Last data update: Jun 24, 2024. (Total: 47078 publications since 2009)
Records 1-14 (of 14 Records) |
Query Trace: Redwood Y [original query] |
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Clinical outcomes from the Alaska Native Tribal Health Consortium Colorectal Cancer Control Program: 2009-2015
Nash SH , Verhage E , Flanagan C , Haverkamp D , Roik E , Zimpelman G , Redwood D . Int J Environ Res Public Health 2024 21 (5) ![]() The Alaska Native Tribal Health Consortium (ANTHC) participated in the United States Centers for Disease Control and Prevention Colorectal Cancer Control Program (CRCCP) from 2009 to 2015. We conducted a descriptive evaluation of ANTHC CRCCP demographics, quality measures, and clinical outcomes, including screening methods employed within the program and screening outcomes. There were 6981 program screenings completed, with the majority (81.3%) of people screened in the 50-75 year age group. Colonoscopy was the primary screening test used, accounting for 6704 (96.9%) of the screening tests. Quality of colonoscopy was high: adequate bowel preparation was reported in 98.2% of colonoscopies, cecal intubation rate was 98.9%, and the adenoma detection rate was 38.9%. A high proportion (58.9%) of colonoscopies had an initial finding of polyps or lesions suspicious for cancer; 41.2% of all colonoscopies had histological confirmation of either adenomatous polyps (40.6%) or cancer (0.5%). The ANTHC CRCCP successfully increased CRC screening among American Indian and Alaska Native peoples living in Alaska; this was achieved primarily through high-quality colonoscopy metrics. These data support a continued focus by the Alaska Native Tribal Health Consortium and its tribal health partners on increasing CRC screening and reducing cancer mortality among Alaska Native peoples. |
Elevated colorectal cancer incidence among American Indian/Alaska native persons in Alaska compared to other populations worldwide
Haverkamp D , Redwood D , Roik E , Vindigni S , Thomas T . Int J Circumpolar Health 2023 82 (1) 2184749 Colorectal cancer (CRC) is a leading cancer worldwide; incidence varies greatly by country and racial group. We compared 2018 American Indian/Alaska Native (AI/AN) CRC incidence rates in Alaska to other Tribal, racial, and international population rates. AI/AN persons in Alaska had the highest CRC incidence rate among US Tribal and racial groups (61.9/100,000 in 2018). AI/AN persons in Alaska also had higher rates than those reported for any other country in the world in 2018 except for Hungary, where males had a higher CRC incidence rate than AI/AN males in Alaska (70.6/100,000 and 63.6/100,000 respectively). This review of CRC incidence rates from populations in the United States and worldwide showed that AI/AN persons in Alaska had the highest documented incidence rate of CRC in the world in 2018. It is important to inform health systems serving AI/AN persons in Alaska about policies and interventions that can support CRC screening to reduce the burden of this disease. |
Use of evidence-based interventions to address disparities in colorectal cancer screening
Joseph DA , Redwood D , DeGroff A , Butler EL . MMWR Suppl 2016 65 (1) 21-8 Colorectal cancer (CRC) is the second leading cause of cancer death among cancers that affect both men and women. Despite strong evidence of their effectiveness, CRC screening tests are underused. Racial/ethnic minority groups, persons without insurance, those with lower educational attainment, and those with lower household income levels have lower rates of CRC screening. Since 2009, CDC's Colorectal Cancer Control Program (CRCCP) has supported state health departments and tribal organizations in implementing evidence-based interventions (EBIs) to increase use of CRC screening tests among their populations. This report highlights the successful implementation of EBIs to address disparities by two CRCCP grantees: the Alaska Native Tribal Health Consortium (ANTHC) and Washington State's Breast, Cervical, and Colon Health Program (BCCHP). ANTHC partnered with regional tribal health organizations in the Alaska Tribal Health System to implement provider and client reminders and use patient navigators to increase CRC screening rates among Alaska Native populations. BCCHP identified patient care coordinators in each clinic who coordinated staff training on CRC screening and integrated client and provider reminder systems. In both the Alaska and Washington programs, instituting provider reminder systems, client reminder systems, or both was facilitated by use of electronic health record systems. Using multicomponent interventions in a single clinical site or facility can support more organized screening programs and potentially result in greater increases in screening rates than relying on a single strategy. Organized screening systems have an explicit policy for screening, a defined target population, a team responsible for implementation of the screening program, and a quality assurance structure. Although CRC screening rates in the United States have increased steadily over the past decade, this increase has not been seen equally across all populations. Increasing the use of EBIs, such as those described in this report, in health care clinics and systems that serve populations with lower CRC screening rates could substantially increase CRC screening rates. |
Use of Tracking and Reminder Systems for Colorectal Cancer Screening in Indian Health Service and Tribal Facilities
Craig JA , Redwood D , Provost E , Haverkamp D , Espey DK . IHS Prim Care Provid 2015 40 (2) 10-17 BACKGROUND: Colorectal cancer (CRC) is a significant cause of morbidity and mortality among American Indian/Alaska Native (AI/AN) people. Screening at recommended intervals can detect CRC in its early, most treatable stages, or prevent CRC through removal of precancerous polyps. However, CRC screening percentages remain low among AI/AN people. Reminder and tracking systems can be used to improve CRC screening percentages. PURPOSE: In this study we assessed the prevalence of CRC screening reminder and tracking systems in Indian Health Service (IHS), Tribal, or Urban (I/T/U) health facilities. METHODS: A telephone survey of randomly selected small, medium and large I/T/U health facilities nationwide was conducted. Three health facilities from each of the 12 IHS areas nationwide were selected from a list of I/T/U healthcare facilities that provide CRC screening or refer patients to another facility for screening, with the goal of having one small, one medium, and one large I/T/U health facility from each IHS area. RESULTS: Thirty-four facilities (94%) participated in the telephone survey between April 1 and September 24, 2010. All facilities used the IHS Resource and Patient Management System to manage their patient care, and 82% used the Electronic Health Record (EHR) version. Over half of these facilities (55%) performed in-office fecal occult blood tests (FOBT) collected during a digital rectal exam, all of which reported that they also sent FOBT cards home with patients. Fifty-three percent of facilities used an opportunistic, visit-based approach to CRC screening. Nearly a third (32%) of facilities reported using a reminder system to notify patients that they were due for CRC screening. Almost two-thirds (65%) of facilities used a reminder system to notify health care providers that patients were due for CRC screening. While 73% of facilities used a system to track whether patients were due for CRC screening, only 61% used a system to track patient results for CRC screening, and 42% used a system to track patients with a personal history of polyps or CRC. CONCLUSIONS: A majority of facilities performed in-office FOBT tests using a digital rectal exam, which is a practice that is contrary to national CRC screening recommendations. Additionally, the majority of facilities reported not using an organized system for CRC screening. Use of patient reminders was suboptimal. However, facilities did report use of provider reminders, tracking when patients were due for CRC screening, and tracking CRC screening results. As the EHR system becomes more widely used and established, I/T/U facilities could be encouraged to increase their use of the EHR tools available to aid in systematically increasing CRC screening percentages. |
A process evaluation of the Alaska Native Colorectal Cancer Family Outreach Program
Redwood D , Provost E , Lopez ED , Skewes M , Johnson R , Christensen C , Sacco F , Haverkamp D . Health Educ Behav 2015 43 (1) 35-42 This article presents the results of a process evaluation of the Alaska Native (AN) Colorectal Cancer (CRC) Family Outreach Program, which encourages CRC screening among AN first-degree relatives (i.e., parents, siblings, adult children; hereafter referred to as relatives) of CRC patients. Among AN people incidence and death rates from CRC are the highest of any ethnic/racial group in the United States. Relatives of CRC patients are at increased risk; however, CRC can be prevented and detected early through screening. The evaluation included key informant interviews (August to November 2012) with AN and non-AN stakeholders and program document review. Five key process evaluation components were identified: program formation, evolution, outreach responses, strengths, and barriers and challenges. Key themes included an incremental approach that led to a fully formed program and the need for dedicated, culturally competent patient navigation. Challenges included differing relatives' responses to screening outreach, health system data access and coordination, and the program impact of reliance on grant funding. This program evaluation indicated a need for more research into motivating patient screening behaviors, electronic medical records systems quality improvement projects, improved data-sharing protocols, and program sustainability planning to continue the dedicated efforts to promote screening in this increased risk population. |
Comparison of fecal occult blood tests for colorectal cancer screening in an Alaska Native population with high prevalence of Helicobacter pylori infection, 2008-2012
Redwood D , Provost E , Asay E , Roberts D , Haverkamp D , Perdue D , Bruce MG , Sacco F , Espey D . Prev Chronic Dis 2014 11 E56 INTRODUCTION: Alaska Native colorectal cancer (CRC) incidence and mortality rates are the highest of any ethnic/racial group in the United States. CRC screening using guaiac-based fecal occult blood tests (gFOBT) are not recommended for Alaska Native people because of false-positive results associated with a high prevalence of Helicobacter pylori-associated hemorrhagic gastritis. This study evaluated whether the newer immunochemical FOBT (iFOBT) resulted in a lower false-positive rate and higher specificity for detecting advanced colorectal neoplasia than gFOBT in a population with elevated prevalence of H. pylori infection. METHODS: We used a population-based sample of 304 asymptomatic Alaska Native adults aged 40 years or older undergoing screening or surveillance colonoscopy (April 2008-January 2012). RESULTS: Specificity differed significantly (P < .001) between gFOBT (76%; 95% CI, 71%-81%) and iFOBT (92%; 95% CI, 89%-96%). Among H. pylori-positive participants (54%), specificity of iFOBT was even higher (93% vs 69%). Overall, sensitivity did not differ significantly (P = .73) between gFOBT (29%) and iFOBT (36%). Positive predictive value was 11% for gFOBT and 32% for iFOBT. CONCLUSION: The iFOBT had a significantly higher specificity than gFOBT, especially in participants with current H. pylori infection. The iFOBT represents a potential strategy for expanding CRC screening among Alaska Native and other populations with elevated prevalence of H. pylori, especially where access to screening endoscopy is limited. |
Neurologic manifestations associated with an outbreak of typhoid fever, Malawi - Mozambique, 2009: an epidemiologic investigation
Sejvar J , Lutterloh E , Naiene J , Likaka A , Manda R , Nygren B , Monroe S , Khaila T , Lowther SA , Capewell L , Date K , Townes D , Redwood Y , Schier J , Barr BT , Demby A , Mallewa M , Kampondeni S , Blount B , Humphrys M , Talkington D , Armstrong GL , Mintz E . PLoS One 2012 7 (12) e46099 BACKGROUND: The bacterium Salmonella enterica serovar Typhi causes typhoid fever, which is typically associated with fever and abdominal pain. An outbreak of typhoid fever in Malawi-Mozambique in 2009 was notable for a high proportion of neurologic illness. OBJECTIVE: Describe neurologic features complicating typhoid fever during an outbreak in Malawi-Mozambique METHODS: Persons meeting a clinical case definition were identified through surveillance, with laboratory confirmation of typhoid by antibody testing or blood/stool culture. We gathered demographic and clinical information, examined patients, and evaluated a subset of patients 11 months after onset. A sample of persons with and without neurologic signs was tested for vitamin B6 and B12 levels and urinary thiocyanate. RESULTS: Between March - November 2009, 303 cases of typhoid fever were identified. Forty (13%) persons had objective neurologic findings, including 14 confirmed by culture/serology; 27 (68%) were hospitalized, and 5 (13%) died. Seventeen (43%) had a constellation of upper motor neuron findings, including hyperreflexia, spasticity, or sustained ankle clonus. Other neurologic features included ataxia (22, 55%), parkinsonism (8, 20%), and tremors (4, 10%). Brain MRI of 3 (ages 5, 7, and 18 years) demonstrated cerebral atrophy but no other abnormalities. Of 13 patients re-evaluated 11 months later, 11 recovered completely, and 2 had persistent hyperreflexia and ataxia. Vitamin B6 levels were markedly low in typhoid fever patients both with and without neurologic signs. CONCLUSIONS: Neurologic signs may complicate typhoid fever, and the diagnosis should be considered in persons with acute febrile neurologic illness in endemic areas. |
Consumption of pesticide-treated wheat seed by a rural population in Malawi
Schier JG , Sejvar JJ , Lutterloh E , Likaka A , Katsoudas E , Karaseva YD , Tippett Barr B , Redwood Y , Monroe S . J Expo Sci Environ Epidemiol 2012 22 (6) 569-73 An outbreak of typhoid fever in rural Malawi triggered an investigation by the Malawi Ministry of Health and the Centers for Disease Control and Prevention in July 2009. During the investigation, villagers were directly consuming washed, donated, pesticide-treated wheat seed meant for planting. The objective of this study was to evaluate the potential for pesticide exposure and health risk in the outbreak community. A sample of unwashed (1430 g) and washed (759 g) wheat seed donated for planting, but which would have been directly consumed, was tested for 365 pesticides. Results were compared with each other (percentage change), the US Environmental Protection Agency's (EPA) health guidance values and estimated daily exposures were compared with their Reference dose (RfD). Unwashed and washed seed samples contained, respectively: carboxin, 244 and 57 p.p.m.; pirimiphos methyl, 8.18 and 8.56 p.p.m.; total permethrin, 3.62 and 3.27 p.p.m.; and carbaryl, 0.057 and 0.025 p.p.m.. Percentage change calculations (unwashed to washed) were as follows: carboxin, -76.6%; pirimiphos methyl, +4.6%; total permethrin, -9.7%; and carbaryl -56.1%. Only carboxin and total permethrin concentration among washed seed samples exceeded US EPA health guidance values (285 x and seven times, respectively). Adult estimated exposure scenarios (1 kg seed) exceeded the RfD for carboxin (8 x ) and pirimiphos methyl (12 x ). Adult villagers weighing 70 kg would have to consume 0.123, 0.082, 1.06, and 280 kg of washed seed daily to exceed the RfD for carboxin, pirimiphos methyl, permethrins, and carbaryl, respectively. Carboxin, pirimiphos methyl, permethrins, and carbaryl were detected in both unwashed and washed samples of seed. Carboxin, total permethrin, and carbaryl concentration were partially reduced by washing. Health risks from chronic exposure to carboxin and pirimiphos methyl in these amounts are unclear. The extent of this practice among food insecure communities receiving relief seeds and resultant health impact needs further study. (Journal of Exposure Science and Environmental Epidemiology advance online publication, 10 October 2012; doi:10.1038/jes.2012.47.) |
Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border
Lutterloh E , Likaka A , Sejvar J , Manda R , Naiene J , Monroe SS , Khaila T , Chilima B , Mallewa M , Kampondeni SD , Lowther SA , Capewell L , Date K , Townes D , Redwood Y , Schier JG , Nygren B , Tippett Barr B , Demby A , Phiri A , Lungu R , Kaphiyo J , Humphrys M , Talkington D , Joyce K , Stockman LJ , Armstrong GL , Mintz E . Clin Infect Dis 2012 54 (8) 1100-6 ![]() BACKGROUND: Salmonella enterica serovar Typhi causes an estimated 22 million cases of typhoid fever and 216,000 deaths annually worldwide. We investigated an outbreak of unexplained febrile illnesses with neurologic findings, determined to be typhoid fever, along the Malawi-Mozambique border. METHODS: The investigation included active surveillance, interviews, examinations of ill and convalescent persons, medical chart reviews, and laboratory testing. Classification as a suspected case required fever and ≥1 other finding (eg, headache or abdominal pain); a probable case required fever and a positive rapid immunoglobulin M antibody test for typhoid (TUBEX TF); a confirmed case required isolation of Salmonella Typhi from blood or stool. Isolates underwent antimicrobial susceptibility testing and subtyping by pulsed-field gel electrophoresis (PFGE). RESULTS: We identified 303 cases from 18 villages with onset during March-November 2009; 214 were suspected, 43 were probable, and 46 were confirmed cases. Forty patients presented with focal neurologic abnormalities, including a constellation of upper motor neuron signs (n=19), ataxia (n=22), and parkinsonism (n=8). Eleven patients died. All 42 isolates tested were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole; 4 were also resistant to nalidixic acid. Thirty-five of 42 isolates were indistinguishable by PFGE. CONCLUSIONS: The unusual neurologic manifestations posed a diagnostic challenge that was resolved through rapid typhoid antibody testing in the field and subsequent blood culture confirmation in the Malawi national reference laboratory. Extending laboratory diagnostic capacity, including blood culture, to populations at risk for typhoid fever in Africa will improve outbreak detection, response, and clinical treatment. |
Comprehensive assessment of maize aflatoxin levels in Eastern Kenya, 2005 - 2007
Daniel JH , Lewis LW , Redwood YA , Kieszak S , Breiman RF , Flanders WD , Bell C , Mwihia J , Ogana G , Likimani S , Straetemans M , McGeehin MA . Environ Health Perspect 2011 119 (12) 1794-9 BACKGROUND: Aflatoxin, a potent fungal toxin, contaminates 25% of crops worldwide. Since 2004, 477 aflatoxin poisonings associated with eating contaminated maize have been documented in Eastern Kenya, with a case-fatality rate of 40%. OBJECTIVE: To characterize maize aflatoxin contamination during the high risk season (April-June) following the major harvests in 2005, 2006 (aflatoxicosis outbreak years), and 2007 (a non-outbreak year). METHODS: Households were randomly selected each year from the region in Kenya where outbreaks have consistently occurred. At each household, we obtained at least one maize sample (n = 716) for aflatoxin analysis using immunoaffinity methods and administered a questionnaire to determine the source (i.e. homegrown, purchased or relief) and amount of maize in the household. RESULTS: During outbreak years-2005 and 2006, 41% and 51% of maize samples respectively, had aflatoxin levels above the 20 ppb Kenyan regulatory limit for aflatoxin in grains for human consumption. In 2007 (non-outbreak year), 16% of samples were above the 20 ppb limit. In addition, geometric mean (GM) aflatoxin levels were significantly higher in 2005 (GM=12.92, max=48,000 ppb) and 2006 (GM=26.03, max=24,400 ppb) compared to 2007 (GM=1.95, max=2,500 ppb) (p value<.001). In all three years combined, maize aflatoxin levels were significantly higher in homegrown maize (GM=17.96) when compared to purchased maize (GM=3.64) or relief maize (GM=0.73) (p value<.0001). CONCLUSIONS: Aflatoxin contamination is extreme within this region and homegrown maize is the primary source of contamination. Prevention measures should focus on reducing homegrown maize contamination at the household level to avert future outbreaks. |
Development of a flexible sigmoidoscopy training program for rural nurse practitioners and physician assistants to increase colorectal cancer screening among Alaska native people
Redwood D , Joseph DA , Christensen C , Provost E , Peterson VL , Espey D , Sacco F . J Health Care Poor Underserved 2009 20 (4) 1041-8 At the Alaska Native Medical Center in Anchorage, colorectal cancer screening rates improved dramatically with the initiation of a dedicated flexible sigmoidoscopy screening program staffed by mid-level providers. We describe the development and implementation of a program to train rural nurse practitioners and physician assistants in flexible sigmoidoscopy. |
Comprehensive cancer control programs and coalitions: partnering to launch successful colorectal cancer screening initiatives
Seeff LC , Major A , Townsend JS , Provost E , Redwood D , Espey D , Dwyer D , Villanueva R , Larsen L , Rowley K , Leonard B . Cancer Causes Control 2010 21 (12) 2023-31 Colorectal cancer control has long been a focus area for Comprehensive Cancer Control programs and their coalitions, given the high burden of disease and the availability of effective screening interventions. Colorectal cancer control has been a growing priority at the national, state, territorial, tribal, and local level. This paper summarizes several national initiatives and features several Comprehensive Cancer Control Program colorectal cancer control successes. |
A spatially-explicit model of acarological risk of exposure to Borrelia burgdorferi-infected Ixodes pacificus nymphs in northwestern California based on woodland type, temperature, and water vapor
Eisen RJ , Eisen L , Girard YA , Fedorova N , Mun J , Slikas B , Leonhard S , Kitron U , Lane RS . Ticks Tick Borne Dis 2010 1 (1) 35-43 In the far-western United States, the nymphal stage of the western black-legged tick, Ixodes pacificus, has been implicated as the primary vector to humans of Borrelia burgdorferi sensu stricto (hereinafter referred to as B. burgdorferi), the causative agent of Lyme borreliosis in North America. In the present study, we sought to determine if infection prevalence with B. burgdorferi in I. pacificus nymphs and the density of infected nymphs differ between dense-woodland types within Mendocino County, California, and to develop and evaluate a spatially-explicit model for density of infected nymphs in dense woodlands within this high-incidence area for Lyme borreliosis. In total, 4.9% (264) of 5431 I. pacificus nymphs tested for the presence of B. burgdorferi were infected. Among the 78 sampling sites, infection prevalence ranged from 0% to 22% and density of infected nymphs from 0 to 2.04 per 100 m2. Infection prevalence was highest in woodlands dominated by hardwoods (6.2%) and lowest for redwood (1.9%) and coastal pine (0%). Density of infected nymphs also was higher in hardwood-dominated woodlands than in conifer-dominated ones that included redwood or pine. Our spatial risk model, which yielded an overall accuracy of 85%, indicated that warmer areas with less variation between maximum and minimum monthly water vapor in the air were more likely to include woodlands with elevated acarological risk of exposure to infected nymphs. We found that 37% of dense woodlands in the county were predicted to pose an elevated risk of exposure to infected nymphs, and that 94% of the dense-woodland areas that were predicted to harbor elevated densities of infected nymphs were located on privately-owned land. |
Social, economic, and political processes that create built environment inequities: perspectives from urban African Americans in Atlanta
Redwood Y , Schulz AJ , Israel BA , Yoshihama M , Wang CC , Kreuter M . Fam Community Health 2010 33 (1) 53-67 Growing evidence suggests that the built environment features found in many high-poverty urban areas contribute to negative health outcomes. Both built environment hazards and negative health outcomes disproportionately affect poor people of color. We used community-based participatory research and Photovoice in inner-city Atlanta to elicit African Americans' perspectives on their health priorities. The built environment emerged as a critical factor, impacting physical and mental health outcomes. We offer a conceptual model, informed by residents' perspectives, linking social, economic, and political processes to built environment and health inequities. Research, practice, and policy implications are discussed within an environmental justice framework. |
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