Southeast Alaska Regional Health Consortium

Historically, Chinook Salmon in the California Central Valley reared in the vast wetlands of the Sacramento–San Joaquin Delta. However, more than 95% of floodplain, riparian, and wetland habitats in the Delta have become degraded because of anthropogenic factors such as pollution, introduced species, water diversions, and levees. Despite pronounced habitat loss, previous work using otolith reconstructions has revealed that some juvenile salmon continue to successfully rear for extended periods in the Delta. However, the extent to which the Delta functions to promote salmon growth relative to other habitats remains unknown. In this study, we integrated otolith microstructure (daily increment count and width) and strontium isotope (87Sr/86Sr) records to fill this critical knowledge gap by comparing the growth of natural-origin fall-run Chinook Salmon from the American River that reared in the Delta with those that remained in their natal stream. Using generalized additive models, we compared daily otolith growth rates among rearing habitats (Delta vs. American River) and years (2014 to 2018), encompassing a range of hydrologic conditions. We found that juvenile Chinook Salmon grew faster in the Delta in some years (2016), but slower in the Delta during drought conditions (2014 to 2015). The habitat that featured faster growth rates varied within and among years, suggesting the importance of maintaining a habitat mosaic for juvenile salmonids, particularly in a dynamic environment such as the California Central Valley. Linking otolith chemistry with daily growth increments provides a valuable approach to explore the mechanisms governing interannual variability in growth across habitat types, and a useful tool to quantify the effects of large-scale restoration efforts on native fishes.

Interprofessional education (IPE) is recommended by many as a means by which to prepare clinicians for collaborative practice and a mechanism by which to improve the overall quality of health care. The objective of this study was to determine the impact of an interprofessional medicine-pharmacy student home visit experience on students' self-assessments of skills and abilities related to team-based care and identification of medication-related problems. Third-year medical and fourth-year pharmacy students completed an interprofessional home visit centered on identification of medication-related problems. Students were surveyed before and after the IPE assignment to assess changes in self-assessed skills and abilities. Survey items consisted of Likert-type statements on a 5-point scale (1=strongly disagree, 5=strongly agree) and free-text responses. Students also completed reflection papers regarding their experiences. Twenty-two medical and 20 pharmacy students conducted medication-focused interviews of 22 patients at home as interprofessional teams. Medical and pharmacy student self-assessments of skills and abilities related to team-based care and identification of medication-related problems improved after completion of the assignment. Both groups of students perceived an improvement in confidence regarding communication skills, both with patients and with other health professions students. Changes were reported on 12 survey items. Student feedback on the IPE experience was positive. Students' self-perception of skills and abilities related to interprofessional team-based care and identification of medication-related problems are improved after IPE medication-focused home visit assignment. Student feedback supports the value of interprofessional patient care clinical experiences.

ABSTRACT Background: Outpatient primary care clerkships are an important part of medical students’ education.Traditional clerkships usually partner a student with a single preceptor in that physician’s clinic. However, it can be quite difficult for the preceptor to balance the educational needs of the students, the expectations of the patients and the organizational demands of the clinic practice.Objective: An innovative scheduling model (named “Patients as Teachers” [PAT] clinic) was developed as part of our third-year Family Medicine clerkship. The goal was to increase the students’ opportunities for independence and improve their satisfaction without negatively impacting the flow of the clinic or patient satisfaction.Design: The third-year medical students spent part of their clerkship working in the PAT clinic and part of the time working with an individual preceptor in that preceptor’s clinic in the traditional, usual fashion (PAU clinic-precepting as usual). The students completed patient-logs regarding the patients they saw and their level of participation. They also completed a voluntary survey regarding their experiences.Results: Students performed more independent interviews (90.3 vs 59.0%) and independent exams (96.2 vs 63.3%) in the PAT clinic than while working with their traditional preceptor (both p<0.01). Students were highly satisfied with the experience with 89.5% stating they would recommend it and 87.7% finding the PAT clinic to be an equal or superior experience to the PAU experience.Conclusions: Using a combination of time in the PAT clinic and time with a one on one preceptor in the usual fashion was successful in increasing opportunities for student autonomy and achieving a high level of student satisfaction in our third-year Family Medicine clerkship. Additional opportunities for innovative scheduling could be considered for meeting a variety of clerkship and clinic needs.

Abstract We explore a “Go With the Older Fish” (GWOF) mechanism of learned migration behaviour for exploited fish populations, where recruits learn a viable migration path by randomly joining a school of older fish. We develop a non-age-structured biomass model of spatially independent spawning sites with local density dependence, based on Pacific herring (Clupea pallasii). We compare a diffusion (DIFF) strategy, where recruits adopt spawning sites near their natal site without regard to older fish, with GWOF, where recruits adopt the same spawning sites, but in proportion to the abundance of adults using those sites. In both models, older individuals return to their previous spawning site. The GWOF model leads to higher spatial variance in biomass. As total mortality increases, the DIFF strategy results in an approximately proportional decrease in biomass among spawning sites, whereas the GWOF strategy results in abandonment of less productive sites and maintenance of high biomass at more productive sites. A DIFF strategy leads to dynamics comparable to non-spatially structured populations. While the aggregate response of the GWOF strategy is distorted, non-stationary and slow to equilibrate, with a production curve that is distinctly flattened and relatively unproductive. These results indicate that fishing will disproportionately affect populations with GWOF behaviour.

Access to specialty alcoholism treatment in rural environments is limited and new treatment approaches are needed. The objective was to evaluate the efficacy of naltrexone alone and in combination with sertraline among Alaska Natives and other Alaskans living in rural settings. An exploratory aim examined whether the Asn40Asp polymorphism of the mu-opioid receptor gene (OPRM1) predicted response to naltrexone, as had been reported in Caucasians. Randomized, controlled trial enrolling 101 Alaskans with alcohol dependence, including 68 American Indians/Alaska Natives. Participants received 16 weeks of either (1) placebo (placebo naltrexone + placebo sertraline), (2) naltrexone monotherapy (50 mg naltrexone + sertraline placebo) and (3) naltrexone + sertraline (100 mg) plus nine sessions of medical management and supportive advice. Primary outcomes included Time to First Heavy Drinking Day and Total Abstinence. Naltrexone monotherapy demonstrated significantly higher total abstinence (35%) compared with placebo (12%, p = 0027) and longer, but not statistically different, Time to First Heavy Drinking Day (p = 0.093). On secondary measures, naltrexone compared with placebo demonstrated significant improvements in percent days abstinent (p = 0.024) and drinking-related consequences (p = 0.02). Combined sertraline and naltrexone did not differ from naltrexone alone. The pattern of findings was generally similar for the American Indian/Alaska Native subsample. Naltrexone treatment response was significant within the group of 75 individuals who were homozygous for OPRM1 Asn40 allele. There was a small number of Asp40 carriers, precluding statistical testing of the effect of this allele on response. Naltrexone can be used effectively to treat alcoholism in remote and rural communities, with evidence of benefit for American Indians and Alaska Natives. New models of care incorporating pharmacotherapy could reduce important health disparities related to alcoholism.

The use of hatcheries has been a subject of lengthy debate in the management of salmon and trout resources in the Pacific Northwest. The problem has resulted in part from the wide distribution of hatchery fish in circumstances where natural populations were disadvantaged by management policy involving hatchery fish and the confusion of the effects of management with the effects of artificial propagation. Recently, the controversy has been epitomized by the recommendations to fisheries management agencies that excess hatchery fish should not be allowed to spawn in the wild, and hatchery fish should be excluded from salmon populations listed under the Endangered Species Act. The authors of the present article disagree with those recommendations and conclude that hatchery fish have an important role in recovery and supplementation of wild stocks. The present article is an attempt to help give balance to the discussion by providing a different perspective on hatchery fish and the literature pertaining to artificial propagation.

Seven Circles is a substance abuse prevention coalition in Southeast Alaska with a two-tiered structure consisting of local partnerships joined together in a regional coalition. Seven Circles incorporates a youth/adult partnership approach to accomplish its activities. This article describes the results of four annual administrations of a partnership member survey designed to assess the development and implementation of youth/adult partnerships in the local projects, assess the value of the partnerships to the participants, and gather feedback about the functioning of the Seven Circles Coalition. The results support the youth/adult partnership model and are also discussed in the context of youth empowerment.

The purpose of this Report from the Field is to describe a regional substance abuse prevention coalition in Southeast Alaska, that has thoroughly integrated a youth/adult partnership model. The principles and key components of the youth/adult partnership model are described, followed by an overview of how this model has been incorporated at the community level, and some of the lessons learned. Since 1994 the Seven Circles Coalition has worked with eleven Southeast Alaska communities to develop and support partnerships that provide youth-focused prevention services using a youth/adult partnership model. Each of these local partnerships serves as a model for other potential youth/adult partnerships in their respective communities.

To provide descriptive epidemiological data on diabetes mellitus among Alaska Natives, including incidence, updated prevalence, and incidence rates of ESRD, LEA, MI, and stroke in the diabetic population. In IHS and tribal contract hospitals and clinics throughout Alaska, Alaskan Indians, Eskimos, and Aleuts living in Alaska with documented diabetes mellitus were studied from 1986 to 1987. The number of diabetic patients increased from 610 to 708, and the prevalence changed from 15.7 to 17.4/1000 (not a statistically significant increase). Incidence rates per 10,000 diabetic person-yr for complications were 38 for ESRD, 69 for LEA, 92 for MI, and 92 for stroke. The prevalence of diabetes mellitus increased during the period of observation, but not to a statistically significant degree. Incidence rates for diabetes are lower than for the U.S. general population, but complications rates are as high as those in other diabetic populations.