/psicologia , Cultura , Dieta , Abastecimento de Alimentos , Adolescente , Alaska , Animais , Estudos Transversais , Feminino , Humanos , Masculino , Projetos Piloto , População Rural , Salmão , Instituições Acadêmicas
15.
J Community Health Nurs ; 36(4): 165-187, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621433

RESUMO

We provide a literature review concerning healthcare access for Native Americans in rural areas. We group previous research around three themes; barriers in rural America; barriers within the Indian Health Services system (including provider recruitment and retention); and the scale of services offered. Considering a wide range of access measures, a general failure exists in providing Native Americans with services comparable to those received by other Americans There are repeated findings of disparities in specific resources available, such as staff and infrastructure. Improvement appears possible through increased funding, and by giving greater management control to each tribe.


Assuntos
Nativos do Alasca , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Índios Norte-Americanos , População Rural , Humanos
16.
Artigo em Inglês | MEDLINE | ID: mdl-31627325

RESUMO

This study explored the lived experiences of suicidality and help-seeking for suicide prevention among Alaska Native and American Indian (AN/AI) people in a tribal health system. An interpretive phenomenological approach was used to analyze semi-structured, in-depth interviews with 15 individuals (ages 15-56) with self-reported histories of suicide ideation and/or attempt. Several factors were found to be central to acquiring resilience to suicide risk among AN/AI people across a wide age range: meaningful and consistent social connection, awareness about how one's suicide would negatively effect loved ones, and knowledge and utilization of available health services. Findings highlight the mutable nature of suicide risk and resilience, as well as the importance of interpersonal factors in suicidality.


Assuntos
Nativos do Alasca/psicologia , Índios Norte-Americanos/psicologia , Resiliência Psicológica , Ideação Suicida , Adolescente , Adulto , Conscientização , Feminino , Acesso aos Serviços de Saúde , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Violência , Adulto Jovem
17.
Am J Obstet Gynecol ; 221(6): 609.e1-609.e9, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31499056

RESUMO

The risk of maternal death in the United States is higher than peer nations and is rising and varies dramatically by the race and place of residence of the woman. Critical efforts to reduce maternal mortality include patient risk stratification and system-level quality improvement efforts targeting specific aspects of clinical care. These efforts are important for addressing the causes of an individual's risk, but research to date suggests that individual risk factors alone do not adequately explain between-group disparities in pregnancy-related death by race, ethnicity, or geography. The holistic review and multidisciplinary makeup of maternal mortality review committees make them well positioned to fill knowledge gaps about the drivers of racial and geographic inequity in maternal death. However, committees may lack the conceptual framework, contextual data, and evidence base needed to identify community-based contributing factors to death and, when appropriate, to make recommendations for future action. By incorporating a multileveled, theory-grounded framework for causes of health inequity, along with indicators of the community vital signs, the social and community context in which women live, work, and seek health care, maternal mortality review committees may identify novel underlying factors at the community level that enhance understanding of racial and geographic inequity in maternal mortality. By considering evidence-informed community and regional resources and policies for addressing these factors, novel prevention recommendations, including recommendations that extend outside the realm of the formal health care system, may emerge.


Assuntos
Comitês Consultivos , Grupos Étnicos/estatística & dados numéricos , Equidade em Saúde , Morte Materna/etnologia , Mortalidade Materna/etnologia , Afro-Americanos/estatística & dados numéricos , Nativos do Alasca/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Geografia , Hispano-Americanos/estatística & dados numéricos , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Morte Materna/prevenção & controle , Morte Materna/tendências , Mortalidade Materna/tendências , Gravidez , Medição de Risco , Estados Unidos
18.
Public Health ; 176: 29-35, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31542168

RESUMO

OBJECTIVES: The aim of the study is to increase seat belt (SB) use and reduce motor vehicle (MV) injuries and death; eight tribal communities implemented evidence-based strategies from the Guide to Community Preventive Services during 2010-2014. STUDY DESIGN: SB use was measured through direct observational surveys and traffic safety activity data. Traffic safety activities included enhanced enforcement campaign events, ongoing enforcement of SB laws, and media. The number of MV injuries (including fatal and non-fatal) was measured through MV crash data collected by police. RESULTS: Percentage change increases in SB use were observed in all eight projects; average annual increases of three projects were statistically significant (ranging from 10% to 43%). Four of the eight projects exceeded their goals for percentage change increases in SB use. Approximately 200 media events and 100 enforcement events focused on SB use were conducted across the eight projects. Five projects had an annual average of ≥100 SB use citations during the project period. MV injuries (fatal and non-fatal combined) significantly decreased in three projects (ranging from a 10% to 21% average annual decrease). CONCLUSIONS: Increases in SB use and decreases in the number of MV injuries can be achieved by tailoring evidence-based strategies to tribal communities.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Nativos do Alasca/estatística & dados numéricos , Índios Norte-Americanos/estatística & dados numéricos , Cintos de Segurança/estatística & dados numéricos , Ferimentos e Lesões/prevenção & controle , Acidentes de Trânsito/mortalidade , Centers for Disease Control and Prevention, U.S. , Humanos , Polícia , Registros , Cintos de Segurança/legislação & jurisprudência , Inquéritos e Questionários , Estados Unidos/epidemiologia , Ferimentos e Lesões/etnologia , Ferimentos e Lesões/mortalidade
19.
BMC Public Health ; 19(1): 1276, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533671

RESUMO

BACKGROUND: Effective leadership is vital in the struggle to decrease the behavioral health disparities between the US population and American Indian Alaska Native (AIAN) communities. AIAN communities have a pre-colonization history of highly effective leadership, yet some AIAN leadership traditions have been eradicated through decades of trauma and genocidal efforts. There is a paucity of research on AIAN public health leadership, and most existing research relies on samples of individuals holding leadership positions rather than individuals purposely selected because of their effectiveness. The aim of the study was to investigate the experiences of successful AIAN behavioral health leaders and present an emerging AIAN public health leadership model. METHODS: Thirty-eight public health leaders in the Substance Abuse and Mental Health Service Administration (SAMHSA) funded Circles of Care project were observed over the course of their three-year leadership role. Stringent criteria for successful community participatory leadership resulted in the selection of 11 of the 38 leaders for inclusion in the study. Ultimately eight leaders (21% of the population of observed leaders) participated in the study. Semi-structured, one-on-one qualitative interviews were conducted. The methods were informed by phenomenology and the data were analyzed using a thematic content analysis approach. RESULTS: The analysis resulted in ten themes: Hopeful Vision for the People, Cultural Humility, Awareness of Historical Context, Purpose Driven Work Behavior, Cultural and Bi-Cultural Knowledge, Trusting a Broader Process, Caring Orientation, Holistic Supervision, Community Centered, and Influence Through Education. Respondents were strongly motivated by a desire to help future generations. They described their success in terms of the application of traditional AIAN values such as cultural humility and community orientation, but also relied heavily on task orientation. An emerging AIAN leadership model is presented. CONCLUSIONS: It is important to encourage AIAN public health leaders to employ leadership research and models conducted or developed in the context of AIAN communities. The emerging model presented in this study could serve as an initial basis for AIAN leadership training. Given the challenging context of AIAN leadership, the lessons taught by these successful leaders could be adapted for use by leaders in non AIAN settings.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Características Culturais , Índios Norte-Americanos/estatística & dados numéricos , Liderança , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adulto , Nativos do Alasca/psicologia , Participação da Comunidade/estatística & dados numéricos , Feminino , Humanos , Índios Norte-Americanos/psicologia , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
20.
Artigo em Inglês | MEDLINE | ID: mdl-31550379

RESUMO

Tribal Institutional Review Boards (IRBs) and other entities that oversee research for American Indians and Alaska Natives are important and unique. They reflect and respond to community needs, changes in research, and revisions to research policy. We provide a framework to capture this dynamism by building on existing work and offering a way to describe the scope of entities that oversee tribal research. As federal research regulations are revised, and policies are developed in response to a rapidly advancing research landscape, it is critical that policy makers, IRB professionals, researchers, and tribal communities have clarity regarding the Tribal IRB.


Assuntos
Nativos do Alasca , Pesquisa Participativa Baseada na Comunidade , Comitês de Ética em Pesquisa , Índios Norte-Americanos , Saúde das Minorias , Humanos
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