Given the high rates for substance use among women and men of childbearing age, perinatal and early childhood home-visiting programs serving tribal communities must consider how they will address substance-use problems among the families they support. In this study, we explored the approaches to identifying and addressing family-based substance-use problems that were implemented by nine home-visiting programs serving American Indian/Alaska Native (AI/AN) communities that are funded through the federal Tribal Maternal, Infant, and Early Childhood Home Visiting Program (Tribal MIECHV). These programs demonstrated a high awareness of substance-use problems and took concrete action to address them above and beyond that included in the home-visiting model they used. All nine programs reported that they provided substance-use preventive services and screened for substance-use problems. While all programs referred to substance-use treatment programs when needed, in six programs the home visitor provided substance-use services. Through Tribal MIECHV, the intense need for substance-use education, assessment, service delivery, and referral in many AI/AN communities is pushing the home-visiting field forward to address this increasingly critical issue for low-income families across the United States and the world.
The purpose of this study was to examine differences in adequacy of prenatal care and incidence of low birthweight between low-income women with Medicaid in Washington State and low-income women with Canadian provincial health insurance in British Columbia.
A population-based cross-sectional study was done by using linked birth certificates and claims data.
Overall, the adjusted odds ratio for inadequate prenatal care in Washington (comparing women with Medicaid with those with private insurance) was 3.2. However, the risk varied by time of Medicaid enrollment relative to pregnancy (2.0, 1.0, 2.7, 6.3; for women who enrolled prior to pregnancy, during the first trimester, during the second trimester, or during the third trimester, respectively). In British Columbia, the adjusted odds ratio for inadequate care (comparing women receiving a health premium subsidy with those receiving no subsidy) was 1.5 for women receiving a 100% subsidy and 1.2 for women receiving a 95% subsidy. The risk for low birthweight followed a similar trend in both regions, but there was no association with enrollment period in Washington.
Overall, the risk for inadequate prenatal care among poor women was much greater in Washington than in British Columbia. Most of the difference was due to Washington women's delayed enrollment in Medicaid. In both regions, the poor were at similar risk for low birthweight relative to their more affluent counterparts.
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Using the coalescent process, DNA sequences of a sample of individuals can be used to study the phylogenetic history of the individuals. Under the infinitely-many-sites mutation model, the DNA sequence data can be summarized by the number of segregating sites (which is numerically equivalent to the number of mutations on the tree). A number of methods exist, including a recursive method presented in this paper, that obtain an estimate of the age of the most recent common ancestor (MRCA), given the number of mutations. This paper introduces a method for finding the ages of mutations, given the total number of mutations on the tree. While the result is not useful in estimating the age of a specific segregating site, it is useful in examining the underlying assumption of a relatively constant population over time. This utilization of the result is illustrated using DNA sequence data obtained from a sample of Amerindians of the Nuu-Chah-Nulth tribe.
A 30-month retrospective review was performed of all trauma patients initially evaluated and operatively stabilized at Level III hospitals, with subsequent specialized air transport within 48 hours of injury to the regional Level I trauma center in Seattle. Nineteen patients were identified, with a mean ISS of 44 (range, 20-66). Mean transport time and distance were 2.4 hours and 456 miles, respectively. The estimated average ground transport time for the same patients was 23.8 hours. No deaths occurred during transport, and the overall survival rate was 58%. Transport charges averaged $4,162, which was 14% of the complete hospitalization cost. We conclude that: 1) patient survival after air transport was no different than that predicted for trauma victims with immediate access to a trauma center; 2) postoperative hemodynamic instability predicted a poor outcome; 3) the higher cost of air relative to ground transport is outweighed by significant time savings in these critically injured patients; and 4) air transport following operative stabilization represents an extension of regionalized trauma care to the isolated areas of Washington and Alaska.
Implementation of Evidence-Based Practices (EBP) within American Indian and Alaskan Natives communities is currently an area of debate and contention. There is considerable concern about expanding EBP policy mandates to AI/AN communities as these mandates, either through funding restrictions or other de facto policies, recall past histories of clinical colonization and exploitation by the state and federal government. As a response, work is being done to evaluate indigenous programs and examine strategies for culturally-sensitive implementation. While the literature reflects the perspectives of AI/AN populations on EBP generally, no one has yet reported the perspectives of AI/AN communities on how to feasibly achieve widespread EBP implementation. We report the findings of a statewide Tribal Gathering focused on behavioral health interventions for youth. The Gathering participants included AI/AN individuals as well as staff working with AI/AN populations in tribal communities. Participants identified strengths and weaknesses of the five legislatively fundable programs for youth delinquency in Washington State and discussed strategies likely to be effective in promoting increased uptake within tribes. Analysis of these discussions resulted in many useful insights in program-specific and community-driven strategies for implementation. In addition, two major themes emerged regarding widespread uptake: the importance of a multi-phase engagement strategy and adopting a consortium/learning community model for implementation. The findings from this Gathering offer important lessons that can inform current work regarding strategies to achieve a balance of program fidelity and cultural-alignment. Attending to engagement practices at the governance, community and individual level are likely to be key components of tribal-focused implementation. Further, efforts to embed implementation within a consortium or learning community hold considerable promise as a strategy for sustainability.
BACKGROUND: American Indians and Alaska Natives (AI/ANs) remain underrepresented in the medical profession. This study sought to understand the supports and barriers that AI/AN students encountered on their path to successful medical school entry. METHOD: The research team analyzed qualitative semistructured, one-on-one, confidential interviews with 10 AI/AN medical students to identify salient support and barrier themes. RESULTS: Supports and barriers clustered in eight categories: educational experiences, competing career options and priorities, health care experiences, financial factors, cultural connections, family and friends, spirituality, and discrimination. Some of the most notable findings of this study include the following: (1) students reported financial barriers severe enough to constrain participation in the medical school application process, and (2) spirituality played an important role as students pursued a medical career. CONCLUSION: Promoting AI/AN participation in medical careers can be facilitated with strategies appropriate to the academic, financial, and cultural needs of AI/AN students.