[show abstract][hide abstract] ABSTRACT: Colorectal cancer (CRC) is the second-leading cause of deaths from cancer in the United States. Screening decreases CRC deaths through early cancer detection and through removal of precancerous lesions. We investigated whether a health exhibit consisting of a giant inflatable colon was an effective educational tool to increase community members' knowledge, intention, and social support for CRC screening and prevention.
Alaska adults (N = 880) attending community events statewide from March 2011 through March 2012 completed a short survey to assess knowledge about CRC, intention to get screened, and level of social support before and after walking through a giant interactive model of a human colon. The survey used a combination of open-ended questions and a Likert scale, where 1 was "very unlikely," 2 was "somewhat unlikely," 3 was "neutral," 4 was "somewhat likely," and 5 was "very likely." The model depicted CRC stages from normal tissue to advanced adenocarcinoma and displayed signs with CRC prevention tips. We used the McNemar test and paired sample t tests for univariate analyses.
Respondents significantly improved their CRC knowledge (P < .05), intention to get screened (mean score increased from 4.3 to 4.5, P < .001), and comfort with talking to others about CRC screening (mean level of comfort increased from 3.8 to 3.9, P < .001). Multivariate analysis showed no significant differences by sex, age, or race for improvements in CRC screening knowledge, intention, or comfort.
Interactive exhibits can improve public knowledge and interest in CRC screening, which may lead to increased CRC screening rates and decreased CRC incidence and deaths.
[show abstract][hide abstract] ABSTRACT: Current mortality rates are essential for monitoring, understanding and developing policy for a population's health. Disease-specific Alaska Native mortality rates have been undergoing change.
This article reports recent mortality data (2004-2008) for Alaska Native/American Indian (AN/AI) people, comparing mortality rates to US white rates and examines changes in mortality patterns since 1980.
We used death record data from the state of Alaska, Department of Vital Statistics and SEER*Stat software from the National Cancer Institute to calculate age-adjusted mortality rates.
Annual age-adjusted mortality from all-causes for AN/AI persons during the period 2004-2008 was 33% higher than the rate for US whites (RR=1.33, 95% CI 1.29-1.38). Mortality rates were higher among AN/AI males than AN/AI females (1212/100,000 vs. 886/100,000). Cancer remained the leading cause of death among AN/AI people, as it has in recent previous periods, with an age-adjusted rate of 226/100,000, yielding a rate ratio (RR) of 1.24 compared to US whites (95% CI 1.14-1.33). Statistically significant higher mortality compared to US white mortality rates was observed for nine of the ten leading causes of AN/AI mortality (cancer, unintentional injury, suicide, alcohol abuse, chronic obstructive pulmonary disease [COPD], cerebrovascular disease, chronic liver disease, pneumonia/influenza, homicide). Mortality rates were significantly lower among AN/AI people compared to US whites for heart disease (RR=0.82), the second leading cause of death. Among leading causes of death for AN/AI people, the greatest disparities in mortality rates with US whites were observed in unintentional injuries (RR=2.45) and suicide (RR=3.53). All-cause AN/AI mortality has declined 16% since 1980-1983, compared to a 21% decline over a similar period among US whites.
Mortality rates and trends are essential to understanding the health of a population and guiding policy decisions. The overall AN/AI mortality rate is higher than that of US whites, although encouraging declines in mortality have occurred for many cause specific deaths, as well as for the overall rate. The second leading cause of AN/AI mortality, heart disease, remains lower than that of US whites.
International journal of circumpolar health. 01/2013; 72.
[show abstract][hide abstract] ABSTRACT: The Alaska Native (AN) population experiences twice the incidence and mortality of colorectal cancer (CRC) as does the U.S. white population. CRC screening allows early detection and prevention of cancer.
We describe pilot projects conducted from 2005 to 2010 to increase CRC screening rates among AN populations living in rural and remote Alaska.
Projects included training rural mid-level providers in flexible sigmoidoscopy, provision of itinerant endoscopy services at rural tribal health facilities, the creation and use of a CRC first-degree relative database to identify and screen individuals at increased risk, and support and implementation of screening navigator services.
Alaska Tribal Health System.
Itinerant endoscopy, patient navigation.
AN patients screened for CRC, colonoscopy quality measures.
As a result of these ongoing efforts, statewide AN CRC screening rates increased from 29% in 2000 to 41% in 2005 before the initiation of these projects and increased to 55% in 2010. The provision of itinerant CRC screening clinics increased rural screening rates, as did outreach to average-risk and increased-risk (family history) ANs by patient navigators. However, health care system barriers were identified as major obstacles to screening completion, even in the presence of dedicated patient navigators.
Continuing challenges include geography, limited health system capacity, high staff turnover, and difficulty getting patients to screening appointments.
The projects described here aimed to increase CRC screening rates in an innovative and sustainable fashion. The issues and solutions described may provide insight for others working to increase screening rates among geographically dispersed and diverse populations.
[show abstract][hide abstract] ABSTRACT: For more than 50 years, Community Health Aides and Community Health Practitioners (CHA/Ps) have resided in and provided care for the residents of their villages.
This study is a systematic description of the clinical practice of primary care health workers in rural Alaska communities. This is the first evaluation of the scope of health problems seen by these lay health workers in their remote communities.
Retrospective observational review of administrative records for outpatient visits seen by CHA/Ps in 150 rural Alaska villages (approximate population 47,370).
Analysis of electronic records for outpatient visits to CHA/Ps in village clinics from October 2004 through September 2006. Data included all outpatient visits from the Indian Health Service National Patient Information Reporting System. Descriptive analysis included comparisons by region, age, sex, clinical assessment and treatment.
In total 272,242 visits were reviewed. CHA/Ps provided care for acute, chronic, preventive, and emergency problems at 176,957 (65%) visits. The remaining 95,285 (35%) of records did not include a diagnostic code, most of which were for administrative or medication-related encounters. The most common diagnostic codes were: pharyngitis (11%), respiratory infections (10%), otitis media (8%), hypertension (6%), skin infections (4%), and chronic lung disease (4%). Respiratory distress and chest pain accounted for 75% (n=10,552) of all emergency visits.
CHA/Ps provide a broad range of primary care in remote Alaskan communities whose residents would otherwise be without consistent medical care. Alaska's CHA/P program could serve as a health-care delivery model for other remote communities with health care access challenges.
International journal of circumpolar health. 01/2012; 71:18543.
[show abstract][hide abstract] ABSTRACT: To understand the knowledge levels, attitudes and perceptions of Alaska Native adolescent girls about cervical cancer, HPV, genital warts and the HPV vaccine.
A qualitative study.
Seventy-nine in-depth interviews were conducted with adolescent females aged 11 through 18 years in 4 communities in Alaska. The convenience sample was recruited through word of mouth, posters and flyers distributed in community schools, medical clinics and stores.
Many of those surveyed didn't know the purpose of a vaccine and were not familiar with basic knowledge about HPV, genital warts and cervical cancer. After learning about cervical cancer and HPV, most teens felt that someone their age had an average likelihood of contracting the diseases and that having the disease would be quite bad. Most teens said they were interested in vaccination. When asked if they would get a vaccine, older teens most commonly cited concerns about side effects or doubts about vaccine efficacy, while younger teens were afraid the shot would hurt. Most teens stated that they preferred to learn about health topics such as these through television programming, followed by the Internet, brochures and posters.
The findings provide valuable information on how to inform adolescents about the vaccine and alleviate their concerns. The design of an educational campaign should vary depending on the age of the adolescents. For younger teens, distribution of information should be at school using a brochure or curriculum, while for older teens a web page may be more appropriate.
International journal of circumpolar health. 06/2011; 70(3):245-53.
[show abstract][hide abstract] ABSTRACT: Colorectal cancer control has long been a focus area for Comprehensive Cancer Control programs and their coalitions, given the high burden of disease and the availability of effective screening interventions. Colorectal cancer control has been a growing priority at the national, state, territorial, tribal, and local level. This paper summarizes several national initiatives and features several Comprehensive Cancer Control Program colorectal cancer control successes.
Cancer Causes and Control 11/2010; 21(12):2023-31. · 3.20 Impact Factor
[show abstract][hide abstract] ABSTRACT: We aimed to describe the epidemiology of stroke among Alaska Natives, which is essential for designing effective stroke prevention and intervention efforts for this population.
We conducted an analysis of death certificate data for the state of Alaska for the period 1984 to 2003, comparing age-standardized stroke mortality rates among Alaska Natives residing in Alaska vs US Whites by age category, gender, stroke type, and time.
Compared with US Whites, Alaska Natives had significantly elevated stroke mortality from 1994 to 2003 but not from 1984 to 1993. Alaska Native women of all age groups and Alaska Native men younger than 45 years of age had the highest risk, although the rates for those younger than 65 years were statistically imprecise. Over the 20-year study period, the stroke mortality rate was stable for Alaska Natives but declined for US Whites.
Stroke mortality is higher among Alaska Natives, especially women, than among US Whites. Over the past 20 years, there has not been a significant decline in stroke mortality among Alaska Natives.
American Journal of Public Health 09/2009; 99(11):1996-2000. · 3.93 Impact Factor
[show abstract][hide abstract] ABSTRACT: At the Alaska Native Medical Center in Anchorage, colorectal cancer screening rates improved dramatically with the initiation of a dedicated flexible sigmoidoscopy screening program staffed by mid-level providers. We describe the development and implementation of a program to train rural nurse practitioners and physician assistants in flexible sigmoidoscopy.
Journal of Health Care for the Poor and Underserved 01/2009; 20(4):1041-8. · 1.10 Impact Factor
[show abstract][hide abstract] ABSTRACT: To describe Alaska Native parents' knowledge of and attitudes towards cervical cancer, the human papillomavirus (HPV) and the HPV vaccine.
This was a qualitative study composed of 11 focus groups (n = 80) that were held in 1 small village, 2 towns and 1 large urban centre in Alaska.
A convenience sample of Alaska Native parents/guardians was recruited in each community to participate in focus groups and to fill out a quantitative survey.
While many parents had heard about HPV, most were unaware of its link with cervical cancer. The majority wanted to vaccinate their daughters because they had health and safety concerns; believed that vaccines work; had personal experiences with cancer; or believed that their daughters were susceptible to HPV. Reasons for refusal included general concerns about vaccines; a need for more information; a fear of side effects; wanting more vaccine research; and a fear of being in an experimental trial.
The majority of parents were interested in having their daughters vaccinated. Acceptance of the vaccine was primarily based on a parent's desire to protect her/his child from cancer; while reasons for refusal revolved around trust issues and fear of unknown negative consequences of the vaccine.
International journal of circumpolar health 10/2008; 67(4):363-73. · 1.30 Impact Factor
[show abstract][hide abstract] ABSTRACT: To determine if video otoscope still images of the tympanic membrane taken in remote clinics are comparable to an in-person microscopic examination for follow-up care.
Comparative concordance, diagnostic reliability.
Community health aide/practitioners in remote Alaska imaged 70 ears following tympanostomy tube placement. The patients were then examined in person by two otolaryngologists. Images were later reviewed at 8 and 14 weeks.
Intraprovider concordance for physical examination findings was: "Tube in," 94 percent -97 percent (kappa = 0.89-0.94); "Tube patent," 94 percent -97 percent (kappa = 0.89-0.94); "Drainage," 90 percent -96 percent (kappa = -0.04-0.38); "Perforation," 90 percent -96 percent (kappa = 0.61-0.82); "Granulation," 97 percent -100 percent (kappa = 0.49-1.0); "Middle ear fluid," 88 percent -96 percent (kappa = 0.28-0.71); "Retracted," 83 percent -91 percent (kappa = 0.26-0.58). These agreement rates are similar to interprovider concordance when two otolaryngologists examine the same patient in person. Intraprovider concordance for diagnoses was 76 percent -80 percent (kappa = 0.64-0.71) and 77 percent -88 percent (kappa = 0.66-0.81) when poor images were excluded. Interprovider diagnostic concordance for the in-person exam was 89 percent (kappa = 0.83).
Video-otoscopy images of the tympanic membrane are comparable to an in-person examination for assessment and treatment of patients following tympanostomy tubes. Store-and-forward telemedicine is an acceptable method of following patients post tympanostomy tube placement.
Otolaryngology Head and Neck Surgery 08/2008; 139(1):87-93. · 1.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: The prevalence of diabetes is increasing rapidly among Alaska's Indian, Eskimo and Aleut populations. Approximately half the Native people with diabetes have no road access to hospitals or physicians, presenting a challenge in the attempt to prevent lower extremity amputation as a complication. In late 1998 funding became available for diabetes prevention and treatment among Native Americans. The tribal health corporations in Alaska decided to use a portion of this funding to implement a high-risk foot program to decrease the amputation rate. PROGRAM DESIGN: The program initially involved a surgical podiatrist who provided training to local staff and performed preventive and reconstructive surgery on several patients with impending amputations. The program then provided training for a physical therapist to become a certified pedorthist. This individual established the long-term maintenance phase of the program by conducting diabetic foot clinics routinely at the Alaska Native Medical Center, a referral center in Anchorage. He also travels to other regions of the state to provide training for village and hospital-based health care providers and to conduct field clinics. A system was established in a common database management program to track the patients' foot conditions. Patient education is emphasized.
The overall amputation incidence among all Alaska Native patients with diabetes decreased from 7.6/1,000 in the pre-program period (1996 to 1998) to 2.7/1,000 in the post-program period (1999-2001) (p<.001). The rate among Aleuts, who previously had the highest amputation incidence, decreased from 17.4/1,000 to 3.1/1,000 over the same time periods (p<.001). Among people who had had diabetes at least 10 years, the overall amputation incidence decreased from 16.4/1,000 to 6.8/1,000 (p=.021); among Aleuts the rate fell from 24.5/1,000 to 2.6/1,000 (p=.01).
Though longer follow-up is needed, these data suggest that even in populations living in isolated regions, diabetic amputations can be prevented by a coordinated system to identify high-risk feet and provide preventive treatment and education in the context of a comprehensive diabetes management program in an integrated health system.
International journal of circumpolar health 02/2004; 63 Suppl 2:114-9. · 1.30 Impact Factor
[show abstract][hide abstract] ABSTRACT: The objective of this study was to determine if video otoscope still images (640 x 480 pixel resolution) of the tympanic membrane following surgical placement of tympanostomy tubes are comparable to an in-person microscopic examination. Forty patients having undergone tympanostomy tube placement in both ears were independently examined in-person by two otolaryngologists and imaged using a video otoscope and telemedicine software package. The two physicians later reviewed images at 6 and 12 weeks. Physical examination findings and diagnosis were documented and compared for their concordance using kappa statistics. For both physicians, the intraprovider concordance between the in-person examination and the corresponding image review was high for each of the physical examination findings: Tube In 93-94% (K 0.85-0.87), Tube Patent 86-93% (K 0.74-0.85), Drainage 94-98% (K 0.42-0.66), Perforation 85-98% (K 0.40-0.84), Granulation 95-99% (K -0.01 to 0.00), Middle Ear Fluid 89-91% (K -0.03 to 0.50), and Retracted 89-94% (K 0.13-0.43). These agreement rates are similar to the normal interprovider concordance observed when two physicians independently examined the same patient in-person for physical exam findings: Tube In 96% (K 0.93), Tube Patent 94% (K 0.88), Drainage 96% (K 0.56), Perforation 90% (K 0.60), Granulation 96% (K 0.39), Middle Ear Fluid 88% (K 0.14), and Retracted 91% (K 0.43). For both physicians, the intraprovider diagnostic concordance between the in-person examination and the corresponding image review was high 79-85% (K 0.67-0.76). The interprovider diagnostic concordance for the in-person exam was 88% (K 0.81). The interprovider diagnostic concordance when two physicians independently reviewed all images was 84% (K 0.74), and 89% (K 0.80) when poor images were excluded. This study demonstrates that physician review of video otoscope images is comparable to an in-person microscopic examination. Store-and-forward video otoscopy may be an acceptable method of following patients post-tympanostomy tube placement.
Telemedicine and e-Health 02/2003; 9(4):331-44. · 1.40 Impact Factor
[show abstract][hide abstract] ABSTRACT: Historically, Alaska Native (AN) people have exhibited low overall rates of heart disease mortality compared with the U.S. white (USW) population. We compared AN and USW heart disease mortality rates during the 27-year period from 1981 through 2007.
We compared AN and USW heart disease mortality rates overall and by gender, age, and disease subtype. We calculated age-adjusted rates for AN people for three nine-year periods from 1981 through 2007 and compared them with the rates for USW people.
AN people > or = 35 years of age had a significantly lower rate of heart disease mortality compared with their USW counterparts (rate ratio [RR] = 0.80). The lower overall RR was due primarily to a lower ischemic heart disease mortality RR (RR = 0.63). Overall heart disease mortality decreased during the 27-year study period for both the AN (33.1%) and USW (35.0%) populations. However, hypertensive heart disease mortality increased 155.2% for AN people and 13.7% for USW people. Age-specific heart disease mortality was about 30.0% lower for AN people > or = 75 years of age compared with their USW counterparts, while it was virtually identical for the two racial/ethnic groups among people 35-74 years of age.
The age-adjusted AN heart disease mortality rate was consistently about 20.0% lower than the USW rate from 1981 through 2007, with similar RRs for men and women. However, combining all ages and all heart disease subgroups into a single, age-adjusted statistic obscures many important differences across ages and disease subtypes.
Public Health Reports 126(1):73-83. · 1.42 Impact Factor
[show abstract][hide abstract] ABSTRACT: This article compared mortality data (1999-2003) for Alaska Natives (AN), U.S. white residents (USW), and Alaska white residents (AKW), and examined changes in mortality rates from 1979 to 2003.
We used SEERStat* software from the National Cancer Institute to calculate age-adjusted mortality rates.
The AN all-cause mortality rate was 40% higher (rate ratio [RR]=1.4) than the rate for both the USW and AKW populations. Based on comparisons with USW, the largest disparities in AN mortality were found for unintentional injuries (RR=3.0), suicide (RR=3.1), and homicide (RR=4.4). Disparities were also found for eight of the 10 leading causes of death, including cancer (AN/USW RR=1.3), cerebrovascular disease (RR=1.3), chronic obstructive pulmonary disease (RR=1.4), pneumonia/influenza (RR=1.6), and chronic liver disease (RR=2.0). In contrast, the mortality rate for heart disease among AN was significantly lower (RR=0.9) than for USW, and lower-though not significantly lower-for diabetes. Findings were quite similar when rates for AN were compared with AKW. AKW also had high rates of unintentional injury mortality and suicide compared with USW, but the magnitude of the difference was much less for AKW. From 1979 to 2003, mortality rates among AN declined 16% for all causes, similar to the USW decline of 15%.
Monitoring mortality rates and their trends is essential not only to understand the health status of a population but also to target areas for prevention and evaluate the impact of policy change or the effect of interventions over time.
Public Health Reports 124(1):54-64. · 1.42 Impact Factor
[show abstract][hide abstract] ABSTRACT: To provide current data on cancer mortality among Alaska Native people for the period of 1994-2003, and to identify and quantitate cancer disparities.
Cancer mortality rates for Alaska Native (AN), U.S., White (USW) and other populations were calculated using SEERStat. Ratios of age-adjusted incidence rates with 95% confidence intervals are provided.
Data were from SEERStat. Age-adjusted cancern mortality rates for Alaska Native exceeded those of USW population by 20%. For specific cancer sites, rates were significantly higher among AN people: oral cavity and pharynx (RR=1.9), esophagus (RR=2.0), stomach (RR=3.9), colon and rectum (RR=1.8), liver (RR=1.9), gallbladder (RR=2.6), pancreas (RR=1.3), lung and bronchus (RR=1.2), and kidney and renal pelvis (RR=2.2). In contrast, mortality rates among AN people were significantly lower than USW rates for cancers of the prostate (RR=0.7), brain and nervous system (RR=0.3), lymphoma (RR=0.6), and leukemia (RR=0.4).
Marked disparities in cancer mortality exist among the Alaska Native population compared to the US White population. Excess mortality is documented for all sites combined and for many cancer specific sites. Rates for all cancers combined and for select sites are among the highest of any racial/ethnic group in the United States.