Use of traditional health practices among Native Americans in a primary care setting

BACKGROUND: This study was undertaken to ascertain the extent that traditional health practices are used by urban American Indian/Alaska Native (AI/AN) primary care patients, to identify related patient characteristics, to determine associations with health status and functioning, and to describe attitudes about care received. METHODS: This study used a brief self-report survey of 869 adult AI/AN patients randomly sampled over a 14-month period from a comprehensive urban primary care program. Current medications were determined by follow-up medical record review. RESULTS: Seventy percent of urban AI/AN patients in primary care often used traditional health practices; use was strongly associated with cultural affiliation. In bivariate analyses, use was significantly associated with male gender, cultural affiliation, poor functional status, alcohol abuse, and trauma and, except for musculoskeletal pain, not with specific medical problems. The multiple logistic regression model for any use versus no use was significant (P < or =0.001). Being of male gender (P < or =0.001), having more than a high school education (P < or =0.05), visiting friends/relatives on a reservation (P < or =0.01), living the Native way of life (P < or =0.001) and not the white way (P < or =0.05), experiencing back pain (P < or =0.01), and having a physical injury inflicted by a family member (P < or =0.001) were predictive of use. CONCLUSIONS: The results in this clinical setting suggest that health care providers should anticipate use of traditional health practices among urban AI/AN patients. Use was predicted by important demographic, clinical, and cultural characteristics.     

The rehabilitation of disabled Native Americans

The Native American population remains a special ethnic group in the United States that is overrepresented at the lower end of the socioeconomic scale, with a suspected greater than average rate of disabling conditions. Utilization of rehabilitation services by adult Native Americans was studied. Three years of Rehabilitation Services Administration (RSA) data were analyzed to compare the rehabilitation success rate of Native Americans with that of all other population groups. Native Americans were significantly less likely to be rehabilitated than clients from the general population. Factors contributing to the poor rehabilitation of Native Americans were analyzed. Three factors identified as significant were the socioeconomic characteristics of the clients, the type of disabilities presented by the clients, and the inability of the counselors to locate clients and complete the rehabilitation plan. Recommendations for improving the rehabilitation of Native Americans are discussed.     

Obesity and coronary artery disease risk in Native Americans

With the aging of the US population and the increase in hypertension, diabetes mellitus, and obesity, the prevalence of chronic kidney disease (CKD) is increasing in the United States. Its prevalence rate has risen to 13.1% of the US population. Patients with CKD experience poor outcomes and have high health care costs. Chronic kidney disease is also a major cardiovascular disease risk factor. In fact, most people with CKD die of heart disease before they progress to end-stage renal disease. The National Kidney Foundation has produced evidencebased guidelines known as the Kidney Disease Outcomes Quality Initiative (KDOQI). These guidelines outline many things that the primary care physician can do to delay the progression of CKD, and to arrange for early referral for the prevention of future complications. However, there is limited knowledge and uptake of these guidelines because of their length and and complexity. Patients with CKD risk factors, hypertension, diabetes mellitus, cardiovascular disease, a family history of CKD, and those older than 60 years should be screened using 2 tests: 1) the estimated glomerular filtration rate and 2) the urinary albumin-creatinine ratio. These tests allow the diagnosis and stratification of CKD into 5 stages. This article synthesizes the key evidence-based behaviors and clinical action plan that primary care physicians can implement to treat CKD and its complications.     

Qualitative Systematic Review of Intimate Partner Violence among Native Americans

The incidence of intimate partner violence (IPV) among Native Americans is high, and a full understanding of how to prevent it is unclear. Based on this qualitative systematic review of 13 research reports, a model of IPV among Native Americans was developed. IPV appears to be grounded within a history of upheaval and loss, and is entrenched and repressed within families. Victims are reluctant to seek assistance, and when they do, they often experience barriers within the service system. To prevent and resolve IPV, service providers are urged to establish trust with individuals who seek assistance and to leverage cultural strengths. They also are encouraged to adapt theoretical models to optimize care.     

Blood pressure in Native Americans switched from celecoxib to rofecoxib

BACKGROUND: Nonsteroidal antiinflammatory drugs have been associated with exacerbation of hypertension. Differing effects on blood pressure (BP) have been reported in studies comparing celecoxib and rofecoxib. Concern regarding the cardiovascular safety of the cyclooxygenase-2 (COX-2) inhibitor class has intensified since the removal of rofecoxib from the market. OBJECTIVE: To evaluate the effect of a formulary change from celecoxib to rofecoxib on the BP of Native American patients at an Indian Health Service medical center. METHODS: Medical records of patients switched from celecoxib to rofecoxib were retrospectively reviewed. BP during the respective treatments was compared as follows: measurements recorded while taking celecoxib within 6 months before the index date and while taking rofecoxib from 1 week after the index date through 6 months of treatment were averaged. Differences in systolic and diastolic BP before and after the therapy change were evaluated using a paired Student's t-test. Subgroup analysis was performed for patients with preexisting hypertension. RESULTS: During rofecoxib therapy, the mean systolic BP was 2.9 mm Hg higher (p = 0.015) and the mean diastolic BP was 1.5 mm Hg higher (p = 0.042) than during celecoxib therapy. Among hypertensive patients, the respective mean systolic and diastolic BPs were 4.8 mm Hg (p = 0.009) and 2.0 mm Hg (p = 0.063) higher while taking rofecoxib. CONCLUSIONS: Switching patients from celecoxib to rofecoxib resulted in an increase in BP, with a larger difference observed in patients with hypertension. Future studies assessing the cardiovascular safety of currently marketed and investigational COX-2 inhibitors should evaluate the possible contribution of BP effects of these agents to overall risk.     

A1C and Diabetes Diagnosis Among Filipino Americans, Japanese Americans, and Native Hawaiians

OBJECTIVE

To examine the sensitivity and specificity of A1C ≥6.5% to diagnose diabetes among Filipino Americans, Japanese Americans, and Native Hawaiians.

RESEARCH DESIGN AND METHODS

This was a cross-sectional study among middle-aged adults without prior diagnosis of type 2 diabetes who completed a 2-h 75-g oral glucose tolerance test (OGTT) and A1C measures.

RESULTS

The 933 participants had a mean age of 54.2 years, and 73% were women. A total of 425 (45.5%) subjects had impaired fasting glucose or impaired glucose tolerance, 145 (15.5%) had type 2 diabetes (by OGTT), and 83 (8.9%) had A1C ≥6.5%. The sensitivity and specificity of A1C ≥6.5% to define diabetes (by OGTT) was 40.0 and 96.8% and 68.9 and 95.3%, respectively (by fasting plasma glucose only). However, (64.8%) of Filipino and Japanese subjects with diabetes had isolated postchallenge hyperglycemia; AIC ≥6.5% sensitivity and specificity was 19.1 and 92.1%, respectively, to define isolated postchallenge hyperglycemia in the total sample.

CONCLUSIONS

A1C ≥6.5% had low sensitivity and may delay diagnosis of type 2 diabetes without OGTT. This limitation is exacerbated by isolated postchallenge hyperglycemia in Asian Americans.An international expert committee recently recommended the use of A1C values ≥6.5% to diagnose type 2 diabetes, and an A1C between 6.1 and 6.49% was considered pre-diabetic (1). Data from the National Health and Nutrition Examination Survey showed low sensitivity (44%) but high specificity (99%) (2). We recently showed similar sensitivity (44%) but lower specificity (79%) in older Caucasians from the Rancho Bernardo Study (3). Ethnic minorities have significantly higher A1C levels, even after adjusting for factors that affect glycemia (4,5). The utility of A1C cut point of 6.5% has not been evaluated among Pacific Islanders and Asian Americans who have an elevated prevalence of type 2 diabetes compared with Caucasians (6,7). The objectives of this study were to determine the sensitivity and specificity of A1C compared with the 1) fasting plasma glucose (FPG) test and the 2) oral glucose tolerance test (OGTT) to define type 2 diabetes among Filipino Americans, Japanese Americans, and Native Hawaiians.     

Comparison of substance abuse treatment utilization and preferences among Native Hawaiians,Asian Americans and Euro Americans

Use and preferences for substance abuse treatment can vary by ethnicity. However, little is known about use and preferences among Native Hawaiians and Asian Americans. Interviews from 192 admitted multi-ethnic residents from two treatment facilities in Hawaii were conducted. More similarities than differences were found. The most utilized treatments were Alcoholics Anonymous and the emergency department, with no significant ethnic differences. However, Native Hawaiians and Asian Americans were significantly less likely to have spoken to a mental health provider about alcohol problems (32%, 39%, respectively vs. 69% of Euro Americans) and to have seen a physician for a drinking-related problem (21% of Native Hawaiians and 19% of Asian Americans vs. 41% of Euro Americans). Native Hawaiians were significantly more likely to consider marriage counselling to be an effective form of treatment (33% vs. 11% of Asian Americans and 9% of Euro Americans). Implications for substance abuse treatment are discussed. The findings suggest that it is important to integrate the field of substance abuse in multiple systems; including substance abuse, medical, criminal, social service and community settings to ensure treatment preferences are met. Ethnic differences may also have implications for expanding and tailoring services.     

Faith,prayer, and health outcomes in elderly Native Americans

This survey questioned 71 Native Americans over age 65 living in the general community on their frequency of prayer, importance of faith, and their health status. The researchers hypothesized that people with higher scores in faith and prayer would experience a more positive health status. Self-reports of health indicated a high level of functioning overall. Older people and those living alone had poorer physical and emotional health outcomes than younger elders and those living with one or more persons, although neither age nor living situation was related to mental health. People who prayed more often and those who indicated a high importance of their faith scored higher in the mental health subscale, confirming the hypothesis for this dimension of health.     

The Relationship Between Experienced Discrimination and Pronociceptive Processes in Native Americans: Results From the Oklahoma Study of Native American Pain Risk

Native Americans (NAs) have higher pain rates than the general U.S. population. It has been found that increased central sensitization and reduced pain inhibition are pronociceptive processes that increase pain risk; yet, little attention has focused on the influence of psychosocial factors. Discrimination is a psychosocial factor associated with increased pain in other minoritized groups; however, it is unclear whether it also promotes pain in NAs. This study analyzed data from 269 healthy, pain-free participants (N = 134 non-Hispanic whites [NHWs], N = 135 NAs) from the Oklahoma Study of Native American Pain Risk. Experienced discrimination was measured using the Everyday Discrimination Scale (EDS). Nociceptive processes were measured via static measures of spinal sensitivity (nociceptive flexion reflex [NFR] threshold, 3-stimulation NFR threshold), temporal summation of pain (TS-Pain) and nociceptive flexion reflex (TS-NFR), and conditioned pain modulation of pain (CPM-Pain) and NFR (CPM-NFR). Results demonstrated that greater discrimination was associated with enhanced TS-NFR and impaired CPM-NFR but not static measures of spinal sensitivity or measures of pain modulation (TS-Pain, CPM-Pain). Although the effects of discrimination on outcomes were similar in both groups (not moderated by ethnicity), NAs experienced higher levels of discrimination and therefore discrimination mediated a relationship between ethnicity and impaired CPM-NFR. This indicates experienced discrimination may promote a pain risk phenotype in NAs that involves spinal sensitization resulting from impaired inhibition of spinal nociception without sensitization of pain experience.PerspectiveThis study found that discrimination was associated with spinal sensitization and impaired descending inhibition of spinal nociception. These findings bolster our understanding of how social stressors experienced disproportionately by minoritized groups can contribute to pain outcomes.     

Use of traditional Indian medicine among urban native Americans.

The purpose of this paper is to provide a systematic explanation of the use of traditional medicine among the native American population living in the San Francisco Bay area. Several hypotheses concerning the factors associated with this behavior are tested. These include tribal grouping, socioeconomic and sociocultural factors, as well as the relationship between traditional medicine and modern Anglo medicine. The analysis is based on a probability sample of 277 native American families, systematically drawn from a specially prepared list of 5,000 in three Bay area counties with the largest native American population (Alameda, San Francisco, and Santa Clara). Traditional medicine was used by almost one of three families in the sample and it is shown that use of traditional medicine, although related to sociocultural factors, did not detract from the use of modern Anglo medicine.     

Research brief: the need for historically grounded HIV/AIDS prevention research among Native Americans.

This is a brief report that summarizes the need for historically grounded HIV prevention research among Native Americans living in the United States. It illustrates the intersection of culture and history, showing that ethnic groups can respond to historical traumatic events for generations, often to the detriment of individual and collective health.     

Prevalence of diabetes among Native Americans and Alaska Natives, 1990-1997: an increasing burden

OBJECTIVE: To determine trends in diabetes prevalence among Native Americans and Alaska Natives. RESEARCH DESIGN AND METHODS: From 1990 to 1997, Native Americans and Alaska Natives with diabetes were identified from the Indian Health Service (IHS) national outpatient database, and prevalence was calculated using these cases and estimates of the Native American and Alaskan population served by IHS and tribal health facilities. Prevalence was age-adjusted by the direct method based on the 1980 U.S. population. RESULTS: Between 1990 and 1997, the number of Native Americans and Alaska Natives of all ages with diagnosed diabetes increased from 43,262 to 64,474 individuals. Prevalence of diagnosed diabetes increased by 29%. By 1997, prevalence among Native Americans and Alaska Natives was 5.4%, and the age-adjusted prevalence was 8.0%. During the entire 1990-1997 period, prevalence among women was higher than that among men, but the rate of increase was higher among men than women (37 vs. 25%). In 1997, age-adjusted prevalence of diabetes varied by region and ranged from 3% in the Alaska region to 17% in the Atlantic region. The increase in prevalence between 1990 and 1997 ranged from 16% in the Northern Plains region to 76% in the Alaska region. CONCLUSIONS: Diabetes is common among Native Americans and Alaska Natives, and it increased substantially during the 8-year period examined. Effective interventions for primary, secondary, and tertiary, prevention are needed to address the substantial and rapidly growing burden of diabetes among Native Americans and Alaska Natives.     

Hypnotizability and the use of traditional dhami-jhankri healing in nepal

This study examined the role of hypnotic responsiveness in the practice of a dhami-jhankri, a traditional Nepali healer. The hypnotic capacity of 248 male patients was measured in an allopathic (Western) clinic, an Ayurvedic (ancient Hindu healing art) clinic, and a dhami-jhankri's practice. Hypnotizability was assessed using the Hypnotic Induction Profile (HIP). The Induction scores of the HIP were significantly higher among the dhami-jhankri's patients than among either the Ayurvedic or allopathic patients. Furthermore, patients who returned to the dhami-jhankri were more highly hypnotizable than first-time dhami-jhankri patients. In addition, treatment satisfaction as reported by dhami-jhankri patients was positively correlated with HIP scores. The authors conclude that hypnotic phenomena as measured in the West might be an important component of the dhami-jhankri's treatment in the East.     

Hypnotizability and the use of traditional dhami-jhankri healing in Nepal

This study examined the role of hypnotic responsiveness in the practice of a dhami-jhankri, a traditional Nepali healer. The hypnotic capacity of 248 male patients was measured in an allopathic (Western) clinic, an Ayurvedic (ancient Hindu healing art) clinic, and a dhami-jhankri's practice. Hypnotizability was assessed using the Hypnotic Induction Profile (HIP). The Induction scores of the HIP were significantly higher among the dhami-jhankri's patients than among either the Ayurvedic or allopathic patients. Furthermore, patients who returned to the dhami-jhankri were more highly hypnotizable than first-time dhami-jhankri patients. In addition, treatment satisfaction as reported by dhami-jhankri patients was positively correlated with HIP scores. The authors conclude that hypnotic phenomena as measured in the West might be an important component of the dhami-jhankri's treatment in the East.