The Native Telehealth Outreach and Technical Assistance Program: a community-based approach to the development of multimedia-focused health care information.

The development and dissemination of culturally relevant health care information has traditionally taken a "top-down" approach. Governmental funding agencies and research institutions have too often dictated the importance and focus of health-related research and information dissemination. In addition, the digital divide has affected rural communities in such a way that their members often do not possess the knowledge or experience necessary to use technological resources.

Culturally competent research with American Indians and Alaska Natives: findings and recommendations of the first symposium of the work group on American Indian Research and Program Evaluation Methodology.

This article describes the collective experience of a multidisciplinary network of researchers, practitioners, and program evaluators who support appropriate research and evaluation methods in working with Native peoples. Our experience underlines the critical importance of culture in understanding and conducting research with the diverse populations of American Indians and Alaska Natives, and documents the need for community-based, collaborative, participatory action research. We discuss the major findings of the first American Indian Research and Program Evaluation Methodology national symposium, and articulate a set of 20 guiding principles for conducting research and program evaluation.

The influence of community-based participatory research principles on the likelihood of participation in health research in American Indian communities.

Objectives: Advocates of community-based participatory research (CBPR) have emphasized the need for such efforts to be collaborative, and close partnerships with the communities of interest are strongly recommended in developing study designs. However, to date, no systematic, empiric inquiry has been made into whether CBPR principles might influence an individual's decision to participate in research.

Design, Setting, And Participants: Using vignettes that described various types of research, we surveyed 1066 American Indian students from three tribal colleges/universities to ascertain the extent to which respondent age, gender, education, cultural affiliation, tribal status, and prior experience with research may interact with the implementation of critical CBPR principles to increase or decrease the likelihood of participating in health research.

Marijuana initiation in 2 American Indian reservation communities: comparison with a national sample.

Objectives: We examined disparities in age-related patterns of marijuana initiation in 2 culturally distinct American Indian reservation communities (from the Northern Plains and the Southwest) compared with a national sample.

Methods: We used discrete-time survival models to estimate age-related risk for initiation with data from 2 population-based studies: the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project and the baseline National Comorbidity Survey.

Results: Among respondents who were born before 1960, peak risk for marijuana initiation in all samples was at age 18 years, and risk was greatest in the national sample.

An economic evaluation of telehealth data collection with rural populations.

Objective: This study compared direct costs of conducting structured clinical interviews via real-time interactive videoconferencing (known as telehealth) versus standard in-person methods with American Indians in rural locations.

Methods: Psychiatrists administered in person and via telehealth on two occasions the Structured Clinical Interview for DSM-III-R to 53 non-VA male, American-Indian veterans. Telehealth interviews were conducted by an integrated services digital network (ISDN) connection at 384 kbps.

A program of research on spirituality and American Indian alcohol use.

In this brief report we summarize a pattern of findings that has emerged from our research on American Indian (AI) alcohol use and spirituality. With funds from the National Institute of Alcohol Abuse and Alcoholism and the Fetzer Institute (AA 13 053; P. Spicer, PI) we have used both epidemiologic and ethnographic methods to develop a more complete understanding of the role that spirituality and religion play in changes in drinking behavior among AIs.

Cognitive impairment, psychiatric disorders, and problematic behaviors in a tribal nursing home.

Objective: Residents' cognitive, psychiatric, and behavioral statuses were examined as part of a larger study of care in a nursing home (NH) owned and operated by a Northern Plains American Indian tribe.

Method: Reviews of 45 medical records and semistructured interviews with 36 staff were completed.

Results: Creekside residents had considerable psychiatric and behavioral morbidity.

Disparities in drug use and disorder: comparison of two American Indian reservation communities and a national sample.

Population-based samples provided estimates of drug use and disorder in two American Indian populations. Comparison to a national sample revealed tribal-national, intertribal, and intratribal gender and age differences. Findings suggest that disparities in drug use and disorder are complex, characterized by important variations across diverse American Indian tribal cultures.

Conduct disorder, war zone stress, and war-related posttraumatic stress disorder symptoms in American Indian Vietnam veterans.

This study examined whether conduct disorder (CD) was associated with war zone stress and war-related post-traumatic stress disorder (PTSD) symptoms in American Indian (AI) Vietnam veterans. Cross-sectional lay-interview data was analyzed for 591 male participants from the American Indian Vietnam Veterans Project. Logistic regression evaluated the association of CD with odds of high war zone stress and linear regression evaluated the association of CD and PTSD symptom severity.

Suboptimal pharmacotherapy in a tribal nursing home.

Objective: Suboptimal medication use among nursing home (NH) residents is common. NH residents tend to be older, suffer from multiple conditions, and take numerous medications, increasing their risk of serious complications. This article examines pharmacotherapy in a rural, tribally owned NH.

Diagnostic reliability of telepsychiatry in American Indian veterans.

Objective: This study examined the reliability of the Structured Clinical Interview for DSM-III-R (SCID) in the administration of psychiatric assessments by real-time videoconferencing compared to face-to-face assessment within a rural American Indian community.

Method: The SCID was administered to 53 male American Indian veterans who were randomly assigned over two separate occasions by different interviewers to face-to-face and real-time interactive videoconferencing within 2 weeks. Comparisons were made with prevalences, the McNemar test, and the kappa statistic.

Traumatic events and alcohol use disorders among American Indian adolescents and young adults.

This study examined the relationship between severe traumatic events and alcohol use disorders in American Indian adolescents and young adults. Interviews of 432 adolescents and young adults who were enrolled tribal members living on or near two closely related American Indian reservations were used. Results indicated that severe trauma increased the odds of alcohol use disorders (p <.

Loss of interhemispheric inhibition in patients with multiple sclerosis is related to corpus callosum atrophy.

Axonal injury and loss in the corpus callosum (CC) is characteristic of the pathology of multiple sclerosis (MS). Functional magnetic resonance imaging (fMRI) potentially allows neurophysiological consequences of this interhemispheric axonal loss to be defined quantitatively. Here we have used 3T fMRI to study the activation in the contralateral primary sensorimotor cortex and deactivation (mediated by transcallosal tracts) in the homologous ipsilateral region in 14 patients with MS and in 14 matched healthy controls during a simple hand-tapping task.

Illicit peyote use among American Indian adolescents in substance abuse treatment: a preliminary investigation.

Few studies to date have addressed illicit (i.e., nonceremonial) peyote use among American Indians (AIs).

The molecular potential energy surface and vibrational energy levels of methyl fluoride. Part II.

New analytical bending and stretching, ground electronic state, potential energy surfaces for CH(3)F are reported. The surfaces are expressed in bond-length, bond-angle internal coordinates. The four-dimensional stretching surface is an accurate, least squares fit to over 2000 symmetrically unique ab initio points calculated at the CCSD(T) level.

General internal coordinate gradient vectors and the vibrational kinetic energy operator of centrally-connected penta-atomic systems. Part I.

New internal coordinate gradients, s-vectors, are derived using geometric algebra. The internal coordinates are based on a completely general description of the molecular geometry in terms of internal vectors. The internal coordinate gradients allow kinetic energy operators to be easily expressed in terms of orthogonal or non-orthogonal coordinate systems.

Mucosa-associated lymphoid tissue (MALT) lymphoma.

Objectives: To review the pathogenesis of MALT lymphoma, and the associations with antigenic stimulation, presentation, and unique treatment.

Data Sources: Research and review articles and textbooks.

Conclusion: MALT lymphoma is a heterogeneous but unique pathologic form of extranodal B-cell non-Hodgkin's lymphoma.

American Indian adolescents in substance abuse treatment: diagnostic status.

The goal of this study was to describe the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) psychiatric disorders among a sample of American Indian (AI) adolescents in residential substance abuse treatment. Data on 89 AI adolescents admitted to a tribally operated residential substance abuse treatment program were collected. Participants reported using a mean of 5.

Cultural aspects of telepsychiatry.

Telepsychiatry may involve working with clinicians, patients and systems of care that are both geographically and culturally distinct. In this context, culturally appropriate care is an important component of telepsychiatry. The outline for cultural formulation from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) provides general principles for addressing these issues.

Help seeking for substance use problems in two American Indian reservation populations.

Objectives: This study examined the extent and types of help seeking (biomedical, traditional, and 12-step groups) for substance use problems in two American Indian reservation populations by using data from the American Indian Service Utilization, Psychiatric Epidemiology, Risk, and Protective Factors Project (AI-SUPERPFP). This study also sought to understand the correlates of such help seeking, including measures of need, demographic characteristics, spirituality, and ethnic identity.

Methods: AI-SUPERPFP, completed between 1997 and 2000, was a cross-sectional probability sample survey.

Latent class analysis of substance use: comparison of two American Indian reservation populations and a national sample.

Objective: Our goal was to carefully examine disparities in substance use between two American Indian reservation communities and a national sample. We sought to identify characteristic patterns of use-both across and within samples-that could be used to inform intervention efforts aimed at reducing disparities.

Method: Latent class analyses were used to identify subgroups within each sample that were characterized by distinctive patterns of use of alcohol and eight drugs; the use patterns and prevalence of subgroups were then compared across samples.

Different factor loadings for SF36: the Strong Heart Study and the National Survey of Functional Health Status.

Background: To increase our understanding of the psychometric characteristics and factor structure of the SF36 in older American Indian populations.

Methods: Between 1993 and 1995, SF36 data were collected from 3,488 Phase II participants of the Strong Heart Study (SHS) between the ages of 48 and 81. Comparison data were provided by an age- and gender-matched sample (n = 695) from the National Survey of Functional Health Status (NSFHS) conducted in 1989 and 1990.

The relationship between post-traumatic stress disorder, depression and cardiovascular disease in an American Indian tribe.

Background: Empirical findings suggest that psychiatric illness is associated with cardiovascular disease (CVD). The purpose of this study was to compare the strength of the association of lifetime post-traumatic stress disorder (PTSD) and lifetime major depression on CVD among Northern Plains American Indians.

Method: A total of 1414 participants aged 18-57 years completed a structured interview that assessed psychiatric diagnoses, alcohol abuse/dependence, self-reported CVD, and traditional CVD risk factors including age, sex, education, diabetes, high blood pressure, and smoking.