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Volume 4, No. 12, December 2006/January 2007
From Your Colleagues
Carolyn Aoyama, HQE
Diabetes on the rise in young Native Americans
From 1994 to 2004, the rate of diagnosed diabetes among American Indians and Alaska Natives younger than 35 years of age increased from 8.5 to 17.1 cases per 1000 population.
This trend is concerning, given the fact that diabetes has a greater potential to cause harm with onset at an early age, according to the authors of the article. The study, which was conducted by researchers from the Centers for Disease Control and Prevention, involved an analysis of patient data collected by the Indian Health Service (IHS), which provides healthcare to American Indian and Alaska Native populations. Roughly 60 percent of the almost 3 million American Indians and Alaska Natives living in the US reside in an area covered by the IHS. At the start of the 10-year period, 6001 American Indians and Alaska Natives younger than 35 years old had diabetes. By 2004, this number had increased to 12,313.
Diagnosed Diabetes Among American Indians and Alaska Natives Aged <35 Years --- United States, 1994—2004 Morbidity and Mortality Weekly Report, November 10, 2006 / 55(44);1201-1203 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5544a4.htm
Burt Attico, Phoenix
Reducing Cardiovascular Risk: Science, Treatment, and Culture
Here are 2 interesting articles from Medscape. They are a bit long, but they deals with important mechanisms in disease management. Issues covered include:
Pharmacologic Management of Type 2 Diabetes
A Profile of Metformin
A Profile of Thiazolidinediones
Mechanism of Action of Thiazolidinediones
Effect of Thiazolidinediones on Fat Content
Effect of Thiazolidinediones on Cardiovascular Disease Risk Factors
Impact of Thiazolidinediones on Cardiovascular Events
A Profile of Insulin Secretagogues
A Profile of Alpha-Glucosidase Inhibitors
Exenatide: A New Approach to Insulin Stimulation
Designing an Oral Diabetes Treatment Program
Integrating Culture Into the Design of an Effective Diabetes Management Program
Importance of Cultural Competence in Current Clinical Practice
Experience in Culturally Oriented Programs
Summary: Reducing Insulin Resistance and Cardiovascular Risk in People With Type
2 Diabetes
http://www.medscape.com/viewarticle/545748_10
Cardiovascular Disease in Type 2 DM: From Research to Clinical Practice
Type 2 Diabetes and Cardiovascular Disease
The Genesis of Cardiovascular Disease
C-Reactive Protein: Inflammatory Marker or Instigator?
Insulin Resistance: An Important Pathophysiologic Factor
Pathways of Insulin Resistance
The Correlation Between Myocardial Infarction and Triglyceride Levels
The Role of Hyperglycemia in Macrovascular Complications
The Role of Advanced Glycation End Products in Diabetic Complications
The Long-term Impact of Intensive Control
http://www.medscape.com/viewarticle/545748_1
Steve Holve, Tuba City
The 2nd International Meeting on Indigenous Child Health
We are pleased to announce an exciting opportunity to present your research at the 2nd International Meeting on Indigenous Child Health!
Child health professionals, researchers, and others who work with indigenous populations will be in attendance at this conference, which will be held April 20-22, 2007 at the Fairmont-The Queen Elizabeth in Montreal, Quebec.
There will be opportunities for both oral abstract presentations and poster presentations.
For additional information, please visit the conference Web pages at
www.aap.org/nach/2InternationalMeeting.htm - US
or
http://www.cps.ca/English/ProEdu/IMICH07.htm Canada
We hope to see you in Montreal!
Call for Abstracts
The 2nd International Meeting on Indigenous Child Health, is being co-sponsored by the American Academy of Pediatrics (AAP), the Canadian Paediatric Society (CPS), the Indian Health Service (IHS), and the First Nations and Inuit Health Branch (FNIHB) of Health Canada. The purpose of this seminal international and collaborative conference will be to focus on innovative clinical care models and cross-border research issues for children in First Nations, Inuit, Métis, American Indian and Alaska Native communities. The program will be held April 20-22, 2007 at the Fairmont The Queen Elizabeth in Montreal, Quebec.
Abstract on all topics pertaining to indigenous child health are welcome. Submit your oral or poster presentation by January 31, 2007. Suggested topics include:
Access to Care, Adolescent Health, Alcohol and Substance Abuse, Asthma, Continuity of Care/Medical Home Models, Diabetes, Environmental Health, Epidemiology, Health Care Administration, Health Promotion and Disease Prevention, Health Services Research, Immunizations, Infectious Disease, Injury Prevention, Mental Health, Nutrition, Obesity, Oral Health, Telemedicine, Traditional Medicine, and Urban Health.
Abstracts meeting one of the following criteria will be given special consideration:
- Submissions by First Nations, Inuit, or AI/AN students
- Research that measures the effectiveness of innovative health care intervention, or that involves exemplary partnerships between researchers and tribes
- Research issues common to indigenous populations in both Canada and the US .
Additional conference information : http://www.aap.org/nach and http://www.cps.ca/English/ProEdu/IMICH07.htm
Judy Thierry, HQE
Menstruation in girls and adolescents: using the menstrual cycle as a vital sign
Evaluation of the menstrual cycle is a viable tool to assess healthy development of teen girls' menstrual patterns. Young patients and their parents often are unsure about what represents normal menstrual patterns, and clinicians also may be unsure about normal ranges for menstrual cycle length and amount and duration of flow through adolescence.
It is important to be able to educate young patients and their parents regarding what to expect of a first period and about the range for normal cycle length of subsequent menses," the authors point out. "It is equally important for clinicians to have an understanding of bleeding patterns in girls and adolescents, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate young patients' conditions appropriately.
American Academy of Pediatrics Committee on Adolescence; American College of Obstetricians and Gynecologists Committee on Adolescent Health Care; Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign Pediatrics. 2006 Nov;118(5):2245-50
ACOG Releases Revised Recommendations for Women's Health Screenings and Care
Recent recommendations for HIV screening, human papillomavirus (HPV) vaccination, and preconception care are among those highlighted in the revised primary and preventive care periodic assessments recommended for women by The American College of Obstetricians and Gynecologists (ACOG). The updated recommendations, published in the December issue of Obstetrics & Gynecology, provide ob-GYNs with a comprehensive schedule of age-appropriate screening exams, laboratory tests, immunizations, and counseling for non-pregnant adolescents and adult women.
The document incorporates recent guidance from individual ACOG committees on specific issues in women's health.
HIV Testing
Routine HIV testing should be offered to women ages 19 to 64 regardless of personal
risk factors, following the new Centers for Disease Control and Prevention (CDC)
guidelines. Ob-GYNs should be aware of and follow their states' HIV testing requirements.
In addition, ACOG recommends HIV testing for adolescents who are or ever have
been sexually active. ACOG previously recommended HIV testing only for women
considered high risk or for those in areas with high HIV prevalence.
Preconception Care
Ob-GYNs should encourage women of childbearing age to develop a reproductive
health plan to help conscientiously assess the desire for a child or children
or desire not to have children. The plan also should address the optimal number,
timing, and spacing of children; determine the steps needed to prevent or plan
for and optimize a pregnancy; and evaluate current health status and other issues
relevant to the health of a pregnancy.
Colorectal Cancer Screening
Women age 50 and older should be screened for colorectal cancer using one of
five recommended screening strategies. If fecal occult blood testing (FOBT) is
used, patients should collect two or three samples at home and return them for
laboratory analysis. Single samples obtained by digital rectal examination in
the ob-gyn's office are not adequate for colorectal cancer screening.
HPV Vaccine
An HPV vaccine was made available for the first time in 2006. ACOG recommends
that HPV vaccination be offered to all girls and women 9 to 26 who have not previously
been vaccinated. The vaccine protects against four HPV strains that cause most
cervical cancers and genital warts and is most effective when administered before
the onset of sexual activity.
Tdap Vaccine
Pertussis has been added to the tetanus and diphtheria booster recommendation
in accordance with CDC recommendations. Adolescents should receive the Tetanus,
Diptheria, Pertussis (Tdap) booster once between ages 11 and 16, then every 10
years thereafter up to age 64.
Meningococcal Vaccine
ACOG now recommends that adolescents not previously immunized receive meningococcal
conjugate vaccination before entry into high school. Older women at high risk
also should receive the vaccine.
Committee Opinion #357, "Primary and Preventive Care: Periodic Assessments," is published in the December 2006 issue of Obstetrics & Gynecology.
http://www.acog.org/from_home/publications/press_releases/nr12-01-06-2.cfm
Smoking During Pregnancy May Influence Children's Smoking: 14 yr cohort study
The smoking patterns among those adolescent offspring whose mothers stopped smoking during pregnancy, but who then smoked at other times during the child’s life, were similar to those whose mothers had never smoked. This association was robust to adjustment for a variety of potential covariates.
Conclusions: The findings provide some evidence for a direct effect of maternal smoking in utero on the development of smoking behaviour patterns of offspring and provide yet another incentive to persuade pregnant women not to smoke.
Al Mamun A et al Does maternal smoking during pregnancy predict the smoking patterns of young adult offspring? A birth cohort study. Tob Control. 2006 Dec;15(6):452-7.
Should a 1 year old be exposed to TV?
The Effects of Electronic Media on Children Ages Zero to Six: A History of Research
ISSUE BRIEF
The Kaiser Family Foundation Issue Brief prepared by the Center on Media and Child Health, Children’s Hospital Boston gives an overview of findings and trends in the studies themselves during each decade from the 1960s to 2000s. The info focuses on controlled experiments testing the effects of media components on young children. The learning factor of electronic media is vastly overvalued and is rapidly causing the productive aspects of children’s lives to become undervalued such as physical and interactive time with family and friends. The Brief also focuses on core research questions about affects of watching television and draws conclusions as to what that could mean for children, i.e. aggression, fear reactions to frightening content, attention/comprehension, infant response, response to advertising and cognitive development as a predictor of selective attention to television (ability to learn from TV). Lastly, the Brief gives overall conclusions to the data stressing the “need to keep pace” with the environmental exposure and suggests future directions for research.
- “Due to research evidence linking media exposure to a variety of health risks from obesity to violent behavior, the AAP in its 2001 Statement entitled Children, Adolescents, and Television recommends that children two years of age and older be limited to two hours of electronic entertainment per day.” Children under age two should be discouraged from TV viewing and encouraged in interactive activities to promote proper brain development, such as talking, playing, singing and reading together.
- “The Zero to Six study found that 74% of children under the age of two have watched television and 59% watch television on a typical day for an average of two hours and five minutes. Thirty percent of children four to six years old have televisions in their bedroom.”
- “Many leading media researchers believe that the evidence that media violence contributes to anxiety, desensitization, and increased aggression has been compelling and virtually unanimous.”
- “The positive influences of age-appropriate, curriculum-based educational television on children’s cognitive abilities and school readiness have been well-documented. Basic scientific research on how children attend to and comprehend television has evolved into sophisticated studies of how children can learn from electronic media. This, in turn, has led to the design and production of a number of effective educational television programs, starting with Sesame Street, which many experts regard as one of the most important educational innovations of recent decades.”
- Future research is critical on: Advertising’s affect on young children, educational media’s true value, interactive media’s true effects, infant media’s repercussions, background media’s impact, long-term outcomes of television and electronic exposure, and the need for media interventions.
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;107/2/423.pdf cited November 6, 2006
US MAP with state health facts links on the following topics:
Limited AIAN data, but for some topics it is available.
-Medicaid and Tobacco Dependence Treatments
Updated information on Medicaid coverage of tobacco-dependence treatments is now available for 2005 from the Centers for Disease Control and Prevention (CDC). The status of coverage by medication and counseling type is available for all states.
http://cme.kff.org/Key=11776.8q.F.C.HPmRnS
-Health Status: Deaths
Updated data on mortality rates by gender and race/ethnicity for 2003 from the Centers for Disease Control and Prevention (CDC) have been added and are available by state and region. Data on deaths caused by diabetes are also available for 2003 by gender and race/ethnicity for all states and the nation.
http://cme.kff.org/Key=11776.8q.G.C.HSfM30
-Child and Teen Deaths
Updated data on child and teen mortality rates for 2003 from the Annie E. Casey Foundation's analysis of CDC data have been added and are available by state and region.
http://cme.kff.org/Key=11776.8q.H.C.H5fsYQ
-Violent Crime
Updated data on violent crime rates for 2005 from the United States Department of Justice have been added and are available by state and region.
http://cme.kff.org/Key=11776.8q.J.C.HcXysX
-HIV/AIDS: AIDS Drug Assistance Programs (ADAP)
Updated information on AIDS Drug Assistance Program (ADAP) policies related to the Medicare prescription drug benefit (Medicare Part D) is now available for May 2006 from the National Alliance for State and Territorial AIDS Directors (NASTAD). Updated topics include the payment of premiums and copays, provision of medications in the coverage gap, disenrollment of clients eligible for low-income subsidies, and collaboration with State Pharmaceutical Assistance Programs (SPAPs) by ADAPs for all states and the nation.
http://cme.kff.org/Key=11776.8q.K.C.H9cjHR
-Providers and Service Use: Medical Malpractice
Data on medical malpractice claims and payments have been updated for 2005 using data from the National Practitioner Data Bank (NPDB). The total number of paid claims, total dollars in paid claims, and average claims payments are available for all states and the nation.
http://cme.kff.org/Key=11776.8q.L.C.H3VHQh
-Demographics and the Economy >> Unemployment Rate
The latest unemployment rates for September 2006 have been added and are now available for all states and the nation. http://cme.kff.org/Key=11776.8q.M.C.HZSNNq
-Want to Link to Your State's Data?
We encourage non-profit organizations, government agencies, academic institutions, and others interested in state health policy to link to statehealthfacts.org. Find out how.
http://cme.kff.org/Key=11776.8q.N.C.HVQlZN
Rural health indicators HRSA 2005
The HRSA 2005 Chart Book using SLAITS (telephone survey) parent reported data from the National Survey on Child Health has an emphasis on rural populations compared to urban and urban rural mix, is stratified by race, age cohorts and SES in many of the charts.
Includes Indicators:
- breastfeeding
- tobacco
- children with special health care needs
- coverage
- injury
- obesity
- health care access
- missed school days
- behavioral issues
- Maternal health and maternal mental health
Further queries of the data by state and other variables are also available.
A free hard copy can be ordered - eminently readable, a useful advocacy tool with management and Tribal leadership, reference for proposals, Child health chart book comes out every 4 years and alternately every 4 years a Children with Special Health Care Needs Chart book also comes out. http://www.mchb.hrsa.gov/ruralhealth/
Births: Preliminary Data for 2005
Results—The crude birth rate in 2005 was 14.0 births per 1,000 total population, unchanged from 2004. The general fertility rate, however, rose to 66.7 births per 1,000 women age 15-44 years in 2005, the highest level since 1993. The birth rate for teenagers declined by 2 percent in 2005, falling to 40.4 births per 1,000 women aged 15-19 years, the lowest ever recorded in the 65 years for which a consistent series of rates are available. The rate declined for teenagers aged 15-17 years to 21.4 births per 1,000, but was essentially stable for older teenagers aged 18-19 years. The birth rate for women aged 20–24 years rose in 2005, whereas the rate for women aged 25–29 years was essentially unchanged. The birth rates for women age 30 years and over rose to levels not seen in almost 40 years. Childbearing by unmarried women increased to record levels for the nation in 2005. The birth rate rose 3 percent to 47.6 births per 1,000 unmarried women aged 15-44 years; the proportion of all births to unmarried women increased to 36.8 percent. The cesarean delivery rate rose by 4 percent in 2005 to 30.2 percent of all births, another record high for the nation. The preterm birth rate continued to rise (to 12.7 percent in 2005) as did the rate for low birthweight births (8.2 percent). http://www.cdc.gov/nchs
By Hamilton BE, Martin, JA, Ventura SJ. Division of Vital Statistics
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OB/GYN
Dr. Neil Murphy is the Obstetrics and Gynecology Chief Clinical Consultant (OB/GYN C.C.C.). Dr. Murphy is very interested in establishing a dialogue and/or networking with anyone involved in women's health or maternal child health, especially as it applies to Native or indigenous peoples around the world. Please don't hesitate to contact him by e-mail or phone at 907-729-3154.
