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Volume 4, No. 7, July 2006
From Your Colleagues
Carolyn Aoymana, HQE
Excellent article on breast cancer in American Indian women seen at PIMC
….and includes an IHS nurse as the second author
BACKGROUND: Breast cancer incidence and survival varies by race and ethnicity. There are limited data regarding breast cancer in Native American women. METHODS: A retrospective chart review was performed of 139 women diagnosed with breast cancer and treated at Phoenix Indian Medical Center in Phoenix, AZ between January 1, 1982 and December 31, 2003. Data points included tribal affiliation, and quantum (percentage American Indian Heritage) along with patient, tumor, and treatment characteristics. RESULTS: Most patients (79%) presented initially with physical symptoms. There were no significant differences based on tribal affiliation; however, higher quantum predicted both larger tumor size and more advanced stage at diagnosis. Obesity also significantly correlated with larger tumor size and more advanced stage. Treatment was inadequate in 21%; this was attributed to traditional beliefs, patient refusal, or financial issues. CONCLUSIONS: When compared to national averages, Native American women presented at a later stage, underutilized screening, and had greater delays to treatment.
Tillman L, Myers S, et al Breast cancer in Native American women treated at an urban-based Indian health referral center 1982-2003. Am J Surg. 2005 Dec;190(6):895-902.
The APN policy is on the Web!
Part 3, Chapter 4, Section 11 - Advanced Practice Nurses
The following Delegation was signed by the Director on July 11, 2006:
Administrative Delegation #15 – Signature Authority for the Department of Health and Human Service Federal-wide Assurance for the Protection of Human Subjects for Domestic Institutions.
Links to the directive and delegation through the Management Policy and Internal Control Staff website are provided below.
http://www.ihs.gov/PublicInfo/Publications/IHSManual/Part3/pt3chapt4/pt3chpt4.htm
http://www.ihs.gov/PublicInfo/Publications/IHSManual/
AdminDelegations/Admin_15/admin_15.htm
Science of Sex and Gender in Human Health Online Course Web Site
From the Office of Research on Women's Health - a description of a course on the science of sex and gender in human health offered by the Office of Research on Women’s Health at NIH and the FDA. http://sexandgendercourse.od.nih.gov/index.aspx
Women of Color Health Data Book and AI/AN Health Education materials
Two great resources:
2006 "Women of Color Health Data Book: Adolescents to Seniors," 3d edition.
http://orwh.od.nih.gov/pubs/WomenofColor2006.pdf
This is the program website for an AI/AN health education resource from NIH’s National Health Lung and Blood Institute:
http://www.nhlbi.nih.gov/health/prof/heart/other/aian_manual/index.htm
Burt Attico, Phoenix
Pregestational Diabetes Linked to Higher Rates of Perinatal Death and Anomalies
This is an intriguing report from the UK. Note that good glycemic control was only achieved in about 1/3 of their subjects, with extremely high perinatal mortality. I am assuming that this is late gestation and neonatal, and not infant mortality. Just like we do with folic acid use, we should probably stress in the diabetic woman of reproductive age that she should be well-controlled, and should check for pregnancy if any abnormal menstrual problems, since they tend to appear late. However, the large number of women that we have locally that are oligomenorrheic makes that difficult.
CONCLUSION: Perinatal mortality and prevalence of congenital anomalies are high in the babies of women with type 1 or type 2 diabetes. The rates do not seem to differ between the two types of diabetes. Macintosh MC, et al Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ. 2006 Jul 22;333(7560):177.
David Boyd, HQE
The AUDIT has been reported to outperform the CAGE
The Alcohol Use Disorders Identification Test (AUDIT), a 10 question instrument developed by the World Health Organization, has been widely studied and may be administered in both primary care and emergency/trauma settings1 The AUDIT has been reported to outperform the CAGE. The AUDIT specifically addresses the alcohol abuse spectrum: questions 1-3 address hazardous use, 4-6 address dependence symptoms, and 7-10 address harmful use. The full AUDIT interview can be administered in 2-4 minutes and scored in a few seconds
The WHO AUDIT Web-site is listed below:
http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6b.pdf
or
http://www.dass.stir.ac.uk/DRUGS/pdf/audit.pdf
Terry Cullen
Best Practices and GPRA Tracking
- Nov 1-2, 2006
- Sacramento CA
- California IHS Area Office
- Contact Elaine.brinn@ihs.gov
Judy Thierry, HQE
Top 10 Preventive Services
The following are the Top 10 Preventive Services. NB: 5 of the stop ten are in the domain of women’s health / MCH routine care now, and the other 5 should be routine women / children care
Top 10 Preventive Services
- Aspirin chemoprophylaxis
- Childhood immunization series
- Tobacco use and screening
- Colorectal cancer screening
- Hypertension screening
- Adult influenza immunization
- Problem drinking screening
- Adult vision screening
- Cervical cancer screening of sexually active women
- Cervical Cancer screening of adolescents within three years of onset of sexual activity or by age 21
Maciosek MV, et al Priorities among effective clinical preventive services: results of a systematic review and analysis. Am J Prev Med. 2006 Jul;31(1):52-61
Full text
http://www.ajpm-online.net/article/PIIS0749379706001243/fulltext
Observing and reading cues from our infants - researched based education tool
I have viewed the video and found it instructive in building your skills both as an observer and as an active participant providing an feedback when the caregiver/mom is “right on”, misreading cues or under-reading cues for their infant – if that makes sense. I offer my testimony both as a board certified pediatrician and as a mother. The maternal/infant communication dynamic has a rich and varied repertoire even in the first days of life; the video and cards help you to consider this further and you can add them to your professional skill set with ease. Especially as we gain knowledge on infant mental health and early childhood development and language and these non-verbal cues this is a remarkable concept that can be applied in multiple settings. This is a worthwhile site. http://ncast.org/p-baby-cues.asp
Accurate data means better programs and more funding
Are you accurately registering your births and deaths? ….you should be
I would like to call your attention to N C H S web site that details vital statistics collection and 2003 Revisions of the U.S. Standard Certificates of Live Birth and Death and the Fetal Death Report (Updated May 2006)
After having returned from the NAPHSIS (National Assoc of Public Health Statistics and Information Systems) meeting in San Diego in June and upon meeting with state registrars and CDC NCHS staff on natality data and infant death registration I feel that the information at this web site is of primary use to us as we record and register over 10,000 AIAN births annually in the IHS (of the 42,000 that occur nationally).
You will find some excerpts from the NCHS web site and several links in orange that you can reference at a later date. Knowledge and proper data entry has multiple utilities – first the accurate and valid documentation by staff during the data abstraction and maternal self report interview for the natality or birth registration is essential. A PowerPoint link is available below to illustrate that.
There is a revised manual (May 2006) that every facility that delivers or fills out a birth registration form should have. It is tabbed and available in hard copy or pdf – I prefer the hard copy and have several if you read this far in the email and would like one I will send one to you! Second for statistical purposes the accurate and complete documentation allows us to aggregate this data and look at perinatal issues across many variables. We rely on natality statistics for so many things – and link the birth with the infant death certification in the 350 to 400 infant deaths that occur annually in our AIAN population. The linking connects maternal race in the infant birth certificate to the death certificate (doesn’t have maternal race) and helps identify and classify an infant by race more accurately. http://www.cdc.gov/nchs/data/dvs/GuidetoCompleteFacilityWks.pdf
NCHS, National Vital /Statistics System Web site http://www.cdc.gov/nchs/vital_certs_rev.htm
The New Birth Certificate http://www.cdc.gov/nchs/ppt/dvs/THE%20NEW%20BIRTH%20CERTIFICATE.ppt
the worksheets we are recommending that states use to collect data for the 2003 revision of the birth certificate are available on the Internet. The worksheets for the mother (for live births) and the patient (for fetal deaths) are available in English and Spanish. The facility worksheet is in English and there is also a separate form that can be used for multiple births, to help facilitate accurate entry for repeated questions. Here are the URLs:
Mother:
http://www.cdc.gov/nchs/data/dvs/momswkstf_improv.pdf
Mother (in Spanish):
http://www.cdc.gov/nchs/data/dvs/MomsWorksheetSpanishBirth1.pdf
Patient (fetal death):
http://www.cdc.gov/nchs/data/dvs/patientwkstfetaldth.pdf
Patient (in Spanish):
http://www.cdc.gov/nchs/data/dvs/PatientWorksheetSpanishFDeath.pdf
Facility (live birth)
http://www.cdc.gov/nchs/data/dvs/facwksBF04.pdf
Facility (multiple birth attachment, live birth):
http://www.cdc.gov/nchs/data/dvs/MULTATTCHFimprov04.pdf
Facility (fetal death):
http://www.cdc.gov/nchs/data/dvs/FacilityFetal04.pdf
Have you ordered your 2006-07 flu vaccine?
The 2006 recommendations include new and updated information.
Principal changes include
1) recommending vaccination of children aged 24--59 months and their household contacts and out-of-home caregivers against influenza;
2) highlighting the importance of administering 2 doses of influenza vaccine for children aged 6 months--<9 years who were previously unvaccinated;
3) advising health-care providers, those planning organized campaigns, and state and local public health agencies to
a) develop plans for expanding outreach and infrastructure to vaccinate more persons than the previous year and
b) develop contingency plans for the timing and prioritization of administering influenza vaccine, if the supply of vaccine is Delayed and/or reduced;
4) reminding providers that they should routinely offer influenza vaccine to patients throughout the influenza season;
5) recommending that neither amantadine nor rimantadine be used for the treatment or chemoprophylaxis of influenza A in the United States until evidence of susceptibility to these antiviral medications has been re-established among circulating influenza A viruses; and
6) using the 2006--07 trivalent influenza vaccine virus strains
This report updates the 2005 recommendations by the Advisory Committee on Immunization Practices regarding the use of influenza vaccine and antiviral agents (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2005;54[No. RR--8]:1--44). http://www.cdc.gov/flu
The Health Consequences of Involuntary Exposure to Tobacco Smoke
The Surgeon General's report, The Health Consequences of Involuntary Exposure to Tobacco Smoke (1), was released on June 27, 2006. The report is an evaluation and synthesis of evidence regarding the health effects of exposure to secondhand smoke. An update of the 1986 report, The Health Consequences of Involuntary Smoking, the report also adds information regarding secondhand smoke to the smoking and health database developed for the 2004 report, The Health Consequences of Smoking; the database link is available below
The six major conclusions of the latest report are as follows:
Secondhand smoke causes premature death and disease in children and in adults who do not smoke.
Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma. Smoking by parents causes respiratory symptoms and slows lung growth in their children.
Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.
The scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.
Many millions of Americans, both children and adults, are still exposed to secondhand smoke in their homes and workplaces despite substantial progress in tobacco control.
Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposures of nonsmokers to secondhand smoke. http://www.cdc.gov/tobacco
Reference
- US Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2006.
Mark Traeger, Whiteriver
How to address health disparities? One story of success – Whiteriver, AZ
We recently published our influenza vaccination rates, showing how Whiteriver bridged the disparity often seen in influenza vaccination rates on reservations. The rates quoted are from 2002-3; since then we have increased our rates another 10% or so. (See abstract below)
OBJECTIVES: The Whiteriver Service Unit (WRSU) used proven effective methods to conduct an influenza vaccination campaign during the 2002-2003 influenza season to bridge the vaccination gap between American Indians and Alaska Natives and the US population as a whole. METHODS: In our vaccination program, we used a multidisciplinary approach that included staff and community education, standing orders, vaccination of hospitalized patients, and employee, outpatient, community, and home vaccinations without financial barriers. RESULTS: WRSU influenza vaccination coverage rates among persons aged 65 years and older, those aged 50 to 64 years, and those with diabetes were 71.8%, 49.6%, and 70.2%, respectively, during the 2002-2003 influenza season. We administered most vaccinations to persons aged 65 years and older through the outpatient clinics (63.6%) and public health nurses (30.0%). The WRSU employee influenza vaccination rate was 72.8%. CONCLUSIONS: We achieved influenza vaccination rates in targeted groups of an American Indian population that are comparable to or higher than rates in other US populations. Our system may be a useful model for other facilities attempting to bridge disparity for influenza vaccination.
Traeger M et al Bridging disparity: a multidisciplinary approach for influenza vaccination in an American Indian community. Am J Public Health. 2006 May;96(5):921-5.
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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.
