ContextUntil recently, methicillin-resistant Staphylococcus
aureus (MRSA) infections have been acquired primarily in nosocomial
settings. Four recent deaths due to MRSA infection in previously healthy children
in the Midwest suggest that serious MRSA infections can be acquired in the
community in rural as well as urban locations.ObjectivesTo document the occurrence of community-acquired MRSA infections and
evaluate risk factors for community-acquired MRSA infection compared with
methicillin-susceptible S aureus (MSSA) infection.DesignRetrospective cohort study with medical record review.SettingIndian Health Service facility in a rural midwestern American Indian
community.PatientsPatients whose medical records indicated laboratory-confirmed S aureus infection diagnosed during 1997.Main Outcome MeasuresProportion of MRSA infections classified as community acquired based
on standardized criteria; risk factors for community-acquired MRSA infection
compared with those for community-acquired MSSA infection; and relatedness
of MRSA strains, determined by pulsed-field gel electrophoresis (PFGE).ResultsOf 112 S aureus isolates, 62 (55%) were MRSA
and 50 (45%) were MSSA. Forty-six (74%) of the 62 MRSA infections were classified
as community acquired. Risk factors for community-acquired MRSA infections
were not significantly different from those for community-acquired MSSA. Pulsed-field
gel electrophoresis subtyping indicated that 34 (89%) of 38 community-acquired
MRSA isolates were clonally related and distinct from nosocomial MRSA isolates
found in the region.ConclusionsCommunity-acquired MRSA may have replaced community-acquired MSSA as
the dominant strain in this community. Antimicrobial susceptibility patterns
and PFGE subtyping support the finding that MRSA is circulating beyond nosocomial
settings in this and possibly other rural US communities.

https://jamanetwork.com/journals/jama/articlepdf/194176/JOC00996.pdf

Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community.

American Indian adults are thought to experience significant depressive symptoms at rates several times higher than adults in the general population, yet we know very little about factors associated with depressive symptoms among this under studied group. Many researchers have argued that depressive symptoms are associated with conflicts between American Indian traditional cultural values, practices, and beliefs and those of the majority culture. This report, based on a sample 287 American Indian adults from the upper Midwest, takes into account two measures of cultural effects: perceived discrimination, as one indicator of culture conflict, and traditional practices, as a measure of cultural identification. The results indicate that discrimination is strongly associated with depressive symptoms among American Indian adults and that engaging in traditional practices is negatively related to depressive symptoms. Moreover, interaction effects between perceived discrimination and traditional practices indicate that engaging in traditional practices buffers the negative effects of discrimination among those who regularly participate in them.

Perceived discrimination, traditional practices, and depressive symptoms among American Indians in the upper midwest.

Based on a review of community care demonstrations, we conclude that expanding public financing of community services beyond what already exists is likely to increase costs Small nursing home cost reductions are more than offset by the increased costs of providing services to those who would remain at home even without the expanded services However, expanded community services appear to make people better off and not to cause substantial reductions in family caregiving Policymakers should move beyond asking whether expanding community care will reduce costs to addressing how much community care society is willing to pay for, who should receive it, and how it can be delivered efficiently

Community care demonstrations: what have we learned?

The commemoration of the Columbian quincentenary played an important role in stimulating new research on the biological effects of the arrival of Europeans on Native American groups throughout the New World. Although these discussions have involved many disciplines, physical anthropology has been underrepresented until recently. This article reviews a range of studies on the biological impact of European colonization of the Americas on native populations. Historical sources, mission and civil records, archaeological information, and human skeletal remains have provided a fund of data that are being used to document and interpret native health and well-being after 1492. Osteological investigations reveal that before contact, native populations were not living in a pristine, disease-free environment. Moreover, prehistoric populations experienced occasional eruptions of social conflict and violence, patterns of which are similar to what has been documented in contemporary small-scale societies. Archaeological, historical, and bioarchaeological studies provide compelling evidence that the arrival of Europeans did not occasion a sudden pandemic of smallpox in the early sixteenth century. Rather, epidemic disease in the contact era was a patchwork affair, striking some populations and not others at various times. Regionally based bioarchaeological investigations have disclosed new details about the contact period in the Americas and elsewhere (e.g., Polynesia), particularly in regard to variability in physiological stress, health status, diet and nutritional quality, and activity patterns. These studies show that although rapid population loss and extinction occurred in some areas, many groups survived and accommodated new and challenging circumstances. These findings also indicate that there are common elements to native response to contact with Europeans, but population and regional changes were shaped by localized factors. The demographic resurgence and population recovery during the twentieth century illustrates that Native Americans are a vital part of today's human biological landscape in the western hemisphere. © 1994 Wiley-Liss, Inc.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ajpa.1330370606

In the wake of Columbus: Native population biology in the postcontact Americas

Objective. —To use vital statistics and communicable disease reports to characterize the health status of an urban American Indian and Alaska Native (AI/AN) population and compare it with urban whites and African Americans and with Al/ ANs living on or near rural reservations. Design. —Descriptive analysis of routinely reported data. Setting. —One metropolitan county and seven rural counties with reservation land in Washington State. Subjects. —All reported births, deaths, and cases of selected communicable diseases occurring in the eight counties from 1981 through 1990. Main Outcome Measures. —Low birth weight, infant mortality, and prevalence of risk factors for poor birth outcomes; age-specific and cause-specific mortality; rates of reported hepatitis A and hepatitis B, tuberculosis, and sexually transmitted diseases. Results. —Urban AI/ANs had a much higher rate of low birth weight compared with urban whites and rural AI/ANs and had a higher rate of infant mortality than urban whites. During the 10 years, urban AI/AN infant mortality rates increased from 9.6 per 1000 live births to 18.6 per 1000 live births compared with no trend among the other populations. Compared with rural AI/AN mothers, urban AI/AN mothers were 50% more likely to receive late or no prenatal care during pregnancy. Relative to urban whites, urban AI/AN risk factors for poor birth outcomes (delayed prenatal care, adolescent age, and use of tobacco and alcohol) were more common and closely resembled the prevalence among the African-American population except for a higher rate of alcohol use among AI/ANs. Compared with urban whites, urban AI/AN mortality rates were higher in every age group except the elderly. Differences between urban whites and AI/ANs were largest for injury- and alcohol-related deaths. All-cause mortality was lower among urban AI/ANs compared with rural AI/ANs and urban African Americans, although injury- and alcohol-related deaths were higher for AI/ANs. All communicable diseases studied were significantly ( P Conclusions. —In this urban area, great disparities exist between the health of AI/ANs and whites across almost every health dimension we measured. No consistent pattern was found in the comparison of health indicators between urban and rural AI/ANs, though rural AI/ANs had lower rates of low birth weight and higher rates of timely prenatal care use. The poor health status of urban AI/AN people requires greater attention from federal, state, and local health authorities. ( JAMA . 1994;271:845-850)

Health Status of Urban American Indians and Alaska Natives: A Population-Based Study

This article describes the burden of illness of Indians eligible for services from the Indian Health Service (IHS) and discusses strategies for reducing morbidity and mortality related to those conditions. To improve health to an extent that parallels the IHS's past achievements, the illnesses that now are prevelant among Indians require changes in personal and community behavior rather than intensified medical services. Analysis of these conditions leads to the conclusion that much of the existing burden of illness can be reduced or eliminated. IHS is responding to this challenge by continuing to ensure Indians' access to comprehensive health care services, by increasing educational efforts aimed at prevention, and by enlisting the support of other government and private organizations in activities that have as their purpose treating diseases if intervention will lessen morbidity and mortality (such as diabetes and hypertension) and encouraging of dietary changes, cessation of smoking, exercise, reduction in alcohol consumption, and other healthy behavior.

The Indian burden of illness and future health interventions.

services has sparked a number of studies comparing the costs of home care relative to the costs of hospitalization and to care in skilled nursing and intermediate care facilities. These comparisons have led several authors to conclude that if greater emphasis were placed on providing health services to patients in their homes in lieu of institutions, significant cost savings would be realized from lowered admissions, earlier discharges, and reduced capital construction costs for inpatient facilities. Others counter that such generalizations fail to account for a number of important qualifying details. They point out, for example, that home health care may be less costly than institutional care for patients with lower levels of impairment but that cost savings tend to disappear when more severely impaired persons are cared for at home. Moreover, increased availability of home health care may inctease the total costs of health care by increasing overall utilization. These caveats open to question whether in-home care is in fact a potential means of cost savings for health care programs.

https://www.jstor.org/stable/info/4596113

Home health care cost effectiveness: an overview of the literature.

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The Indian burden of illness and future health interventions.

Home health care cost effectiveness: an overview of the literature.