Introduction: The prevalence, mortality, and healthcare impact of Alaska Native and American Indian (ANAI) people with Alzheimer's disease and related dementias (ADRD) are unknown. Methods: We conducted a cohort study of electronic health record data that compared healthcare service utilization in patients with and without an ADRD diagnosis. Zero-inflated negative binomial regression with robust standard errors was used to estimate utilization rates. Results: Compared with patients without ADRD, utilization rates were similar before but higher after ADRD diagnosis. For those with diagnosed ADRD, utilization increased gradually over time with sharp upward change during the year of diagnosis. Discussion: This is the only study quantifying changes in healthcare service utilization before and after ADRD diagnosis among ANAI people, which is crucial for tailoring geriatric care for ANAI populations.

Background: We conducted a population health environment program in Lake Victoria Basin (LVB) and assessed incorporation and integration of family planning with environmental conservation.Methods: Routine program data were collected from clients by community-based distributors from four environmental community-based organizations. Multivariable regressions identified factors associated with distribution of: (1) oral contraceptive pills to women, (2) male condoms, and (3) integrated family planning and environmental messaging.Results: April 2015 through May 2016, 10,239 client encounters were completed, with 56% made by men. We distributed contraceptive pills at 28% of client encounters. Multivariable modeling showed this was more likely for women <40 years old (p < 0.001) and was less likely for women attending household (30%) and group sessions (46%) compared to individual sessions (p < 0.001). Male condoms were distributed at 73% of client encounters; (p < 0.01, all) women were half as likely to receive condoms than men, and single and widowed clients were more likely than married clients to receive condoms. Integrated messaging occurred at 89% of client encounters, and was 85% more likely for women, increased with client age, and was less likely for single and widowed persons. Exit interviews with 87 clients (42% male, 58% female) confirmed program data by report of commodities received: 27% contraceptive pills, 75% male condoms, 91% integrated messaging.Conclusions: Partnership with environmental conservation organizations effectively expanded family planning and reproductive health to non-traditional audiences and men among rural communities surrounding LVB-Kenya. Specific client subgroups can be targeted for improved mobilization and uptake of services.

Objectives: Home blood pressure monitoring (HBPM) is an important component of blood pressure (BP) management. We assessed performance of two HBPM devices among Alaska Native and American Indian people (ANAIs). Methods: We measured BP using Omron BP786 arm cuff, Omron BP654 wrist cuff, and Baum aneroid sphygmomanometer in 100 ANAIs. Performance was assessed with intraclass correlation, paired t-tests, and calibration models. Results: Compared to sphygmomanometer, average BP was higher for wrist cuff (systolic = 4.8 mmHg and diastolic = 3.6 mmHg) and varied for arm cuff (systolic = −1.5 mmHg and diastolic = 2.5 mmHg). Calibration increased performance from grade B to A for arm cuff and from D to B for wrist cuff. Calibration increased false negatives and decreased false positives. Discussion: The arm HBPM device is more accurate than the wrist cuff among ANAIs with hypertension. Most patients are willing to use the arm cuff when accuracy is discussed.

Background Home blood pressure monitoring (HBPM) is an effective tool in treatment and long-term management of hypertension. HBPM incorporates more data points to help patients and providers with diagnosis and management. The characteristics of HBPM devices matter to patients, but the relative importance of the characteristics in choosing a device remains unclear. Methods We used data from a randomized cross-over pilot study with 100 Alaska Native and American Indian (ANAI) people with hypertension to assess the choice of a wrist or arm HBPM device. We use a random utility framework to evaluate the relationship between stated likely use, perceived accuracy, ease of use, comfort, and participant characteristics with choice of device. Additional analyses examined willingness to change to a more accurate device. Results Participants ranked the wrist device higher compared to the arm on a 5-point Likert scale for likely use, ease of use, and comfort (0.3, 0.5, 0.8 percentage points, respectively). Most participants (66%) choose the wrist device. Likely use (wrist and arm devices) was related to the probability of choosing the wrist (0.7 and − 1.4 percentage points, respectively). Independent of characteristics, 75% of participants would be willing to use the more accurate device. Ease of use (wrist device) and comfort (arm device) were associated with the probability of changing to a more accurate device (− 1.1 and 0.5 percentage points, respectively). Conclusion Usability, including comfort, ease, and likely use, appeared to discount the relative importance of perceived accuracy in the device choice. Our results contribute evidence that ANAI populations value accurate HBPM, but that the devices should also be easy to use and comfortable to facilitate long-term management.

Suicide rates are higher in some Alaska Native and American Indian communities than the general U.S. population. Screening for suicide risk typically requires self-report, but many people may not engage with conventional screening because of distrust or are reluctant to disclose thoughts of suicide. Resource-sensitive methods of detecting suicide risk are needed. This study identifies routinely collected electronic health record data to identify demographic, clinical, and utilization factors associated with suicide-related visits in a tribal health care system. In this retrospective, case-control study, cases were defined as any person with a suicide-related visit from 2012 to 2015. Cases and controls were matched by age, sex, and urban/rural residence. We used conditional logistic regression to estimate odds ratios, which were interpreted as prevalence ratios (PR) based on the rare outcome assumption. The dataset included 314 cases and 1,169 controls. In the year before the index visit, cases had higher prevalence of poisoning or overdose (PR = 13.4, 95% confidence interval [CI] [3.5, 51.7]), emergency department and urgent care visits (PR = 15.8, 95% CI [6.6, 38.1]), and hospitalizations (PR = 4.5, 95% CI [3.0, 6.8]). Electronic health records can be used to identify factors that are significantly associated with suicide risk among those who may not be flagged by screening. Risk detection through electronic health record assessment might increase clinical workload in the short term, but this change would be offset by downstream prevention of suicide-related events. Such efforts could improve suicide risk detection and help to improve suicide-related health disparities in Alaska Native and American Indian populations.