Southcentral Foundation

Abstract Background In February 2025, pediatricians alerted the Alaska Department of Health to a possible increase in cases of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). ARF/RHD are immune-mediated sequelae of group A Streptococcus (GAS) infections. ARF primarily affects school-aged children and can progress to RHD without appropriate antibiotic treatment and prophylaxis. RHD is characterized by damage to heart valves and can result in death. Early diagnosis, appropriate antibiotic treatment, and prophylaxis for people with ARF/RHD reduce the risk of ARF recurrence and RHD progression.Table 1:Demographic characteristics of patients with ARF and RHD included in medical records review, Alaska, Jan 2022–Feb 2025. (N=52)Table 2.Incidence of ARF/RHD among ages 3-17 years from medical records review, Alaska, Jan 2022–Feb 2025. Methods We calculated ARF/RHD incidence among children aged 3–17 years living in Alaska during January 2022–February 2025 using data reported by healthcare systems in response to a statewide call for cases. We conducted medical chart reviews to collect information on presenting signs and symptoms, prior GAS infections, clinical management, and outcomes. We also conducted a secondary data analysis of the Indian Health Service’s (IHS) National Patient Information Reporting System to calculate incidence of ARF/RHD during 2014–2023 among Alaska Native children aged 3–17 who received care within the Tribal Health System.Figure 1.Indian Health Service National Patient Information Reporting System trends in reported incidence of new ARF and RHD among AI/AN children aged 3–17 years, Alaska, 2014–2023Figure 2.Indian Health Service’s National Patient Information Reporting System reported average ARF incidence (3–17 years) among AI/AN people by region, Alaska, 2014–2023 Results ARF and RHD incidence among children aged 3–17 increased from 3.8 and 1.9 per 100,000 persons per year in 2022 to 5.3 and 5.3 per 100,000 persons per year, respectively, in 2024. Incidence was highest in the northern (ARF: 33.5; RHD: 33.5) and southwestern (ARF: 23.0; RHD: 41.4) regions of Alaska and among children who were Alaska Native (ARF: 11.1; RHD: 11.1) or Native Hawaiian/Pacific Islander (ARF: 27.3; RHD: 16.4). Analysis of IHS data found the average annual incidences of ARF/RHD during 2014–2023 among Alaska Native children aged 3–17 were 6.2 per 100,000 persons and 8.5 per 100,000 persons, respectively. Conclusion ARF/RHD incidence in Alaska is higher than the rest of the United States, particularly among Alaska Native and Native Hawaiian/Pacific Islander people. The observed recent increases may be linked to factors such as a rise in GAS infections. Potential opportunities to improve early diagnosis and clinical management of GAS infections and sequelae can inform public health recommendations and clinical guidance. Disclosures All Authors: No reported disclosures

American Indian and Alaska Native (AI/AN) communities are at a critical juncture in health research, where combining participatory methods with advancements in artificial intelligence and machine learning (AI/ML) can promote equity. Community-based participatory research methods which emerged to help Alaska Native communities navigate the complicated legacy of historical research abuses provide a framework to allow emerging AI/ML technologies to align with their unique world views, community strengths, and healthcare goals. A consortium of researchers (including Alaska Native Tribal Health Consortium, the Center for Alaska Native Health Research at University of Alaska, Fairbanks, Stanford University, Southcentral Foundation, and Maniilaq Association) is using community-engaged AI/ML methods to address air medical ambulance (medevac) utilization in rural communities within the Alaska Tribal Health System (ATHS). This mixed-methods convergent triangulation study uses qualitative and quantitative analyses to develop AI/ML models tailored to community needs, provider concerns, and cultural contexts. Early successes have led to a second funded project to expand community perspectives, pilot models, and address issues of governance and ethics. Using the Ethical, Legal, and Social Implications of Research framework to address implementation of AI/ML in AI/AN communities, this second grant expands community engagement, technical capacity, and creates a body within the ATHS able to provide recommendations about AI/ML security, privacy, governance and policy. These two projects have the potential to provide equitable AI/ML implementation in Alaska Native healthcare and provide a roadmap for researchers and policy makers looking to effect similar change in other AI/AN and marginalized communities.

Abstract PurposeThis study compared the wait-time for treatment completion and pre- and post-treatment outcomes of treating early childhood caries with silver diamine fluoride, sedation, and general anesthesia.MethodsThis retrospective study examined children with early childhood caries treated with either silver diamine fluoride, sedation, or general anesthesia at federally qualified health centers. Demographics, wait-time for treatment completion, and pre- and post-treatment clinical outcomes were compared with analysis of variance for continuous variables and the Chi-square test for categorical variables. This study was reviewed and approved by Southcentral Foundation Research Review.ResultsThe outcomes between the silver diamine fluoride, sedation, and general anesthesia groups were respectively: 1) average wait-times to complete treatment at 49.6, 62.5, and 116.3 days, 2) mean number of pre-treatment visits at 1.08, 1.25, and 1.61, 3) mean number of post-treatment visits at 1.41, 1.29, and 1.45.Multiple negative outcomes were identified when the sedation and general anesthesia groups were compared with the silver diamine fluoride reference group for 1) pre-treatment visits with un-planned visits (for general anesthesia only), pain, intra-oral swelling, and prescriptions for pain and antibiotic medications (general anesthesia only) and 2) post-treatment visits with new carious lesions on permanent molars, new carious lesions on primary teeth (sedation only), intra-oral swelling (sedation only only), broken restorations, displaced restorations, and pulpal therapy (sedation only).ConclusionsSilver diamine fluoride provides timely and effective caries management with lower wait-time for treatment completion, clinical outcomes consistent with minimally invasive treatment, and mitigation for the risk of negative pre- and post-operative clinical outcomes compared to treatment under sedation or general anesthesia.

This study was a secondary data analysis of factors associated with alcohol-related child removal among American Indian/Alaska Native (AI/AN) adults enrolled in a clinical trial of an alcohol intervention. Among 326 parent participants, 40% reported ever having a child removed from their care in part because of the parent's alcohol use, defined here as alcohol-related child removal. Seventy-five percent of parents reported at least one separation during their own childhood (M = 1.3, SD = 1.0). In a multivariable analysis, alcohol-related child removal was associated with parental boarding school attendance. No relationship was found between alcohol-related child removal and alcohol intervention outcomes. Results may provide evidence of multigenerational child removal impacts of boarding schools on AI/AN adults receiving an alcohol use disorder intervention. Assessment of parental history of child removal by practitioners, strategies to prevent alcohol-related separation and to support reunification should be integrated into addiction treatment in AI/AN communities.

To educate people about the psychological and social sequalae experienced by TGD youth and bring to light both the dangers of suicide and need for resilience, we have created a special life-promoting garment in the form of a chrysalis shroud. Our provocative chrysalis shroud was inspired by historical Korean death clothing and culture. The life-promoting garment was enhanced to create a metaphorical cocoon, one of healing and well-being. Our medicinally functional garment was made from 100% natural and environmentally friendly materials and contains multiple metaphors and deconstructed messages of love and support. The authors, both LGBTQ and TGD allies, wanted to promote resilience and bring awareness to the emotional anguish and too frequent suicide that occurs in this stigmatized, marginalized, and stressed population.

Objective: Research on mental health interventions, largely from observational studies, suggests that individuals who are Black, Indigenous, and People of Color (BIPOC) have lower treatment engagement than non-Latino Whites. This systematic review focuses on prospective, experimental treatment trials, which reduce variability in patient and intervention characteristics and some access barriers (eg, cost), to examine the association of race/ethnicity and engagement. Data Sources: A systematic search of PubMed and PsycINFO through May 2020 using terms covering mental health treatment, engagement, and race/ethnicity. Study Selection: US-based, English-language, prospective experimental (including quasi-experimental) trials of adults treated for DSM-defined mental disorders were included. Studies had to compare engagement (treatment initiation and retention, medication adherence) across 2 or more ethnoracial groups. Fifty-five of 2,520 articles met inclusion criteria. Data Extraction: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Collaboration bias-risk assessment tool were used to report study findings. Results: Twenty-nine articles (53%) reported significant ethnoracial engagement differences, of which 93% found lower engagement among BIPOC groups compared largely to non-Latino Whites. The proportion of significant findings was consistent across quality of studies, covariate adjustments, ethnoracial groups, disorders, treatments, and 4 engagement definitions. Reporting limitations were found in covariate analyses and disaggregation of results across specific ethnoracial groups. Conclusions: Prospective experimental treatment trials reveal consistently lower BIPOC engagement, suggesting persisting disparities despite standardized study designs. Future research should improve inclusion of understudied groups, examine covariates systematically, and follow uniform reporting and analytic practices to elucidate reasons for these disparities.

Abstract BackgroundDirect-acting antiviral (DAA) drugs have been effective in the treatment of chronic hepatitis C virus (HCV) infection. Limited data are available on safety, tolerability, and efficacy in American Indian or Alaska Native people. We aim to evaluate the treatment outcomes of sofosbuvir-based regimens for treatment of HCV in a real life setting in Alaska Native/American Indian (AN/AI) people.MethodsAN/AI patients within the Alaska Tribal Health System with confirmed positive anti-HCV and HCV RNA, who were 18 years of age and older were included in the study. Pretreatment baseline patient characteristics, treatment efficacy based on sustained virologic response (SVR) 12 weeks after treatment completion, and adverse effects were assessed. The following treatments were given according to the American Association for the Study of Liver Diseases/Infectious Disease Society of America (AASLD/IDSA) HCV Guidance: ledipasvir/sofosbuvir, sofosbuvir plus weight-based ribavirin, and sofosbuvir/velpatasvir.ResultsWe included 501 patients with a mean age of 54.3 (range 21.3 -78.3) in the study. Overall SVR was achieved in 95.2% of patients who received one of the three DAA regimens. For those with cirrhosis, overall SVR was 92.8% and for those with genotype 3 91.1% achieved SVR. The most common symptom experienced during treatment was headache. Joint pain was found to decrease during treatment. One person discontinued sofosbuvir plus ribavirin due to myocardial infarction and one discontinued sofosbuvir/velpatasvir due to urticaria.ConclusionsIn the real-world setting, sofosbuvir-based treatment is safe, effective, and well tolerated in AN/AI patients. Sustained virologic response was high regardless of HCV genotype or cirrhosis status.

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 = 4.8mmHg and diastolic = 3.6mmHg) and varied for arm cuff (systolic = -1.5mmHg and diastolic = 2.5mmHg). 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.

Public deliberation has risen to the forefront of governance as a technique for increasing participation in policy making. Scholars and practitioners have also noted the potential for deliberation to give greater influence to historically marginalized populations, such as Indigenous peoples. However, there has been less attention paid to the potential fit between the ideals of deliberation and the governance and decision making practices of American Indian and Alaska Native (AI/AN) peoples. In this paper, we begin to address this gap by analyzing accounts of AI/AN governance from the perspective of deliberation, and note areas of overlap, synergy, and conflict. We conduct a close reading of key historical and ethnographic accounts of four historical AI/AN contexts—the Iroquois Confederation under the Great Law of Peace, 19th century accounts of the Ojibwa village, the Santa Clara Pueblo government in pre-19th century, and Yup’ik village life in the early 20th century—and a more contemporary case in the form of the Santa Clara Pueblo’s Constitution from the Indian Reorganization Act period. We then apply two sets of key criteria for deliberative democracy—from the scholars Robert Dahl and John Gastil—to these accounts and note the ways in which each system is or is not congruent with these frameworks of deliberation. We find variations between these historical tribal contexts in our analysis. Social components of deliberation, such as respectful discussion and equal opportunities to participate, were partially or fully present in many accounts of governance practices, but it was less clear whether the analytic components, such as discussion of a range of solutions, were included in some forms of tribal governance. We then explore the potential implications of our findings for public deliberation within and in AI/AN tribes. We note that deliberative scholars and practitioners should be wary of overgeneralizing about AI/AN tribes.