Incidence of macroalbuminuria was computed as the number of new cases per 1000 person-years at risk. New cases were identiﬁed at the ﬁrst ap- pearance of macroalbuminuria in sub- jects who had at least 1 previous exam- ination before 20 years of age with an ACR of ⬍ 300 mg/g. In nondiabetic sub- jects, the period at risk extended from the date of the ﬁrst nondiabetic re- search examination to the date of the ﬁrst nondiabetic examination at which macroalbuminuria was diagnosed or, for those who did not develop mac- roalbuminuria, to the date of the last nondiabetic examination within the study period. In diabetic subjects, the period at risk extended from the date of the ﬁrst diabetic examination to the date of the ﬁrst examination at which macroalbuminuria was diag- nosed or, for those who did not de- velop macroalbuminuria, to the date of the last examination within the study period. Subjects could be counted as both nondiabetic and diabetic if they developed diabetes during follow-up and had at least 2 nondiabetic and 2 diabetic examinations with ACR mea- surements. Time-dependent Cox re- gression models were used to esti- mate the risk of macroalbuminuria associated with ACR adjusted for age, gender, BMI, blood pressure, and dura- tion of diabetes (in the diabetic sub- jects). The ﬁnal model in the diabetic subjects was stratiﬁed according to blood pressure, because this variable violated proportionality assumptions,
Increases in HDL apoC-III may result from increased transfer from surplus non-HDL apoC-III, a particle which we have previously shown to be associated with insulin resistance in children  and is known to be a predictor of atherosclerotic lesion progression [25,26]. The apolipoprotein changes with increasing BMI oc- curred in association with an increased triglyceride and low HDL-C, the classic derangements in lipid transport observed in insulin resistant states. Besides preceding DM2 and occurring in association with the metabolic syndrome and cardiovascular risk [27,28], the criteria were independent risk factors for DM2 in the PROCAM study, and low HDL-C was found to be interactive with obesity in predicting diabetes . Conversely high levels of HDL-C were protective against DM2 in Arizona Pima women but not men .
Additional barriers exist for AI/AN youth. Envi- ronmental obstacles (eg, harsh climate, lack of trans- portation, limited access to healthy foods) create dif- ficulties. Specific tribal or cultural issues, including beliefs and feelings about diabetes, may interfere with optimal self-care. For example, many families have a fatalistic attitude about diabetes: “My parents died of diabetes. I have it, and my children are going to get it.” Eating and mood disorders, life stresses, and low self-esteem are common obstacles. Lack of appropriate role models, particularly healthy indi- viduals living with diabetes, creates significant hard- ship for AI/AN children with diabetes. A low level of reading comprehension and proficiency in English may add additional barriers for some families. Fur- thermore, substance abuse is particularly problem- atic for many AI/AN children and their families. The health care system’s frequent lack of understanding and respect for cultural beliefs may be a barrier to achieving optimal self-care. Many strategies have been shown to help overcome such barriers, includ- ing the use of trained professional interpreters, cul- tural competence and humility training for health care professionals and staff, and inclusion of mem- bers of the community in the design of clinical ser- vices.
Age was categorized in groups as 0 to 4, 5 to 9, 10 to 14, or 15 to 19 years. Data on race and ethnicity were based on self-reports or medical charts. Based on 2000 US census classification, participants were categorized as Hispanic, black, Asian or Pacific Islander, American In- dian, non-Hispanic white, and multiple, other, or un- known race. Classification of the type of diabetes was based on the clinical diagnosis made by a health care provider and was collected from the providers at the time of the case report to SEARCH or otherwise from medical charts. The clinical type was categorized as fol- lows: type 1, type 2, or other or unknown diabetes type. Family income and history of diabetes were obtained through the health questionnaire. Responses to ques- tions about health insurance sources, which permitted multiple choices, were categorized hierarchically as pri- vate only, private plus anything else, Medicaid only, other, and none. Patients with the Indian Health Service as their only insurance source are included in “other.” Parental educational attainment is that of the parent with the higher attainment.
A logical early step in advancing pre- ventive strategies may be for the dia- betes medical community to reach consensus on how to approach wide- spread translational programs that po- tentially can be implemented on a global level. Although lifestyle interventions are effective, our sole reliance on peo- ple ’ s adherence to diet and physical ac- tivity recommendations will not be enough to delay progression for a large portion of the at-risk population. Thus, attention also must be given to recom- mendations for pharmacological ther- apy to yield long-term societal bene ﬁ ts in the area of type 2 diabetes prevention and reduction in diabetes complica- tions, including cardiovascular disease. Hence, in this Expert Forum, we also discussed a possible alternative avenue for FDA approval of a new prevention indication for metformin. Speci ﬁ cally, we developed a compelling argument that the evidence base for metformin already may be substantial enough to support approval of such an indication. We readily admit that additional work will be needed, and many hurdles re- main. Still, this is an exciting time for diabetes prevention, and although real-world translation is the next great- est hurdle, it also represents the biggest opportunity to stem the tide of the global diabetes pandemic.
AmericanIndian rights are protected by the trust doctrine, which means that lands owned by AmericanIndian tribes is held in trust by the U.S. government. Wilkins & Lomawaima (2001) highlight that the trust doctrine, in its broadest sense, is about the federal responsibility to protect tribal assets through policy and management decisions (e.g., natural, human, cultural or financial). Through the trust doctrine, the federal government developed a different relationship with tribal governments than it did with the states. Much of the difference revolved, and still does, around the recognition that tribes were sovereign nations continuing to reside within the new boundaries of the U.S. The growth and expansion of states necessitated some level of federal protection of American Indians from states who were hungry for growth and asserting local power. While the U.S. government promised tribes provisions, money, healthcare, and education as part of the many treaties it executed and the removal of land that accompanied them, states retained a significant level of local control over education policies and decisions that directly impacted AmericanIndian students – which has continued until present day. In states that do not work with their local tribes, AmericanIndian representation in the policy decisions continue to be absent. In particular, this lack of representation in policy and politics limits the AmericanIndian voice and authority in educational policy matters impacting their people.
When evaluating these findings several accompanying limitations must also be considered. First, the cross-sectional study design prevents causal inference and the ability to adjust for time-varying confounders. Second, we presented adjusted odds ratios as our point estimate. When using cross-sectional data with a common outcome, odds ratios may overestimate the association. Thus, we also estimated the prevalence ratios (PR) (analyses not presented), which were slightly more conservative estimates. As with the adjusted odds ratios, the adjusted prevalence ratios were significant and our conclusions remained the same. Third, the current analysis included a relatively small sample of American Indians and Alaska Natives, which may limit the power to detect significant differences, as suggested by wider confidence intervals. Fourth, American Indians and Alaska Natives is an aggregated group from hundreds of tribes that may mask many important differences in culture and experience relating to PTSD and AUD. This is a limitation of the dataset where specific tribal affiliation is not collected and where overall AmericanIndian and Alaska Native participation is low. Fifth, given that the study’s information is collected by interviews, recall bias and
We used Poisson regression to estimate the risk ratios for episodes of DKA, hypoglycemia, hospitalizations, and ED visits and the general linear model procedure to calculate the least square means HbA1c among partici- pants with mildly and moderately/severely depressed mood compared with participants with minimally de- pressed mood. Level of depressed mood is an indepen- dent variable in these models. Analyses were limited to youth with diabetes for at least 1 year because we wanted to exclude events associated with diagnosis and the acute phase of the preliminary illness. In addition to demographic and diabetes-related variables, these mod- els were adjusted for participants’ use of psychiatric medication because of a suggestion by Musselman et al 35
The National Youth Policy of India defines a “youth” as a person in the age group 15 to 35 years of age. The UN, on the other hand, defines a youth as somebody between 15 to 24 years of age. According to the 2011 Census, youth account for 20 per cent of the total population. However, 84.5 million young people in India live below the poverty line, which is the highest rate worldwide, at 44.2 per cent of the total youth population. There are 44 million Indianyouth who are undernourished, which constitutes 23 per cent of the youth population of India.
Reflecting on these themes, we made the following ad- aptations to the FOY + ImPACT curriculum: (1) enhance content around reproductive anatomy, sexual and repro- ductive health information, pregnancy prevention strat- egies and applied skills training; (2) teach proper condom and contraceptive use and community- and youth-centered strategies for overcoming access barriers; (3) build in comprehensive substance use prevention components teaching peer refusal and pro-peer rela- tions; (4) reflect the importance of social pressure on males and self-esteem and connectedness on females for sexual decision making ; (5) modify all content to reflect the local language, include familiar characters, and add culturally relevant examples and scenarios; (6) reproduce the ImPACT DVD with local actors and testi- monials, include traditional Native storytelling, and add emphasis on the balance among physical, spiritual and emotional health.
These findings indicate that women with low vitamin D levels are at higher risk of cardiovascular diseases (Boucher, 1998; Barter et al., 2007). Among non-pregnant women, low HDL-cholesterol has been reported as an independent risk factor of vitamin D deficiency (Forrest & Stuhldreher, 2011). Another study looked at 13,039 adults and showed that higher 25(OH)D levels were associated with higher HDL- cholesterol and a lower total cholesterol/HDL ratio, after considering factors such as diabetes, physical activity, BMI, and waist circumference (Faridi et al., 2016). The mechanism of this association is not clear, but vitamin D may indirectly influence lipid metabolism mediated by insulin resistance and inflammation (Guasch et al., 2012). Matsuura and colleagues (2006) proposed that vitamin D may regulate macrophage function of reverse cholesterol transport, and the number of large HDL particles may be elevated, by taking over cholesterol through macrophages. Zhou and colleagues (2008) revealed that vitamin D possibly improves free fatty acid-induced insulin resistance. Meanwhile, Kang et al. (2012) suggest that vitamin D could stimulate cytokine gene expression in macrophage, and perform many systemic anti- inflammatory actions. Most recently, Slominski et al. (2015) reported that novel vitamin D 3 -hydroxyderivatives are non-calcemic, unlike 1,25(OH) 2 D 3, thus potentially
Abstract: Gestational diabetes mellitus (GDM) is one of the most common medical conditions in pregnancy, and the prevalence is growing with increasing rates of women of advanced age becoming pregnant and the increasing prevalence of maternal obesity and inactivity. GDM is associated with an increased risk of maternal and infant short- and long-term ill-health. There is a positive linear association between increasing maternal glucose at oral glucose tolerance testing and risk of important perinatal outcomes, including cesarean section, large for gestational age, and infant adiposity. A “step-up” approach, where diet and lifestyle information is provided followed by pharmacological interventions as required to control and reduce hyperglycemia, is effective at reducing the risk of macrosomia, but treatment of GDM will increase demand on health services. There is limited evidence to suggest which identification strategy is best or what thresholds should be used to diagnose GDM or what the effects of different diagnostic strategies have on short- or long-term maternal and offspring outcomes. Trials of interventions in pregnancy aimed at preventing GDM have not demonstrated a benefit; therefore, trials are needed to evaluate interventions aimed at optimizing the health of all women of childbearing age, outside of pregnancy. A consistent, evidence-based, sustained approach to supporting women to live healthily, including the achievement of a normal body mass index before and after pregnancy, is urgently needed.
GREEN, RAYNA, Cherokee, was born and raised in Texas. She took a B.A. and M.A. in English from Southern Methodist University and an Ph.D. in Folklore and American Studies from Indiana University in 1973. She has taught with the Peace Corps in Ethiopia, and at the Universities of Arkansas and Massachusetts (Amherst) where she was an Assistant Professor of English and Folklore. She is presently Director of the Project on Native Americans in Science for the American Association for the Advancement of Science in Washington, D.C. She has served as Coordinator of the Regional America Program for the Bicentennial Festival of American Folklife at the Smithsonian Institution and on the Native American Advisory Board for the Smithsonian.
Almost all of the Indian students in the "Barriers" study—even those who had chosen the sciences and technical fields where exposure to, need for, and use of math is much greater than in the humanities—expressed a great anxiety at being able to do and understand math. Most expressed a distaste for math even when they were relatively competent in the skills required of them. And even if their anxieties about ability to do math had been allayed by recent successes, the power of their real or imagined failures in the past caused nothing but trouble for them in the present. Most non-science students avoided math whenever they could, and they and the science students struggled painfully with it when avoidance was not possible. The problem that math represents for them can be clearly understood when one views the statistics of Indian career choices—fewer than five Ph.D.'s in mathematics in the country; fewer than ten Ph.D.'s in the physical sciences, the most math-related of the natural sciences; less than fifteen Ph.D.'s in the "hard" or quantification-oriented social sciences and fewer than five in economics, less than two hundred engineers and fewer than twenty in the computer fields. (Most are in the low-level two-year programs.) In the small sample of eighty-five students interviewed for the "Barriers" project, I spoke with only two math majors, several students who had been tutors, and several science students who had math minors. But I met a large number of science students who had dropped math as a major, and most of those had then entered the biological rather than physical sciences as fields of study.
Of particular interest to Indian educators is the fact that the trial court had much to say about the legal interpretation of the Navajo Treaty provisions relating to education. First of all, the court said that in interpreting a treaty provision, courts must look at more than just the treaty provision itself. Because of the plenary power of Congress over Indian tribes, courts must also look to legislation enacted subsequent to the treaty. 18 Consequently, the courts will not construe a treaty in a manner inconsistent with a subsequent federal statute. 19 But even more important, the trial court said that the interpretation given treaties by the Executive Department merits important consideration and will be given great weight. 20 The court took special note of the fact that the Intermountain School was initially established by a 1949 Act of Congress, 21 and said that this statute and other legislation 22 clearly evidence an intent on the part of Congress to provide off-reservation schooling for Indianyouth, and have the effect of altering the treaty provisions to the contrary. The court made the following observation:
Funded programs for Indian students include curriculum components such as history of the Indian tribe for which the program has been developed, language(s), legends, religion, medicine, and the like. Contributions of Indians to American society generally are included. The physical environment of the classroom should reflect the culture and lifestyle of pupils as should instructional materials whenever possible. For example, children can count objects, or models or pictures of objects, which are familiar to them such as cradle boards, baskets, rugs, as easily as they can birds, flowers and trees which may not exist in the child's world. The difference is subtle and yet important. Children can learn shapes from viewing the designs in Navajo rugs as easily (or more so) as they can using pictures of unfamiliar abstractions. Pictures and content in beginning reading materials can reflect the familiar before the child is exposed to the unfamiliar setting of non-Indian children who live in houses in the suburbs of the city. Parents of Indian pupils are utilized as important resources both in the planning and implementation of culturally relevant experiences. This is the kind of curriculum relevance that exemplary Indian education programs exhibit. Content and processes which reflect the child's culture should enable pupils to appreciate and value their legacy as Indians and build prideful identity so important for self actualization.
The shortage of Choctaw college graduates results in almost total reliance on non- Choctaws as teachers and administrators in the Choctaw school system operated by the Choctaw Agency, Bureau of Indian Affairs. Of approximately sixty-five classroom teachers in regular and title programs, only seven are Choctaw. Of twelve educational administrators, only two are Choctaws. Since over 85% of Choctaw students enter the school system speaking primarily Choctaw, they face an educational environment in which they cannot initially communicate with the professional educators. As a result they fall further behind national norms with each passing year. The senior class in Choctaw Central High in 1972 averaged 8.64 battery total on the California Achievement Tests. Further, only one-third of these high school seniors had reached the senior class in 12 years. One-third had required 13 years, while the remaining third had required 14 years. With this level of academic preparation, it is not surprising that most of the Choctaw students entering college fail to graduate.
Over the years of boarding school existence, they have externally and internally gone through various stages that kept in step with social and economic changes with the mainstream America. Our boarding school program opened its doors in the mid 1880's truly reflecting the agrarian lifestyle of American with few trade skills offered for variation, which, was followed by the concept of building schools closer to the Indian population to address the schools more to the liking of the communities and to keep youngsters closer to the home environment. Off-reservation schools continued to attract high school and post-high age students during the 50's and 60's. We cannot deny that some of the schools are experiencing a decline in enrollment. More and more Indian youngsters are attending public schools. However, for many, the boarding school remains the only option. For many high school age Indianyouth, they express preference to boarding rather than to public school. A major problem facing them in public schools, as expressed by many, is eventual failure and having to contend with discrimination from both the majority anglo students as well as teachers. Scholastic failure stemming from these problems leaves no alternative except to be where a person is accepted, and less embarrassment and ridicule and be able to experience success. One might say that we all must learn to live with social pressure and learn to adjust but on the other hand, we are all humans and we need desperately to succeed in whatever small quantities it may come. Those small successes lead to larger ones, if we feel good about ourselves and feel accepted. These are things that our boarding schools offer. Much more important than that, they provide an environment that is conducive to self acceptance and not self-rejection.