Native Americans - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

NATIVE AMERICANS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J ...

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NATIVE

AMERICANS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Native American Health: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-11075-X 1. Native American Health-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on Native American health. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON NATIVE AMERICAN HEALTH ................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Native American Health ............................................................. 10 E-Journals: PubMed Central ....................................................................................................... 55 The National Library of Medicine: PubMed ................................................................................ 55 Academic Periodicals covering Native American Health ............................................................ 80 Dissertations on Native American Health................................................................................... 80 CHAPTER 2. NUTRITION AND NATIVE AMERICAN HEALTH ......................................................... 83 Overview...................................................................................................................................... 83 Finding Nutrition Studies on Native American Health.............................................................. 83 Federal Resources on Nutrition ................................................................................................... 85 Additional Web Resources ........................................................................................................... 86 CHAPTER 3. BOOKS ON NATIVE AMERICAN HEALTH ................................................................... 89 Overview...................................................................................................................................... 89 Book Summaries: Federal Agencies.............................................................................................. 89 Book Summaries: Online Booksellers........................................................................................... 91 Chapters on Native American Health .......................................................................................... 91 Directories.................................................................................................................................... 94 CHAPTER 4. MULTIMEDIA ON NATIVE AMERICAN HEALTH ......................................................... 97 Overview...................................................................................................................................... 97 Video Recordings ......................................................................................................................... 97 Audio Recordings......................................................................................................................... 98 CHAPTER 5. RESEARCHING MEDICATIONS .................................................................................... 99 Overview...................................................................................................................................... 99 U.S. Pharmacopeia....................................................................................................................... 99 Commercial Databases ............................................................................................................... 100 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 103 Overview.................................................................................................................................... 103 NIH Guidelines.......................................................................................................................... 103 NIH Databases........................................................................................................................... 105 Other Commercial Databases..................................................................................................... 107 APPENDIX B. PATIENT RESOURCES ............................................................................................... 109 Overview.................................................................................................................................... 109 Patient Guideline Sources.......................................................................................................... 109 News Services and Press Releases.............................................................................................. 113 Newsletters on Native American Health ................................................................................... 115 Newsletter Articles .................................................................................................................... 115 Finding Associations.................................................................................................................. 117 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 119 Overview.................................................................................................................................... 119 Preparation................................................................................................................................. 119 Finding a Local Medical Library................................................................................................ 119 Medical Libraries in the U.S. and Canada ................................................................................. 119 ONLINE GLOSSARIES................................................................................................................ 125 Online Dictionary Directories ................................................................................................... 125 NATIVE AMERICAN HEALTH DICTIONARY..................................................................... 127

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INDEX .............................................................................................................................................. 169

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with Native American health is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about Native American health, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to Native American health, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on Native American health. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to Native American health, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on Native American health. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON NATIVE AMERICAN HEALTH Overview In this chapter, we will show you how to locate peer-reviewed references and studies on Native American health.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and Native American health, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “Native American health” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Access of Native Americans to Renal Transplantation in Arizona and New Mexico Source: Blood Purification. 14(4): 292-304. July-August 1996. Contact: Available from S. Karger Publishers, Inc. 26 West Avon Road, P.O. Box 529, Farmington, CT 06085. Summary: Lower rates of transplantation among minority groups are a nationally recognized phenomenon. Native Americans nationally have nearly four times the risk of end-stage renal disease (ESRD) as white Americans and are significantly overrepresented in the Network 15 ESRD population. This article reports on a study undertaken to understand more about Native American and white transplant rates. The authors looked at all reported Arizona (AZ) and New Mexico (NM) resident cases from

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the Network 15 database. Age of onset, sex, primary diagnosis, payment source, transplant donor source, and other factors were examined. Native Americans experienced a slightly earlier onset of ESRD than whites, and diabetes mellitus was the primary ESRD diagnosis for 63 to 73 percent of Native Americans and for 34 to 39 percent of whites. Because age distribution and frequency of diabetes mellitus of the Native American ESRD population differ from those of whites in the Network, agespecific and diagnosis-specific transplant rates were examined. Age-adjusted transplant rates for 100 ESRD patients for AZ were 16.4 (Native Americans) and 21.0 (whites) and for NM 14.2 (Native American) and 22.4 (whites). Diagnosis-specific, age-adjusted transplant rates for patients with the primary diagnoses of diabetes mellitus and glomerulonephritis, the two most common causes of ESRD among Native Americans, showed a large difference between white and Native American rates. In all comparisons and in both the white and Native American ESRD populations, women were transplanted at lower rates than men. Native Americans experienced a greater delay from onset of treated ESRD to transplant than whites. Payment source and transplant donor source did not appear to be significantly different between the two populations. The authors conclude that the lower transplant rates in Native Americans versus whites in Network Number 15 cannot be explained by age-specific or diagnosis-specific factors. 12 tables. 7 references. (AA-M). •

Prevalence and Correlates of the Insulin Resistance Syndrome Among Native Americans: The Inter-Tribal Heart Project Source: Diabetes Care. 22(3): 441-447. March 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article describes a study that examined the clustering of four traits for cardiovascular disease (CVD), hypertension, diabetes, high triglycerides, and low high density lipoprotein (HDL) cholesterol, and the association of these traits with adiposity and fasting insulin levels among people living in three Chippewa and Menominee communities in Wisconsin and Minnesota. Cross sectional data from 488 men and 822 women aged 25 or older in the Inter-Tribal Heart Project were included. Results indicate that, among the men, 40.4 percent, 32.6 percent, 17.4 percent, and 9.6 percent had none, one, two, or three of the four traits, respectively. Among the women, the respective percentages were 53.2 percent, 25.6 percent, 15.3 percent, and 6.0 percent. The percentage of those who had each particular trait increased significantly among those with none, one, or at least two other syndrome traits. Among those who had normal fasting glucose levels, insulin positively correlated with serum glucose and triglycerides and who inversely related to HDL cholesterol for both men and women. Insulin was also positively associated with systolic and diastolic blood pressure, weight, and all measures of adiposity. Insulin was not associated with low density lipoprotein cholesterol. Having more syndrome traits was significantly related to higher body mass index (BMI), conicity index, waist circumference, and waist to hip and waist to thigh ratios. Among those who had normal glucose levels, having more syndrome traits was significantly related to higher fasting insulin levels after adjusting for age and measures of adiposity, although associations were attenuated with adjustment for either BMI or waist circumference. The article concludes that traits characterizing the insulin resistance syndrome were clustered to a significant degree among Native Americans in this study. Comprehensive public efforts are needed to reduce adverse levels of these risk factors in this high-risk population. 2 figures. 4 tables. 39 references. (AA-M).

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Diabetes Education for the Native American Population Source: Diabetes Educator. 27(2): 181-182, 187-188. March-April 2001. Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, 4th Floor, Chicago, IL 60603-1901. (312) 424-2426. Summary: This article discusses diabetes education for the Native American population. There is a diversity among Native American tribes and villages with regard to language or dialect, philosophy, customs, and government structure, so it is difficult to develop a diabetes education program that is culturally specific. Various educational materials are available and can be adapted for use in an existing program. Native Americans have a present oriented sense of time, and this flexible time orientation tends to conflict with rigidly timed appointment schedules. Therefore, accommodation should be made for this view. Scheduling appointments and follow up teaching during the pow wow season can also be challenging. Exercise is encouraged for Native Americans, and culturally specific exercise videos are available. Diet varies greatly among Native Americans, but generally the westernized diet of high fat and fast food is common among most Native Americans. Clients should be encouraged to eat more traditional foods and to prepare foods in the traditional manner. 12 references.

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Professional Practice at a Native American Community: An Introduction to Renal Social Services with Pima-Maricopa Tribal Community Members Source: Contemporary Dialysis and Nephrology. 11(12): 23-25, 28. December 1990. Summary: This article discusses renal social services within the Pima-Maricopa tribal community. The cultural heritage and kinships of the Salt River Pima-Maricopa Indian Tribal Community represent a foundation of individual and community strengths needed to support the Native American patient when interacting with the medical, psychological, social, and cultural environments endemic to chronic renal failure and dialysis therapy. The author demonstrates this support through case studies and tribal stories. 8 references. (AA-M).

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Type II Diabetes and Cognitive Function: A Population-Based Study of Native Americans Source: Diabetes Care. 17(8): 891-896. August 1994. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article presents a short report on a research study exploring the relationship between noninsulin-dependent diabetes (NIDDM) and cognitive function in older Native Americans and assessing the effects of other selected risk factors for cognitive dysfunction on this relationship. Cognitive function was assessed in 80 Native Americans with diabetes and 81 Native Americans without diabetes; all were 45-76 years of age and included in a cross-sectional population-based substudy of the Strong Heart Study. Thirteen cognitive function tests were administered during a personal interview. Information about six other risk factors for cognitive dysfunction, including depressive symptoms, physical function, alcoholism, current alcohol use, hypertension, and myocardial infarction, was ascertained from interviews and from abstraction of medical records. Results showed little evidence that NIDDM in this population of Native Americans is associated with decrement in cognitive function. The authors note that some of the cognitive impairment previously attributed to diabetes may be related to the influence of other risk factors. 4 tables. 31 references. (AA-M).

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Diabetic End-Stage Renal Disease Among Native Americans Source: Diabetes Care. 16(Supplement 1): 346-348. January 1993. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Summary: This article reports on a study that examined why end-stage renal disease (ESRD) has become a major source of morbidity and mortality for Native Americans with diabetes mellitus. Using data from the Medicare ESRD Program, the authors examined incidence rates for ESRD among Native Americans for the years 1983 through 1987. During this period, the annual incidence of total ESRD in Native Americans increased by 18 percent, from 170.5 per million to 200.1 per million. The incidence of diabetes-related ESRD increased by 47 percent, from 80.6 per million to 118.2 per million. In 1987, the age-adjusted incidence rate of diabetes-related ESRD was 6.8 times higher in Native Americans than in whites. The authors present recommendations for the prevention of diabetes-related ESRD including early identification of renal disease and improved control of hypertension and blood glucose levels. The magnitude of diabetes-related ESRD among Native Americans also underscores the need for primary prevention of noninsulin-dependent diabetes mellitus (NIDDM). 3 figures. 1 table. 15 references. (AA-M).

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Study of Dental Caries and Risk Factors Among Native American Infants Source: Journal of Dentistry for Children. 62(4): 283-287. July-August 1995. Summary: This article reports on a study undertaken to establish the prevalence of caries among Native American infants and to identify risk factors contributing to the disease. The subjects were 77 infants, 12 to 36 months of age, and their parents or caregivers. All parents/caregivers completed questionnaires that consisted of 29 questions focusing on behavioral risk factors for dental diseases. Caries experienced was assessed in the children. An overall caries prevalence of 46.8 percent and average number of carious teeth per child of 2.09 were obtained. The authors note that no child had filled or missing teeth caused by caries; this may suggest that these young Native American children do not have access to dental care. It appears that children with caries ingest snacks between meals more frequently than children without caries. In addition, other lifestyle-related behaviors, e.g., toothbrushing behavior, were found to be risk factors for dental caries. The authors call for culturally appropriate preventive, screening, and education efforts. 4 tables. 25 references.

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Participant Satisfaction with a Culturally Appropriate Diabetes Education Program: The Native American Diabetes Project Source: Diabetes Educator. 25(3): 351-363. May-June 1999. Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, 4th Floor, Chicago, IL 60603-1901. (312) 424-2426. Summary: This article reports on participant satisfaction with the Native American Diabetes Project (NADP). This project was developed to facilitate diet and lifestyle modifications among Native Americans with type 2 diabetes in New Mexico. The NADP consisted of five sessions designed according to the transtheoretical model of change and social action theory with input from community members. Eight pueblo communities participated in the program. Sessions were taught by a community mentor in three sites in New Mexico. One site taught sessions in one-on-one format, and two sites taught sessions in a group format. There were 151 participants in the education

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program as measured by attendance at session one. Retention was high across all sites. Retention rates for the sessions were 81 percent for group sessions and 91 percent for one-on-one sessions. Overall, participants responded positively to sessions designed according to social action theory and with cultural competency. However, qualitative and quantitative analyses show different aspects of participant satisfaction. The qualitative analyses results reveal a very similar range of responses across sites and program delivery format regarding aspects of the program that were designed to be culturally appropriate and theoretically based. The quantitative chi square analysis that compared the proportion of negative to nonnegative responses and retention rates shows some statistically significant differences. The proportion of negative comments was smaller at one site than the other two sites and smaller for one-on-one program delivery than for the group format. The qualitative range of responses highlights the overall similarities in the types of program aspects that participants liked, disliked, and would alter. The quantitative measures of retention and negative responses proved an overall proportional account of participant satisfaction. The article concludes that using a strong theoretical framework and community input to design diabetes education sessions may be important factors in participant satisfaction and retention in diabetes lifestyle education sessions. 5 tables. 24 references. (AA-M). •

Strong in Body and Spirit: Lifestyle Intervention for Native American Adults with Diabetes in New Mexico Source: Diabetes Care. 25(1): 78-83. January 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reports on research undertaken to determine the effects of a culturally appropriate diabetes lifestyle intervention for Native Americans on risk factors for complications of diabetes. A nonrandomized, community based diabetes intervention trial was conducted in three Native American sites in New Mexico from 1993 to 1997. Participants were assigned to intervention or control based on community of residence. Intervention sessions were held approximately 6 weeks apart over a period of 10 months. The intervention was delivered in site A in family and friends (FF) groups (n = 32); site B received the same intervention in one on one (OO) appointments (n = 39); and site C received usual medical care (UC, n = 33). Total participants were 104. Primary change in HbA1c level (a measure of blood glucose levels over time) was assessed at 1 year. Adjusted mean change in HbA1c value varied significantly across the three intervention arms at 1 year. The UC arm showed a statistically significant increase in adjustment mean HbA1c change, whereas both intervention arms showed a small nonsignificant increased in the adjusted mean change. The increase was statistically significantly smaller in the combined intervention arms compared with the UC arm. An increase in HbA1c levels indicates a reduction in effective diabetes management. The authors conclude that lifestyle intervention has the potential to substantially reduce microvascular complications, mortality, and health care utilization and costs if the change is sustained over time. 1 figure. 2 tables. 32 references.

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Dental Experiences and Parenting Practices of Native American Mothers and Caretakers: What We Can Learn for the Prevention of Baby Bottle Tooth Decay Source: Journal of Dentistry for Children. 66(2): 120-126. March-April 1999. Contact: Available from American Society of Dentistry for Children. John Hancock Center, 875 North Michigan Avenue, Suite 4040, Chicago, IL 60611-1901. (312) 943-1244.

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Summary: This article reports on the dental experiences and parenting practices of Native American mothers and caretakers, with an emphasis on the prevention of baby bottle tooth decay (BBTD). The authors discuss the prevalence of BBTD, interventions for BBTD, the use of a focus group study to elucidate the American Indian experience in this area, the dental treatment experiences of the adult and the child, concerns and caring for the parent's and the child's teeth, and feeding practices. The authors note that an ethnographic approach (training local women to gather perceptions) has provided sensitive and useful information. In addition to promoting early screening and preventive services for young children, enhancing efforts to provide positive dental experiences for mothers and women of childbearing age is recommended. While some parents and caretakers may lack knowledge concerning BBTD, effort should be made to correct misinformation, such as that a young child can clean his or her own teeth, and providing brief counseling regarding culturally appropriate options. 16 references. •

Population At Risk: Diabetes and Native Americans Source: Living Well With Diabetes. 5(4): 12-13. Fall 1990. Summary: This article reviews the hereditary and environmental risk factors for diabetes among Native Americans and discusses current Federal programs addressing the problem. The author reviews the history of diabetes in the Native American population and the history of Federal funding and participation in Native American health care. A description of the Indian Health Service (IHS) Diabetes Program is also provided.

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Peripheral Vascular Disease Among Native Americans: Pitfalls of the Vascular Examination in Patients with Diabetes Source: IHS Primary Care Provider. Indian Health Service Primary Care Provider. 18(3): 49-51. March 1993. Contact: Available from IHS Primary Care Provider. Indian Health Service/PHS, Clinical Support Center, 4212 North 16th Street, Phoenix, AZ 85016. (602) 640-2140. Fax (602) 640-2138. Summary: This is the first in a series of two articles about peripheral vascular disease in Native Americans with diabetes. The author deals with the diagnosis of peripheral vascular disease, the basic vascular examination of the diabetic foot, and pitfalls of the vascular examination in patients with diabetes. The author discusses the symptoms of ischemia, including claudication (pain that occurs with exercise), trophic changes, and the absence of a pulse in the foot. The author then considers the diagnostic tests used to confirm peripheral vascular problems, including doppler signals, the ankle arm index (AAI), capillary refill, and plethysmography. The authors stresses that, in addition to controlling infection, debriding dead tissue, and providing proper footwear (or keeping a patient off his or her foot), a vascular examination should be performed. If the patient can withstand vascular surgery, the he or she should be evaluated by a vascular surgeon, and perhaps obtain angiograms for the purpose of undergoing revascularization. Revascularization offers the potential for limb salvage for those individuals presenting to the provider with a threatened limb. 4 references. (AA-M).

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Cross-Cultural Perspectives: Caribbean, Native American, and Yoruba Source: International Psychogeriatrics. 8(Supplement 3): 483-486. 1996.

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Summary: This journal article describes a cross-cultural comparison of the behavioral disturbances of dementia in four population groups: Jamaicans in Kingston; Cree in Northern Manitoba, Canada; Yoruba in Ibadan, Nigeria; and African-Americans in Indianapolis, Indiana. The severity of dementia tended to be greatest in the Jamaican group and least in the Nigerian group. American caregivers were the most likely to report personality changes, and the Nigerian caregivers were the most concerned about the possibility of their spouses with dementia becoming involved in embarrassing situations. Treatment of behavioral symptoms in the Jamaican, Cree, and Nigerian groups depended on various psychosocial and demographic factors, including the availability of health care services. In all three societies, older people are held in high regard and a considerable degree of tolerance exists for some regressive behaviors. The authors conclude that caregivers in these diverse cultures all recognize the problem of behavioral disturbances of dementia, but differ in their approach to treatment and the frequency with which such treatment is sought. 3 tables, 5 references. •

Supplement 1: Diabetes in Native Americans Source: Diabetes Care. 16(1): 211-382. January 1993. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This special supplement in Diabetes Care includes proceedings of a symposium held as part of a conference in Mesa, Arizona, in November 1989. The symposium was sponsored by the Indian Health Service and the National Institute of Diabetes and Digestive and Kidney Diseases, in collaboration with the Intertribal Council of Arizona. The 32 articles in the supplement include reports on diabetes prevalence, complications, and mortality in Native Americans and Alaska Natives; descriptions of prevention, treatment, and educations programs in tribal communities; an introductory overview; and a concluding statement.

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Association of the Insulin Resistance Syndrome and Microalbuminuria Among Nondiabetic Native Americans. The Inter-Tribal Heart Project Source: JASN. Journal of the American Society of Nephrology. 13(6): 1626-1634. June 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: This study investigated the association between microalbuminuria (the presence of microscopic protein in the urine) and the insulin resistance syndrome (IRS) among nondiabetic Native Americans. In a cross-sectional survey, age-stratified random samples were drawn from the Indian Health Service clinic lists for one Menominee and two Chippewa reservations. Information was collected from physical examinations, personal interviews, and blood and urine samples. the urinary albumin to creatinine ratio (ACR) was measured using a random spot urine sample. The IRS was defined by the number of composite traits: hypertension (high blood pressure), impaired fasting glucose (IFG), high fasting insulin, low HDL cholesterol, and hypertriglyceridemia (high levels of blood fats). Among the 934 eligible non-diabetic participants, 15.2 percent exhibited microalbuminuria. The prevalence of one, two, and three or more traits was 17.0 percent, 16.6 percent and 7.4 percent, respectively. Of the individual IRS traits, only hypertension and IFG were associated with microalbuminuria. Among these nondiabetic Native Americans, the IRS was associated with a twofold increased prevalence of microalbuminuria. The authors conclude that

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health promotion efforts should focus on lowering the prevalence of hypertension, as well as glucose intolerance and obesity, in this population at high risk for renal and cardiovascular disease. 1 figure. 4 tables. 47 references.

Federally Funded Research on Native American Health The U.S. Government supports a variety of research studies relating to Native American health. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to Native American health. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore Native American health. The following is typical of the type of information found when searching the CRISP database for Native American health: •

Project Title: ACNP ANNUAL MEETING SPECIAL PROGRAMS Principal Investigator & Institution: Sanders-Bush, Elaine; Professor; Pharmacology; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2003; Project Start 30-SEP-1998; Project End 31-JUL-2008 Summary: (provided by applicant): There is ample evidence for racial and ethnic disparities in the health of our nation and, specifically, in the neuroscience research community. An emerging central component of the strategic plans to eliminate health disparities focus on medical research and research training. With RFAs such as "Increasing Diversity", the NIH seeks to address the need to expand both the size and the diversity of the scientific workforce committed to reducing health disparities. The under-representation for African Americans, Hispanic Americans and Native Americans is especially acute in neuroscience. As reported in Doctorate Recipients from United States Universities - Summary Report, published by the National Academic Press, Washington, D.C., in 1997, 432 Ph.D.'s were awarded in neuroscience by U.S. universities. Six (1.4%) African Americans, 8 (1.9%) Hispanic Americans and no Native Americans were among these Ph.D. recipients. Furthermore, a review of the statistics for the three-year period from 1997 to 1999 showed that underrepresented minorities (defined as African Americans, Hispanic Americans and Native Americans) were awarded only 4.2% of the neuroscience Ph.D. degrees conferred by U.S. universities. This shocking statistic illustrates an immediate, pressing challenge - to expand the human resource pool in neuroscience to include a more representative number of minorities. The American College of Neuropsychopharmacology (ACNP) shares the scientific community's concerns over the need to increase minority participation in the

2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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medical sciences and scientific research. The Minority Travel Program is an important part of our effort to increase diversity in neuroscience research and education. The ACNP believes that the continued support of a Travel Award Program providing funding for post-doctoral minority professionals to attend the annual scientific meeting would play a significant role in encouraging young minority scientists to enter the field of neuroscience research. Attendance at the Annual Meeting provides an opportunity for the awardee to become familiar with the evolving field of neuropsychopharmacology and experience the stimulation and excitement of meeting experts in the field. The evident success and effectiveness of the NIMH Minority Travel Award Program, and the clear continuing need to encourage minority post-doctoral professionals to enter and pursue careers in science, merits the continuation of the NIMH Minority Travel Award Program. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ATHLETICS & EATING PROBLEMS IN NATIVE & CAUCASIAN YOUTH Principal Investigator & Institution: Lynch, Wesley C.; Psychology; Montana State University (Bozeman) Bozeman, Mt 59717 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2004 Summary: (provided by applicant): Current literature indicates that risk factors for eating disorders (ED) among native Americans are poorly understood. However, available evidence suggests that Native American adolescents females are one of the few groups at equal or greater risk for eating disorders than age-matched Caucasian females. Other recent research suggests that strenuous physical activity may be an independent risk factor for ED, although it remains unknown whether or not this applies to sub-clinical eating problems in adolescents. Still other evidence suggest that athletic involvement may either enhance or reduce the risk of ED depending on factors such as age, self-esteem, and level of competition. In light of this, the proposed study has two main goals: 1) to characterize the weight control practices of matched samples of Caucasian and Native American females at various ages pre-and post puberty and 2) to determine what aspects of athletic involvement may increase or reduce ED risks in each group. We expect athletic involvement to modify the risk for maladaptive weight control behaviors depending on ethnicity, type and level of athletic involvement, and the individual's level of sexual maturation. A proposed structural equation model (SEM) expressing specific hypotheses about various potential risk factors will be tested with data from each ethnic group. A cross-sectional survey will be administered to students in grades 5-10 from selected public schools in Billings and Hardin, MT. Measures of maladaptive weight control behavior, assessed by the Mc Knight risk factor Survey (MRFS-IV) and ED symptom profiles, assessed by the Eating Disorders Symptoms Checklist, will provide measures of the main dependent variables. As a supplement to goodness-of-fit analyses of the proposed model, a more exploratory regression-tree analytical approach will be used to examine which of several independent variables (predictors), including ethnicity, age, gender, maturational status, body shape satisfaction, height, weight, waist/hip ratio, and BMI, best predict specific ED symptoms. In addition of the survey data, a selected sample of the oldest students will participate in interviews designed to assess the onset-age and development history of specific weight control behaviors and physical activity patterns. A part of each interview will also assess differences in Native and Caucasian cultural views regarding eating weight-management and related issues. This work is a first attempt to our knowledge to compare age-matched Native American and Caucasian youth along these dimensions

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and should provide valuable data not currently available. Ultimately this work should inform decision-making regarding the advisability of specific types of athletic participation as interventions aimed at reducing the risk of eating disorders and/or obesity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BRIDGES TO BACCALAREATE FOR NATIVE AMERICANS Principal Investigator & Institution: Cruickshank, Brandon J.; Chemistry and Biochemistry; Northern Arizona University Department of Biological Sciences Flagstaff, Az 86011 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 29-SEP-2004 Summary: (Provided by applicant): At Northern Arizona University (NAU), two of our goals are to increase the number of Native Americans majoring in the biomedical sciences and to increase the academic performance, retention, and graduation rates of these students. This program proposes to serve Native American students at two community college campuses: Dine College at Tsaile and Dine College at Shiprock. The proposed program requests 3 years of funding to introduce Native American students to baccalaureate and career opportunities in the biomedical sciences. As a result of this program, we plan to support and encourage a larger number of Native American students to pursue degree and career opportunities in the biomedical sciences. We also plan to increase the number of students that transfer to NAU from Dine College and to increase the retention and academic performance of these students once on the NAU campus. To achieve our goals, we plan to implement a Bridges to the Baccalaureate Degree Program, The specific aims of the program are: 1) To conduct an annual program to provide students at Dine college with information regarding career opportunities in the biomedical sciences and to encourage them to choose to pursue a baccalaureate degree in the biomedical sciences. 2) To develop a program of research seminars at Dine College with a goal of encouraging Native American students to pursue research and career opportunities in the biomedical sciences. 3) To provide up to ten annual scholarships to students at Dine College with a goal of encouraging the most promising students to become part of the Bridge program. 4) To host a 2-day orientation program at NAU to introduce Dine students and faculty to our campus, our research and laboratory facilities, faculty mentors that did not present seminars, and our minority academic support system. 5) To provide an 8-week summer research experience for up to ten students and two faculty from Dine College each under the direction of an NAU faculty mentor, with a goal of encouraging Native American students to pursue research opportunities in the biomedical sciences. 6) To provide a laboratory skills workshop and field work experience for the ten Native American students participating in the summer research experience. 7) To continue to provide research opportunities for Native American students who transfer from Dine College to biomedically related degree programs at NAU. Students will be encouraged to join active research programs funded through our Minority Student Development and Howard Hughes Medical Institute programs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CLINICAL OUTCOME OF HEMODIALYSIS IN UTAH Principal Investigator & Institution: Cheung, Alfred K.; Professor of Medicine; Internal Medicine; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2001; Project Start 30-SEP-1994; Project End 31-AUG-2004

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Summary: The mortality rate of U.S. chronic hemodialysis patients is higher than that in other industrialized nations. Available data suggest that this high mortality rate is partially a result of inadequate delivery of dialysis. The MMHD is a prospective, randomized, multicenter, two-by-two factorial trial sponsored by NIDDK to determine if increasing the amount of delivered dialysis (as assessed by a two-pool, variablevolume urea kinetic model) and using high flux biocompatible dialysis membranes would improve the clinical outcome of these patients. This application describes the University of Utah Dialysis Program (together with the Salt Lake City VA Medical Center dialysis unit) and proposes that this Program participates as a Clinical Center in the MMHD Full Scale Study. The University of Utah Dialysis Program consists of 7 dialysis units, some of which are located in suburban communities, that have common administrative and medical guidelines originating from the University headquarters. The VA-unit is also closely affiliated and has similar protocols. The investigators in this proposal have significant expertise in their respective areas. Both the institution and the investigators have a long tradition in laboratory and clinical dialysis research. They have recently performed several clinical studies involving patients from the different dialysis units within the Program. The P.I. has also participated in several multicenter clinical trials with centers outside Utah. The ESRD population in this Program has been growing. The number of in-center hemodialysis patients, as of December 31, 1993, was 237, of which 37% were diabetic. The majority of these patients are Caucasian (78%), but there is a significant fraction (5%) of Native Americans. This Program will recruit approximately 108 patients during the first 18 months of the Study and randomly allocate 60 of them to 4 hemodialysis treatment strategies that differ in the amount of delivered dialysis and/or the type of dialysis membrane. Sixty patients will be maintained throughout the study by using a "recruit to replace" strategy. Many of the medical and technical aspects of therapy, including nutritional intake, will be standardized during the baseline and a 60 month follow-up period. The primary outcome is death of the patient; secondary outcomes include non-access related hospitalization, hospitalization for heart disease or infection, and declining serum album in. The results from this trial will guide hemodialysis therapy in the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AMERICANS

COGNITIVE

EFFECTS

OF

SUBSTANCE

USE

IN

NATIVE

Principal Investigator & Institution: Halpern, John H.; Mc Lean Hospital (Belmont, Ma) Belmont, Ma 02478 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2004 Summary: This application is designed to train Dr. John Halpern to be an independent investigator with special skills in assessing both neuropsychological effects and cultural aspects of substance abuse. Dr. Halpern is now completing a third-year postdoctoral fellowship in substance abuse research at the Alcohol and Drug Abuse Research Center, McLean Hospital, Harvard Medical School-a nationally recognized major substance abuse research facility. Dr. Halpern has already published several peer-reviewed papers on substance abuse, most recently a critical review of studies of the long-term neuropsychological effects of hallucinogens-a class of drugs increasing in popularity among high school students and young adults, 1,2 yet still inadequately studied. Dr. Harrison G. Pope, Jr., the proposed mentor for this project, is a well-recognized substance abuse investigator with an established record of mentoring junior investigators. With Dr. Pope's guidance, Dr. Halpern has already obtained pilot data assessing neuropsychological performance in 42 Native Americans. Ten of these

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Native American Health

subjects are members of the Native American Church. The practitioners of this religion are virtually unique in North America in that they extensively ingest a hallucinogen, the peyote cactus, but typically use no other drugs. Thus, they offer a valuable opportunity to assess the long-term effects of hallucinogen use without the confounding effects of other substances. Dr. Halpern has also obtained pilot data on comparison groups of 11 Native Americans with past alcohol dependence and 21 Native American controls. Under Dr. Pope's mentorship, Dr. Halpern proposes to expand this work over the next four years to study an additional 210 Navajo subjects: 70 peyote users, 70 former alcohol users, and 70 controls. These data will provide information of major public health significance, both for the Native American population itself and for the population at large, regarding the long-term neuropsychological effects of hallucinogens and alcohol. Dr. Halpern will supplement this work with a full program of courses in the Harvard School of Public Health, leading to an MPH degree within the four years, and with continued didactic experience with Dr. Pope and other investigators at the Alcohol and Drug Abuse Research Center. This program will enable Dr. Halpern to become an experienced investigator, capable of designing and performing future studies independently. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE--BEHAVIORAL MEASUREMENT Principal Investigator & Institution: Giuliano, Anna R.; Associate Professor; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2003; Project Start 04-AUG-2003; Project End 30-JUN-2008 Summary: (Revised Abstract) (provided by applicant): The Behavioral Measurement Shared Service (BMSS) provides services to support AZCC researchers investigating behaviors such as diet and food consumption, physical activity patterns, body composition, tobacco exposure, solar protection, sexual practices, cancer screening knowledge, and lifestyle risk factors in the context of cancer prevention or therapy. This research requires accurate and reliable questionnaires and research designs for assessing human behavior related to primary and secondary prevention of cancer and for identifying atrisk populations in community and clinical environments. Behavioral assessment instruments are available across a wide range of behaviors, with specialized instruments for culturally diversified groups such as Mexican Americans and Native Americans. The BMSS provides an accurate and reliable source of technical support for the use of these tools (optical scanning technology, nutrition assessment software, and light pen entry system for developmental instruments). Consultation in research design development, measurement methodologies, and collection and analysis of data on human behavior remain important functions of the BMSS. The objectives of the BMSS are as follows: To provide consultation and expertise regarding the design, validation, and implementation of behavioral measurement instruments in the context of clinical research; To develop and provide standardized, validated questionnaires for assessing human behavior; To provide technical support for data collection in the following areas: physical activity, diet, solar protection, screening, body composition, sexual practices, tobacco use knowledge, and behavior assessment methods; To provide technical support on data management for research trials involving human behavior and behavior change. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORE--CANCER RESEARCH Principal Investigator & Institution: Baquet, Claudia R.; Associate Dean / Associate Professor Of; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2007 Summary: Background: Cancer is the second leading cause of death in the United States. Yet, while of national public health significance, cancer presents a disproportionate burden on health disparity populations (i.e. African Americans, Native Americans, rural and urban underserved and the poor, and certain Hispanic communities). The factors that produce disparities in incidence, morbidity, mortality and survival are complex. While some factors upon which interventions may be applied to reduce these disparities are known, there remain substantial unknown factors, which require rigorous investigation and discovery. This research core will focus on the spectrum of multidisciplinary research, from basic, clinical, translational, behavioral and health services research. The aims of this research core are consistent with the overall aims of the Center. The Cancer Research Core aims are: Specific Aim One: Foster Cancer Disparities Research at each Partnering Institution. Research will be consistent with the research aims of the UMSOM's Program in Oncology Cancer Disparities Program: surveillance, explanatory research, intervention, translation and application of results. Specific Aim Two: Create a UM Program in Oncology-wide focus on cancer disparities by increasing the number of UM investigators who incorporate disparities related aspects into their ongoing research. This will involve expanding the breadth and effectiveness of UMSOM cancer-related research to benefit minority and medically underserved populations in Maryland. Specific Aim 3: Create a stable, long-term collaborative relationship between UMES and UMSOM in cancer research, outreach, and faculty development that will increase the emphasis on problems and issues relevant to the disproportionate cancer rates in minorities in Maryland's urban and rural underserved communities. Specific Aim 4: Build and stabilize independent, competitive cancer research projects at UMES. Key activities designed to foster the interaction of faculty members of the UM Program In Oncology will allow the systematic increase in disparities research, training and community outreach and dissemination of research results at both UMSOM and UMES. Note that faculty of UMES have been members of the UMSOM Program in Oncology for over a year. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORE--CLINICAL Principal Investigator & Institution: Weiner, Myron F.; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002 Summary: The Clinical Core will recruit, diagnose and follow control subjects and patients with Alzheimer's disease (AD) and other dementias. We will provide wellsubjects, clinical data and body fluids to investigators at UT Southwestern and other institutions. Our emphases will be (a) recruiting, evaluating and following controls and AD patients, (b) providing to investigators materials for antemortem and postmortem studies, (c) employing SPECT in the differential diagnosis of dementia, (d) increasing service to and data collection from minorities and other under served populations, (e) designing and participating in studies through the Alzheimer's Disease Study Unit (ADSU) and contributing data to the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) (f) educating healthcare professionals in the diagnosis and management of dementing illness, and (g) analyzing and correlating our clinical data

16

Native American Health

with neuropsychological, imaging, CSF and neuropathological findings. We will continue to train and to monitor staff at our North Texas and Northern Oklahoma Satellites, which have given us access to a significant number of African-Americans, Hispanics and Native Americans. We will also encode data and collect CSF for those sites. We will direct vigorous efforts to increasing our recruitment of controls and following patients whom we have evaluated. To maximize patient retention, we will undertake a user satisfaction survey with the Education and Information Transfer (EIT) Core. Our research efforts will be focused, with the help of the Statistics and Data Management (SDM) Core, on analysis of data we gather routinely in patient evaluations, such as assessments of mood and agitation. We will add to our database the CERAD Behavioral Rating Scale for Dementia, and will continue to refine our databasing operation with the help of the SDM Core. We will continue our clinicopathologic conferences cosponsored by the Neuropathology Core. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE--CLINICAL Principal Investigator & Institution: Kaye, Jeffrey A.; Professor and Director of Adcc; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002 Summary: The Clinical Core operates as the unit of the OADC with responsibility for identification, recruitment, characterization, and follow-up of populations of wellcharacterized subjects for clinical dementia research. In order to fulfill this mission, the Clinical Core completes systematic assessments resulting in standardized diagnoses of the research cohort which are then entered into the relational database of the OADC. Many types of data are collected in order to be responsive to current and anticipated needs of the research community; clinical histories, physical and neurological examinations, neuropsychological and behavioral assessments, and laboratory data. The Clinical Core works closely with the other Cores of the Center to ensure if possible tissue donations (Neuropathology Core), characterization of genetic-associations (Genetics Core) and smooth transfer, entry, storage and eventual retrieval for analysis of the data. The Clinical Core is dedicated to on-going evaluation of its identified cohorts and to ensuring that no subjects are lost to follow-up. Several groups form a particular focus of the Clinical Core. These include Alzheimer disease patients, Parkinson disease patients and healthy elderly control subjects. The latter subjects are formed primarily from a unique community-based population of oldest old (those 85 years or older) who are at high risk to develop incident dementia over a five year period. The Clinical Core also enhances its research mission of the OADC through its Satellite Programs comprising of two main components: (1) an African-American minorities program in Northeast Portland targeted to enroll at least a representative sample of all elderly African-Americans with dementia in the Portland metropolitan area and (2) a rural Oregon program which enrolls subjects from 3 rural counties and Native Americans over 65 years of age residing on the Warm Springs Reservation. Clinical Core personnel will also function as a resource for consultation and guidance in designing and operating research projects in their early or developmental phases or to problem-solve at latter stages. Members of the Clinical Core will participate frequently in the educational and information transfer activities of the OADC. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: AMERICANS

CULTURALLY-APPROPRIATE

TREATMENT

FOR

17

NATIVE

Principal Investigator & Institution: Venner, Kamilla; Assistant Professor; Psychology; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): There are ongoing debates but very few empirical data regarding the development of culturally appropriate treatment methods for alcohol use disorders among Native Americans. The usual research-practice gap is further widened by the fact that many Indian people receive substance abuse treatment through separate programs specifically for Native American clientele but not usually empirically based. The University of New Mexico requests early career development and training support for Dr. Kamilla Venner, whose primary research interests are in the advancement of treatment methods for Native American peoples. Her training plan focuses on the development of independent investigator skills in three areas: (1) research design, statistics and grant-writing (2) research management skills and (3) training therapists to provide manual-guided therapies for use in future clinical trials. Each of these areas is incorporated into an integrated sequence of coursework, mentored research experience, training with expert colleagues and scientific writing. Her research plan builds upon her predoctoral research studying processes of recovery from alcohol dependence among Native Americans. One hundred Native Americans will be recruited to provide quantitative and qualitative data designed to describe the severity of alcohol problems, create a chronology of events used to resolve alcohol dependence, and examine factors contributing to change and maintenance. This research will yield the first empirical study examining the natural history of recovery events among Native Americans, and will contribute new cross-cultural knowledge regarding successful methods for resolving alcohol dependence. The primary goal of the proposed research is to advance knowledge about how current evidence-based treatment methods could be modified or supplemented to be more culturally appropriate for treating Native American patients and in training Native American practitioners. Dr. Venner's career plan includes the development of R03 and R01 proposals to develop and test such treatment methods within Indian-specific treatment services, thus forming a strong foundation for a research scientist career. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPING NATIVE AMERICAN SCIENTISTS Principal Investigator & Institution: Ruffolo, John J.; Research/Sponsored Programs; South Dakota State University Brookings, Sd 57007 Timing: Fiscal Year 2001; Project Start 01-AUG-2000; Project End 31-JUL-2004 Summary: South Dakota State University (SDSU) will collaborate with Lower Brule Community College, Oglala Lakota College, Si Tanka College, and Sisseton Wahpeton Community College [tribal colleges] to provide qualified Native American students enrolled in a two-year academic program at a tribal college and majoring in an area of science with academic and program support to: attain a high level of academic achievement; gain an appreciation for scientific research and career opportunities; transition from the tribal college to SDSU and complete their educational program for the baccalaureate degree. The goal is to increase the number of Native Americans who graduate with baccalaureate degrees in the sciences. The specific objectives (outcomes) are to: Expand collaboration of SDSU with tribal colleges in education and research; Increase awareness of professional opportunities in the sciences for Native Americans;

18

Native American Health

Increase access to education in the sciences for Native Americans; Increase retention and academic achievement of Native American students; Enhance the quality of science education at the tribal colleges: and Produce role models of educational and professional achievement among American Indians. The consortium will attain the project objectives by the following methods: Recruit and enroll qualified students into this program at the tribal colleges (8/year for 2 years); Facilitate transfer from tribal colleges to SDSU by course credit transfer articulation and orientation; Provide a system of student support through advising, mentoring, and counseling; Establish a program of mentoring and student research apprenticeships through individual funded projects; Enrich science curricula and develop science faculty at the tribal colleges through individual funded projects; Support visiting lectureships at tribal colleges by science faculty from SDSU. Establish and maintain a database on the students in the program; Track future placement and accomplishments of students in the program; and Assess program outcomes. By increasing access to education in the sciences for Native Americans this program aims to increase the number of American Indians who will become active in biomedical sciences and health professions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIABETES BASED SCIENCE EDUCATION IN TRIBAL SCHOOLS PROG* Principal Investigator & Institution: Abeita, Catherine L.; Southwestern Indian Poly Institute Institute Albuquerque, Nm 87184 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Jemez Valley Schools, Jemez's Indian Education Programs and Jemez Pueblo will collaborate with Southwestern Indian Polytechnic Institute to develop a science based diabetes prevention education curriculum for students in grades 7-12 that are aligned with national and state teaching standards and benchmarks. The curriculum design will enhance the understanding and appreciation of this devastating disease by the development of culturally appropriate activities and career awareness opportunities. The goal is two-fold: to enhance the students, family and community members as well as teachers' understanding of diabetes in order to prevent the development of diabetes and to help Tribal members better manage diabetes and, to increase the numbers of Native Americans entering the health science professions. The objectives of the Diabetes Based Science Education in Tribal Schools, Grades 7-12 program are: 1) To decrease the incidence of NIDDM [non-insulin dependent diabetes mellitus] among Native American populations, thereby decreasing diabetes related heart disease, glycemic, digestive and kidney diseases; and 2) To stimulate career choices in the Biomedical field among Native American students. The Curriculum will include: culturally sensitive teaching materials designed to enhance the understanding attitudes and knowledge levels of students in grades 7 - 12; hands-on, science based materials that reflect traditional learning styles emphasizing visual, spatial and perceptual modes of learning; multi-dimensional lesson plans facilitating ease of use in a variety of classrooms and core subject areas; diabetes education web site and lesson plan center; CD ROM will provide teacher support including educational tips and tools for distance instruction; and evaluation tools for pre and post-testing for determining the progress, attitude change and knowledge increase in students. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EIGHTH INTERNATIONAL WORKSHOPS ON OPPORTUNISTIC PROTISTS Principal Investigator & Institution: Cushion, Melanie T.; Associate Professor; Internal Medicine; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2004 Summary: (provided by applicant): The 8th meeting of the International Workshops on Opportunistic Protists (IWOP 8) will be held with the International Conference on Anaerobic Protozoa (ICAP) in Hilo, Hawaii July 25-29, 2003. This Workshop series focuses on the AIDS-related opportunistic protists, Pneumocystis, Cryptosporidium, Toxoplasma, microsporidia as well as the free living amoebae. The goals of the Workshops, sponsored by The Society of Protozoologists, were first set at the initial Workshop held in Bristol, U.K., 1988 and remain generally the same: a free exchange of information facilitated by open admission to the meeting and rapid publication of the proceedings. The organisms discussed at these scientific meetings are responsible for much of the morbidity and mortality in immunocompromised individuals. Although meetings sponsored by other organizations have had special sessions on one or several of these opportunistic pathogens, the Workshops on Opportunistic Protists have become the primary mechanism by which many investigators gather to obtain comprehensive information that focuses only on these eukaryotic pathogens. This is the one crossdisciplinary meeting in which most major research groups working on these organisms participate. The rapid publication of the proceedings resulting from these workshops in The Journal of Eukaryotic Microbiology ensures efficient dissemination of up to date information on these pathogens and the diseases they cause. One of the outstanding features of the Workshops is that participation (presentations by platform or poster) is open to anyone wishing to present their findings; the only requirement being registration and attendance. Another is the use of the Workshops as a forum to make community decisions on matters such as gene and species nomenclature. Previous NIHfunding of these Workshops has been used to promote participation by young investigators, minorities, and students by issuance of travel awards and remains a primary budgetary item in the present proposal. Additional support is requested for the rentals and supplies necessary to ensure a high quality meeting. For the first time in the history of the Workshops, specific and widespread advertisements for minority travel awards targeting students and young investigators will be implemented. We hope to not only increase diversity in this manner, but also foster the entrance of young investigators into these fields. The site of the meeting, Hilo Hawaiian International Hotel, is handicap accessible and adheres to all regulations and guidelines governing handicap access. The joint sponsor is the University of Hilo, Hawaii. The organizers of IWOP 8 reflect the population diversity of the USA and the meeting attendees: Cushion, Kaneshiro, Marciano-Cabral, and Mead are females; Lindsay and Weiss are males. Mead's and Cushion's ancestors include native Americans; Marciano-Cabral is Hispanic; Kaneshiro has Pacific-Asian ancestry; Lindsay, Weiss are white. Lindsay is a physically handicapped individual. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ENHANCING NATIVE AMERICAN PARTICIPATION IN RT TRIALS Principal Investigator & Institution: Petereit, Daniel G.; Radiation Oncologist; Rapid City Regional Hospital Rapid City, Sd 57701 Timing: Fiscal Year 2002; Project Start 27-SEP-2002; Project End 31-AUG-2007

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Summary: (provided by applicant): The Cancer Care Institute (CCI) in Rapid City, South Dakota, serves approximately 100,000 Native Americans from three reservations. Some patients live up to four hours from the cancer center. Identifying barriers which prevent Native Americans from presenting with earlier stages of cancer, or in some circumstances not at all, will be investigated. A culturally responsive questionnaire will be administered to randomly selected Native Americans on the reservation who do not have cancer. A second questionnaire will be given to cancer patients, and address similar issues, but concentrate on additional questions of oncologic relevance. It is hypothesized that a major barrier is geographic dislocation from cultural/community roots close to home. Traditional radiotherapy involves a 6 to 8 week course and daily treatments. This treatment approach may represent a major barrier. With the use of advanced technologies such as intensity modulated radiotherapy and brachytherapy, the treatment course can be shortened to 1 to 4 weeks. Therefore, to address this barrier, clinical trials have been developed which shorten treatment duration. A series of phase II studies are proposed for malignancies commonly seen among the Native Americans: metastatic disease, non-small cell lung (NSCLC), breast, prostate and head and neck (H and N) cancer. For patients with stage I and II breast cancer, high-dose-rate (HDR) brachytherapy will be substituted for a conventional course of external beam radiation. Patients with advanced prostate cancer will be treated with a 2 week course of conformal external beam radiation followed by an HDR implant in combination with androgen ablation. Pilot tomotherapy trials are proposed for patients with metastatic disease, locally advanced H&N, and NSCLC. The final pilot trial will investigate the use of HDR brachytherapy alone for early stage prostate cancer. A genetic milieu may exist which renders Native Americans more sensitive to radiation. Therefore, a laboratory study will be conducted to investigate whether Native Americans have a higher mutation rate of the AT (ataxia-telangiectasia) gene determined through HPLC of the peripheral blood lymphocytes. Through patient education, screening, assessing potential barriers to health care, and innovative treatment strategies, it is hoped that Native Americans will eventually present earlier in their disease process. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AMERICANS

ENVIRONMENTAL

RESPIRATORY

DISEASE

IN

NATIVE

Principal Investigator & Institution: Burchiel, Scott S.; Medicine; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 31-MAR-2004 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EVALUATION OF ALASKAN PLANTS FOR TUBERCULOSIS TREATMENT Principal Investigator & Institution: Smith, David C.; Alaska Green Gold Box 100558 Anchorage, Ak 99510 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2004 Summary: (provided by applicant): This proposal aims to evaluate the efficacy of Native American ethnobotanical treatments for tuberculosis for the purpose of making available acceptable, affordable alternatives to current TB drugs, especially in developing countries with massive TB case loads such as the People's Republic of China. No new drugs have been introduced for the treatment of tuberculosis for the past 30

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years. Today the world faces a resurgence of tuberculosis, the number one bacterial killer and an intensive search has been launched to find new drugs, primarily in the public, academic and biotech sectors. One of the confounding factors is the high cost of any new drug development (and thus cost of the drugs to the public) together with the relatively low profit potential for TB drugs, thus discouraging big pharmaceuticals from investing in TB. Native Americans relied entirely upon botanical treatments for tuberculosis following the epidemics that occurred with the introduction of this disease by the European colonialists. Some of these treatments continued to be used ethnomedically throughout the 20th century. Preliminary phytochemical and bacteriological studies confirmed the anti-TB activity of 2 such plants but studies were discontinued prematurely due to lack of funds (and perceived lack of urgency at the time). This study will evaluate the activity of ethobotanical and organic solvent preparations of 2 plants in mice infected by aerosol with low doses of Mycobacterium tuberculosis. Both acute and chronically infected mice will be treated for 2-3 weeks and the treatment evaluated by determining the number of bacteria in lungs and comparing to untreated controls. Concurrent with this evaluation will be a bioassay-guided fractionation of the plants in order to identify the active principle(s) for the purpose of standardization of botanical preparations. At every step of the fractionation, both cytotoxicity and anti-TB activity will be assessed in an attempt to identify a preparation requiring minimal processing that possesses maximum selectivity for the tubercle bacillus. Such a preparation would be the subject of further development for use in clinical TB. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FAS, SIDS AND STILLBIRTHS IN CAPE TOWN, SOUTH AFRICA Principal Investigator & Institution: Jacobson, Sandra W.; Professor; Psychiatry & Behav Neuroscis; Wayne State University 656 W. Kirby Detroit, Mi 48202 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2006 Summary: (provided by applicant):Sudden infant death syndrome (SIDS) is a leading cause of infant mortality with incidence of about 0.8/1000 live births in the U.S. and considerably higher rates in at-risk populations, including Native Americans and the Cape Coloured (mixed ancestry) community in South Africa. A recent study has implicated prenatal alcohol exposure as an important risk factor for SIDS that warrants further investigation. It has been hypothesized that medullary serotonergic network deficits may be responsible, in part, for some SIDS deaths. For the past 5 years, we have been conducting a prospective, longitudinal study on the effects of prenatal alcohol exposure in the Cape Coloured community in collaboration with researchers from the University of Cape Town School of Medicine. This research has demonstrated our ability to recruit mothers from this community; obtain valid assessments of FAS, prenatal alcohol exposure, maternal alcoholism, smoking and depression, and socioenvironmental and medical risk; and perform state-of-the-art infant neurobehavioral assessments with Cape Town infants. We have found an exceptionally high rate of alcohol abuse and dependence among pregnant women in this population and of FAS among their infants. The high incidence of both SIDS and FAS in this large metropolitan area, the readily accessible maternal heavy drinking population, and our established, productive research collaboration make Cape Town uniquely appropriate as a Comprehensive Clinical Site. The proposed cooperative agreement would expand our ongoing collaboration to include researchers in pathology and obstetrics. The aims are (1) to conduct an assessment of the incidence of SIDS and stillbirths in Cape Town, using contemporary diagnostic criteria and procedures, including neuropathological

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examinations of SIDS victims and controls; (2) to test the hypothesis that prenatal binge drinking increases the risk of SIDS and to evaluate that risk in relation to risks associated with prenatal maternal smoking, preterm birth, infant gender and sleeping position, seasonal variation, parental education, and maternal depression; (3) to test the hypothesis that certain moderator variables-- years of drinking, severity of maternal alcohol abuse and dependence, lower maternal weight and prenatal smoking, and the absence of an ADH2*2 allelo will increase the risk of SIDS in alcohol-exposed infants; and (4) to examine whether heavily alcohol-exposed neonates will exhibit alterations in autonomic nervous system behaviors similar to those described in SIDS victims, which are known to be regulated by the medullary serotonergic system, including arousal, cardiorespiratory reflex integration, and sleep/wake patterns. This research has the potential to improve our understanding of neurophysiological mechanisms involved in SIDS and to contribute to developing interventions for mothers and infants whose behaviors indicate that they are at risk for this adverse outcome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC EDUCATION FOR NATIVE AMERICANS Principal Investigator & Institution: Burhansstipanov, Linda; Executive Director; Native American Cancer Research 3022 S Nova Rd Pine, Co 804707830 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-MAR-2003 Summary: The proposal addresses the area of genetic research and testing among Native Americans, particularly so that they can make informed decisions related to genetics. Although the need for genetic information by all individuals cannot be understated, it is especially important for genetic information to be presented in a culturally acceptable manner. The 3 year project intends to modify existing genetics education curricula to create culturally competent education interventions (i.e., independent modules and a 20-hour comprehensive intervention) which will be targeted to the Native American college and university students, and to educators who teach Native Americans. The genetic education interventions are destined to improve the Native Americans' understanding of genetics, thereby helping the student to make decisions based on sound information and cultural perspectives relevant to their local tribal Nation. This educational intervention will assist in informing and in encouraging Native American students to pursue genetic science careers, including genetic counseling and research. The interventions will be implemented in geographically diverse settings throughout the U.S., primarily in conjunction with selected Native American science and education conferences and meetings, in order that more Native Americans can benefit from the proposed genetic education interventions. The specific aims are to (1) develop, pretest, refine, promote, implement, and evaluate the effectiveness of culturally competent genetic education interventions (e.g., individual modules and comprehensive workshop) for Native American college and university students, and educators; (2) pretest and modify culturally relevant genetic educational information and resources, including, pre- and post-tests for the educational interventions; (3) compare the effectiveness (knowledge and attitudes) of the individual education modules implemented independently with the same module implemented as part of the 20-hour comprehensive education workshop; and, (4) initiate the development of a national database of scientists willing to provide genetic research mentorship opportunities, and Native American students (college and graduate students) who are interested in genetic education, research and care. The overall goal of this application is to develop culturally acceptable materials providing Native American

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students with information so that they can make informed decisions about genetic issues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HARVARD MENTORED CLINICAL SCIENTIST DEVELOPMENT PROGRAM Principal Investigator & Institution: Lipsitz, Lewis A.; Professor of Medicine; Divison on Aging; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-AUG-1985; Project End 30-JUN-2004 Summary: This revised competing renewal proposal seeks support to continue a highly successful, NIA-funded Mentored Clinical Scientist Development Program Award. The program represents a major, multidisciplinary and interdepartmental collaboration among the medical school, school of public health, as well as the affiliated institutions in the Longwood Medical Area and around Boston. We have increased our efforts at recruiting candidates widely, including those who are members of under-represented minorities in aging research, and those who are from other medical schools including schools of osteopathy. We have provided information on eight superb prospective trainee candidates of which five are women, three are African American, one is Hispanic, and one is a doctor of osteopathy working with underserved elderly (including Native Americans) in rural Maine. Many of these candidates are interested in pursuing research in public and social medicine, especially the care of minority elderly in the underserved, inner-city and underserved rural communities of America. The proposed Program is designed to support and enhance research experience in several interrelated gerontologic disciplines. Six specific areas will be emphasized. These are (1) cardiovascular disease, (2) cell proliferation disorders, (3) neurodegenerative disease and dementia, (4) endocrine/renal dysfunction, (5) geriatric syndromes, and (6) public health. More than 50 experienced, well-funded faculty scientists (20 of whom are women), many of whom are established gerontologic investigators, will serve as potential primary or secondary mentors for the clinician scientist trainees. A dual mentoring system has been implemented to ensure ongoing exposure to gerontologic/geriatric expertise and orientation. Ultimately, we plan to develop the trainees into clinician investigators who can facilitate the translation of important research findings into improved care for all older Americans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HAZARDOUS MATERIALS WORKER SAFETY AND HEALTH TRAINING Principal Investigator & Institution: King, Judith L.; Associate Professor; Educational Development; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 16-SEP-1992; Project End 31-AUG-2005 Summary: The University of Alabama at Birmingham 's Center for Labor Education and Research, in its application for funding an EPA- HWWT cooperative agreement, will provide courses to four populations of workers who share the need for general and specialized training in topics related to 29 CFR 1910.120, Hazardous Waste Operations and Emergency Response. The overall goal is to improve the health and safety of members of the Communications Workers of America (CWA), Native Americans, emergency health care providers and fire fighters, by helping them reduce exposures to hazardous chemicals. Classes include Hazardous Materials Awareness, Operations, and Technician, adapted for the four different training populations; Handling Contaminated

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Patients; Hazardous;SCBA Fit Testing; Air Surveillance in Chemical Emergency Incidents; Health Effects of Chemical Exposure; Confined Space Entry and Rescue, Hazardous Waste Handling; and Worker Training Methods. Classes will be taught in train-the-trainer mode, and materials provided for workplace training by the participants and for outreach to their respective communities. The four target populations have in common their potential for exposures to chemicals, training budgets that are inadequate or nonexistent, and job- and finance- related restrictions on extensive travel for training. CWA workers in manufacturing, product distribution and service, health care, printing and publishing, and numerous crafts will have regional classes throughout the United States, as will members of all 557 federally-recognized Native American tribes. Indian law enforcement officers, fire fighters, highway and hospital workers, emergency planners, natural resource personnel, environmental planners, and search-and-rescue units will be trained in safe Awareness Level response and Incident Management in classes coordinated through cooperation with the Native American Fish and Wildlife Society. In the southeastern United States, emergency room personnel will be trained to handle contaminated patients; surveys show most are unprepared for this problem and are in violation of the regulations of several agencies, including OSHA 1910.120. Because fire fighters have increased risk of diseases shown to be related to the inhalation of chemicals and smoke, they will be trained in toxicology, fit testing, air monitoring, and rescue from confined spaces with hazardous atmospheres. Computer-based asynchronous training will be utilized to achieve some of the objectives, and this method formally compared with traditional training. Professional safety and health trainers will develop and deliver all training using curricula developed and piloted under previous cooperative agreements. Total number of trainees will exceed 20,000, with tribal peer trainees and community outreach participants not included in the estimate. The total proposed cost of the five- year project is 3,296,947 dollars. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEALTH SURVEY OF TWO-SPIRITED NATIVE AMERICANS Principal Investigator & Institution: Walters, Karina L.; Associate Professor; None; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 28-JUN-2002; Project End 31-MAY-2007 Summary: (provided by applicant): American Indian and Alaskan Native lesbian, gay, bisexual, transgendered, and two-spirited individuals (two spirits) are a drastically understudied and underserved group, at risk for multiple health and mental health problems. There are no national, quantitative, representative studies of this population on any topic. This application, in response to PA-01-096, is for a FIRST TIME R01 by a NEW INVESTIGATOR. Building upon solid preliminary data, it proposes three innovative and significant aims. First, we will conduct structured survey interviews with 400 two spirits drawn from six sites across the U.S. With these interview data, we will test a theoretical model of stress and coping specific to this population. Sub-aims are to (a) establish preliminary prevalence rates of trauma and health outcomes (i.e., HIV sexual risk behaviors, alcohol and other drug use, and mental health indicators); (b) test the direct associations between trauma and health outcomes; (c) determine how cultural and spiritual coping factors moderate the effect of trauma on health outcomes; and (d) examine the mediating role of substance use on the trauma-HIV sexual risk behavior and trauma-mental health relationships. The second aim is to test the, feasibility of an innovative non-probability sampling methodology that combines targeted, partial network, and respondent-driven sampling procedures in order to

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approximate a representative national sample of two spirits. Additionally, we will test the feasibility of two different mechanisms (agency based vs. census based) by which we execute this sampling method. Our results will contribute toward the refinement of a sample strategy useful in studying other hidden and stigmatized populations. Our third and final aim is to conduct a qualitative study involving 12 focus groups and 60 key informant interviews in order to identify emergent themes regarding stressors and coping strategies specific to two spirits. Through the course of this project, we aim to develop the research infrastructure at the six community agencies comprising our participant recruitment sites in order to facilitate future goals of designing and evaluating interventions to address the urgent needs of two spirits. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEPATITIS C VIRUS REPLICATION AND LIVER INJURY Principal Investigator & Institution: Fausto, Nelson; Professor and Chairman; Pathology; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 30-JUN-2005 Summary: (Adapted from application): Hepatitis C is an emerging infectious disease of major public health importance. Approximately 2% of the population of the USA and Europe are chronically infected with hepatitis C virus (HCV). Although major progress has been made in studies of the HCV genome and its encoded protein, basic aspects of the mechanisms of HCV pathogenesis are still poorly understood. One of the major difficulties has been the lack of an adequate tissue culture in which to study the interactions between HCV and hepatocytes, its natural host. Furthermore, the mechanisms of viral persistence and quasispecies evolution in HCV infected patients as well as the relationships between viral replication and disease progression remain to be determined. This application seeks to study the relationships between HCV replication and hepatocyte injury in a newly developed tissue culture system for human fetal hepatocytes (HFH) as well as in the human host. It is hypothesized that cell killing by apoptosis, preservation of permissive cells in which the virus persists and activation of cytokine signaling are events that occur in HCV infection and can be modified by the virus, the hepatocyte as its natural host or by interaction between virus and host cells. The application consists of 3 projects and 2 cores. Project 1 proposes to analyze HCV replication and the mechanisms of HCV-induced apoptosis in cultures transfected with full length HCV RNA or a 3'deleted virus used as control as well as in HFH cultures infected with patient sera. Project 2 will use cDNA microarrays to conduct a comprehensive analysis of gene expression in HFH transfected with full length and mutant HCV RNAs and investigate the effects of interferon on these cells. Project 3 will investigate the relationships between HCV replication, quasispecies evolution and hepatitis C disease progression in a population of Alaskan Native Americans (ANA cohort) from which serum, liver biopsies and clinical and epidemiological data have been collected. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HOWARD UNIV.EXCELLENCE IN HEALTH PROFESSIONAL EDUCATION Principal Investigator & Institution: Lecca, Pedro J.; None; Howard University Washington, Dc 20059 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2003

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Summary: (provided by applicant): The purpose of this proposal is to extensively expand the teaching, research and recruitment endeavors of Howard University, College of Pharmacy, Nursing, and Allied Health Sciences through the formation of the Excellence in Health Professional Education Program. This program will be closely affiliated with the Center of Excellence in the School of Pharmacy, and will function with the following primary goals; a. Reduce the disparities in professional health education training among African-Americans, Hispanics, Native Americans, and other underserved populations through the funding of merit-based tuition scholarships; b. Improving student performance in the health professional programs through the Endowment Fund Summer Academy, and enhancement of tutorial and remediation programs. These elements are critical to the success of our institution in the recruitment and retention of talented minority students and the development of our professional programs at this institution in the healthcare arena. The administrative functions of this program will be executed through the Principal Investigator (PI), Co-investigators, Project Director, and an Administrative Assistant. The PI will have prime responsibility for development and implementation of policies and procedures, and execution of all requirements of the grant as specified by NCMDH, National Institute of Health (NIH). Again, the Excellence in Health Professional Education Program will enhance the efforts of the existing Center of Excellence, and provide resources for the development of needed educational and financial programs to aid in the efforts to increase opportunities for health professional training among ethnic minorities, and socioeconomically disadvantaged students. Howard University is applying as a S-22 Institution based upon the criteria established for this RFA. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HUMAN DIVERSITY IN KILLER CELL INHIBITORY RECEPTOR GENES Principal Investigator & Institution: Parham, Peter R.; Professor; Structural Biology; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2002; Project Start 01-MAY-1981; Project End 31-JAN-2004 Summary: Since its inception the goal of this project has been to understand how HLA class I polymorphisms modulate the immune response to viral infections and transplanted tissues. Initially, the cytolytic T cells of adaptive immunity formed the functional context for the research. They are now joined by the natural killer (NK) cells of innate immunity, which are also regulated by cell-surface receptors that interact with HLA class I determinants. These receptors consist of two kinds: CD94:NKG2 and killer cell inhibitory receptors (KIR), encoded by gene families unlinked to the HLA complex. Within individuals, expression of different receptor combinations by subsets of NK cells creates diverse NK-cell repertoires. Such repertoires are influenced by the HLA types of individuals and also by differences in their KIR. Whereas knowledge of HLA class I polymorphism is fairly complete, that of KIR is rudimentary. An initial survey reveals diversity in KIR phenotype, due both to the types of KIR genes, as well as their allelic polymorphism. A systematic analysis of KIR gene diversity will in four Aims test hypotheses emerging from the initial survey. To define individual KIR haplotypes, recently developed DNA typing methods will be used in Aim 1 to track the segregation of Kir genes in families. In Aim 2, a multiethnic panel of B-cell lines will be analyzed by Southern blotting and DNA typing. This approach will assess the extent of KIR genotype and haplotype diversity in the human population. Aim 3 will define the extent of allelic polymorphism at each of the Kir genes by cDNA cloning and sequencing. Analysis of these sequences will place KIR diversity in the context of the three-

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dimensional structure of KIR glycoproteins and their function, and assess the importance of natural selection. An expanded database of accurate KIR nucleotide sequences will permit design and development of high-resolution KIR typing, applicable to the study of populations, disease associations and clinical outcome in transplantation. Aim 4 is a study of KIR in Native Americans, populations whose genetic diversity is most likely due to natural selection rather than population admixture. This study will provide a yardstick for KIR diversity in other populations, assess KIR diversity that can be maintained under natural selection, and determine whether KIR have, like HLA class I, undergone rapid evolution in South America. The proposed investigation of KIR diversity will greatly benefit from prior experience with HLA class I diversity, and will complement genomic analyses of the KIR gene family from other laboratories. Collectively, the four Aims should give a picture of KIR diversity and an understanding of how polymorphic KIR and their HLA class I ligands assort in human population to produce NK-cell receptor repertoires. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INCREASING DIVERSITY IN NEUROSCIENCE RESEARCH Principal Investigator & Institution: Berger-Sweeney, Joanne E.; Associate Professor; Society for Neuroscience 11 Dupont Cir Nw, Ste 500 Washington, Dc 20036 Timing: Fiscal Year 2002; Project Start 20-JUL-2000; Project End 30-JUN-2005 Summary: In 1991, the Society for Neuroscience (SFN) established a fellowship program to increase the pool of underrepresented minority groups pursuing careers in mental health-related neuroscience research and teaching programs. This Fellowship Program is now under new direction and the SFN has developed an innovative 5-year program to recruit, train and track outstanding individuals of traditionally underrepresented racial and ethnic minorities (African Americans, Hispanics, Native Americans, Alaskan Natives, and Asian/Pacific Islanders) to work in preeminent neuroscience research laboratories. The integrated study of the nervous system has evolved into one of the most challenging areas of mental health research. Although some strides have been made in increasing representation of racial and ethnic minorities in mental health research careers, equity has not been achieved in either academia, industry or government research arenas. The SFN, as the largest organization of researchers studying the nervous system, is ideally suited to direct a national effort to increase the diversity of the pool of individuals participating in neuroscience research. The objectives of this 5 year program are to: a) recruit and select individuals of underrepresented minorities for 8 predoctoral fellowships and 3 postdoctoral fellowships, b) support the development of each Fellow through networking, mentoring, and enrichment activities, c) develop an organizational structure to support the program and coordinate with other established minority fellowship programs, d) track the Fellows and counsel them in ethical conduct of research, and e) undertake an evaluation of the program since its inception in 1991 to determine the most effective strategies to support and retain underrepresented minorities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INFO CONFERENCE - MINORITIES ON THE HUMAN GENOME PROJECT Principal Investigator & Institution: Malvern, Kathryn T.; Zeta National Educational Foundation 1734 New Hampshire Ave Nw Washington, Dc 20009 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 28-FEB-2004

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Summary: (provided by applicant): This project is an Information Conference for Minorities on the Human Genome Project: The Challenges and Impact of Human Genome Research for Minority Communities. The two-day conference is designed primarily for representatives from the minority communities (African-Americans, Hispanics, Asian Americans, Native Americans), but will be open to all interested persons. Outreach for conference attendance will be targeted to minority community leaders, community organizations, churches, educators, government officials, fraternal groups, civic and social groups, business and professional organizations, and health care organizations. The project's broad objective is to raise the level of awareness in minority communities of the rapid strides being made in human genome research, and the potential and value to minorities, particularly with respect to health care; to identify issues that are important to the minority communities and avenues for more involvement of these communities; and to explore post-conference ways of continuing input. Through presentations, workshops and open discussions, the conference will address the ethical, legal and social issues raised by human genome research developments; the impact on treatments for health problems such as sickle cell anemia, cancer and other physical and mental health concerns. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INSTITUTIONAL NATIONAL RESEARCH SERVICE AWARD HISPANIC * Principal Investigator & Institution: Hromas, Robert A.; Medicine; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2009 Summary: (provided by applicant): The percentage of scientists investigating Lung and Blood disease that belong to ethnic minorities is far below their representation in the general population. This is also a self-perpetuating phenomenon, where the lack of role models and supportive mentors produces further declines in the number of minorities seeking advanced degrees in these fields. To address this, there has been a concerted effort to increase the number minorities obtaining advanced degrees in biomedical research. However, these efforts have not been as successful as hoped, mainly because there are simply not enough qualified undergraduate students applying for advanced degrees in these fields. Therefore, the most important method of increasing the number of minorities entering biomedical research as principle investigators is to increase the undergraduate applicant pool for these advanced degrees. Perhaps the best way to increase the undergraduate applicant pool would be to provide minority undergraduate students an exciting and rewarding experience in biomedical research early in their collegiate career, before they have made career decisions. This proposal seeks funds to provide rewarding research experience to minority undergraduate students in New Mexico in a Research Internship Program (RIP). There are three unique advantages to this proposal. First, New Mexico is a minority-majority state, where Hispanics and Native Americans together represent the majority of the population. Second, the University of New Mexico has long established and nationally-recognized research programs in pulmonary and hematologic diseases. Third, the University of New Mexico has a highly successful undergraduate training program to assist minorities entering careers in clinical medicine. A minority student research program here would 1) Recruit ten Hispanic or Native American students per year for 3 months of remunerated research in pulmonary or hematology research, 2) Assist in the presentation of their research at national meetings or in publications, 3) Mentor these students during and

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after the research program to enhance retention in a research career track, and 4) Assist these students in the application process for graduate degree programs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTERDISCIPLINARY SUMMER BIOMEDICAL RESEARCH FOR UNDERGR Principal Investigator & Institution: Slaughter, Gayle; Associate Professor; Molecular and Cellular Biology; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 01-MAR-2001; Project End 28-FEB-2005 Summary: (taken from application): This project will provide a 10-week summer mentored biomedical research experience to 10 undergraduates each year who are majoring in a physical science (chemistry, physics, etc.), computer science, engineering or mathematics. Students will be participants in biomedical projects at the forefront of research, often using high-tech equipment. Their projects will span the spectrum of biomedical research and be designed to make use of their specialized skills and introduce them to the opportunities for careers in biomedical research. They will make a final oral or poster presentation on their work and write a critiqued abstract. Students will realize how valuable their talents and skills are through solving biomedical problems. The participants will be co-registered in the SMART Program at Baylor College of Medicine (www.bcm.mac.edu/smart/). They will have access to all elements of the SMART Program including the unique daily interdisciplinary Fundamentals and Frontiers of Biomedical Research seminar series, a weekly research discussion group, career development activities and career counseling. Participants will have the opportunity to enroll in the SMART GRE Prep Course, which has helped more than 50% of the enrollees raise their general GRE Scores by more than 300 points with limited interference to their research productivity. Social activities and dormitory housing in the Texas Medical Center will facilitate interaction between the 80-90 participants in the umbrella SMART Program. Students from different majors and backgrounds will learn about science, careers and life from each other. Participants will be chosen from a variety of disciplines and campus environments, with a concerted effort to recruit students from populations that are under-represented in SMET (science, math, engineering and technology), including women, African Americans, Hispanics, Native Americans and Pacific Islanders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MARC AT ARIZONA STATE UNIVERSITY Principal Investigator & Institution: Bustoz, Joaquin; Zoology; Arizona State University P.O. Box 873503 Tempe, Az 852873503 Timing: Fiscal Year 2003; Project Start 01-JUN-1993; Project End 31-MAY-2008 Summary: (provided by applicant): This proposal seeks to increase the participation of currently underrepresented minorities in bio-medical research. There is a special focus on Native Americans in the proposal. Minorities, especially Native Americans, suffer disproportionately from health problems. Increased participation in bio-medical research by members of these groups will help to address this problem. The proposal identifies recruitment of high potential minority students into appropriate university science majors as the first step in the solution. These recruitment efforts must reach into minority communities and reservations, contacts must be made with secondary school students and their families; this is being completed by the SUMS Institute. The desired outcome of these recruitment efforts is full-time enrollment in a science major at Arizona

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State University. The second step in the solution is the main focus of this MARC proposal. This involves a nucleus of minority students already enrolled at Arizona State University. This proposal seeks to recruit high potential minority students into the MARC and PreMARC programs via an intensive summer course on Minority Health Issues and Science Research. Newly recruited students will join this existing nucleus of like-minded minority students (Pre-MARC and MARC trainees) majoring in areas such as Biology, Mathematics, Chemistry, and Physics. They will become members of an undergraduate research community whose members have high aspirations. Through the Pre-MARC and MARC programs, these students will be introduced to research, they will work with carefully selected faculty mentors who will teach and guide them. Throughout, the students will have a support structure that includes faculty mentors, MARC advisement, mandatory MARC coursework and the Guaymas Course, as well as individual tutoring when necessary. In their first two years of university they must develop the self-confidence necessary to persist in difficult majors, the PreMARC program is designed to do just that. The support structure, which already exists at Arizona State University and in the SUMS Institute, is an indispensable part of this process. Their last two undergraduate years, years where they will be MARC trainees, are very critical, this is the time when they will rely on the self-confidence they have developed in order to graduate with academic records that are competitive for admission to graduate school. They will have well-developed academic and research skills that will sustain them through graduate school and into professional research careers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MATERNAL ANTITHYROID ANTIBODIES AND CONGENITAL HYPOTHYROIDISM IN NATIVE AMERICANS Principal Investigator & Institution: Selva, Karin A.; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MINORITY SCIENTIST DEVELOPMENT PROGRAM Principal Investigator & Institution: Weiss, Richard L.; Professor; Chemistry and Biochemistry; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 30-SEP-1996; Project End 31-JAN-2006 Summary: (provided by applicant): The long-term objective of this proposal is to increase the number of underrepresented UCLA students who go on to enter careers in biomedical research. The general approach proposed to meet this objective is to interest students from those ethnic groups that are significantly underrepresented in science programs nationally (African Americans, Hispanic Americans [Chicanos and Latinos], Puerto Ricans, Native Americans, Alaskan Natives, and Pacific Islanders) in biomedical research careers and to prepare them for success as undergraduate and graduate students. The specific goals are to increase the number of UCLA undergraduates from underrepresented groups who complete majors in the biomedical sciences, enter into graduate studies at UCLA (and other institutions) in areas of biomedical science, and subsequently pursue careers in biomedical research. The UCLA Minority Scientist Development (MSD) program will build a cadre of underrepresented undergraduate

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and graduate students in the biomedical sciences, supporting them with university resources, mentors, and promising career experiences. The MSD program has three major components: outreach, recruitment and preparation for university life; academic support and enrichment; and research training and career development. Through the MSD program and experience gained from other science development programs, we can increase the numbers of underrepresented students at UCLA who enter into biomedical related majors and who successfully complete both undergraduate and advanced programs in these majors, leading to careers in biomedical research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MONTANA CANCER CONSORTIUM Principal Investigator & Institution: Cobb, Patrick W.; Md, Facp; Montana Cancer Consortium 1236 N 28Th St, Ste 204 Billings, Mt 59101 Timing: Fiscal Year 2002; Project Start 18-SEP-1995; Project End 31-MAY-2003 Summary: (Applicant's Description) The Montana Cancer Consortium (MCC) consists of three components (two from Billings and one from Great Falls) and seven affiliates (Missoula, Helena, Kalispell, Butte, Bozeman and Great Falls). The Consortium encompasses a catchment area which includes the entire state of Montana with extension into Wyoming, Idaho, and the Dakotas (some 150,000 sq. miles/population of 900,000). This area is uniquely rural, as well as home to Native Americans from eight reservations which are served by MCC. The Consortium has a centralized data management office in Billings which serves to register participants and transmit data to the national cooperative groups. The components and affiliates of the MCC have been accruing participants on NCI-approved clinical studies for more than 18 years with a current composite total of 2200 patients. All medical oncologists from the state of Montana will be participating in the Montana Cancer Consortium. Objective 1: Accrual. MCC has named the Southwest Oncology Group (SWOG), the National Surgical Breast and Bowel Project (NSABP) and Gynecologic Oncology Group (GOG) as primary research bases with future addition of Radiation Therapy Oncology Group (RTOG). First-year therapeutic credits are projected at 70. Cancer control credits for the first year are projected at 75. This clearly exceeds the requirements of the RFA for 50 treatment credits and 50 cancer control credits. Objective 2: Quality. MCC centralized data management for this large geographic area to one office in Billings. Centralization will facilitate registrations and data management for 22 participating Montana Oncologists and expedites the transmittal of data to the research bases. Quality of data submitted to the national groups will be enhanced by quality assurance measures within the central office. Centralized data management will add to the efficiency of quality assessments (i.e. site visits). Objective 3: Access. The cooperative effort of the MCC with hospital and health care providers from Montana and surrounding states will improve access to state-of-the-art cancer treatment and prevention for an extensive, largely rural population. The network of oncologists will provide a higher profile for clinical trials which will create a stimulus to increased accrual. By promoting protocol participation in this geographically unique area with its inclusion of the minority component, MCC provides an excellent site for diffusion of knowledge and improved cancer care in a consortium which embodies the NCI's CCOP intent. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NATIVE AMERICANS AND RESEARCH CAREERS Principal Investigator & Institution: Matyas, Marsha L.; Education Officer; American Physiological Society 9650 Rockville Pike Bethesda, Md 20814

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Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2005 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NATIVE AMERICANS IN BIOLOGICAL SCIENCE AT OK STATE UNIV Principal Investigator & Institution: Miller, Robert V.; Microbiol & Molecular Genetics; Oklahoma State University Stillwater Stillwater, Ok 74078 Timing: Fiscal Year 2004; Project Start 05-MAR-2004; Project End 30-APR-2008 Summary: (provided by applicant): The Native Americans in Biological Sciences (NABS) program at Oklahoma State University (OSU) is designed to increase the number of Native American students at OSU who successfully earn a degree in a biomedical related field, and to increase the number of Native Americans students entering careers in biological science. The NABS program targets Native Americans, who are the largest group of minorities on the campus of OSU and in the state of Oklahoma. Native American students from OSU and surrounding Indian communities will be recruited to the NABS program, as many of these students come to OSU from rural communities or 2-year colleges which lack quality science education. The NABS program consist of two main components: 1) curriculum enhancement for freshmen and sophomores, and 2) research experiences for junior and seniors. The curriculum enhancement program will increase the success of Native Americans in the biology, mathematics, and chemistry disciplines. Difficulty in these courses is the reason most Native American students decide to change majors from science to a non-science discipline. The program will provide supplemental courses using cooperative learning techniques to teach independent learning skills and to strengthen scientific communication skills, as well as to provide inclusion into their field of study. The research experience program will provide an opportunity for Native American students from a diversity of biological related disciplines to engage in laboratory research. These students will learn and understand basic research, under the mentorship of experienced scientists who have volunteered to prepare the students for graduate school, professional school or research careers in biological science. The success of the NABS program will be evaluated by analyzing baseline data and data from the general measurable objectives. The NABS program provides a unique opportunity for the largest minority group in the state of Oklahoma, as it seeks to increase the number of Native Americans in biological science. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROBIOLOGY OF ALZHEIMER'S DISEASE AND AGING Principal Investigator & Institution: Rosenberg, Roger N.; Professor; Neurology; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 01-MAY-1994; Project End 31-MAR-2005 Summary: The Alzheimer's Disease Center (ADC) has as its long-range goal to continue to develop and expand its Clinical Core functions to evaluate and follow comprehensively, selected patients with memory loss, Alzheimer's Disease (AD), and other dementias, and similarly to longitudinally follow and evaluate control subjects and encode pertinent data in a central database. Patients will be assigned to appropriate follow- up and study protocols and a computerized tracking system to monitor and document progress will be employed. Minority recruitment has been emphasized to increase our number of patients who are African- American, Hispanic, and Native-

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American. It is our plan to evaluate potential predisposing events to AD, clinical course and complications of AD, clinical course and complications of AD, quantify emotional/behavioral symptoms and quality of life, utilization of imaging studies in the diagnosis of AD, and obtain clinical pathologic correlations. It will be our intent to achieve an 80% follow-up rate for persons designated for long-term studies. Wellstudied subjects, clinical data and body fluids will be supplied to investigators, and in particular ante- mortem and perimortem information to investigators using postmortem tissues from our controls and patients. Patients and control subjects will be evaluated with comprehensive neuropsychological testing, brain imaging, CSF and neuropathologic findings, in order to detect and assess preclinical and early AD. A Memory Disorders for Native Americans will be developed in Dallas to study their prevalence and clinical features of AD. The collaboration with the Alzheimer's Disease Clinical Studies Unit will continue. ADC patients and controls will be autopsied to provide an accurate diagnosis of AD or other basis of dementia. The Brain Bank will be expanded over the next five years from these autopsy studies and banked tissues will be made available to be utilized by investigators on our campus and at other ADC's. The Clinical Core will also supply information about the ante mortem state of control and AD patients for correlation with cellular and molecular analyses. Genotyping of AD autopsied cases for apolipoprotein E will be conducted as will ELISA assays for synaptophysin and tau proteins, and quantification of neocortical neuritic dystrophy in immunostained sections using image analysis. It is our intent as well to expand the isolation and banking of DNA from frozen and fixed autopsied tissue samples to facilitate ongoing and new studies of molecular alterations in AD and aging. The Statistics and Data Management Core will enter, store and analyze additional new patient data for comparative studies. The functionality of the existing centralized database will be enhanced with appropriate security over a central network to authorized ADC investigators at our institutions. The Education Core has extensive plans that have been developed over the past five years to extend knowledge about AD and specifically, availability of patient services to minority populations and also to primary health care providers. Educational videotapes and TV announcements will be developed both in English and Spanish. The Alzheimer's Researcher Newsletter will be published semi-annually and distributed to our 5000 subscribers in this five-state region. The number and scope of research projects will be increased during the next five years. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NIDDM PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: Horton, Edward S.; Director, Endocrinology & Metabolism; Joslin Diabetes Center Boston, Ma 02215 Timing: Fiscal Year 2002; Project Start 20-AUG-1994; Project End 14-MAY-2003 Summary: Several factors are known to increase the risk of developing NIDDM, including a family history of diabetes, previous history of gestational diabetes (GDM), obesity, decreased physical activity, presence of impaired glucose tolerance (IGT) or insulin resistance. Moreover, the incidence of NIDDM is higher in several racial and ethnic minority groups in the US including African Americans, Hispanics, Native Americans, Native Alaskans, and Asian Americans. A five year multicenter trial is proposed to evaluate intervention strategies to prevent or delay the progression of IGT to NIDDM, or the progression of previously undiagnosed NIDDM with normal fasting glucose to fasting hyperglycemia. Within the context of the overall study design, the Joslin Diabetes Center, (JDC) South Cove Community Health Center (SCCHC) and Brigham and Women's Hospital (BWH) will collaborate to form a participating clinical

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center and will identify a cohort of 200 high risk patients (equal to approximately 100 patients with IGT or previously undiagnosed NIDDM and 100 obese women with a previous history of GDM) to be prospectively and randomly assigned to one of four intervention groups, comprising a 2 x 2 factorial design. Half of the patients will receive standard diet and exercise recommendations (standard group), while half will receive an intensive lifestyle modification program, including individualized dietary and exercise programs, instruction in behavioral change, stress reduction, smoking cessation and close follow up (intensive group). Within each group, half will be randomized to treatment with low dose sulfonylurea, and half will receive placebo. Volunteers will be screened and recruited from specifically identified high risk populations. These include first degree relatives of patients with NIDDM at the JDC, first degree relatives of patients with NIDDM at the SCCHC, first degree relatives of patients with NIDDM in the Harvard Community Health Plan and patients with a past history of obesity and GDM at BWH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NM MINORITY BASED COMMUNITY CLINICAL ONCOLOGY PROGRAM Principal Investigator & Institution: Willman, Cheryl L.; Director, Univ Cancer Research and Treat; Pathology; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2003; Project Start 17-AUG-2000; Project End 31-MAY-2008 Summary: (provided by applicant): The State of New Mexico is characterized by ethnic diversity and unusual patterns of cancer incidence and mortality. A substantial number of New Mexicans are young, rural, poor, and medically uninsured and underserved. With a higher percentage of Hispanics and Native Americans than any other State, New Mexico's 1.8 million citizens are 45% White, 42% Hispanic, 10% Native American, 2% Black, and 1% other ethnic minorities. In addition to English and Spanish, our Pueblo, Navajo, Apache, and Ute Indian Tribes speak over twenty different languages and dialects. In this context, the mission of the University of New Mexico Cancer Research and Treatment Center (UNM CRTC) is to use its expertise in basic, translational, and clinical cancer research, cancer epidemiology, and community intervention to reduce the incidence and mortality of cancer in New Mexico's multiethnic populations. Participation in cooperative cancer prevention and treatment trials sponsored by the National Cancer Institute (NCI) and the MB-CCOP program, is a critical part of this mission. CRTC investigators have been contributing patients and scientific expertise to the NCI program since the Center opened in 1975. Currently funded with an NCI P20 Cancer Center Planning Grant, the CRTC has excellent research and primary cancer prevention programs supported by $83 million in total peer-reviewed funding. Among these is the New Mexico Tumor Registry (NMTR), one of the original Surveillance, Epidemiology and End Results (SEER) programs, now in its 30th year of NCI funding. The NMTR holds the world's largest database on cancer incidence and mortality in Hispanics and Native Americans and has documented strikingly different patterns of cancer incidence and mortality in these groups. Funded under the the MB-CCOP program since August 2000, the CRTC is building strong clinical cancer programs through the recruitment of 14 new oncology clinical specialists and the development of a new expanded clinical trials infrastructure at UNM and its affiliate sites. Together, the UNM CRTC and its Affiliates serve 80% of the cancer patients in the State. In close parallel with New Mexico's ethnic diversity, 52% of the patients currently enrolled from our MB-CCOP program to NCl-sponsored treatment and prevention trials are ethnic

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minorities: 31% Hispanic, 16% American Indian, 4% Asian, and 1% Black. Prior to being funded as a MB-CCOP program, the CRTC was a member institution of the Southwest Oncology Group (SWOG) and the Pediatric Oncology Group (POG); CRTC faculty continue to play significant leadership roles in these groups. Additional Research Bases include the National Surgical Adjuvant Breast and Bowel Project (NSABP) and most recently, the Eastern Cooperative Oncology Group (ECOG). Renewed funding of this MB-CCOP program will insure increased access and accrual of minorities to clinical trials, strengthen our Affiliate Network, facilitate the building of clinical trials programs with Hispanic and Native American Tribes and communities, and expand outreach to minority populations and the medically underserved in our region. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NORTHERN ARIZONA UNIVERSITY: MINORITY STUDENT SUPPORT Principal Investigator & Institution: Nishikawa, Kiisa C.; Professor; Biological Sciences; Northern Arizona University Department of Biological Sciences Flagstaff, Az 86011 Timing: Fiscal Year 2002; Project Start 01-APR-1998; Project End 31-MAR-2006 Summary: (provided by applicant): At NAU, our goals are to increase the academic performance, retention, and graduation rates of underrepresented minority students, especially Native Americans, who are or who could become interested in careers in biomedical sciences. As a result of this program, we hope to increase rates of acceptance into and completion of post- graduate degree programs in biomedical sciences at NAU as well as at other institutions across the nation. To achieve these goals, we have implemented a Minority Student Development Program (MSD). The MSD Program includes research participation, academic enrichment, academic support and faculty development activities. The specific aims of the MSD program are: 1) to provide opportunities for minority students to become involved in biomedical research projects with selected NAU faculty. Students will be encouraged to give presentations on their research at national meetings and to publish the results of their research in peerreviewed journals. Changes from the previous funding cycle include an increase in participating faculty from 16 to 30 and development of two new courses, "Introduction to Biomedical Research" and "Research Rotations" that will provide MSD students with more information about careers in biomedical research. 2) to implement academic enrichment programs for minority students that will strengthen their academic performance in gatekeeper courses in science and mathematics. Continuing activities include Supplemental Instruction (SI), faculty-led recitations and a readiness test. We also propose the development of a new course, "Skills for Science" which will target students whose readiness scores indicate that they may not succeed in gatekeeper courses. 3) to maintain an academic support system for minority students. This support system will include a central meeting place where students can meet with academic advisors and Supplemental Instruction leaders. Through this support system, academic advisors will provide academic advisement and personal counseling for MSD students, and provide them with information about research participation and academic enrichment opportunities that are available through the MSD program. 4) to provide professional development for faculty who teach gatekeeper courses in biomedical sciences. Faculty will reform their courses by using new models of teaching that facilitate increased learning by underrepresented students, especially Native Americans. Ultimately, the faculty are catalysts for the persistence of the MSD program at NAU. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NORTHWEST/ALASKA CENT. TO REDUCE ORAL HEALTH DISPARITIES Principal Investigator & Institution: Milgrom, Peter M.; Professor of Dental Public Health Scienc; Dental Public Health Sciences; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-JUL-2008 Summary: This proposal is in response to RFD DE-99-003 to establish the Northwest and Alaska Center for Oral Health Disparity for research to reduce oral health disparities in the Pacific Northwest and Alaska. It is proposed that the Center develop basic and applied knowledge that addresses the needs of poor, minority, and rural children and their caretakers, utilizing approaches that go beyond the traditional strategies from dental public health that have not found success in these populations. While the research in the proposed center may involve traditional dental personnel, it also stresses the roles of pediatricians, mothers as well as children; and preventive agents beyond fluorides. Participants include Alaska Natives, Native Americans from the Yakima Indian Nation, Hispanics from the agricultural areas of Washington, African Americans and Hispanics from the local military reservations, Hispanics and Pacific Islanders served by urban hospitals as well as rural and low-income Whites. We propose to accomplish this goal through five specific aims: (1) To address the needs of the Pacific Northwest and Alaska by conducting clinical research to evaluate the efficacy of nontraditional interventions to prevent and treat oral disease in children and their caretakers; (2) To develop community-based research that translates existing knowledge and new information regarding children and their caretakers into new technologies and interventions that hold promise for reducing disparities in these high risk populations; (3) To expand health science education and research training opportunities for minority populations in the Pacific Northwest and Alaska by collaborations with key minority educational and health serving institutions in the region; (4) To conduct basic research to further understand the role of host defenses and genetic bases for caries and periodontal disease affect underserved populations as well as to probe the biologic basis for antibacterial that change disease susceptibility; and (5) To increase the impact of the center beyond the projects included in this proposal by recruiting investigators and students from minority institutions in the Pacific Northwest and Alaska and prioritizing and encouraging pilot and center-affiliated studies in which they are involved. The collaborating institutions and partners are Heritage College (Hispanic and Native American-serving institution sited on the Yakima Indian Nation), Alaska Native Tribal Health Consortium/Yukon-Kuskokwim Native Health Corporation, Yakima Valley Farm Workers Clinic, Northwest Portland Area Indian Health Board/Northwest Tribal Epidemiology Center, Washington Dental Service an Foundation (major private dental insurer); and Medical Assistance Administration (Medicaid agency for Washington State). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OKLAHOMA NATIVE AMERICAN EXPORT CENTER Principal Investigator & Institution: Lee, Elisa T.; Professor; Ctr/Amer Indian Health Res; University of Oklahoma Hlth Sciences Ctr Health Sciences Center Oklahoma City, Ok 73126 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): There is ample evidence of health disparities in the Native American population. One of the major health disparities in this population is

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Type 2 diabetes. The prevalence rate of Type 2 diabetes in Native Americans is several times higher than the general population. More alarmingly, type 2 diabetes, which was considered to be a disease for middle-aged adults, is increasingly present in Native American children and adolescents. It is therefore imperative that health promotion and disease prevention strategies to reduce diabetes be developed and validated in this population. This proposal is to establish an Oklahoma Native American EXPORT Center to reduce health disparities in Native Americans with an emphasis on diabetes prevention in children and adolescents. Our approach is to partner with Native American tribes, community-based programs and organizations, and programs at the University of Oklahoma. The proposed Oklahoma Native American EXPORT Center has five components: Administrative Core, Research Core, Community Outreach and Information Dissemination Component, Training Component, and Shared Resources Core. Two full projects and one pilot pROJECT are proposed in the Research Core. These projects focus on strategies for preventing diabetes and obesity from infancy to adolescents involving family, school and community organizations. Activities proposed in the Community Outreach and Information Dissemination Component include disseminating information on the epidemiology, intervention and prevention of diabetes and obesity to American Indian communities, promoting positive attitudes towards treatment and prevention of diabetes and obesity, encouraging and preparing communities to participate in scientific studies of health, and providing science education opportunities to Indian high school students. The Training component will provide opportunities to increase knowledge in Indian health and introduce health field career opportunities to Native American students, sponsor continuing education workshops/conferences on Indian health to health care providers, University of Oklahoma faculty and other health professionals, and recruit Native American students to the University of Oklahoma and its Health Sciences Center. Lastly, the Shared Resources Core will provide resources for study design and monitoring, data management and statistical analysis. It is believed that the proposed EXPORT Center will be effective in the efforts to reduce health disparities, particularly in childhood diabetes and obesity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PARKINSON'S DISEASE CLINICAL TRIAL GROUP SITE Principal Investigator & Institution: Calabrese, Vincent P.; Mc Guire Research Institute, Inc. 1201 Broad Rock Blvd, Res 151 Richmond, Va 23249 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Researchers at the McGuire Veterans Affairs Medical Center (MVAMC) bring to the Parkinson Disease (PD) Neuroprotection Clinical Trial Group exceptional expertise, outstanding clinical and laboratory resources, and a qualified and motivated patient population from which to recruit subjects. The McGuire Parkinson Disease Research, Education, and Clinical Center (PADRECC) provides PD treatment for military personnel and veterans throughout the southeastern United States, ranging from Pennsylvania down to Florida (including Puerto Rico) and west to the Mississippi River. Veterans with PD from this entire region are referred to MVAMC for treatment. Native Americans in this region seeking treatment for PD and patients referred from private practice are also eligible to attend the MVAMC PADRECC. This combined pool of potential study participants will exceed the enrollment needs for a member site of the proposed PD Neuroprotection Clinical Trial Group. The research mission of the MVAMC PADRECC is to establish a center of excellence for clinical trials, emerging biomolecular strategies, and integrated health services. The MVAMC and its

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affiliate university, Virginia Commonwealth University/Medical College of Virginia Hospitals (VCU/MCVH), boast a talented group of scientist-practitioners with a broad range of clinical interests and research expertise related to PD. The MVAMC PADRECC personnel, resourc6s, and patient population will be available for the PD Neuroprotection Clinical Trial Group. MVAMC investigators have a long history of excellent recruitment and retention capabilities and a supportive clinical environment in which to conduct studies. Their history of participation in multicenter trials managed by pharmaceutical companies, the Parkinson Study Group, and the NIH demonstrate their commitment to cooperative research projects. MVAMC investigators will cooperate fully with all other centers in the PD Neuroprotection Clinical Trial Group in the conduct of each pilot and main study to test agents approved by the Oversight and Steering Committees. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATHWAYS TO MENTAL HEALTH SERVICES AMONG NATIVE WOMEN Principal Investigator & Institution: Duran, Bonnie M.; Family and Community Medicine; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2002; Project Start 18-JUL-2001; Project End 30-JUN-2006 Summary: (provided by applicant): For Native American populations, mental disorder prevalence, distribution and subsequent treatment seeking is not well known. Evidence from the few studies that have been published and research underway now, however, suggests a serious disparity in the prevalence of mental disorders for this population compared to the general US population and a very low utilization of mental health services. Research Plan: Two complementary studies are proposed. The first is a small qualitative investigation of illness experience and contextual factors related to treatment seeking among Native American women with current and lifetime psychological pathology. The second is a quantitative secondary analysis of pathways to mental health treatment and care seeking among Native women. Both studies aim to provide descriptive and analytic information on utilization by type of disorder and treatment system and identify other influences on care seeking as suggested by the NetworkEpisode Model theory. The research will test models regarding the pathways into care that consider social, community and system variables as determinants of access to treatment and provide narratives to contextualize the results. One data set to be used for the secondary analysis is drawn from the largest psychiatric epidemiologic, risk and protective factors study ever conducted among Native Americans (the SUPERPFP study N=3200). The other data set is from the candidates own study of the same variables drawn from Native women in a primary care setting (Mental Health and Abuse Among Native Women in Primary Care N=234) Career Development Program: This study will be conducted within the broader context of an expert-led training program. The proposed 5-year course of study includes instruction in advanced quantitative research design and statistical methods, multi-level and mixed method approaches, psychiatric nosology, and the operationalization of theory in pathways to mental health care research. The ultimate goal of this revised Career Development Award is for the candidate to have the skills, knowledge, and experience to teach and conduct rigorous, culturally competent mental health services research for Native Americans and other culturally distinct groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PILOT--NATIVE AMERICAN USE OF TRADITIONAL MEDICINE Principal Investigator & Institution: Reifel, Nancy M.; Dental Public Health Information Systems; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2007 Summary: Although the incidence of many different types of cancer appears to be less among Native Americans than white or African American patients, their survival rate appears to be worse. Native peoples employ a variety of prevention and treatment approaches, including traditional Indian treatments, to decrease mortality associated with cancer. The overall goal of this research is to determine the resources - clinical, complementary, and historically traditional Native American treatments - used by American Indian/Alaska Native people for cancer care. Native Americans have a longstanding mistrust of the medical research community, therefore, this preliminary study will be conducted to determine the feasibility of conducting research on the use of traditional Native American healing practices. Twenty key informants will be interviewed for this study. Eight health care practitioners, specifically, four biomedical clinicians and four traditional Native American practitioners, will be interviewed. Twelve Native American cancer survivors will be interviewed, specifically, six urban American Indians and six Native Americans who are reservation-based in Southern California. The interviews will be designed to elicite the following information: descriptions of clinical, complementary and traditional Native American treatments, Southern California Native peoples' beliefs the aspects of traditional medicine amenable to systematic research, and opinions about what physicians need to know about traditional Native American medicine in order to improve outcomes of cancer treatment. Grounded Theory coding methods will be used on the audio-taped interviews for content analysis. Follow-up interviews will also be used to pursue new areas that emerge from the analyses. Findings from this preliminary study will help us develop research methodologies for a larger study to question Native Americans about the frequency and function of distinct types of cancer treatment resources, including traditional American Indian treatments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PILOT--PAIN MANAGEMENT AND TELEHEALTH FOR CROW INDIANS Principal Investigator & Institution: Zuklowski, Karen; Montana State University (Bozeman) Bozeman, Mt 59717 Timing: Fiscal Year 2002 Summary: (from applicant's Abstract) Cancer-related pain and nonmalignant pain is a health concern for the Native American people of Montana and Wyoming because reservations are geographically remote from health specialists, alternative approaches to health care delivery are necessary Telehealth is currently being used to bring specialized health care to under-served Americans throughout the United States. Native American reservations are a prime location for telemedicine interventions because of the specialized resources on the reservations and the long distance needed to travel to access specialized health care. Little research is available on the use of telehealth with the Native American population. Even less is available on the pain experience in Native Americans. A person's response to pain is influenced by his or her past experience with pain, the duration and intensity of the pain, and their culture. Culture is an especially important consideration in the Native American population. Current pain assessment

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instruments do not take the Native American culture and language barriers into consideration. Adequate pain management and alternative methods of health care delivery in the Native American population have not been well researched. Therefore, the overall goal of this study is to evaluate the adaptation of a standardized pain assessment questionnaire as well as the acceptance of telemedicine as a means of delivery for pain management treatment in the Crow Native American population. Specific aims this study will address include. 1) Evaluation of the adaptability of the Brief Pain Inventory for use with a Native American population, and 2) Evaluation of the feasibility of nursing management of chronic pain using telehealth technology with a Native American population. The Brief Pain Inventory will first be adapted in culturally sensitive English. This translation will be refined and preliminary testing conducted. Expert-patient agreement will be established and intra-item correlation performed. There will be 10 Crow patients with complaints of pain over 3 months in duration. Each participant will have one face-to-face consultation with the Advanced Practice Nurse pain expert There will be three consultations over telehealth Telehealth will be considered an acceptable mechanism of pain management delivery if Crow participants' pain scores decrease over the course of the study and they score 4 or above on the Acceptance of Telehealth Questionnaire. Results of this study provide the basis for tool development and alternative methods of health care delivery in a medically underserved Crow population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: POPULATION AND EVOLUTIONARY GENETICS OF NIDDMI Principal Investigator & Institution: Di Rienzo, Anna D.; Associate Professor; Human Genetics; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2002; Project Start 01-FEB-2001; Project End 31-DEC-2004 Summary: (Investigator's Abstract): Type 2 diabetes is one of the most common metabolic disorders in humans and has a complex etiology due to environmental and genetic factors. Recently, a positional candidate region, NIDDM1, has been proposed to contain variation which contributes to diabetes risk. According to the thrifty genotype hypothesis, diabetes susceptibility genotypes conferred a selective advantage in the ancient past in times of feast a famines. In this application, we propose to conduct a detailed study on the population and evolutionary genetics of the candidate region for the genetic susceptibility to type 2 diabetes. The ultimate goals of our study are to provide information on the haplotype structure of variation that can be used to design and interpret replication studies, understand the forces that shape sequence variation and LD at this locus in aboriginal human populations, and use the signature of natural selection on this region to validate the mapping evidence. To advance these goals, we propose to: Survey sequence variation in small random samples (10 individuals) from each of four major ethnic groups (Africans, Asians, Europeans, and Native Americans) in the two genes found in the NIDDM1 candidate susceptibility region. The data generated in this survey will be analyzed to identify sub-regions with evidence for positive natural selection. These regions in addition to those containing candidate diabetes susceptibility variants will be further studied in Specific Aim 2. Conduct a detailed analysis of sequence variation and LD in a sample of 25 individuals each from large outbred populations from three major ethnic groups (Africa, Asia, and Europe). We will use these data to provide critical information for disease mapping and look for the signature of natural selection based on the "thrifty" genotype hypothesis. Carry out an extensive survey of allele frequencies at NIDDM1 candidate susceptibility variants in 20 human population samples with a broad range of ethnic and geographic origins and

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rates of type 2 diabetes prevalence. The survey results will be analyzed to ask if the atrisk genotype frequencies correlate with diabetes prevalence rates In different populations. In addition, we will be able to determine whether the degree of interpopulation differentiation is significantly different from that observed at a large number of neutrally evolving nuclear loci and whether the geographic distribution of allele frequencies is correlated with environmental features, such as latitude or climate. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: Molitch, Mark E.; Professor; Northwestern University Office of Sponsored Research Chicago, Il 60611

Medicine;

Timing: Fiscal Year 2002; Project Start 20-AUG-1994; Project End 30-APR-2003 Summary: This proposal is submitted in response to the RFA: DK-93-07, "NIDDM primary Prevention Trial" NIDDM is a major public health problem in the United States and its prevalence is disproportionately high among a number of minority groups including Native American, Hispanics and African-Americans, Members of these minority groups, obese subjects, persons with a family history of NIDDM among first degree relatives and women with prior gestational diabetes mellitus (GDM) of all racial and ethic groups are at high risk for the development of NIDDM. We have developed a protocol for a multicenter study to test the hypothesis that the appearance of NIDDM can be delayed or prevented by life style or pharmacological intervention in women with prior GDM or in subjects at high risk for NIDDM who presently have impaired glucose tolerance (IGT). We propose to compare the rate of progression of IGT to NIDDM and mild NIDDM to NIDDM with fasting hyperglycemia in groups receiving intensive life-style intervention with diet, (low fat moderated fiber reduced calorie) and exercise (supervise instruction and maintenance of physical fitness) or drug treatment (sulfonylurea oral hypoglycemic agent or an anorectic agent) with conventional advice regarding diet and exercise. We propose that subjects with prior GDM represent half of the women recruited for the study and that the total population enrolled include 20 percent Hispanics, 20 percent African-American, 10 percent native Americans and 50 percent Caucasians and members of other minorities. We have identified a large population of women with previous GDM that includes approximately equal numbers of Black, hispanic and White women and are prepared to serve as a center for a concentrated subgroup enrollment of such subjects. We are also prepared to recruit Hispanic, African- American and White subjects from the general population who are at high risk for IGT. Our study investigators have extensive experience in the care of patients with diabetes mellitus, have broad and in depth experience in collaborative diabetes related and cardiovascular disease related clinical and epidemiological studies. These projects have provided extensive experience in recruitment and retention of minority subjects including women with prior GDM. The project investigators are prepared to collaborate and cooperate in the final design of the study protocol by the steering committee as well as implement it with enthusiasm and to the best of our collective abilities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: Schade, David S.; Professor; Medicine; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2002; Project Start 20-AUG-1994; Project End 14-APR-2003

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Summary: During the last 30 years, the combined mortality of the Native American and Hispanic populations living in New Mexico has almost doubled. This dramatic rise can be partially attributed to the increased incidence of type II diabetes. We will assess the outcome of interVention strategies to prevent the onset of type Il diabetes in high risk groups (impaired glucose tolerance and/or a history of gestational diabetes). The two principal minority groups in the state of New Mexico will be studied: the urban Native American population and the urban Hispanic (Mexican-American) population. Recruitment techniques will include direct interrogation of three large health care databases and participation of many community support organizations involved with Native Americans and Hispanics. Two hundred individuals (100 Native Americans, 100 Hispanics) will be randomized into one of four treatment groups. The first treatment group will receive standard therapy (diet plus exercise counseling every six months). The second treatment group will also receive standard therapy plus glyburide 5 mg once per day. The third treatment group will receive' intensified dietary instruction plus scheduled exercise with the goal of achieving ideal body weight and a healthy lifestyle. These individuals will exercise three times per week and meet monthly for dietary counseling and body weight measurements. The fourth treatment group will receive the same therapy as the third group (a combination of the intensified dietary instruction and scheduled exercise) plus glyburide 5 mg once per day. In order to increase adherence, volunteers and their families will interact with nurse/educators sensitive to the cultural needs of the study population. Positive reinforcement techniques will be used. Primary study endpoints include 75 gm oral glucose tolerance testing every six months plus measurement of integrated C-peptide and insulin. Secondary endpoints include hemoglobin AlC, body composition measurements, body weight, dietary alterations, and changes in health status. Administratively, a Central Coordinating Unit, composed of individuals experienced in the various treatments, will oversee the trial. Guidance to the Central Coordinating Unit will be provided by an Advisory Committee comprised of prominent members of both the Native American and Hispanic communities. A nurse/educator will be provided for each of the three satellite clinics caring for the volunteers. Comparing standard treatment against other treatment(s), the protocol design provides 90% power to detect a 33% minimum improvement in the conversion rate from impaired glucose tolerance to diabetes, p<0.Ol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PUBLIC USE MICRODATA SAMPLE OF THE 1900 CENSUS Principal Investigator & Institution: Ruggles, Steven; Professor & Director; History; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 06-JUL-1998; Project End 31-MAY-2003 Summary: This project will create a nationally representative 1-in-100 Public Use Microdata Sample (PUMS) of the 1900 census of the United States population to be disseminated through the National Archives, the Inter-University Consortium for Political and Social Research, and via the Internet. Preparation of the 1900 PUMS involves seven steps: 1)transcribe census information on approximately 783,000 individuals drawn from microfilm of original enumerators' manuscripts; 2) develop data dictionaries to convert each census inquiry into a format compatible with existing census microdata files; 3) evaluate sample quality through consistency checks, random blind verification, and comparison with aggregate census tabulations; 4) edit missing, illegible, and inconsistent data items using logical inference and hot-deck allocation techniques; 5) create new variables describing family relationships, household composition, occupational status, and city and county level characteristics; 6) prepare

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documentation on sampling and data processing procedures, a procedural history of the 1900 census, and a user's guide; and 7) integrate the sample into the Integrated Public Use Microdata Series (IPUMS). As the earliest surviving modern census, the 1900 census provides a baseline for measuring the monumental social changes of the twentieth century. Variables available for the first time in1900 reflect some of the social concerns at the turn of the century: year of immigration, years in the United States, citizenship status, ability to speak English, children ever-born, children surviving, duration of marriage, farm residence, home ownership, mortgage status, number of months attending school, and date of birth. There are numerous key areas of research available through the 1900 sample including child mortality, fertility analysis, and ethnicity and immigration. In addition, a planned oversample of Native Americans will allow new opportunities for quantitative studies of American Indian demography and social structure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RESILIENCE IN NATIVE AMERICAN OLDER ADULTS Principal Investigator & Institution: Wallace, Kimberly A.; Psychology; University of Montana University Hall 202 Missoula, Mt 598124104 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2006 Summary: (provided by applicant): The aims of the proposed study are to: (1) advance understanding of resilience in later adulthood in a sample of Native Americans, and (2) identify and examine personal and support factors that contribute to positive health outcomes in this sample. In addition, an important aim of this research is to: (3) examine resilience profiles as they relate to health outcomes among Native American older adults. Resilience refers to one's ability to bounce back after adversity and is thought to be a function of one's available protective factors. Although a substantial literature on resilience has emerged with children and adolescence, this process is not well understood in later life. Because of the multitude of challenges that often accompany aging, older adulthood is a particularly important age-span in which to examine resilience. At the same time, although minority research in the field of aging is increasing, there is still a dearth of information in this area as well. Designed to begin to address these gaps in the literature, the proposed study combines qualitative and quantitative methodologies to examine stress, personal (spirituality; sense of self) and support (family and community support) resources, and health outcomes (mental and physical) in a sample of Native Americans over the age of 50 living on a reservation. Specifically, Study 1 is an examination of the factors that contribute to positive adaptation in a sample of Native American older adults. Data will be collected using semi-structured interviews and analyzed using a process of thematic categorization. Study 2 is an investigation of the factors identified in Study 1 as they relate to positive health outcomes. Study 2 will be conducted using in-person surveys; cluster analysis will be used to classify groups of individuals according to similarities on levels of stress and the protective factors, and ANOVA will be used to validate the cluster solution and investigate any differences in health outcomes by cluster membership. Findings from this research will help further theoretical understanding of resilience in later life by elucidating the complexities of resilience not normally observed in the general population. This research will also serve as a foundation for future inquiries in this area, particularly with regards to the complex, multidimensional nature of resilience, its psychological, social, and physical components, and trajectories of change in resilience mechanisms over time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RISK FACTORS FOR ALCOHOLISM IN NATIVE AMERICANS Principal Investigator & Institution: Ehlers, Cindy L.; Associate Member; Scripps Research Institute Tpc7 La Jolla, Ca 92037 Timing: Fiscal Year 2002; Project Start 26-SEP-1994; Project End 31-MAY-2005 Summary: Certain tribes of Native Americans have very high rates of alcoholism and other alcohol related disease when compared to Euroamericans, African Americans, and Asian American samples. These ethnic differences in rates of alcoholism are thought to reflect a combination of sociocultural and biological factors. Within the biological realm few studies have evaluated whether ethnic and/or racial diversities exist in physiological markers of alcoholism risk. Recent data do suggest that there is genetic diversity in biologic sensitivity to alcohol among ethnic groups. The source of the differences in alcohol sensitivity results, in part, from genetic differences in metabolic factors, i.e., polymorphisms of the genes that regulate alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), as well as inborn differences in brain cellular responses to alcohol. The overall objective of the proposed studies is to extend our previous investigations, which evaluated risk factors for the development of alcoholism as well as biological responses to alcohol and placebo challenge. Our studies suggest that Native American men have a quantitatively different response to alcohol than Euro- American and Asian American men using subjective (feelings of intoxication) as well as objective (EEGs, ERPs, cardiovascular responsivity, hormone levels) measures of intoxication. We believe that this diversity in level of response to alcohol may, in part, account for their increased risk for the development of alcoholism. In order to explore this further, these studies will be extended to Native American women age 18-25 years who will be tested for biologic response to alcohol and placebo using a modification of the same alcohol challenge protocol from our previous studies. Our preliminary studies in Native Americans ages 8-11 years will also be extended in order to determine whether specific risk factors might be present in young boys and girls prior to any alcohol exposure. A follow-up study of both the children and young adults will be carried out to deter-mine if factors identified at the initial interview are predictive of the development of alcohol- related life problems. Additionally, 18-50 year old Native American adult sibling-pairs and family members with and without alcohol dependence will be assessed using a structured diagnostic interview (SSAGA). These assessments will serve as the basis for future genetic analyses. These studies have the potential to verify whether Native Americans have any specific biological or behavioral factors that may help to explain the high risk for alcoholism within the tribes evaluated. The identification of such variables may potentially be useful in the development of specific prevention and treatment programs for this population as well as other Native American tribes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SACNAS: INITIATIVES FOR EQUITY IN SCIENCE Principal Investigator & Institution: Haro, Luis S.; Associate Professor of Biochemistry; Society/Adv/Chicanos/Native Americans Native Americans in Science Santa Cruz, Ca 95060 Timing: Fiscal Year 2003; Project Start 20-DEC-1988; Project End 31-JAN-2008 Summary: (provided by applicant): SACNAS requests funding from the National Institutes of General Medical Sciences Minority Access to Research Careers program, for underrepresented undergraduate and graduate students, and professionals to encourage and develop an interest in biomedical sciences. Humans are a natural

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resource that continue to be underdeveloped in the U.S. and within the U.S. scientific community. This is particularly true for people who are members of minority groups, especially Chicanos and Native Americans. A recent NSF study (NSF 00 327) shows that while minorities make up nearly 25% of population in the U.S., Chicanos, Latinos, Native American and African Americans make up less than 6% of all Ph.D.s in science, engineering and mathematics (SEM). SEM are areas of expertise that are the comerstones for the future of this country. The underrepresentation of these people in the scientific enterprise is a serious national problem with many contributing factors (Chronicle of Higher Ed, Jan 2002). The Society for Advancement of Chicanos/Latinos and Native Americans (SACNAS) seeks to change this statistic by encouraging all underrepresented groups - while focusing on Chicanos/Latinos and Native Americansto pursue advanced degrees in science, mathematics and engineering. SACNAS' mission and that of the NIH MARC program are congruent. The proposed activities integrate biomedical research and promote educational opportunities in NIH relevant areas. We have solicited funds from other sources to support scientists and budding scientists with interests in other areas of research. The hypothesis to be tested is that, with the active mentoring, career development, and specific interventions provided by SACNAS as supported by NIH, undergraduate, graduate, postdoctoral researchers, and professional minority scientists will be retained in science and will achieve excellence in this endeavor. SACNAS has a 15-year history of annual conferences with workshops, scientific sessions, student presentations, and mentoring activities. Past and current SACNAS activities are a foundation, and the springboard we shall use to launch the following specific aims: Aim 1. Provide an annual conference that enhances career development and higher education of undergraduate students (285), pre- (34) and post(20) doctoral researchers (20) and faculty (5) interested in biomedical sciences; Aim 2. Provide year-round activities that will enhance student, postdoctoral and faculty development; and Aim 3. Evaluate the effectiveness of the proposed activities. The rationale for the proposed activities in this application is that without early, specific and well thought-out interventions, and without opportunities for students, postdoctoral researchers and faculty to take part in career and educational development our target communities will remain underrepresented in scientific endeavors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SOCIOECONOMIC IMPACT OF NATIVE AMERICAN CASINOS Principal Investigator & Institution: Evans, William N.; Professor; Economics; University of Maryland College Pk Campus College Park, Md 20742 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2005 Summary: (provided by applicant): Native Americans living on reservations have historically been one of the poorest groups in the United States. In the late 1980s, a series of legal rulings and accompanying Federal legislation allowed tribes in some states to run casinos on reservations. As a result of these laws, about 200 of the 556 federallyrecognized tribes run about 310 gaming centers, of which 220 are Las Vegas-style casinos with slot machines and/or table games. Given the large number of tribes that have embraced casino gaming as an economic development program, it is worth considering whether Indians on reservations have benefited from these operations. As the legal and legislative controversies surrounding tribal-owned gaming persist, the interest in this question continues to grow. The authors of this proposal are currently involved in the first nationwide evaluation of the social and economic impact of Native American-owned gaming operations on tribes and their surrounding communities. Using aggregate tribe-level data from the Bureau of Indian Affairs, Evans and Topoleski

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demonstrate that on average, five years after a tribe opens a casino, reservation population increased 20 percent, employment rose by 55 percent, the employment to population ratio increased by 25 percent, and the percentage of workers living in poverty by a third. In this proposal, we outline a research program that uses restricteduse data from the 1990 and 2000 Census longform samples to examine the impact of gambling on people who live on or near reservations. The long-form samples are sent to one in six households and contain a wealth of social, demographic, and economic information about households and their members. Public-use versions of this data do not contain enough geographic detail to place households in particular tribes or on reservations, but detailed geographic data are available on restricted-use versions of the data set, available for use at the Center for Economic Studies at the U.S. Census Bureau, a few miles from the University of Maryland Campus. Given the structure of most operations and the available data, we plan to investigate the following questions concerning the impact of gaming. What is the impact of Native American-owned gaming operations on the employment, wages, earnings, and incomes of those living on or near reservations? Who benefits most from gaming operations: Indians or nonIndians, males or females, high or low educated, established residents or new residents? As gaming operations have brought more money and jobs into tribes, has the historically poor housing stock on reservations improved? Has the rapid economic change on reservations generated by casinos changed family life through fertility, marriage, or divorce? Is educational attainment increasing as tribes use gaming profits to foster human capital accumulation? Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SOUTHWEST ALCOHOL RESEARCH GROUP Principal Investigator & Institution: Wallerstein, Nina B.; Associate Professor; Institute for Public Health; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2006 Summary: (provided by applicant): The Southwest Alcohol Research Group (SARG) is a partnership of researchers and senior administrators at the University of New Mexico Institute for Public Health (IPH), the grantee, within the School of Medicine, a Minority Serving Institution; and the Center on Alcoholism, Substance Abuse and Addictions (CASAA), the collaborating research program. The SARG will promote regional and national leadership in the development of alcohol-related interventions research with (1) Native Americans, (2) Hispanics, and (3) the rural poor of the American Southwest. Although there is a reasonable base of knowledge with regard to the epidemiology and patterns of alcohol use among southwest communities of color, very little is known about how to adapt and implement empirically supported interventions (ESIs). Similarly, little is known about implementation and evaluation of culturally supported interventions (CSIs). With a primary focus on intervention research, training and outreach dissemination, SARG will recruit and engage scientists from the target populations and others working with these groups to reduce alcohol-related health disparities and social problems. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SOUTHWEST ONCOLOGY GROUP--CLINICAL TRIALS Principal Investigator & Institution: Ozer, Howard; Professor; Medicine; University of Oklahoma Hlth Sciences Ctr Health Sciences Center Oklahoma City, Ok 73126

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Timing: Fiscal Year 2002; Project Start 24-MAY-1993; Project End 31-DEC-2003 Summary: Participation in the Southwest Oncology Group (SWOG) has been a major part of the clinical investigative effort of the section of Hematology- Oncology in the Department of Medicine at the University of Oklahoma Health Sciences Center (OUHSC). This effort results in the enrollment of a consistent number of eligible and evaluable patients into SWOG trials. SWOG protocols at the University of Oklahoma provide the major opportunity for Oklahoma residents to participate in large scale, well designed clinical trials. Patients are accrued via both the parent institution and affiliated CGOPs. Most patients in the state, including a large number of Native Americans and rural Oklahomans, are treated by physicians who are part of this network. Annual accrual for the entire network has been ninety-seven patients. We have been working to increase our involvement in the scholarly aspects of clinical trials. At the member institution, we have focused our efforts in five areas including breast cancer, head and neck cancer, genitourinary cancer, lung cancer, and hematological malignancies. This effort has resulted in the establishment of multidisciplinary programs in these areas which has helped to facilitate identification and enrollment of patients on SWOG protocols. In addition, it has allowed for the development of in-house protocols which might serve as pilot studies for future SWOG trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SPIRIT LAKE SIOUX NATION DIABETES EDUCATION PROJECT Principal Investigator & Institution: Peltier, Clayton; Science Education; Cankdeska Cikana Community College Box 269 Fort Totten, Nd 58335 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The long-term outcome of this Diabetes-based science education curriculum developed on the Spirit Lake Sioux Nation reservation is to have a K-12 curriculum in place in all reservation schools. The Diabetes-focused curriculum will be based on the National and State Science and Social [sic]The curriculum includes activities that teach the value of exercise, and proper diet within the culture of the Spirit Lake Sioux traditions. The science will focus on nutrition, digestion, metabolism, anatomy, physiology, and genetics where appropriate and reservation health data. The chemistry of foods including natural foods, processed foods, vitamins, minerals, and the social customs of food use and distribution will be developed. The K12 curriculum will reach out to the community to involve students with parents and elders in a positive, culturally sensitive health program that integrates the goals of a Standards-based curriculum. The community will be involved at all phases of planning, development, writing, and implementation of the school and community components. The advisory council made up of representatives of the Tribal Council, Board of Regents, K-12 and College School Administration, Indian Health Service, Diabetes Fitness Center, enrolled tribal members, parents, project directors, and teachers will oversee the entire process and approve of each component before, during and after the units are developed. When the process is completed all the four reservations of North Dakota will have been invited to participate and share in the curriculum dissemination. The advisory council is composed primarily of Native Americans who will advocate for the health of the young people on the reservation. Advisory members work closely with the principal investigator and the science education curriculum consultant and the curriculum writing group. The teachers are responsible for selecting materials and methodology appropriate to the grade level, and with the assistance of the curriculum specialist will develop the content, teaching strategy, and evaluation procedures that will be used in the classroom. The process of developing the diabetes-based curriculum

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begins at the K-1 level and buil [description was truncated at this point in the application] Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STRESS AND COPING AMONG STIGMATIZED POPULATIONS Principal Investigator & Institution: Balsam, Kimberly F.; Psychology; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2003; Project Start 16-SEP-2003; Project End 15-SEP-2006 Summary: (provided by candidate): Elevated rates of mental disorders among stigmatized individuals have been hypothesized to be linked to the individual and cultural oppression experienced by this population. However, this "minority stress" hypothesis has not been adequately examined in empirical studies, in part due to the lack of a clear definition for this construct and the lack of a culturally-sensitive instrument to assess it. The proposed study will, in three components, develop a program of research for the applicant that will address the relationships between minority stress, coping, and mental health of populations stigmatized for reasons other than race/ethnicity or gender. First, the applicant will develop survey instruments to assess minority stress and culturally-specific coping processes. Second, these instruments will be used in an anonymous survey of stigmatized individuals examining stressors (traumatic events, minority stressors, and general stressors), coping (culturallyspecific and general) and mental health outcomes (depression, anxiety, suicidality, PTSD, and substance use). Third, the applicant will work on a larger, NIMH-funded study of two-spirit Native Americans, utilizing innovative sampling strategies, in order to examine the construct of minority stress in a specific ethnic minority population while simultaneously gaining advanced skills and knowledge in the area of sampling methodology. Outcomes from all three studies may be used to advance the field of mental health research and treatment of stigmatized groups and may have public-policy implications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SUMMER RESEARCH PROGRAM FOR MINORITY STUDENTS Principal Investigator & Institution: Wiley, Clayton A.; Professor; Pathology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2009 Summary: (provided by applicant): The Pittsburgh Medical Scientist Training Program (MSTP) offers a 10-week research and career development program for underrepresented minority students interested in careers as physician scientists. The program is designed for students in their freshman, sophomore or junior years of college. Students receive intensive research laboratory experience and abundant mentorship. The program is for U.S. citizens and permanent residents, and is limited to minority groups underrepresented in the biomedical sciences including African Americans, Alaskan Natives, Mexican Americans, Native Americans, Other Hispanic Americans, Pacific Islanders and Puerto Rican Mainlanders. Application to the program includes a personal statement, transcript and 2 letters of recommendation each including a coversheet, and is available online at www.mdphd.pitt.edu. Students receive a stipend for the ten-week period plus round trip airfare. The stipend provides students with a comfortable budget to live in Pittsburgh. All students must have medical insurance for the duration of the program. Since they will be working with human materials, they are encouraged to be vaccinated for hepatitis B. Minority

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undergraduates work with biomedical researchers in a variety of areas including, but not limited to cardiovascular, pulmonary, hematologic, immunology, transplantation or sleep disorders. The undergraduate students are also paired with current MSTP students who are active members of the mentoring team. Students participate in a variety of career development programs, scientific seminars, responsible conduct of research, and specific career enhancement opportunities including preparation for national examinations. By the end of the summer, students have created a research poster for presentation on the last day of the program as well as at a national conference. Social activities are included in the program to help build a network of peers with similar career paths. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SUPPLEMENT: BIOMEDICAL RESEARCH TRAINING IN MAINE Principal Investigator & Institution: Hand, Patricia H.; Administrative Director; Mount Desert Island Biological Lab Old Bar Harbor Road Salisbury Cove, Me 04672 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2004 Summary: (provided by applicant): This proposal seeks supplemental support for a Biomedical Research Infrastructure Network (BRIN) between six Maine institutions, with the Mount Desert Island Biological Laboratory (MDIBL) serving as lead institution. The overall goal of this BRIN is to develop a collaborative partnership and strong network composed of two premier research institutions [MDIBL, The Jackson Laboratory (TJL)], two undergraduate and graduate degree granting institutions [University of Maine (UME), College of the Atlantic (COA)], and two undergraduate degree granting institutions (Bates College, Colby College). These six institutions have formed a network for research training of faculty and students that is advantageous by virtue of the quality and geographic proximity of the institutions involved. The scientific focus of the BRIN is comparative functional genomics. The principal hypothesis is that comparison of sequence and function of genes between aquatic species, murine species and man will provide new insights into the mechanistic interactions between environmental stressors and human tissues, and the genetic basis for disease susceptibility. This BRIN addresses the statewide need to enhance the biomedical research capacity and competitiveness of students and faculty by: a) facilitating the networking of high quality biomedical research institutions with undergraduate and graduate degree granting institutions, b) providing training, education and mentoring of undergraduate and graduate students and junior faculty in biomedical research, and c) stimulating the year-round biomedical research program at MDIBL and basic science research by faculty at four undergraduate colleges. The objective of this supplement application is to enhance further the research capacity of ME's BRIN by expanding the statewide network and strengthening the resources and programs of each BRIN Core. We will incorporate BC as a full member institution, recruit under-represented minority students from one of ME's larger and historically important minority groups, Native Americans, provide start-up funds for NIH competitive, new faculty hires at member institutions, and provide funds for equipment, support, and renovation of training laboratories and cores within the BRIN. ME's biomedical research capacity will be strengthened by an increase in research training opportunities at all participating institutions, and by an increase in the year round presence of NIH-funded investigators at MDIBL. As faculty and students from participating academic institutions become better trained in biomedical research, there will be a greater number of successful competitive NIH research grant applications from these institutions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THE NIH FELLOW PROGRAM Principal Investigator & Institution: Frame, Kathleen S.; Biotechnology Institute 1840 Wilson Blvd, Ste 202 Arlington, Va 22201 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 31-DEC-2002 Summary: (provided by applicant): The Minority Biotechnology Training Program, referred to as the "NIH Fellows Program, was successfully piloted in 2001. This program brought minority students and faculty from historically minority colleges and universities throughout the country to San Diego to attend the 2001 annual international convention of the Biotechnology Industry Organization (BIO) and a two-day preconvention workshop. This workshop provided students and faculty with a deeper grounding in new and emerging technologies, industrial entrepreneurship and curriculum development in biotechnology and related sciences. NIH funding was supplemented by BIO and numerous biotech companies to allow 43 minority students and faculty to participate. The feedback from participants was clear: the program is very important to help bring diversity to the biotechnology field and must be continued. Building on the positive momentum for this program, the Biotechnology Institute, a newly created non-profit organization dedicated to biotechnology education, proposes to oversee the planning, implementation, and institutionalization of this program, beginning the transition with a program for 20 minority students and 5 faculty from minority institutions. The Institute will rely on the expertise of key personnel who contributed to last year's success, specifically Dr. Robert Pozos and Dr. Stephen Dahms of San Diego State University. BIO has already committed complimentary registration, worth $25,000, for all participants for which we are requesting NIH funds, and companies such as Genentech have indicated their willingness to provide substantial supplementary funds. Funding of $79,268 from NIH will support this transition and allow the Institute to put together essential partnerships with important organizations such as the American Society of Microbiology (ASM) and the Society for the Advancements for Chicanos and Native Americans into Sciences (SACNAS) to plan for expansion over time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TOBACCO INDUSTRY TACTICS AIMED AT NATIVE AMERICANS Principal Investigator & Institution: Beebe, Laura A.; Biostatistics and Epidemiology; University of Oklahoma Hlth Sciences Ctr Health Sciences Center Oklahoma City, Ok 73126 Timing: Fiscal Year 2004; Project Start 01-MAR-2004; Project End 28-FEB-2007 Summary: (provided by applicant): Rates of tobacco use among Native American youth and adults are substantially higher than any other subgroup. In addition, the role of tobacco in Native American communities is complex due to its traditional and spiritual use, and the economic boon from smoke shops to many communities. For decades, the tobacco industry has used Native American imagery in the packaging and marketing of commercial tobacco. This unique set of circumstances renders research to expose the strategies used by the tobacco industry to influence Native American communities imperative. The overall goal of this project is to gain an understanding of tobacco industry tactics related to the targeting and marketing of commercial tobacco to Native American communities, so that more effective techniques for the prevention and control of tobacco abuse may be developed. Through a systematic review and analysis of tobacco industry documents, the specific aims of this project are to: 1) Identify and describe the use of Native American cultural elements and images by the tobacco

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industry to promote commercial tobacco use among both Native Americans and nonNatives; 2) Describe tobacco industry strategies designed to target and market to Native American communities; 3) Explore tobacco lobby efforts to influence Native Americans and tribal governments throughout the United States with respect to tobacco excise taxes, clean indoor air legislation, youth access enforcement efforts, tobacco lobby related tort and product liability reform efforts, anti-tobacco education efforts, tobacco sampling, promotion, and advertising restrictions, tobacco sales restrictions including in vending machines, and tobacco ingredient regulation; 4) Explore how the tobacco industry strategies identified in aims 1 through 3 are perceived and received by Native Americans; 5) Disseminate the documents and findings via a website, presentations and publications; 6) Make specific recommendations concerning intervention programs for tobacco abuse in Native American communities, using the results of this research and guidance by a national Advisory Council. Research methodology will include qualitative methods such as content analysis, opinion leader surveys and focus group interviews. The results of this research will assist tribal, community and state agencies in their efforts to develop culturally appropriate counter-marketing strategies and tobacco abuse prevention and control interventions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UC DAVIS BIOLOGY EDUCATION PROGRAM Principal Investigator & Institution: Horwitz, Barbara A.; Vice Provost of Academic Personnel; Neurobiol/Physiol & Behavior; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2002; Project Start 01-FEB-1998; Project End 31-MAR-2006 Summary: (provided by applicant): Although the past two decades have seen higher undergraduate enrollments of minorities, there remains significant underrepresentation of African Americans, Native Americans, Hispanic Americans, and Pacific Islanders in biomedical research careers. Solving this problem involves increasing the number of these students who pursue doctoral programs in sciences related to biomedicine. With IMSD funding, we have developed a coherent, coordinated series of enrichment activities which support and encourage minority students academically and financially from freshman through the second year of graduate school. We have cultivated academic excellence in freshman undergraduates through a structured academic program of supplemental course work in chemistry and math, gate-keepers to success in biology, while more advanced undergraduates have participated in a series of coordinated academic enrichment activities designed to hone their oral and written communication skills as well as enhance their excitement about biology. Evaluation of our undergraduate IMSD program indicates that research experience is a critical factor for graduation of these students with a degree in Biology and a 3.0 average. It also suggests that beginning this research experience during the freshman year can be a distraction to the students. Thus, in this renewal proposal, we have eliminated the placement of freshmen in a research lab, substituting a summer lab skills course instead, and providing research opportunities for the students starting their sophomore year. These activities will create investigative partnerships between research faculty and undergraduate minority students, develop the students' investigative skills, demonstrate that research is a viable career option, and increase the number of minority students eligible for graduate school. We will also continue to provide financial, academic, and personal support to minority students during their first 2 years of graduate study. Entering doctoral students will participate in a summer bridge program involving a 7 week laboratory rotation with an experienced research mentor plus

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weekly group meetings designed to enhance oral and written communication skills and to discuss current research topics from campus experts. These group activities, which will continue through the first year of graduate school, will help smooth the way for success in graduate school and biomedical research careers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UNIVERSITY OF MARYLAND CENTER FOR HEALTH DISPARITIES RE* Principal Investigator & Institution: Wilson, Donald E.; Dean; Medicine; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): This is an application to establish the "University of Maryland Center for Health Disparities Research, Training, and Outreach, a partnership between two University System of Maryland institutions, the University of Maryland School of Medicine (UMSOM and designated institution) and the University of Eastern Shore (UMES collaborating and Minority serving institution). The theme for the Center is "Reducing and Eliminating Health Disparities through technology and translation of research advances from bench to clinic and clinic to community. The target areas for this proposed Center are Maryland's rural and urban underserved communities including: African Americans, Native Americans, Hispanics and low-income whites. The Center is composed of seven component cores: an Administrative Core; a central Community Outreach, Information and Dissemination Core which will develop in partnership with key community leaders and organizations, culturally sensitive evidenced-based outreach strategies; Training Core; Shared Resource Core which supports data collection and analysis and mining as well as novel telemedicine and videoconferencing; three research cores which focus on key diseases/disorders affecting the target populations and yielding disparities in morbidity and mortality: Cancer Research Core; Renal/Eye Disease Core, and Mental Health Core. Each institution brings its individual strengths and a history of mutually beneficial partnerships to this initiative. Value added for this Center will allow coordination and integration of research and training activities, strategic planning, evaluation and implementation of the aims of this Center and thus will eliminate uncoordinated and fragmented disparities activities. The aims for the Center are: Aim One: To foster health disparities research on renal and eye disease, cancer and mental health between the two collaborating institutions. Aim Two: To promote and expand the ability of collaborating institutions to foster, coordinate and conduct evidenced-based, culturally appropriate community outreach and dissemination. Aim Three: To enhance and expand the ability of collaborating institutions to foster minority student and faculty training in health disparities research. Aim Four: To enhance and formalize the coordination of shared resources among Export cores to promote health disparities research, community outreach and training activities. Each institution brings excellence in multidisciplinary research and community outreach to this grant. And the Principal investigator, Center directors for UMSOM and UMES bring a career of research excellence, institutional leadership and community outreach commitment to this Partnership. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: USU HEALTH DISPARITIES RESEARCH AND OUTREACH PROJECT Principal Investigator & Institution: Lewis, Evelyn L.; Henry M. Jackson Fdn for the Adv Mil/Med Rockville, Md 20852

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Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): Despite overall improvements in health in the United States, there continue to be substantial health disparities within ethnic/racial minority populations (e.g., African Americans, Hispanics, Native Americans, Asians) and underserved majority populations. These disparities are believed to be the result of a complex interaction of many variables, such as biological factors, the environment, patients' health behaviors, and inadequate provider training. Greater efforts are needed to develop effective and efficient methods to reduce and ultimately eliminate these disparities. The Center for the Enhancement of Healthcare Training and Outcomes (CEHTO) is a biopsychosocial training program for medical, nursing, and graduate students, other prospective health care professionals, and faculty at the Uniformed Services University. An effective infrastructure for Project EXPORT, CEHTO was established to optimize patient adherence and treatment outcomes by enhancing health providers' interpersonal/communication skills with diverse patients, educating practitioners about health disparities, and highlighting the importance of establishing collaborative patient-provider relationships. Therefore, the goals of the USU Health Disparities Research and Outreach Project, our proposed EXPORT Center, will be to: (1) Carry out research to systematically investigate issues central to the understanding and amelioration of health disparities (e.g., evaluate recently developed training methods to improve medical providers' knowledge and skills to reduce health disparities, and explore other bio-behavioral and biomedical contributions to health care disparities in minority groups); (2) educate students, faculty, and health care professionals about health disparities and methods to reduce disparate treatment and improve healthcare outcomes; (3) Develop mutually-beneficial and collaborative research and training partnerships with ethnic/minority community groups (e.g., churches, community health centers and providers, the YMCA, etc.), academic institutions, scientific communities, and medical centers; (4) Use culturally-tailored strategies to disseminate specific, health-relevant information to our community partners; and (5) Create effective mechanisms to recruit and train minority students in the biomedical sciences, research, and the health care fields. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VALIDITY AND RELIABILITY OF ASCA FOR NATIVE AMERICANS Principal Investigator & Institution: Canivez, Gary L.; Psychiatry; Eastern Illinois University Charleston, Il 61920 Timing: Fiscal Year 2003; Project Start 01-DEC-2002; Project End 30-NOV-2004 Summary: (provided by applicant): The long-term aim of this project is to determine the validity and reliability of the Adjustment Scales for Children and Adolescents for use with Native American youths. "TheStandards for Educational and Psychological Testing (AERA, APA, NCME, 1999) stress the need for validation of tests for use with specific subgroups within the population. To date, there appears to be no empirical investigations of the adequacy of commonly used behavior rating scales or measures ofpsychopathology for use with Native American youths. Without such data, school and clinical psychologists may not confidently utilize scales such as the ASCA for clinical assessment of Native American youths. Without valid measures of psychopathology, school and clinical psychologists cannot adequately assess psychopathology in Native American youths referred for evaluation and research on psychopathology among Native American youths is also adversely affected. The ASCA is a relatively new teacher report behavior rating scale that assesses six core syndromes (Attention-Deficit/Hyperactive, Solitary Aggressive-Provocative, Solitary Aggressive-

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Impulsive, Oppositional Defiant, Diffident, and Avoidant) and two supplementary syndromes (Delinquent and Lethargic/Hypoactive). The ASCA also provides two global or overall adjustment scales (Overactivity and Underactivity) that correspond to the second-order factors and are similar to the externalizing (or conduct problem) and internalizing (or withdrawal) dimensions consistently found in the majority of child psychopathology measures and in the child psychopathology literature. School psychologists working in participating school districts will be trained in the administration, scoring, and interpretation of the Adjustment Scales for Children and Adolescents and school psychologists will provide assistance in data collection. Large samples of specific tribes of Native American youths between the ages of 5 and 17 from Arizona and Minnesota will be obtained. Classroom teachers will anonymously complete ASCA forms on randomly selected boys and girls from their class who are of specific Native American tribal status. For each tribe, factor analyses will determine the factorial validity of the ASCA and indicate what and how many dimensions of psychopathology the ASCA measures. Internal consistency of the syndromes will also be assessed. Finally, the ability of the ASCA to discriminate seriously emotionally disabled students from normal students matched on key variables such as age and gender will be investigated to determine the discriminant validity of the ASCA with Native American youths. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: WORKER HEALTH AND SAFETY TRAINING COOPERATIVE AGREEMENT Principal Investigator & Institution: Schurman, Susan J.; George Meany Center for Labor Studies 10000 New Hampshire Ave Silver Spring, Md 20903 Timing: Fiscal Year 2002; Project Start 01-SEP-1992; Project End 31-AUG-2005 Summary: The George Meany Center for Labor Studies, in cooperation with eight rail unions, the AFL-CIO Department of Occupational Safety and Health, and the AFL-CIO Transportation Trades Department submits this application for EPA-HWWT. The total cost requested for this program is 5,083,868 dollars. The long-term aims of the poposal are to: Facilitate the safe transport of hazardous materials throughout the United States by educating rail workers to the dangers posed by hazmats and the proper safety techniques for responding to emergency situations; Encourage workplace and community safety and environmental protection generally by raising the level of worker awareness and involving employees directly in health and safety implementation; Expand training efforts to underserved populations by special efforts to reach out to Native Americans and those of limited English-speaking skills; Enhance access to information about hazardous materials through expanded use of advanced technologies. These efforts will be embodied in the proposed training program which will be provided to an estimated 17,245 workers during the five year funding cycle. All training will be designed to fully meet both DOT and OSHA standards for worker health and safety. The program is national in scope to be available to all types and categories of railroad workers throughout the country. Specific geographic targets will be established in California, Arizona, Texas, and Illinois to coincide with high concentrations of underserved Native American workers and employees with limited English- speaking skills. New initiatives that are part of this proposal are as follows: Expanded use of advanced technology and provision of computer access to make hazardous materials safety information available online and to make possible distance learning of training coursework; Enhancement of train-the-trainer efforts by establishment of certificate trainer program through the National Labor College;

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Development of multi-grantee efforts through increased coordination and expansion of joint efforts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “Native American health” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for Native American health in the PubMed Central database: •

A molecular analysis of dietary diversity for three archaic Native Americans. by Poinar HN, Kuch M, Sobolik KD, Barnes I, Stankiewicz AB, Kuder T, Spaulding WG, Bryant VM, Cooper A, Paabo S.; 2001 Apr 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=31832

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Asian genotypes of JC virus in Native Americans and in a Pacific Island population: Markers of viral evolution and human migration. by Agostini HT, Yanagihara R, Davis V, Ryschkewitsch CF, Stoner GL.; 1997 Dec 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=25048

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Transient and Persistent Helicobacter pylori Colonization in Native American Children. by Perez-Perez GI, Sack RB, Reid R, Santosham M, Croll J, Blaser MJ.; 2003 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=156565

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals.

3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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To generate your own bibliography of studies dealing with Native American health, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “Native American health” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for Native American health (hyperlinks lead to article summaries): •

“Montana gin”: ingestion of commercial products containing denatured alcohol among native Americans. Author(s): Burd L, Shea TE, Knull H. Source: J Stud Alcohol. 1987 July; 48(4): 388-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3613589

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“Rediscovering” the health status of Native Americans. Author(s): Waldman HB. Source: Asdc J Dent Child. 1992 May-June; 59(3): 216-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1629443

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A founder mutation in Artemis, an SNM1-like protein, causes SCID in Athabascanspeaking Native Americans. Author(s): Li L, Moshous D, Zhou Y, Wang J, Xie G, Salido E, Hu D, de Villartay JP, Cowan MJ. Source: Journal of Immunology (Baltimore, Md. : 1950). 2002 June 15; 168(12): 6323-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12055248

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A glimpse of Native Americans in the profession. Author(s): Schuman E. Source: Jaapa. 2000 July; 13(7): 95-6, 99. No Abstract Available. Erratum In: Jaapa 2000 October; 13(10): 96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11521632

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A holistic system of care for Native Americans in an urban environment. Author(s): Nebelkopf E, King J. Source: J Psychoactive Drugs. 2003 January-March; 35(1): 43-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12733757

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A macro-level fetal alcohol syndrome prevention program for Native Americans and Alaska Natives: description and evaluation. Author(s): May PA, Hymbaugh KJ. Source: J Stud Alcohol. 1989 November; 50(6): 508-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2586104

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A molecular analysis of dietary diversity for three archaic Native Americans. Author(s): Poinar HN, Kuch M, Sobolik KD, Barnes I, Stankiewicz AB, Kuder T, Spaulding WG, Bryant VM, Cooper A, Paabo S. Source: Proceedings of the National Academy of Sciences of the United States of America. 2001 April 10; 98(8): 4317-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11296282

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A new DRB1 allele (DRB1*0811) identified in Native Americans. Author(s): Williams TM, Wu J, Foutz T, McAuley JD, Troup GM. Source: Immunogenetics. 1994; 40(4): 314. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8082900

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A 'new' low-incidence red cell antigen, WARR: unique to Native Americans? Author(s): Coghlan G, Crow M, Spruell P, Moulds M, Zelinski T. Source: Vox Sanguinis. 1995; 68(3): 187-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7625077

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A proline-threonine substitution in codon 351 of ADH1C is common in Native Americans. Author(s): Osier MV, Pakstis AJ, Goldman D, Edenberg HJ, Kidd JR, Kidd KK. Source: Alcoholism, Clinical and Experimental Research. 2002 December; 26(12): 175963. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12500098

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A reconsideration of the origins of the type 2 diabetes epidemic among Native Americans and the implications for intervention policy. Author(s): Benyshek DC, Martin JF, Johnston CS. Source: Medical Anthropology. 2001; 20(1): 25-64. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11820766

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A strategy for reducing tuberculosis among Oglala Sioux Native Americans. Author(s): Breault JL, Hoffman MG. Source: American Journal of Preventive Medicine. 1997 May-June; 13(3): 182-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9181205

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A ten-year follow-up of alcoholic Native Americans in Minnesota. Author(s): Westermeyer J, Peake E. Source: The American Journal of Psychiatry. 1983 February; 140(2): 189-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6849432

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Acanthosis Nigricans among Native Americans: an indicator of high diabetes risk. Author(s): Stuart CA, Smith MM, Gilkison CR, Shaheb S, Stahn RM. Source: American Journal of Public Health. 1994 November; 84(11): 1839-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7977931

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Access of Native Americans to renal transplantation in Arizona and New Mexico. Author(s): Narva A, Stiles S, Karp S, Turak A. Source: Blood Purification. 1996; 14(4): 293-304. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8873955

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Alcohol abuse among Native Americans. Author(s): Lamarine RJ. Source: Journal of Community Health. 1988 Fall; 13(3): 143-55. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3068262

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Alcohol and the future of Native Americans. Author(s): Prager K. Source: Jama : the Journal of the American Medical Association. 1993 January 27; 269(4): 471-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8419659

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Alcohol dehydrogenase polymorphisms in Native Americans: identification of the ADH2*3 allele. Author(s): Wall TL, Garcia-Andrade C, Thomasson HR, Carr LG, Ehlers CL. Source: Alcohol and Alcoholism (Oxford, Oxfordshire). 1997 March-April; 32(2): 129-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9105506

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Alcoholism as a mental health problem of Native Americans. A review of the literature. Author(s): Brod, TM. Source: Archives of General Psychiatry. 1975 November; 32(11): 1385-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1200762

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Alternative explanation for similarities between Native Americans and Siberians. Author(s): Pardner Hicks AM. Source: Human Biology; an International Record of Research. 1998 February; 70(1): 13740. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9489240

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An examination of ALDH2 genotypes, alcohol metabolism and the flushing response in Native Americans. Author(s): Gill K, Eagle Elk M, Liu Y, Deitrich RA. Source: J Stud Alcohol. 1999 March; 60(2): 149-58. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10091951

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Analysis of the HLA-DRw8 haplotype: recognition by HTC typing of three distinct antigen complexes in Caucasians, Native Americans, and Orientals. Author(s): Mickelson EM, Nisperos B, Layrisse Z, Kim SJ, Thomas ED, Hansen JA. Source: Immunogenetics. 1983; 17(4): 399-410. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6187680

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Anglo adoptions of native Americans: repercussions in adolescence. Author(s): Berlin IN. Source: J Am Acad Child Psychiatry. 1978 Spring; 17(2): 387-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=659755

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Asian genotypes of JC virus in Native Americans and in a Pacific Island population: markers of viral evolution and human migration. Author(s): Agostini HT, Yanagihara R, Davis V, Ryschkewitsch CF, Stoner GL. Source: Proceedings of the National Academy of Sciences of the United States of America. 1997 December 23; 94(26): 14542-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9405649

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Association of the insulin resistance syndrome and microalbuminuria among nondiabetic native Americans. The Inter-Tribal Heart Project. Author(s): Hoehner CM, Greenlund KJ, Rith-Najarian S, Casper ML, McClellan WM. Source: Journal of the American Society of Nephrology : Jasn. 2002 June; 13(6): 1626-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12039992

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Associations of community-based health education programs with food habits and cardiovascular disease risk factors among Native Americans with diabetes: the intertribal heart project, 1992 to 1994. Author(s): Archer SL, Greenlund KJ, Casper ML, Rith-Najarian S, Croft JB. Source: Journal of the American Dietetic Association. 2002 August; 102(8): 1132-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12171460

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Attitudes and beliefs concerning organ donation among Native Americans in the upper Midwest. Author(s): Danielson BL, LaPree AJ, Odland MD, Steffens EK. Source: J Transpl Coord. 1998 September; 8(3): 153-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9866544

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Behavioral health funding for Native Americans in Arizona: policy implications for states and tribes. Author(s): Provan KG, Carson LM. Source: The Journal of Behavioral Health Services & Research. 2000 February; 27(1): 1728. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10695238

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Biliary enteric fistulas. Management of 47 cases in native Americans. Author(s): Zwemer FL, Coffin-Kwart VE, Conway MJ. Source: American Journal of Surgery. 1979 August; 138(2): 301-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=464235

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Birthweight-specific infant mortality for native Americans compared with whites, six states, 1980. Author(s): Vanlandingham MJ, Buehler JW, Hogue CJ, Strauss LT. Source: American Journal of Public Health. 1988 May; 78(5): 499-503. Erratum In: Am J Public Health 1988 November; 78(11): 1412. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3354730

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Birthweight-specific infant mortality risks for Native Americans and whites, United States, 1960 and 1984. Author(s): VanLandingham MJ, Hogue CJ. Source: Soc Biol. 1995 Spring-Summer; 42(1-2): 83-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7481922

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Blood types of the native Americans of Oklahoma. Author(s): Kasprisin DO, Crow M, McClintock C, Lawson J. Source: American Journal of Physical Anthropology. 1987 May; 73(1): 1-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3618747

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Bone marrow transplantation for T-B- severe combined immunodeficiency disease in Athabascan-speaking native Americans. Author(s): O'Marcaigh AS, DeSantes K, Hu D, Pabst H, Horn B, Li L, Cowan MJ. Source: Bone Marrow Transplantation. 2001 April; 27(7): 703-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11360109

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Breakthrough to nursing. Caring through understanding: Part I. Native Americans. Author(s): Richardson L. Source: Imprint. 1982 February; 29(1): 13, 67, 71 Passim. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6915867

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Brief communication: an update on stature estimation in prehistoric Native Americans of Ohio. Author(s): Sciulli PW, Giesen MJ. Source: American Journal of Physical Anthropology. 1993 November; 92(3): 395-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8291623

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Cancer incidence among native Americans of western Washington. Author(s): Norsted TL, White E. Source: International Journal of Epidemiology. 1989 March; 18(1): 22-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2722367

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Cancer mortality among Native Americans. Author(s): Burhansstipanov L. Source: Cancer. 1998 December 1; 83(11): 2247-50. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9840522

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Cancer mortality in Native Americans in North Carolina. Author(s): Horner RD. Source: American Journal of Public Health. 1990 August; 80(8): 940-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2368854

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Cancer surveillance. A problem for Native Americans and Appalachian populations. Author(s): Hampton JW, Friedell GH. Source: Cancer. 2001 January 1; 91(1 Suppl): 242-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11148587

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Cardiovascular disease risk factors in native Americans: a literature review. Author(s): Ellis JL, Campos-Outcalt D. Source: American Journal of Preventive Medicine. 1994 September-October; 10(5): 295307. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7848673

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Clinical hypertension in Native Americans: a comparison of 1987 and 1992 rates from ambulatory care data. Author(s): Acton KJ, Preston S, Rith-Najarian S. Source: Public Health Reports (Washington, D.C. : 1974). 1996; 111 Suppl 2: 33-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8898769

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Cocaine smokers and injection drug users in Alaska: what distinguishes Native Americans from non-Native Americans? Author(s): Paschane DM, Cagle HH, Fisher DG. Source: Int J Circumpolar Health. 1998; 57 Suppl 1: 474-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10093327

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Community health representatives: a valuable resource for providing coronary heart disease health education activities for Native Americans. Author(s): Cleaver VL, Ratcliff R, Rogers B. Source: Health Educ. 1989 October-November; 20(6): 16-20. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2576268

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Corneal astigmatism in preschool Native Americans. Author(s): Maples WC, Herrmann M, Hughes J. Source: J Am Optom Assoc. 1997 February; 68(2): 87-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9120215

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Coronary artery bypass grafting in Native Americans: a higher risk of death compared to other ethnic groups? Author(s): Nallamothu BK, Saint S, Saha S, Fendrick AM, Kelley K, Ramsey SD. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2001 August; 16(8): 554-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11556933

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Cutaneous diseases in Native Americans. Author(s): Cornelison RL Jr. Source: Dermatologic Clinics. 2003 October; 21(4): 699-702. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14717410

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Decreased beta2 adrenergic mediated venodilatation in Native Americans. Author(s): Vajo Z, Cruz E, Szekacs B, Dachman W. Source: International Angiology : a Journal of the International Union of Angiology. 1998 December; 17(4): 276-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10204662

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Dental indicators of stress and reduced age at death in prehistoric Native Americans. Author(s): Duray SM. Source: American Journal of Physical Anthropology. 1996 February; 99(2): 275-86. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8967328

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Determination of cystic fibrosis carrier frequency for Zuni native Americans of New Mexico. Author(s): Kessler D, Moehlenkamp C, Kaplan G. Source: Clinical Genetics. 1996 February; 49(2): 95-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8740921

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Developing cancer clinical trial resources for Native Americans. Author(s): Boesch M. Source: Cancer Practice. 2002 September-October; 10(5): 263-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12236841

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Diabetes and associated risk factors among Native Americans. Author(s): Muneta B, Newman J, Wetterall S, Stevenson J. Source: Diabetes Care. 1993 December; 16(12): 1619-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8299459

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Diabetes and plasma lipoproteins in Native Americans. Studies of the Pima Indians. Author(s): Howard BV. Source: Diabetes Care. 1993 January; 16(1): 284-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8422793

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Diabetes mellitus and major depression: considerations for treatment of Native Americans. Author(s): Warnock JK, Mutzig EM. Source: J Okla State Med Assoc. 1998 December; 91(9): 488-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9864955

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Diabetes-associated mortality in Native Americans. Author(s): Newman JM, DeStefano F, Valway SE, German RR, Muneta B. Source: Diabetes Care. 1993 January; 16(1): 297-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8422795

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Diabetic end-stage renal disease among Native Americans. Author(s): Muneta B, Newman J, Stevenson J, Eggers P. Source: Diabetes Care. 1993 January; 16(1): 346-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8422807

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Differences in need for orthodontic treatment between Native Americans and the general population based on DAI scores. Author(s): Jenny J, Cons NC, Kohout FJ, Jakobsen J. Source: J Public Health Dent. 1991 Fall; 51(4): 234-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1941776

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Dissipation and offsite movement of forestry herbicides in plants of importance to Native Americans in California National Forests. Author(s): Ando C, Segawa R, Gana C, Li L, Walters J, Sava R, Barry T, Goh KS, Lee P, Tran D, White J, Hsu J. Source: Bulletin of Environmental Contamination and Toxicology. 2003 August; 71(2): 354-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14560388

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Distribution of the four founding lineage haplotypes in Native Americans suggests a single wave of migration for the New World. Author(s): Merriwether DA, Rothhammer F, Ferrell RE. Source: American Journal of Physical Anthropology. 1995 December; 98(4): 411-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8599378

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Drinking-related locus of control and the drinking status of urban Native Americans. Author(s): Mariano AJ, Donovan DM, Walker PS, Mariano MJ, Walker RD. Source: J Stud Alcohol. 1989 July; 50(4): 331-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2755134

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Effects of age on lactose malabsorption in Oklahoma Native Americans as determined by breath H2 analysis. Author(s): Caskey DA, Payne-Bose D, Welsh JD, Gearhart HL, Nance MK, Morrison RD. Source: Am J Dig Dis. 1977 February; 22(2): 113-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=835552

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End state renal disease among Native Americans, 1983-86. Author(s): Newman JM, Marfin AA, Eggers PW, Helgerson SD. Source: American Journal of Public Health. 1990 March; 80(3): 318-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2305914

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Endemic pemphigus foliaceus (fogo selvagem) in native Americans from Brazil. Author(s): Friedman H, Campbell I, Rocha-Alvarez R, Ferrari I, Coimbra CE, Moraes JR, Flowers NM, Stastny P, Fernandez-Vina M, Olague-Alcala M, et al. Source: Journal of the American Academy of Dermatology. 1995 June; 32(6): 949-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7751464

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Environmental causes of cancer among Native Americans. Author(s): Cobb N. Source: Cancer. 1996 October 1; 78(7 Suppl): 1603-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8839579

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Estimation of sex from the talus in prehistoric Native Americans. Author(s): Barrett C, Cavallari W, Sciulli PW. Source: Coll Antropol. 2001 June; 25(1): 13-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11787537

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Ethnic differences in mortality from cerebrovascular disease among New Mexico's Hispanics, Native Americans, and non-Hispanic whites, 1958 through 1987. Author(s): Kattapong VJ, Becker TM. Source: Ethn Dis. 1993 Winter; 3(1): 75-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8508109

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Evolution of dentition in prehistoric Ohio Valley Native Americans III. Metrics of deciduous dentition. Author(s): Sciulli PW. Source: American Journal of Physical Anthropology. 2001 October; 116(2): 140-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11590586

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Evolution of the dentition in prehistoric Ohio Valley Native Americans: II. Morphology of the deciduous dentition. Author(s): Sciulli PW. Source: American Journal of Physical Anthropology. 1998 June; 106(2): 189-205. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9637183

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Faculty experiences teaching Native Americans in a university setting. Author(s): Dickerson SS, Neary MA. Source: Journal of Transcultural Nursing : Official Journal of the Transcultural Nursing Society / Transcultural Nursing Society. 1999 January; 10(1): 56-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10476153

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Faith, prayer, and health outcomes in elderly Native Americans. Author(s): Meisenhelder JB, Chandler EN. Source: Clinical Nursing Research. 2000 May; 9(2): 191-203. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12162242

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Family structure and the use of agency services: an examination of patterns among elderly Native Americans. Author(s): Murdock SH, Schwartz DF. Source: The Gerontologist. 1978 October; 18(5 Pt 1): 475-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=263564

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Fatal motor vehicle traffic accidents among Native Americans. Author(s): Mahoney MC. Source: American Journal of Preventive Medicine. 1991 March-April; 7(2): 112-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1910885

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Four Corners Research Consortium for Native Americans and cancer research. Author(s): Osborn KL, Davis SM, Slattery M, Giuliano A, Teufel NI, Joe J, Ritenbaugh C. Source: Cancer. 1996 October 1; 78(7 Suppl): 1629-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8839584

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Four Directions Summer Program guides Native Americans toward medical careers. Author(s): Friedrich MJ. Source: Jama : the Journal of the American Medical Association. 2001 September 19; 286(11): 1301-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11560518

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Further data on the microsatellite locus D12S67 in worldwide populations: an unusual distribution of D12S67 alleles in Native Americans. Author(s): Mitchell RJ, Federle L, Sofro AS, Papiha SS, Briceno I, Bernal JE. Source: Human Biology; an International Record of Research. 2000 August; 72(4): 697705. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11048795

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Genes may link ancient Eurasians, Native Americans. Author(s): Morell V. Source: Science. 1998 April 24; 280(5363): 520. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9575096

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Genetic link between Asians and native Americans: evidence from HLA genes and haplotypes. Author(s): Tokunaga K, Ohashi J, Bannai M, Juji T. Source: Human Immunology. 2001 September; 62(9): 1001-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11543902

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Genomic diversity of human papillomavirus-16, 18, 31, and 35 isolates in a Mexican population and relationship to European, African, and Native American variants. Author(s): Calleja-Macias IE, Kalantari M, Huh J, Ortiz-Lopez R, Rojas-Martinez A, Gonzalez-Guerrero JF, Williamson AL, Hagmar B, Wiley DJ, Villarreal L, Bernard HU, Barrera-Saldana HA. Source: Virology. 2004 February 20; 319(2): 315-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14980491

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Gentamicin pharmacokinetics in Native Americans of Apache ancestry. Author(s): Murphy JE, Severnak T. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 1996 September 15; 53(18): 2189-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8879327

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GM allotypes in Native Americans: evidence for three distinct migrations across the Bering land bridge. Author(s): Williams RC, Steinberg AG, Gershowitz H, Bennett PH, Knowler WC, Pettitt DJ, Butler W, Baird R, Dowda-Rea L, Burch TA, et al. Source: American Journal of Physical Anthropology. 1985 January; 66(1): 1-19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3976868

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Health care for native Americans: who will pay? Author(s): Smith EM. Source: Health Aff (Millwood). 1987 Spring; 6(1): 123-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3556366

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Health care for the underprivileged in the land of affluence: California Native Americans. Author(s): Montgomery TA. Source: Pediatrics. 1978 September; 62(3): 377-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=360154

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Health education interventions among Native Americans: a review and analysis. Author(s): LeMaster PL, Connell CM. Source: Health Educ Q. 1994 Winter; 21(4): 521-38. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7843981

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Health status of the Australian aboriginal people and the Native Americans--a summary comparison. Author(s): Michael JM, Michael MA. Source: Asia Pac J Public Health. 1994; 7(2): 132-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7946653

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Heart disease in Asians and Pacific-Islanders, Hispanics, and Native Americans. Author(s): Yu PN. Source: Circulation. 1991 April; 83(4): 1475-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2013171

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Heart disease in native Americans. Author(s): Alpert JS, Goldberg R, Ockene IS, Taylor P. Source: Cardiology. 1991; 78(1): 3-12. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2021963

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Heterogeneity of HLA-DR2 haplotypes in Caucasoid Americans, African Americans, Chinese Americans, Native Americans and Xiamen Chinese. Author(s): Lee A, Huang R, Yan L, Shaw CK, Zeng S, Lin PY, Lee TD. Source: European Journal of Immunogenetics : Official Journal of the British Society for Histocompatibility and Immunogenetics. 1999 August; 26(4): 275-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10457891

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Historical racism: implications for Native Americans. Author(s): Belcourt-Dittloff A, Stewart J. Source: The American Psychologist. 2000 October; 55(10): 1166-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11080850

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How native Americans deal with stress. Author(s): Barnes H. Source: Wash State J Nurs. 1977 Winter; 49(1): 9-11. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=584112

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HTLV-II risk factors in Native Americans in Florida. Author(s): Lowis GW, Sheremata WA, Wickman PR, Dube S, Dube K, Poiesz BJ. Source: Neuroepidemiology. 1999; 18(1): 37-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9831814

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Hyperlipidemia in Native Americans: evaluation of lipid management through a cardiovascular risk reduction program. Author(s): Burden RW, Kumar RN, Phillips DL, Borrego ME, Galloway JM. Source: Journal of the American Pharmaceutical Association (Washington,D.C. : 1996). 2002 July-August; 42(4): 652-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12150364

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Hypertension in Hispanics, Asians and Pacific-Islanders, and Native Americans. Author(s): Martinez-Maldonado M. Source: Circulation. 1991 April; 83(4): 1467-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2013167

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Indian Health Service: a dental student opens her heart to native Americans. Author(s): Philo D. Source: Dentistry. 1990 February; 10(1): 5-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2376232

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Integrating the communicative predicament and enhancement of aging models: the case of older Native Americans. Author(s): Barker V, Giles H. Source: Health Communication. 2003; 15(3): 255-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12788674

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Interpersonal violence between 18th century Native Americans and Europeans in Ohio. Author(s): Williamson MA, Johnston CA, Symes SA, Schultz JJ. Source: American Journal of Physical Anthropology. 2003 October; 122(2): 113-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12949831

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Interrelationships among alcohol abuse, obesity, and type II diabetes mellitus: focus on Native Americans. Author(s): Mohs ME, Leonard TK, Watson RR. Source: World Review of Nutrition and Dietetics. 1988; 56: 93-172. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3055698

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Kidney disease in Native Americans. Author(s): Narva AS. Source: Journal of the National Medical Association. 2002 August; 94(8): 738-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12152933

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Knowledge, attitudes and behaviors related to physical activity among Native Americans with diabetes. Author(s): Stolarczyk LM, Gilliland SS, Lium DJ, Owen CL, Perez GE, Kriska AM, Ainsworth BE, Carter JS. Source: Ethn Dis. 1999 Winter; 9(1): 59-69. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10355475

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Knowledge, skills and attitudes of nursing students regarding culturally congruent care of Native Americans. Author(s): Wittig DR. Source: Journal of Transcultural Nursing : Official Journal of the Transcultural Nursing Society / Transcultural Nursing Society. 2004 January; 15(1): 54-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14768416

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Locus of control, depression, and anger among Native Americans. Author(s): Young TJ. Source: The Journal of Social Psychology. 1991 August; 131(4): 583-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1943078

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Marketing for Native Americans needed. Author(s): Nunnery BD. Source: Asha. 1993 April; 35(4): 72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8484826

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Meta-analysis reveals association between most common class II haplotype in fullheritage Native Americans and rheumatoid arthritis. Author(s): Williams RC, Jacobsson LT, Knowler WC, del Puente A, Kostyu D, McAuley JE, Bennett PH, Pettitt DJ. Source: Human Immunology. 1995 January; 42(1): 90-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7751165

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Methods for using Medicare data to compare procedure rates among Asians, blacks, Hispanics, Native Americans, and whites. Author(s): Escarce JJ, McGuire TG. Source: Health Services Research. 2003 October; 38(5): 1303-17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14596392

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Microsatellites and intragenic polymorphisms of transforming growth factor beta and platelet-derived growth factor and their receptor genes in Native Americans with systemic sclerosis (scleroderma): a preliminary analysis showing no genetic association. Author(s): Zhou X, Tan FK, Stivers DN, Arnett FC. Source: Arthritis and Rheumatism. 2000 May; 43(5): 1068-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10817561

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Mitochondrial genome diversity of Native Americans supports a single early entry of founder populations into America. Author(s): Silva WA Jr, Bonatto SL, Holanda AJ, Ribeiro-Dos-Santos AK, Paixao BM, Goldman GH, Abe-Sandes K, Rodriguez-Delfin L, Barbosa M, Paco-Larson ML, PetzlErler ML, Valente V, Santos SE, Zago MA. Source: American Journal of Human Genetics. 2002 July; 71(1): 187-92. Epub 2002 May 17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12022039

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Model system of ongoing care for native Americans--a 5-year followup. Author(s): Dietrich AJ, Olson AL. Source: Public Health Reports (Washington, D.C. : 1974). 1986 March-April; 101(2): 1847. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3083473

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More highlights on Native Americans. Author(s): Bullock K. Source: Mcn. the American Journal of Maternal Child Nursing. 1997 March-April; 22(2): 72, 104. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9068247

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Mortality rates and aggression management among Native Americans. Author(s): Young TJ. Source: Psychological Reports. 1992 April; 70(2): 665-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1598385

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mtDNA and Native Americans: a Southern perspective. Author(s): Cann RL. Source: American Journal of Human Genetics. 1994 July; 55(1): 7-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7517627

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MtDNA haplogroups in Native Americans. Author(s): Torroni A, Wallace DC. Source: American Journal of Human Genetics. 1995 May; 56(5): 1234-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7726181

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mtDNA variation of aboriginal Siberians reveals distinct genetic affinities with Native Americans. Author(s): Torroni A, Sukernik RI, Schurr TG, Starikorskaya YB, Cabell MF, Crawford MH, Comuzzie AG, Wallace DC. Source: American Journal of Human Genetics. 1993 September; 53(3): 591-608. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7688933

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Multirooted anomalies in the primary dentition of Native Americans. Author(s): Winkler MP, Ahmad R. Source: The Journal of the American Dental Association. 1997 July; 128(7): 1009-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9231606

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Native Americans and the constant death instinct hypothesis. Author(s): Young TJ. Source: Percept Mot Skills. 1991 June; 72(3 Pt 1): 814. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1760030

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Native Americans and the Vaccine Act: excluding those we found here. Author(s): Leach JD. Source: Am Univ Law Rev. 1997 August; 46(6): 1935-43. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10179830

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Native Americans. Author(s): Kopetski LM. Source: Social Work. 2000 January; 45(1): 94-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10634090

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Native Americans: a multi-dimensional challenge. Author(s): Toubbeh JI. Source: Asha. 1982 June; 24(6): 395-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7181977

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Native Americans: a neglected health care crisis and a solution. Author(s): Zechetmayr M. Source: Journal of Health & Social Policy. 1997; 9(2): 29-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10174377

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Novel HLA-B35 subtypes: putative gene conversion events with donor sequences from alleles common in native Americans (HLA-B*4002 or B*4801). Author(s): Marcos CY, Fernandez-Vina MA, Lazaro AM, Nulf CJ, Raimondi EH, Stastny P. Source: Human Immunology. 1997 April 1; 53(2): 148-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9129972

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Obesity and suicide in Native Americans. Author(s): Lester D. Source: Percept Mot Skills. 1999 August; 89(1): 218. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10544419

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Opportunity knocks. UMD opens doors to health careers for native Americans. Author(s): Miller P. Source: Minn Med. 1989 May; 72(5): 281-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2733665

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Oral corn pollen hypersensitivity in Arizona Native Americans: some sociologic aspects of allergy practice. Author(s): Freeman GL. Source: Ann Allergy. 1994 May; 72(5): 415-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8179227

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Oral healthcare of Native Americans of the Plains States. Author(s): Brunick A, Nelson DM. Source: Journal of Dental Hygiene : Jdh / American Dental Hygienists' Association. 1994 September-October; 68(5): 234-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8632196

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Outreach services for elderly native Americans. Author(s): Cooley RC, Ostendorf D, Blickerton D. Source: Social Work. 1979 March; 24(2): 151-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10240955

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Patterns of cancer mortality among Native Americans. Author(s): Cobb N, Paisano RE. Source: Cancer. 1998 December 1; 83(11): 2377-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9840538

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Pedestrian and hypothermia deaths among Native Americans in New Mexico. Between bar and home. Author(s): Gallaher MM, Fleming DW, Berger LR, Sewell CM. Source: Jama : the Journal of the American Medical Association. 1992 March 11; 267(10): 1345-8. Erratum In: Jama 1992 November 4; 268(17): 2378. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1740855

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Phylogenetic relationships among JC virus strains in Japanese/Koreans and Native Americans speaking Amerind or Na-Dene. Author(s): Zheng HY, Sugimoto C, Hasegawa M, Kobayashi N, Kanayama A, Rodas A, Mejia M, Nakamichi J, Guo J, Kitamura T, Yogo Y. Source: Journal of Molecular Evolution. 2003 January; 56(1): 18-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12569419

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Physical abuse of urban Native Americans. Author(s): Buchwald D, Tomita S, Hartman S, Furman R, Dudden M, Manson SM. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 2000 August; 15(8): 562-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10940148

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Physical growth and development of urban native Americans: a study in urbanization and its implications for nutritional status. Author(s): Johnston FE, McKigney JI, Hopwood S, Smelker J. Source: The American Journal of Clinical Nutrition. 1978 June; 31(6): 1017-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=665546

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Poverty, suicide, and homicide among Native Americans. Author(s): Young TJ. Source: Psychological Reports. 1990 December; 67(3 Pt 2): 1153-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2084743

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Prenatal behavioral risk screening by computer among Native Americans. Author(s): Lapham SC, Henley E, Kleyboecker K. Source: Family Medicine. 1993 March; 25(3): 197-202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8458562

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Prevalence and correlates of the insulin resistance syndrome among Native Americans. The Inter-Tribal Heart Project. Author(s): Greenlund KJ, Valdez R, Casper ML, Rith-Najarian S, Croft JB. Source: Diabetes Care. 1999 March; 22(3): 441-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10097926

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Prevalence of diabetes among Native Americans and Alaska Natives, 1990-1997: an increasing burden. Author(s): Burrows NR, Geiss LS, Engelgau MM, Acton KJ. Source: Diabetes Care. 2000 December; 23(12): 1786-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11128353

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Prevalence of prone sleeping position and selected infant care practices of North Dakota infants: a comparison of whites and Native Americans. Author(s): Burd L. Source: Public Health Reports (Washington, D.C. : 1974). 1994 May-June; 109(3): 446-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8190870

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Provision of cancer control services to Native Americans by state health departments. Author(s): Michalek AM, Mahoney MC. Source: Journal of Cancer Education : the Official Journal of the American Association for Cancer Education. 1994 Fall; 9(3): 145-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7811601

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Quantitative complete tooth variation among east Asians and Native Americans: developmental biology as a tool for the assessment of human divergence. Author(s): Shields ED. Source: Journal of Craniofacial Genetics and Developmental Biology. 1996 OctoberDecember; 16(4): 193-207. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8897209

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Racial misclassification of Native Americans in a surveillance, epidemiology, and end results cancer registry. Author(s): Frost F, Taylor V, Fries E. Source: Journal of the National Cancer Institute. 1992 June 17; 84(12): 957-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1629916

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Reducing injuries among Native Americans: five cost-outcome analyses. Author(s): Zaloshnja E, Miller TR, Galbraith MS, Lawrence BA, DeBruyn LM, Bill N, Hicks KR, Keiffer M, Perkins R. Source: Accident; Analysis and Prevention. 2003 September; 35(5): 631-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12850063

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Relationship between prevalence of alcohol problems and socioeconomic conditions among Oklahoma Native Americans. Author(s): Stratton R. Source: Curr Alcohol. 1981; 8: 315-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7343188

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Risk factors for coronary heart disease in diabetic and nondiabetic Native Americans. The Strong Heart Study. Author(s): Howard BV, Welty TK, Fabsitz RR, Cowan LD, Oopik AJ, Le NA, Yeh J, Savage PJ, Lee ET. Source: Diabetes. 1992 October; 41 Suppl 2: 4-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1526334

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Screening for alcohol abuse among urban Native Americans in a primary care setting. Author(s): Shore J, Manson SM, Buchwald D. Source: Psychiatric Services (Washington, D.C.). 2002 June; 53(6): 757-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12045316

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Sexually transmitted diseases and native Americans: trends in reported gonorrhea and syphilis morbidity, 1984-88. Author(s): Toomey KE, Oberschelp AG, Greenspan JR. Source: Public Health Reports (Washington, D.C. : 1974). 1989 November-December; 104(6): 566-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2511589

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Smokeless tobacco use and attitudes toward smokeless tobacco among Native Americans and other adolescents in the northwest. Author(s): Hall RL, Dexter D. Source: American Journal of Public Health. 1988 December; 78(12): 1586-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3189641

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Smoking during pregnancy among northwest Native Americans. Author(s): Davis RL, Helgerson SD, Waller P. Source: Public Health Reports (Washington, D.C. : 1974). 1992 January-February; 107(1): 66-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1738811

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Stature estimation in prehistoric Native Americans of Ohio. Author(s): Sciulli PW, Schneider KN, Mahaney MC. Source: American Journal of Physical Anthropology. 1990 November; 83(3): 275-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2252075

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Strokes in Asians and Pacific-Islanders, Hispanics, and Native Americans. Author(s): Yatsu FM. Source: Circulation. 1991 April; 83(4): 1471-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2013169

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Suicide and homicide among Native Americans: a comment. Author(s): Lester D. Source: Psychological Reports. 1995 August; 77(1): 10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7501745

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Suicide and homicide among Native Americans: anomie or social learning? Author(s): Young TJ. Source: Psychological Reports. 1991 June; 68(3 Pt 2): 1137-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1924613

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Suicide and social status among Native Americans. Author(s): Young TJ, French LA. Source: Psychological Reports. 1993 October; 73(2): 461-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8234596

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Suicide rates among Native Americans in 1890. Author(s): Lester D. Source: Percept Mot Skills. 1995 June; 80(3 Pt 1): 830. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7567399

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Suicide rates in Native Americans by state and size of population. Author(s): Lester D. Source: Percept Mot Skills. 1994 June; 78(3 Pt 1): 954. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8084717

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The apportionment of dinucleotide repeat diversity in Native Americans and Europeans: a new approach to measuring gene identity reveals asymmetric patterns of divergence. Author(s): Urbanek M, Goldman D, Long JC. Source: Molecular Biology and Evolution. 1996 September; 13(7): 943-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8752003

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The delivery of culturally sensitive health care to Native Americans. Author(s): Sanchez TR, Plawecki JA, Plawecki HM. Source: Journal of Holistic Nursing : Official Journal of the American Holistic Nurses' Association. 1996 December; 14(4): 295-307. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9146187

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The effects of socioeconomic characteristics and off-reservation contacts on the service awareness and usage patterns of elderly native Americans. Author(s): Murdock SH, Schwartz DF, Hwang S. Source: Long Term Care Health Serv Adm Q. 1980 Spring; 4(1): 64-76. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10245510

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The epidemiology of atherosclerosis and its risk factors among Native Americans. Author(s): Galloway JM. Source: Curr Diab Rep. 2002 June; 2(3): 274-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12643185

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The epidemiology of stroke in Native Americans. Author(s): Gillum RF. Source: Stroke; a Journal of Cerebral Circulation. 1995 March; 26(3): 514-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7886735

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The expected impact of a smoking cessation program for pregnant women on infant mortality among Native Americans. Author(s): Bulterys M, Morgenstern H, Welty TK, Kraus JF. Source: American Journal of Preventive Medicine. 1990 September-October; 6(5): 267-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2268455

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The gene for severe combined immunodeficiency disease in Athabascan-speaking Native Americans is located on chromosome 10p. Author(s): Li L, Drayna D, Hu D, Hayward A, Gahagan S, Pabst H, Cowan MJ. Source: American Journal of Human Genetics. 1998 January; 62(1): 136-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9443881

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The incidence of pathological gambling among Native Americans treated for alcohol dependence. Author(s): Elia C, Jacobs DF. Source: Int J Addict. 1993 May; 28(7): 659-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8500926

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The interleukin-6 (-174) G/C promoter polymorphism is associated with type-2 diabetes mellitus in Native Americans and Caucasians. Author(s): Vozarova B, Fernandez-Real JM, Knowler WC, Gallart L, Hanson RL, Gruber JD, Ricart W, Vendrell J, Richart C, Tataranni PA, Wolford JK. Source: Human Genetics. 2003 April; 112(4): 409-13. Epub 2003 February 14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12589429

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The lived experience of Native Americans with diabetes within a transcultural nursing perspective. Author(s): Parker JG. Source: Journal of Transcultural Nursing : Official Journal of the Transcultural Nursing Society / Transcultural Nursing Society. 1994 Summer; 6(1): 5-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7826547

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The NHLBI workshop on Hypertension in Hispanic Americans, Native Americans, and Asian/Pacific Islander Americans. Author(s): Havas S, Fujimoto W, Close N, McCarter R, Keller J, Sherwin R. Source: Public Health Reports (Washington, D.C. : 1974). 1996 September-October; 111(5): 451-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8837635

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The rehabilitation of disabled Native Americans. Author(s): Morgan J, O'Connell JC. Source: International Journal of Rehabilitation Research. Internationale Zeitschrift Fur Rehabilitationsforschung. Revue Internationale De Recherches De Readaptation. 1987; 10(2): 139-49. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2960628

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The responsiveness and equality of mental health care to Chicanos and Native Americans. Author(s): Sue S, Allen DB, Conaway L. Source: American Journal of Community Psychology. 1978 April; 6(2): 137-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=264147

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Through indigenous eyes: Native Americans and the HIV epidemic. Author(s): Weaver HN. Source: Health & Social Work. 1999 February; 24(1): 27-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14533417

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Transcultural nursing with Native Americans: critical knowledge, skills, and attitudes. Author(s): Weaver HN. Source: Journal of Transcultural Nursing : Official Journal of the Transcultural Nursing Society / Transcultural Nursing Society. 1999 July; 10(3): 197-202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10693406

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Two new projects to help Native Americans end substance abuse and domestic violence. Author(s): Mitka M. Source: Jama : the Journal of the American Medical Association. 2002 October 16; 288(15): 1834, 1837. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12377068

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Type II diabetes and cognitive function. A population-based study of Native Americans. Author(s): Lowe LP, Tranel D, Wallace RB, Welty TK. Source: Diabetes Care. 1994 August; 17(8): 891-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7956638

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Unexpected patterns of mitochondrial DNA variation among Native Americans from the southeastern United States. Author(s): Bolnick DA, Smith DG. Source: American Journal of Physical Anthropology. 2003 December; 122(4): 336-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14614755

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Use of tacrolimus as the primary immunosuppression after renal transplant in Native Americans and Hispanics. Author(s): Eghtesad B, Malhotra D, Hecker WP, Haq M, Gibel LJ, Wheeler D, Smith AY, Harford AM. Source: Transplantation Proceedings. 1998 June; 30(4): 1232-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9636500

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Use of traditional health practices among Native Americans in a primary care setting. Author(s): Buchwald D, Beals J, Manson SM. Source: Medical Care. 2000 December; 38(12): 1191-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11186298

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Use of traditional Indian medicine among urban native Americans. Author(s): Fuchs M, Bashshur R. Source: Medical Care. 1975 November; 13(11): 915-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1195900

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Validity of the MMPI with native Americans. Author(s): Pollack D, Shore JH. Source: The American Journal of Psychiatry. 1980 August; 137(8): 946-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7416296

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Venereal diseases and aggression management among Native Americans. Author(s): Young TJ. Source: Psychological Reports. 1991 December; 69(3 Pt 1): 906. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1784682

Academic Periodicals covering Native American Health Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to Native American health. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

Dissertations on Native American Health ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to Native American health. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “Native American health” (or a synonym) in their titles. The following covers recent dissertations found when using this search procedure:

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A QUALITATIVE STUDY OF THE MEANING OF AGING TO EUROPEANAMERICAN MIDDLE-CLASS AND NATIVE AMERICAN PARTICIPANTS IN A SENIOR CITIZENS' NUTRITION PROGRAM by THEOBALD, BARBARA J., PHD from Syracuse University, 1991, 193 pages http://wwwlib.umi.com/dissertations/fullcit/9204558

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CULTURAL VALUES AND WELLNESS OF NATIVE AMERICAN HIGH SCHOOL STUDENTS (WELLNESS, ACCULTURATION) by GARRETT, MICHAEL T., PHD from The University of North Carolina at Greensboro, 1996, 196 pages http://wwwlib.umi.com/dissertations/fullcit/9632136

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Factors that enabled success of Native American baccalaureate nursing graduates at Montana State University from 1986 to 1995 by Yurkovich, Eleanor Eloise, EdD from Montana State University, 1997, 209 pages http://wwwlib.umi.com/dissertations/fullcit/9729972

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One Mother Earth, one doctor water: A story about environmental justice in the age of nuclearism. A Native American view (New Mexico) by Ross, Annie Grace; PhD from University of California, Davis, 2002, 505 pages http://wwwlib.umi.com/dissertations/fullcit/3074601

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CHAPTER 2. NUTRITION AND NATIVE AMERICAN HEALTH Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and Native American health.

Finding Nutrition Studies on Native American Health The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. Once you have entered the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “Native American health” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “Native American health” (or a synonym): •

A low-cost competitive approach to weight reduction in a Native American community. Author(s): Zuni PHS Hospital, NM 87327. Source: Wilson, R Smith, J Marfin, A M Helgerson, S Int-J-Obes. 1989; 13(6): 731-8 03070565

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Beverage choice among native american and african american urban women. Author(s): Alcohol Research Group, Berkeley, California 94709-2176, USA. Source: Graves, Karen Kaskutas, Lee Ann Alcohol-Clin-Exp-Res. 2002 February; 26(2): 218-22 0145-6008

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Coumarin-containing plants and serum albumin polymorphisms: biomedical implications for Native Americans of the Southwest. Source: Raichelson, R.M. Plants in indigenous medicine & diet : biobehavioral approaches / edited by Nina L. Etkin. Bedford Hills, N.Y. : Redgrave, c1986. page 229251. ISBN: 0913178020

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Dieatry survey of Hopi Native American elementary students. Source: Brown, A.C. Brenton, B. J-Am-Diet-Assoc. Chicago : the Association, 1925-. May 1994. volume 94 (5) page 517-522. 0002-8223

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Dietary survey of Hopi Native American elementary students. Author(s): Department of Health, Physical Education and Nutrition, Northern Arizona University, Flagstaff 86011. Source: Brown, A C Brenton, B J-Am-Diet-Assoc. 1994 May; 94(5): 517-22 0002-8223

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Four generations trading pinon nuts with Native Americans: changes needed for future prosperity. Source: Tanner, E. Grieser, D. Gen-tech-rep-RM. Fort Collins, Colo. : Rocky Mountain Forest and Range Experiment Station, Forest Service, U.S. Department of Agriculture. October 1993. (236) page 29-33. 0277-5786

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Inflammation and Native American medicine: the role of botanicals. Author(s): Department of Nutrition, the Division of Rheumatology/Allergy and Clinical Immunology, the University of California, Davis 95616, USA. Source: Borchers, A T Keen, C L Stern, J S Gershwin, M E Am-J-Clin-Nutr. 2000 August; 72(2): 339-47 0002-9165

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Kenneth Maryboy. Answering the dreams, wishes, + needs of Native Americans. Source: Anonymous Caring. 2002 December; 21(12): 28-31, 2 0738-467X

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Lifestyles, diets, and Native American exposure factors related to possible lead exposures and toxicity. Author(s): Special Science and Resources Program, Confederated Tribes of the Umatilla Indian Reservation, Pendleton, Oregon 97801, USA. Source: Harris, S Harper, B L Environ-Res. 2001 June; 86(2): 140-8 0013-9351

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Native American medicine in the treatment of chronic illness: developing an integrated program and evaluating its effectiveness. Author(s): Center for Complementary Medicine, University of Pittsburgh Medical Center, USA. Source: Mehl Madrona, L E Altern-Ther-Health-Med. 1999 January; 5(1): 36-44 1078-6791

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Native Americans in California surveyed on diets, nutrition needs. Source: Ikeda, J. Dugan, S. Feldman, N. Mitchell, R. Calif-Agric. Oakland, Calif. : Division of Agriculture and Natural Resources, University of California. May/June 1993. volume 47 (3) page 8-10. 0008-0845

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Nutrient characteristics of southwest Native American pre-contact diets. Source: Teufel, N.I. J-nutr-environ-med. Abingdon, U.K. : Carfax Publishing Company. Sept 1996. volume 6 (3) page 273-284. 1359-0847

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Nutrient-health associations in the historic and contemporary diets of southwest Native Americans. Source: Teufel, N.I. J-nutr-environ-med. Abingdon, U.K. : Carfax Publishing Company. June 1996. volume 6 (2) page 179-189. 1359-0847

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Residues of forestry herbicides in plants of importance to California Native Americans. Author(s): California Environmental Protection Agency, Department of Pesticide Regulation, Environmental Monitoring and Pest Management, 1020 N Street, Room 161, Sacramento, California 95814-5624, USA. Source: Segawa, R Bradley, A Lee, P Tran, D Hsu, J White, J Goh, K S Bull-EnvironContam-Toxicol. 1997 October; 59(4): 556-63 0007-4861

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Selected risk factors for diabetes in Native Americans. Source: Mohs, M.E. Leonard, T.K. Watson, R.R. Nutr-Res. Elmsford : Pergamon Press. Sept 1985. volume 5 (9) page 1035-1045. charts. 0271-5317

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Survival and reproduction of stored-product beetles on seeds cached by a desert rodent and by Native Americans. Source: Wicklow, D.T. Mcalpin, C.E. Nelsen, T.C. Environ-entomol. Lanham, Md. : Entomological Society of America. April 1994. volume 23 (2) page 414-419. 0046-225X

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Toward comprehensive obesity prevention programs in Native American communities. Author(s): Indian Health Service Diabetes Program, Albuquerque, NM 87110, USA. Source: Broussard, B A Sugarman, J R Bachman Carter, K Booth, K Stephenson, L Strauss, K Gohdes, D Obes-Res. 1995 September; 3 Suppl 2289s-297s 1071-7323

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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•

The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMD®Health: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to Native American health; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Minerals Stinging Nettle Alternative names: Urtica dioica, Urtica urens, Nettle Source: Integrative Medicine Communications; www.drkoop.com

•

Food and Diet Abalone Source: Healthnotes, Inc.; www.healthnotes.com Anasazi Beans Source: Healthnotes, Inc.; www.healthnotes.com

Nutrition

Burdock Alternative names: Arctium lappa, Arctium minus, Arctium tomentosum Source: Integrative Medicine Communications; www.drkoop.com Chestnuts Source: Healthnotes, Inc.; www.healthnotes.com Clams Source: Healthnotes, Inc.; www.healthnotes.com Cucumbers Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,18,00.html Jerusalem Artichokes Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,39,00.html Lima Beans Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,151,00.html Milk Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,95,00.html Nuts Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,84,00.html Plums Source: Healthnotes, Inc.; www.healthnotes.com Sardines Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,317,00.html Sunflower Seeds Source: Healthnotes, Inc.; www.healthnotes.com Walnuts Source: Healthnotes, Inc.; www.healthnotes.com Wild Rice Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

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Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,178,00.html Wound Healing Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. BOOKS ON NATIVE AMERICAN HEALTH Overview This chapter provides bibliographic book references relating to Native American health. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on Native American health include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “Native American health” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on Native American health: •

Native Americans Sources of Health Materials Contact: US Department of Health and Human Services, Public Health Service, Office of Minority Health Resource Center, PO Box 37337, Washington, DC, 20013-7337, (800) 444-6472, http://www.omhrc.gov. Summary: This catalog is a compilation of health educational materials for Native Americans. Listed publications discuss a range of health issues, such as substance abuse, cancer, nutrition, diabetes, and HIV/AIDS.

•

National Native American AIDS Prevention Center Resource Directory Contact: National Native American AIDS Prevention Center, 436 - 14th St Ste 1020, Oakland, CA, 94612, (510) 444-2051, http://www.nnaapc.org. National Native

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American AIDS Prevention Center, Media Services, 436 14th St., Ste. 1020, Oakland, CA, 94612, (510) 444-2051, http://www.nnaapc.org. Summary: This directory lists resources for preventing Human immunodeficiency virus (HIV) and Acquired immunodeficiency syndrome (AIDS) available to Native Americans in various states. Services include health education programs located both on and off reservations, health care services, risk assessment, counseling for high-risk behaviors, and information sources. Resources are listed alphabetically with a description of services, contact person, and materials produced, if any. •

Native American/American Indian AIDS Prevention Programs: A Preliminary Directory of Organizations, Contacts, and Resources Contact: ROW Sciences, Incorporated, Drug Use and AIDS Community Education Technical Assistance, Project, 5515 Security Ln Ste 500, Rockville, MD, 20852, (301) 7706070. Summary: This directory provides a listing of programs for Native Americans to prevent the transmission of Acquired immunodeficiency syndrome (AIDS) and Human immunodeficiency virus (HIV). It contains community organizations, contacts, and information resources.

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HIV Prevention in Native American Communities: A Manual for Native American Health and Human Service Providers Contact: National Native American AIDS Prevention Center, 436 - 14th St Ste 1020, Oakland, CA, 94612, (510) 444-2051, http://www.nnaapc.org. Summary: This manual, intended for use by Native American health educators, clinic staff, tribal health departments, and others working in or with Native American communities, was developed as a response to the changes taking place in the Native American community due to AIDS. Its primary focus is on educational interventions and training, and it includes contributions by health educators, HIV program coordinators, and HIV service providers. Divided into five sections, it opens with an overview of the spectrum of HIV disease. This includes information on HIV-antibody testing and current treatment strategies. In Section 2, the manual turns to the relationship between HIV infection and risky behaviors such as alcohol and drug abuse. A risk assessment questionnaire is included, and information on other sexually transmitted diseases (STDs) is provided. Section 3 deals specifically with educational activities, offering guidelines on HIV education, an overview of related psychosocial issues, and methods for incorporating Native American traditions and culture into training. Section IV looks at concerns related to four special target populations: men who have sex with men, injecting drug users (IDUs), women, and adolescents; while Section 5 concludes with planning guidelines for developing HIV interventions.

•

HIV Prevention With Native American Youth; A Program Planning Manual Contact: National Native American AIDS Prevention Center, 436 - 14th St Ste 1020, Oakland, CA, 94612, (510) 444-2051, http://www.nnaapc.org. Summary: This program planning manual focuses on HIV prevention program development with, and for, Native American youth. The first eight chapters of this manual describe steps that program planners can take to design and implement AIDS education programs at the community level. Since having a well-developed program plan is usually not sufficient to guarantee program success, the authors have included a

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chapter which suggests a variety of actions that can be taken to facilitate ownership of the educational effort. The manual is organized as follows: laying the foundation, HIV and Native youth, setting objectives for a youth program, strategies and methods, curricula, selected approaches, youth empowerment program workshop sessions, evaluation, and building community support.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: When following the link below, you may discover non-medical books that use the generic term “Native American health” (or a synonym) in their titles. •

Amazon.com: http://www.amazon.com/exec/obidos/externalsearch?tag=icongroupinterna&keyword=Native American health&mode=books

Chapters on Native American Health In order to find chapters that specifically relate to Native American health, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and Native American health using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “Native American health” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on Native American health: •

Who Gets Diabetes? Source: in Hirsch, I.B. 12 Things You Must Know About Diabetes Care Right Now!. Alexandria, VA: American Diabetes Association. 2000. p. 9-19. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400612. Summary: This chapter is devoted to nonmodifiable and modifiable risk factors for diabetes. Nonmodifiable risk factors include heredity, race, and a history of diabetes during pregnancy. Although type 2 diabetes is more closely linked to genetics, there is also a genetic link with type 1 diabetes. Certain minorities, including Native Americans, Hispanics, African Americans, and Asian Americans, are at higher risk for developing type 2 diabetes. In addition, women who have had gestational diabetes are at higher risk of developing diabetes later in life. Modifiable risk factors include impaired glucose tolerance, medications, high blood pressure or high blood fat, and obesity. People who have impaired glucose tolerance will not develop the eye, kidney, and nerve diseases linked with diabetes, but they are at a higher risk of developing heart disease and stroke. Certain medications can cause impaired glucose tolerance, impaired fasting glucose, or even diabetes. People who have high blood pressure or high levels of lipids

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are at higher risk of developing diabetes. One of the most important modifiable risk factors is obesity, so weight loss is a way to modify this risk factor. The chapter concludes with American Diabetes Association guidelines on screening for type 2 diabetes. The chapter includes a list of questions a patient may ask a doctor and questions a doctor may ask a patient. 2 tables. •

Diabetes in North American Indians and Alaska Natives Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 683-701. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Full-text book and chapter available online at no charge; book may be purchased for $20.00. Order number: DM-96 (book). Summary: This chapter on diabetes in North American Indians and Alaska Natives is from a compilation and assessment of data on diabetes and its complications in the United States. The author notes that the epidemic of noninsulin-dependent diabetes mellitus (NIDDM) in Native American communities has occurred primarily during the second half of this century. Although NIDDM has a genetic component, with rates highest in full-blooded Native Americans, the incidence and prevalence of the disease have increased dramatically as traditional lifestyles have been abandoned in favor of westernization, with accompanying increases in body weight and diminished physical activity. Diabetes was once described as benign in American Indians; now, diabetes and its complications are major contributors to morbidity and mortality in all Native American populations, except the isolated Arctic groups whose lifestyles remain relatively unchanged. Insulin-dependent diabetes mellitus (IDDM) is rare in Native Americans. The relationship of obesity to subsequent diabetes, as described in studies of the Pimas, is present in all Native American populations. Native American communities experience high rates of microvascular complications from diabetes, although the rates of cardiovascular disease differ from tribe to tribe. The differences may reflect genetically based variations in lipid metabolism or other coronary risk factors, or, alternatively, differences in lifestyle. The author concludes that the extent of diabetes in Native American communities demands public health programs that incorporate specific psychosocial and cultural adaptations for individual tribes. 2 appendices. 10 figures. 5 tables. 143 references. (AA-M).

•

Prevalence and Incidence of Non-Insulin-Dependent Diabetes Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 47-67. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Full-text book and chapter available online at no charge; book may be purchased for $20.00. Order number: DM-96 (book). Summary: This chapter on the prevalence and incidence of noninsulin dependent diabetes (NIDDM, or Type II) is from a compilation and assessment of data on diabetes and its complications in the United States. In 1993, approximately 7.8 million people in

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the United States had been diagnosed as having diabetes. This represents a prevalence rate of 3.1 percent of the U.S. population. However, rates range from about 1.3 percent of those age 18 to 44 years to about 10.4 percent of those older than 65 years. Both the prevalence rate for diabetes and the number of people with diabetes have increased steadily since a national system for ascertaining diagnosed diabetes was established in 1958. Diabetes is more prevalent in U.S. blacks, Mexican Americans, and Native Americans, compared with non-Hispanic whites. For all ages, approximately 90 percent of people with diabetes have NIDDM, but at age greater than 45 years virtually all people with diabetes have NIDDM. In addition to known cases of NIDDM, there is about one undiagnosed case of NIDDM for every diagnosed case, based on oral glucose tolerance testing in U.S. population samples. About 11 percent of U.S. adults had impaired glucose tolerance (IGT) in national surveys. Rates of total glucose intolerance (diabetes plus IGT) range from 7 to 14 percent at age 20 to 44 years to 28 to 44 percent at age 45 to 74 years, depending on the racial or ethnic group studied. The authors note that monitoring of national trends in the prevalence and incidence of NIDDM is needed so that the burden of diabetes can be assessed, the impact of risk factors can be described, interventions can be developed and their impacts determined, and needs for future health services can be projected. 7 appendices. 12 figures. 6 tables. 73 references. (AA-M). •

Plasma Glucose Source: in Office of Disease Prevention and Health Promotion, U.S. Public Health Service. Put Prevention Into Practice: Clinician's Handbook of Preventive Services. 2nd ed. Germantown, MD: International Medical Publishing, Inc. 1998. p. 272-276. Contact: Available from International Medical Publishing, Inc. Reiter's Scientific and Professional Books, 2021 K Street, NW, Washington, DC 20006. (800) 591-2713 or (202) 223-3327. Fax (202) 296-9103. PRICE: $20.00 plus shipping and handling. ISBN: 1883205328. Also available from the U.S. Government Printing Office. Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. (202) 512-1800. Fax (202) 5122250. Summary: This chapter presents recommendations of major authorities on screening for diabetes mellitus. Approximately 5 percent of those who have diabetes have type 1, and they require insulin for survival. They usually have symptoms and are diagnosed soon after clinical onset. The remaining 95 percent have type 2 diabetes. People who have this type can be relatively symptom free for years before diagnosis. The prevalence of diabetes is significantly higher among certain ethnic groups, including Hispanics, African Americans, and Native Americans. Diabetes complications include end-stage renal disease, blindness, nontraumatic lower extremity amputation, neuropathy, cardiovascular disease, and peripheral vascular disease. The most accurate method of screening is by measuring fasting plasma glucose. The American College of Obstetricians and Gynecologists, the American College of Physicians, the Canadian Task Force on the Periodic Health Examination, and the U.S. Preventive Services Task Force recommend diabetes screening for patients who have various risk factors for the disease. The American Diabetes Association recommends diabetes screening every 3 years for all adults 45 years old or older and screening for younger people who have various risk factors. The chapter provides guidelines on plasma glucose screening, lists patient resources, and presents criteria for diagnosing diabetes in nonpregnant adults. 16 references.

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Summary Source: in Harris, M.I., et al., eds., for the National Diabetes Data Group (NDDG). Diabetes in America. 2nd ed. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 1995. p. 1-13. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail: [email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Full-text book and chapter available online at no charge; book may be purchased for $20.00. Order number: DM-96 (book). Summary: This summary chapter is from a compilation and assessment of data on diabetes and its complications in the United States. Five general areas are addressed. These include the descriptive epidemiology of diabetes in the United States, based on national surveys and community based studies, including prevalence, incidence, sociodemographic and metabolic characteristics, risk factors for developing diabetes, and mortality; the many complications that affect patients with diabetes; characteristics of therapy and medical care for diabetes; economic aspects, including health insurance and health care costs; and diabetes in specific populations, including African Americans, Hispanics, Asian and Pacific Islanders, Native Americans, and pregnant women. The author briefly summarizes current data in each of these areas.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to Native American health have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:8 •

Native Americans: Sources of health materials Source: Washington, DC: Office of Minority Health, U.S. Department of Health and Human Services. 1994. 5 pp. Contact: Available from U.S. Office of Minority Health Resource Center, P.O. Box 37337, Washington, DC 20013-7337. Telephone: (800) 444-6472 or (301) 589-0951 TDD / fax: (301) 589-0884 / e-mail: [email protected] / Web site: http://www.omhrc.gov. Available at no charge. Summary: This directory lists producers or distributors of health promotion materials directed toward Native Americans, Alaskan Eskimos, and Aleuts. The sources are both

8

You will need to limit your search to “Directory” and “Native American health” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “Native American health” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

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public agencies and private organizations. The range of materials includes pamphlets, brochures, booklets, fact sheets, videotapes, and other items. Sources are listed alphabetically and a brief subject index is provided.

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CHAPTER 4. MULTIMEDIA ON NATIVE AMERICAN HEALTH Overview In this chapter, we show you how to keep current on multimedia sources of information on Native American health. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on Native American health is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “Native American health” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “Native American health” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on Native American health: •

Face to Face: Native Americans Living With the AIDS Virus Contact: Alaska Native Health Board, HIV/AIDS Prevention Project, 3700 Woodland Dr Ste 500, Anchorage, AK, 99517-2567, (907) 562-6006, http://www.anhb.org. Summary: This videorecording consists of five interviews with Native Americans living with HIV. Each segment is preceded by a display of Native art pieces and accompanied by tribal music. A single mother describes the psychological factors connected with her diagnosis and her ability to begin new relationships. An attorney discusses his use of folk medicine and the cultural factors involved in his treatment, including tribal ideals of spirituality and family relations. An HIV-infected woman, whose daughter is also HIV positive, talks about issues relating to children with AIDS, as well as her alcoholism and attitudes toward her sexuality and safer sexual conduct. A young man with AIDS describes his community activism and emphasizes that educational efforts must be directed toward local concerns and attitudes, using the language of the people. A single mother with AIDS, whose son is not infected, describes her relationship with her son, his

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feelings about the disease, and her efforts to educate youth in her community about AIDS. In addition to producers listed above, this videorecording was produced by People of Color Against AIDS Network and the National Native Americans AIDS Prevention Center.

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “Native American health” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on Native American health: •

1994 National Skills Building Conference: Session 12, Native American and HIV/AIDS Institute Contact: HMR Duplications, 18 Gregory Place, Oakland, CA, 94619, (510) 482-8732. Summary: This session discusses the impact of the HIV/AIDS epidemic on Native Americans. The first speakers address the ways in which HIV/AIDS prevention and education consortia evolved in Arizona. The specific cultural needs of Native Americans, and aspects of advocacy that need to be addressed when conducting prevention programs in this population, are expressed. The education and prevention programs in this state grew out of a community planning and funding process that represented and served the 21 tribes of Arizona. The speaker had concerns about separating out the Native American community for prevention and education. If Native Americans do not make their needs heard, their cultural issues are not taken into consideration. In the end, there were 10 Native American representatives on the state's prevention planning committee. Members of the audience contribute their experience in trying to involve the Native American community in the prevention planning process throughout the United States. The ways in which Ryan White consortia work in various states are addressed by members of the audience. Participants discuss the work they are doing and the needs they are experiencing in the field. Some problems that emerge in this free-flowing discussion include the need for HIV school-based education and prevention programs, community prejudice toward those who are HIV-positive, the need for anonymous and confidential testing, and adequate training for health professionals. The need for regional training and educational programs and the funding of these programs is discussed. Participants also discuss the difficulties and challenges they face in the implementation of these prevention and education programs in rural areas populated by Native Americans. Because of their cultural background, Native Americans, for example, are more likely to respond to a holistic approach to HIV prevention and treatment. The participants each describe ways in which they have dealt with ignorance, homophobia, and denial in the Native American community. It is key to work with influential leaders of the tribal community. When dealing with these gatekeepers of the Native American community, it is important to acknowledge the shame associated with homosexuality and conduct educational forums in a c.

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CHAPTER 5. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for Native American health. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI® Advice for the Patient® can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with Native American health. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks,

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etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to Native American health: Hepatitis A Vaccine Inactivated •

Systemic - U.S. Brands: Havrix; Vaqta http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202902.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult™ Mosby’s Drug Consult™ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute9: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

9

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.10 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:11 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

10

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 11 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway12 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.13 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “Native American health” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 7502 1123 686 145 105 9561

HSTAT14 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.15 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.16 Simply search by “Native American health” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

12

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

13

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 14 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 15 16

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists17 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.18 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.19 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

17 Adapted 18

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 19 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on Native American health can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to Native American health. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to Native American health. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “Native American health”:

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Diabetes http://www.nlm.nih.gov/medlineplus/diabetes.html Native-American Health http://www.nlm.nih.gov/medlineplus/nativeamericanhealth.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on Native American health. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

What Native Americans Should Know About AIDS Contact: Phoenix Indian Medical Center, Indian Health Service, 4212 N 16th St, Phoenix, AZ, 85016, (602) 263-1200. Summary: This brochure provides Native Americans with information about Acquired immunodeficiency syndrome (AIDS) and Human immunodeficiency virus (HIV) infection, its transmission, and its prevention. It dispels myths about casual contact transmission of HIV and lists ways to practice safer sexual conduct and safer drug use.

•

Testing for HIV in Native American Communities: Special Considerations Contact: GlaxoSmithKline, 5 Moore Dr, Research Triangle Park, NC, 27709, (888) 8255249, http://corp.gsk.com/. Summary: This fact sheet considers issues and concerns germane to HIV-antibody testing among Native American populations. The fact sheet explains that cultural norms and traditions often present barriers to HIV detection and treatment among Native Americans. Some of the solutions proposed to overcome these barriers include anonymous testing within the community, culturally sensitive education and intervention strategies, and the support of community-based tribal councils. The fact sheet describes reactions that might be expected from Native Americans who test positive for HIV, and solutions to address and mitigate these reactions.

•

The Ahalaya Project: Redesigning HIV Service for Native Americans, Alaskan Natives, and Hawaiian Natives Contact: Ahayalaya Project, National Native American AIDS Prevention Center, 5350 S Western Ave Ste B109, Oklahoma City, OK, 73109, (405) 631-9988.

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Summary: This media package contains an article highlighting the case management portion of the Ahalaya Project, a program designed to meet the daily living, medical, personal, emotional, and psychosocial needs of Native Americans living with HIV. The package also contains a variety of background materials, including papers from the Annual Indian AIDS Conference, a directory of state AIDS hotlines, a paper on community planning groups in areas heavily populated by Native Americans, and article reprints. The Ahalaya is a freestanding, client focused center. The article chronicles the implementation and operations of the Ahalaya, and its replication in cities across the United States. Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

A Quiet Crisis: Federal Funding and Unmet Needs in Indian Country Summary: This study reveals that federal funding directed to Native Americans through programs at six federal agencies has not been sufficient to address the basic and very urgent needs of indigenous peoples. Source: U.S. Commission on Civil Rights http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7685

•

Actions for American Indians/Alaska Natives - Making Prevention Work Summary: Making Prevention work ,seek information about options for health promotion, disease prevention, and health care for Native Americans. Source: SAMHSA's National Clearinghouse for Alcohol and Drug Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6839

•

Bibliography on Native Americans in Agriculture: Ethnobotany/Traditional Medicine Summary: Bibliography on Native Americans in Agriculture: Ethnobotany/Traditional Medicine (Selected Sources from the AGRICOLA Database) Source: U.S. Department of Agriculture http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6772

•

Division of Indian and Native American Programs' (DINAP) Partnership Home Page Summary: This web site has been designed to provide general information about the Workforce Investment Act (WIA), Section 166 Indian and Native American Program, to enrich the lives of Indian and Native Source: General Government Agency http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5570

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HIV/AIDS: Education and Prevention for Native Americans/Alaska Natives Summary: This is a page of links to various HIV/AIDS health information resources. Source: National Network of Libraries of Medicine http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6960

•

Job Vacancies Database - Indian Health Service/HHS Summary: Search this database regularly for updated job vacancies in a variety of health and medical fields, usually in geographical areas that are populated by Native Americans. Source: Indian Health Service http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2755

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Native American Cardiology Program Summary: This program was developed to provide direct cardiovascular care to Native Americans at reservation clinics within the Navajo, Phoenix, and Tucson areas as well as provide tertiary care for complex Source: Indian Health Service http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5560

•

Native American Diabetes Project Summary: The goal of this project is to encourage Native Americans towards healthy behaviors through partnerships with Native America communities. Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2806

•

Native American Outreach Summary: Huntsman Cancer Institute has launched this special program designed to meet the needs of Native Americans. Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7678

•

Native Americans and Cancer Summary: This brief fact sheet outlines the cultural implications for Native Americans with cancer. Source: Native American Cancer Research http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7009

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The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to Native American health. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMD®Health: http://my.webmd.com/health_topics

News Services and Press Releases One of the simplest ways of tracking press releases on Native American health is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “Native American health” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to Native American health. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “Native American health” (or synonyms).

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “Native American health” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “Native American health” (or synonyms). If you know the name of a company that is relevant to Native American health, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “Native American health” (or synonyms).

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Newsletters on Native American Health Find newsletters on Native American health using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “Native American health.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “Native American health” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

The dream catcher Source: Aberdeen, SD: Northern Plains Healthy Start. 1997-. quarterly. Contact: Available from Northern Plains Healthy Start (Iowa, Nebraska, North Dakota, and South Dakota), 405 Eighth Avenue, N.W., Aberdeen, SD 57401. Telephone: (605) 229-3846 / fax: (605) 229-2174 / e-mail: [email protected]. Available at no charge. Summary: This newsletter describes current activities of Northern Plains Healthy Start program, serving Native Americans in South Dakota, North Dakota, Nebraska and Iowa. The program addresses maternal and infant health issues including family violence and adolescent pregnancy. [Funded by the Maternal and Child Health Bureau].

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “Native American health” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on Native American health: •

Design of Clinical Trial Underway Source: WIN Notes. p.2,10. Spring 2000. Contact: Weight-Control Information Network. 1 WIN WAY, Bethesda, MD 20892-3665, USA. (877) 946-4627. [email protected]. Summary: The Study of Health Outcomes of Weight Loss (SHOW) clinical trial will examine the impact of weight loss interventions on health in obese individuals with type 2 diabetes. The trial, conducted by the National Institute of Diabetes and Digestive and Kidney Diseases, is now in the design stage. Sixteen clinical centers will participate. Approximately 6,000 patients are expected to be recruited over a three-year period, with at least four additional years of treatment and followup. Study organizers hope to include a large number of African Americans, Hispanic Americans, and Native Americans in SHOW.

•

Incontinence in Elders: A Practical Diagnostic and Management Schema Source: IHS Primary Care Provider. 24(5): 73-78. May 1999.

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Contact: Available from Indian Health Service Clinical Support Center. Two Renaissance Square, Suite 780, 40 North Central Avenue, Phoenix, AZ 85004. (602) 3647777. Fax (602) 364-7788. E-mail: [email protected]. Website: www.ihs.gov. Summary: This article reminds readers that urinary incontinence (UI) is not an inevitable consequence of aging, rather it is a treatable condition in the majority of patients. The authors focus on a specific population (Native Americans) and provide a scheme for diagnosis and management of UI in this population. The authors note that many elders fear UI, because it is often a primary reason that they may cease community living to be placed in a nursing home. For this reason, health care providers are encouraged to ask their patients specifically about incontinence and to let them know that most incontinence can be successfully treated, so that these elders may regain their dignity and improve their quality of life. The authors summarize the types of incontinence, including stress, urge, functional, overflow, mixed, and transient, then review the diagnostic tests used to evaluate incontinence and determine treatment. The goals of treatment include to preserve the upper urinary tract, to maintain or regain adequate bladder capacity with good compliance, to promote low pressure micturition (urination), to avoid bladder overdistention, to prevent urinary tract infection (UTI), to minimize the use of Foley catheters, and to choose therapy that minimizes the patient's risks while maximizing his or her social, emotional, and vocational acceptability. Treatment options include behavior modification (including Kegel exercises and bladder training), electrostimulation, biofeedback, pharmacotherapy (drugs), surgical procedures, collagen injection, intermittent self catheterization, mechanical plugs and appliances, neuroimplantation (for the spinal cord patient with incontinence), and environmental changes (such as providing a bedside commode). 4 tables. 12 references. •

Growing Older: Health Issues for Minorities Source: Closing the Gap. p.1-2. May 2000. Contact: Department of Health and Human Services. Office of Public Health and Science. Office of Minority Health Resource Center, P.O. Box 37337, Washington, DC 20013-7337. Summary: This article reviews the health issues facing minorities who are age 65 and older. Cardiovascular disease, diabetes, and immunizations are of special concern to this population. Cardiovascular disease is the leading killer among men and women, across all racial and ethnic groups. Diabetes affects 6.3 million people age 65 and over, and occurs most often among older African Americans, Hispanic Americans, and American Indians. Influenza and pneumonia were the fifth leading cause of death for African Americans and Hispanics age 65 and older. The article discusses the health issues for older Asian Americans and Pacific Islanders, Native Americans and Alaska Natives, African Americans, and Hispanics and Latinos.

•

Lupus for the Non-Rheumatologist Source: Bulletin on the Rheumatic Diseases. 48(9): 1-4. 1999. Contact: Available from Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (404) 872-7100. Fax (404) 872-9559. Summary: This newsletter article provides health professionals with information on the etiology, pathogenesis, classification, epidemiology, clinical presentation, diagnosis, treatment, and prognosis of systemic lupus erythematosus (SLE). Most people who have SLE are women, and Native Americans are most susceptible to developing it. The cause

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of SLE, which is an autoimmune multisystem disease with several variants, is unknown. Possible contributing factors include environmental provocation, chemical exposure, infections, estrogen containing hormones, and certain forms of stress. Types of lupus include SLE, chronic cutaneous lupus, drug induced lupus, mixed connective tissue disease, antiphospholipid syndrome, and neonatal lupus. SLE can present in many different ways. Half of the patients with SLE have musculoskeletal problems, skin changes, cognitive dysfunction, and serositis. The remainder have more serious disease activity, with major internal organ involvement. Diagnosis involves obtaining a medical history, performing a physical examination, and ordering various laboratory tests, including an antinuclear antibody test. Treatment involves educating the patient about physical measures he or she can take to manage SLE, using topical glucocorticoids for chronic cutaneous lupus, taking low doses of prednisone, and taking immunosuppressants. The overall prognosis for patients who have SLE is excellent. 1 table and 5 references.

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to Native American health. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with Native American health. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about Native American health. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “Native American health” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information.

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The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “Native American health”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “Native American health” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “Native American health” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.20

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

20

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)21: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

21

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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NATIVE AMERICAN HEALTH DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Ablation: The removal of an organ by surgery. [NIH] Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [EU] Abscess: A localized, circumscribed collection of pus. [NIH] Acantholysis: Separation of the prickle cells of the stratum spinosum of the epidermis, resulting in atrophy of the prickle cell layer. It is seen in diseases such as pemphigus vulgaris (see pemphigus) and keratosis follicularis. [NIH] Accommodation: Adjustment, especially that of the eye for various distances. [EU] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Age Distribution: The frequency of different ages or age groups in a given population. The distribution may refer to either how many or what proportion of the group. The population is usually patients with a specific disease but the concept is not restricted to humans and is not restricted to medicine. [NIH] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH]

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Age-Adjusted: Summary measures of rates of morbidity or mortality in a population using statistical procedures to remove the effect of age differences in populations that are being compared. Age is probably the most important and the most common variable in determining the risk of morbidity and mortality. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Alcohol Dehydrogenase: An enzyme that catalyzes reversibly the final step of alcoholic fermentation by reducing an aldehyde to an alcohol. In the case of ethanol, acetaldehyde is reduced to ethanol in the presence of NADH and hydrogen. The enzyme is a zinc protein which acts on primary and secondary alcohols or hemiacetals. EC 1.1.1.1. [NIH] Aldehyde Dehydrogenase: An enzyme that oxidizes an aldehyde in the presence of NAD+ and water to an acid and NADH. EC 1.2.1.3. Before 1978, it was classified as EC 1.1.1.70. [NIH]

Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Ambulatory Care: Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility. [NIH]

Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH]

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Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anomie: A state of social disorganization and demoralization in society which is largely the result of disharmony between cultural goals and the means for attaining them. This may be reflected in the behavior of the individual in many ways - non-conformity, social withdrawal, deviant behavior, etc. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibodies, Anticardiolipin: Antiphospholipid antibodies found in association with systemic lupus erythematosus (lupus erythematosus, systemic), antiphospholipid syndrome, and in a variety of other diseases as well as in healthy individuals. The antibodies are detected by solid-phase immunoassay employing the purified phospholipid antigen cardiolipin. [NIH] Antibodies, Antiphospholipid: Autoantibodies directed against phospholipids. These antibodies are characteristically found in patients with systemic lupus erythematosus, antiphospholipid syndrome, related autoimmune diseases, some non-autoimmune diseases, and also in healthy individuals. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH]

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Antidiabetic: An agent that prevents or alleviates diabetes. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antiphospholipid Syndrome: The presence of antibodies directed against phospholipids (antibodies, antiphospholipid). The condition is associated with a variety of diseases, notably systemic lupus erythematosus and other connective tissue diseases, thrombopenia, and arterial or venous thromboses. In pregnancy it can cause abortion. Of the phospholipids, the cardiolipins show markedly elevated levels of anticardiolipin antibodies (antibodies, anticardiolipin). Present also are high levels of lupus anticoagulant (lupus coagulation inhibitor). [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Approximate: Approximal [EU] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articulation: The relationship of two bodies by means of a moveable joint. [NIH]

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Astigmatism: A condition in which the surface of the cornea is not spherical; causes a blurred image to be received at the retina. [NIH] Asynchronous: Pacing mode where only one timing interval exists, that between the stimuli. While the duration of this interval may be varied, it is not modified by any sensed event once set. As no sensing occurs, the upper and lower rate intervals are the same as the pacema. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Autopsy: Postmortem examination of the body. [NIH] Bacillus: A genus of Bacillaceae that are spore-forming, rod-shaped cells. Most species are saprophytic soil forms with only a few species being pathogenic. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Behavioral Symptoms: Observable manifestions of impaired psychological functioning. [NIH]

Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH]

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Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Bioassay: Determination of the relative effective strength of a substance (as a vitamin, hormone, or drug) by comparing its effect on a test organism with that of a standard preparation. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biomolecular: A scientific field at the interface between advanced computing and biotechnology. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Blister: Visible accumulations of fluid within or beneath the epidermis. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures.

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[NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Budgets: Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogenic: Producing carcinoma. [EU] Cardiolipins: Acidic phospholipids composed of two molecules of phosphatidic acid covalently linked to a molecule of glycerol. They occur primarily in mitochondrial inner membranes and in bacterial plasma membranes. They are the main antigenic components of the Wassermann-type antigen that is used in nontreponemal syphilis serodiagnosis. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Career Choice: Selection of a type of occupation or profession. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are

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made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH]

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Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Claudication: Limping or lameness. [EU] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cluster Analysis: A set of statistical methods used to group variables or observations into strongly inter-related subgroups. In epidemiology, it may be used to analyze a closely grouped series of events or cases of disease or other health-related phenomenon with welldefined distribution patterns in relation to time or place or both. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Codon: A set of three nucleotides in a protein coding sequence that specifies individual amino acids or a termination signal (codon, terminator). Most codons are universal, but some organisms do not produce the transfer RNAs (RNA, transfer) complementary to all codons. These codons are referred to as unassigned codons (codons, nonsense). [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Community Health Centers: Facilities which administer the delivery of health care services to people living in a community or neighborhood. [NIH] Competency: The capacity of the bacterium to take up DNA from its surroundings. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a

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bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Confined Spaces: A space which has limited openings for entry and exit combined with unfavorable natural ventilation such as caves, refrigerators, deep tunnels, pipelines, sewers, silos, tanks, vats, mines, deep trenches or pits, vaults, manholes, chimneys, etc. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Diseases: A heterogeneous group of disorders, some hereditary, others acquired, characterized by abnormal structure or function of one or more of the elements of connective tissue, i.e., collagen, elastin, or the mucopolysaccharides. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Cooperative group: A group of physicians, hospitals, or both formed to treat a large number of persons in the same way so that new treatment can be evaluated quickly. Clinical trials of new cancer treatments often require many more people than a single physician or hospital can care for. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a

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single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Cross-Cultural Comparison: Comparison of various psychological, sociological, or cultural factors in order to assess the similarities or diversities occurring in two or more different cultures or societies. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cytogenetics: A branch of genetics which deals with the cytological and molecular behavior of genes and chromosomes during cell division. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH]

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Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Demography: Statistical interpretation and description of a population with reference to distribution, composition, or structure. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Developmental Biology: The field of biology which deals with the process of the growth and differentiation of an organism. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Foot: Ulcers of the foot as a complication of diabetes. Diabetic foot, often with infection, is a common serious complication of diabetes and may require hospitalization and disfiguring surgery. The foot ulcers are probably secondary to neuropathies and vascular problems. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diagnostic Services: Organized services for the purpose of providing diagnosis to promote and maintain health. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other

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holds the patient's blood. [NIH] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic blood pressure: The minimum pressure that remains within the artery when the heart is at rest. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dilatation: The act of dilating. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disease Susceptibility: A constitution or condition of the body which makes the tissues react in special ways to certain extrinsic stimuli and thus tends to make the individual more than usually susceptible to certain diseases. [NIH] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU]

Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Domestic Violence: Deliberate, often repetitive, physical abuse by one family member against another: marital partners, parents, children, siblings, or any other member of a household. [NIH] Dose-rate: The strength of a treatment given over a period of time. [NIH] Dreams: A series of thoughts, images, or emotions occurring during sleep which are dissociated from the usual stream of consciousness of the waking state. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH]

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Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Entrepreneurship: The organization, management, and assumption of risks of a business or enterprise, usually implying an element of change or challenge and a new opportunity. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Estrogen: One of the two female sex hormones. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Evaluable patients: Patients whose response to a treatment can be measured because enough information has been collected. [NIH]

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Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Family Relations: Behavioral, psychological, and social relations among various members of the nuclear family and the extended family. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Fetal Alcohol Syndrome: A disorder occurring in children born to alcoholic women who continue to drink heavily during pregnancy. Common abnormalities are growth deficiency (prenatal and postnatal), altered morphogenesis, mental deficiency, and characteristic facies - small eyes and flattened nasal bridge. Fine motor dysfunction and tremulousness are observed in the newborn. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fistulas: An abnormal passage from one hollow structure of the body to another, or from a hollow structure to the surface, formed by an abscess, disease process, incomplete closure of a wound, or by a congenital anomaly. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Food Habits: Acquired or learned food preferences. [NIH] Food Preferences: The selection of one food over another. [NIH] Foot Ulcer: Lesion on the surface of the skin of the foot, usually accompanied by inflammation. The lesion may become infected or necrotic and is frequently associated with diabetes or leprosy. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Forestry: The science of developing, caring for, or cultivating forests. [NIH] Fractionation: Dividing the total dose of radiation therapy into several smaller, equal doses delivered over a period of several days. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually

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between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Conversion: The asymmetrical segregation of genes during replication which leads to the production of non-reciprocal recombinant strands and the apparent conversion of one allele into another. Thus, e.g., the meiotic products of an Aa individual may be AAAa or aaaA instead of AAaa, i.e., the A allele has been converted into the a allele or vice versa. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic Counseling: Advising families of the risks involved pertaining to birth defects, in order that they may make an informed decision on current or future pregnancies. [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genomics: The systematic study of the complete DNA sequences (genome) of organisms. [NIH]

Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomeruli: Plural of glomerulus. [NIH] Glomerulonephritis: Glomerular disease characterized by an inflammatory reaction, with leukocyte infiltration and cellular proliferation of the glomeruli, or that appears to be the result of immune glomerular injury. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH]

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Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [NIH]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glyburide: An antidiabetic sulfonylurea derivative with actions similar to those of chlorpropamide. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Hallucination: A sense perception without a source in the external world; a perception of an external stimulus object in the absence of such an object. [EU] Hallucinogen: A hallucination-producing drug, a category of drugs producing this effect. The user of a hallucinogenic drug is almost invariably aware that what he is seeing are hallucinations. [NIH] Handicap: A handicap occurs as a result of disability, but disability does not always

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constitute a handicap. A handicap may be said to exist when a disability causes a substantial and continuing reduction in a person's capacity to function socially and vocationally. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Haplotypes: The genetic constitution of individuals with respect to one member of a pair of allelic genes, or sets of genes that are closely linked and tend to be inherited together such as those of the major histocompatibility complex. [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Hematologic Diseases: Disorders of the blood and blood forming tissues. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH]

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Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocyte: A liver cell. [NIH] Herbicides: Pesticides used to destroy unwanted vegetation, especially various types of weeds, grasses, and woody plants. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Homicide: The killing of one person by another. [NIH] Homodimer: Protein-binding "activation domains" always combine with identical proteins. [NIH]

Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Homosexuality: Sexual attraction or relationship between members of the same sex. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Human papillomavirus: HPV. A virus that causes abnormal tissue growth (warts) and is often associated with some types of cancer. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH]

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Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]

Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Ileum: The lower end of the small intestine. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunocompromised: Having a weakened immune system caused by certain diseases or treatments. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]

Immunofluorescence: A technique for identifying molecules present on the surfaces of cells or in tissues using a highly fluorescent substance coupled to a specific antibody. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in

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walking, talking, and self-feeding. [NIH] Infant Care: Care of infants in the home or institution. [NIH] Infant Mortality: Perinatal, neonatal, and infant deaths in a given population. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH]

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Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH]

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Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Luxation: The displacement of the particular surface of a bone from its normal joint, without fracture. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Major Histocompatibility Complex: The genetic region which contains the loci of genes which determine the structure of the serologically defined (SD) and lymphocyte-defined (LD) transplantation antigens, genes which control the structure of the immune responseassociated (Ia) antigens, the immune response (Ir) genes which control the ability of an animal to respond immunologically to antigenic stimuli, and genes which determine the structure and/or level of the first four components of complement. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Medical oncologist: A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, and biological therapy. A medical oncologist often serves as the main caretaker of someone who has cancer and coordinates treatment provided by other specialists. [NIH]

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Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medically Uninsured: Individuals or groups with no or inadequate health insurance coverage. Those falling into this category usually comprise three primary groups: the medically indigent, those whose clinical condition makes them medically uninsurable, and the working uninsured. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental deficiency: A condition of arrested or incomplete development of mind from inherent causes or induced by disease or injury. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Health Services: Organized services to provide mental health care. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microtubule-Associated Proteins: High molecular weight proteins found in the microtubules of the cytoskeletal system. Under certain conditions they are required for tubulin assembly into the microtubules and stabilize the assembled microtubules. [NIH] Microtubules: Slender, cylindrical filaments found in the cytoskeleton of plant and animal cells. They are composed of the protein tubulin. [NIH]

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Micturition: The passage of urine; urination. [EU] Midaxillary line: An imaginary vertical line that passes midway between the anterior and posterior axillary (armpit) folds. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Millimeter: A measure of length. A millimeter is approximately 26-times smaller than an inch. [NIH] Minority Groups: A subgroup having special characteristics within a larger group, often bound together by special ties which distinguish it from the larger group. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mixed Connective Tissue Disease: A syndrome with overlapping clinical features of systemic lupus erythematosus, scleroderma, polymyositis, and Raynaud's phenomenon. The disease is differentially characterized by high serum titers of antibodies to ribonucleasesensitive extractable (saline soluble) nuclear antigen and a "speckled" epidermal nuclear staining pattern on direct immunofluorescence. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH]

Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH]

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Natural selection: A part of the evolutionary process resulting in the survival and reproduction of the best adapted individuals. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH] Neurofibrillary Tangles: Abnormal structures located in various parts of the brain and composed of dense arrays of paired helical filaments (neurofilaments and microtubules). These double helical stacks of transverse subunits are twisted into left-handed ribbon-like filaments that likely incorporate the following proteins: (1) the intermediate filaments: medium- and high-molecular-weight neurofilaments; (2) the microtubule-associated proteins map-2 and tau; (3) actin; and (4) ubiquitin. As one of the hallmarks of Alzheimer disease, the neurofibrillary tangles eventually occupy the whole of the cytoplasm in certain classes of cell in the neocortex, hippocampus, brain stem, and diencephalon. The number of these tangles, as seen in post mortem histology, correlates with the degree of dementia during life. Some studies suggest that tangle antigens leak into the systemic circulation both in the course of normal aging and in cases of Alzheimer disease. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropil: A dense intricate feltwork of interwoven fine glial processes, fibrils, synaptic terminals, axons, and dendrites interspersed among the nerve cells in the gray matter of the central nervous system. [NIH] Neuropil Threads: Abnormal structures located chiefly in distal dendrites and, along with neurofibrillary tangles and senile plaques, constitute the three morphological hallmarks of Alzheimer disease. Neuropil threads are made up of straight and paired helical filaments which consist of abnormally phosphorylated microtubule-associated tau proteins. It has been suggested that the threads have a major role in the cognitive impairment seen in Alzheimer disease. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nonmalignant: Not cancerous. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a

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widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclear Family: A family composed of spouses and their children. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nutrition Assessment: Evaluation and measurement of nutritional variables in order to assess the level of nutrition or the nutritional status of the individual. Nutrition surveys may be used in making the assessment. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Oncologist: A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. [NIH] Oncology: The study of cancer. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Ownership: The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papillomavirus: A genus of Papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH] Partnership Practice: A voluntary contract between two or more doctors who may or may

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not share responsibility for the care of patients, with proportional sharing of profits and losses. [NIH] Parturition: The act or process of given birth to a child. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvic: Pertaining to the pelvis. [EU] Pemphigus: Group of chronic blistering diseases characterized histologically by acantholysis and blister formation within the epidermis. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH]

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Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Platelet-Derived Growth Factor: Mitogenic peptide growth hormone carried in the alphagranules of platelets. It is released when platelets adhere to traumatized tissues. Connective tissue cells near the traumatized region respond by initiating the process of replication. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Plethysmography: Recording of change in the size of a part as modified by the circulation in it. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Pollen: The male fertilizing element of flowering plants analogous to sperm in animals. It is released from the anthers as yellow dust, to be carried by insect or other vectors, including wind, to the ovary (stigma) of other flowers to produce the embryo enclosed by the seed. The pollens of many plants are allergenic. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for

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the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH] Prejudice: A preconceived judgment made without adequate evidence and not easily alterable by presentation of contrary evidence. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Private Practice: Practice of a health profession by an individual, offering services on a person-to-person basis, as opposed to group or partnership practice. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Program Development: The process of formulating, improving, and expanding educational, managerial, or service-oriented work plans (excluding computer program development). [NIH]

Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prone: Having the front portion of the body downwards. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH]

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Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Quality of Life: A generic concept reflecting concern with the modification and

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enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

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Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Ribonuclease: RNA-digesting enzyme. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Rod: A reception for vision, located in the retina. [NIH] Rural Population: The inhabitants of rural areas or of small towns classified as rural. [NIH] Satellite: Applied to a vein which closely accompanies an artery for some distance; in cytogenetics, a chromosomal agent separated by a secondary constriction from the main body of the chromosome. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of

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thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serositis: Inflammation of a serous membrane. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shame: An emotional attitude excited by realization of a shortcoming or impropriety. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH]

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Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Social Change: Social process whereby the values, attitudes, or institutions of society, such as education, family, religion, and industry become modified. It includes both the natural process and action programs initiated by members of the community. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Medicine: A branch of medicine concerned with the role of socio-environmental factors in the occurrence, prevention and treatment of disease. [NIH] Social Problems: Situations affecting a significant number of people, that are believed to be sources of difficulty or threaten the stability of the community, and that require programs of amelioration. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spirochete: Lyme disease. [NIH] Standard therapy: A currently accepted and widely used treatment for a certain type of cancer, based on the results of past research. [NIH] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between

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the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synaptophysin: A 38-kDa integral membrane glycoprotein of the presynaptic vesicles in neuron and neuroendocrine cells. It is expressed by a variety of normal and neoplastic neuroendocrine cells and is therefore used as an immunocytochemical marker for neuroendocrine differentiation in various tumors. In Alzheimer disease and other dementing disorders there is an important synapse loss due in part to a decrease of synaptophysin in the presynaptic vesicles. [NIH] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]

Systemic: Affecting the entire body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the

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activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Talus: The second largest of the tarsal bones and occupies the middle and upper part of the tarsus. [NIH] Tarsal Bones: The seven bones which form the tarsus - namely, calcaneus, talus, cuboid, navicular, and first, second and third cuneiforms. The tarsus is a skeletal part of the foot. [NIH]

Tarsus: The region of the articulation between the foot and the leg. [NIH] Tau Proteins: One of the two major classes of microtubule-associated proteins isolated from the brain. The proteins have two domains: one that binds to microtubules and a second that binds to other cell components. By binding to several unpolymerized tubulin molecules simultaneously, tau proteins speed up the nucleation process in tubulin polymerization. Chemically modified tau proteins also appear to be involved in the formation and/or composition of the neurofibrillary tangles and neuropil threads found in Alzheimer disease. [NIH]

Teaching Materials: Instructional materials used in teaching. [NIH] Telangiectasia: The permanent enlargement of blood vessels, causing redness in the skin or mucous membranes. [NIH] Telecommunications: Transmission of information over distances via electronic means. [NIH]

Telemedicine: Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services. [NIH] Terminator: A DNA sequence sited at the end of a transcriptional unit that signals the end of transcription. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombopenia: Reduction in the number of platelets in the blood. [NIH] Thromboses: The formation or presence of a blood clot within a blood vessel during life. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a

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specific function. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tobacco Industry: The aggregate business enterprise of agriculture, manufacture, and distribution related to tobacco and tobacco-derived products. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Training Support: Financial support for training including both student stipends and loans and training grants to institutions. [NIH] Transcultural Nursing: A nursing specialty created to answer the need for developing a global perspective in the practice of nursing in a world of interdependent nations and people. The focus of this nursing discipline is on the integration of international and transcultural content into the training. Courses include study in the area of cultural differences, nursing in other countries, and international health issues and organizations, as an example. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transforming Growth Factor beta: A factor synthesized in a wide variety of tissues. It acts synergistically with TGF-alpha in inducing phenotypic transformation and can also act as a negative autocrine growth factor. TGF-beta has a potential role in embryonal development, cellular differentiation, hormone secretion, and immune function. TGF-beta is found mostly as homodimer forms of separate gene products TGF-beta1, TGF-beta2 or TGF-beta3. Heterodimers composed of TGF-beta1 and 2 (TGF-beta1.2) or of TGF-beta2 and 3 (TGFbeta2.3) have been isolated. The TGF-beta proteins are synthesized as precursor proteins. [NIH]

Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein

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through a cell or organelle membrane. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Trophic: Of or pertaining to nutrition. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tubercle: A rounded elevation on a bone or other structure. [NIH] Tubulin: A microtubule subunit protein found in large quantities in mammalian brain. It has also been isolated from sperm flagella, cilia, and other sources. Structurally, the protein is a dimer with a molecular weight of approximately 120,000 and a sedimentation coefficient of 5.8S. It binds to colchicine, vincristine, and vinblastine. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urbanization: The process whereby a society changes from a rural to an urban way of life. It refers also to the gradual increase in the proportion of people living in urban areas. [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU]

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VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venous: Of or pertaining to the veins. [EU] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Waist circumference: To define the level at which the waist circumference is measured, a bony landmark is first located and marked. The subject stands, and the technician, positioned to the right of the subject, palpates the upper hip bone to locate the right ileum. Just above the uppermost lateral border of the right ileum, a horizontal mark is drawn and then crossed with a vertical mark on the midaxillary line. The measuring tape is then placed around the trunk, at the level of the mark on the right side, making sure that it is on a level horizontal plane on all sides. The tape is then tightened slightly without compressing the skin and underlying subcutaneous tissues. The measure is recorded in centimeters to the nearest millimeter. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to

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treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

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INDEX A Ablation, 20, 127 Abortion, 127, 130 Abscess, 127, 141 Acantholysis, 127, 154 Accommodation, 5, 127 Adaptability, 40, 127, 134 Adaptation, 40, 43, 127, 147 Adjustment, 4, 7, 53, 127 Adolescence, 43, 59, 127 Adrenergic, 62, 127, 140 Adverse Effect, 127, 160 Aerosol, 21, 127 Age Distribution, 4, 127 Age Groups, 127 Age of Onset, 127, 165 Age-Adjusted, 4, 6, 128 Albumin, 9, 128, 155 Alcohol Dehydrogenase, 44, 128 Aldehyde Dehydrogenase, 44, 128 Algorithms, 128, 132 Alleles, 66, 72, 128 Alpha Particles, 128, 158 Alternative medicine, 114, 128 Alveoli, 128, 138, 166 Ambulatory Care, 61, 128 Amino acid, 128, 129, 135, 143, 145, 154, 156, 157, 159, 160, 163, 164, 165 Ammonia, 128, 165 Amputation, 93, 128 Amyloid, 129 Anal, 38, 129, 149 Analogous, 129, 155, 164 Anaphylatoxins, 129, 136 Anatomical, 129, 134, 140, 146, 160 Anemia, 28, 129 Anions, 128, 129, 148, 160 Ankle, 8, 129 Anomalies, 71, 129 Anomie, 76, 129 Antibacterial, 36, 129, 161 Antibiotic, 129, 161 Antibodies, 129, 130, 145, 149, 151, 158 Antibodies, Anticardiolipin, 129, 130 Antibodies, Antiphospholipid, 129, 130 Antibody, 90, 110, 117, 129, 130, 135, 145, 146, 147, 158 Anticoagulant, 129, 130, 157

Antidiabetic, 130, 143 Antigen, 57, 59, 129, 130, 133, 136, 145, 146, 147, 151 Antigen-Antibody Complex, 130, 136 Anti-inflammatory, 130, 142, 156 Antiphospholipid Syndrome, 117, 129, 130 Anus, 129, 130 Anxiety, 48, 130 Apolipoproteins, 130, 149 Apoptosis, 25, 130 Approximate, 25, 130 Aqueous, 130, 131, 137, 148 Arterial, 130, 134, 136, 145, 157, 162 Arteries, 130, 132, 137, 149, 150, 151 Arterioles, 130, 132, 133 Arteriosclerosis, 130, 146 Artery, 62, 130, 137, 139, 157, 159 Articulation, 18, 130, 163 Astigmatism, 62, 131, 158 Asynchronous, 24, 131 Ataxia, 20, 131, 163 Autonomic, 22, 131, 153, 161, 162 Autonomic Nervous System, 22, 131, 161, 162 Autopsy, 33, 131 B Bacillus, 21, 131 Bacteria, 21, 129, 130, 131, 138, 150, 161, 164, 165 Bacterial Physiology, 127, 131 Bacterium, 131, 135 Basal Ganglia, 131 Basal Ganglia Diseases, 131 Base, 46, 131, 138, 148 Behavioral Symptoms, 9, 33, 131 Benign, 92, 131, 152, 158, 166 Bile, 131, 132, 149 Bilirubin, 128, 132 Bioassay, 21, 132 Biochemical, 128, 132, 160 Biological response modifier, 132, 147 Biological therapy, 132, 149 Biomolecular, 37, 132 Biotechnology, 50, 55, 105, 114, 132 Biotransformation, 132 Bladder, 116, 132, 136, 146, 157, 165 Blister, 132, 154

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Blood Glucose, 6, 7, 132, 144, 146, 147 Blood pressure, 9, 91, 132, 133, 145, 151, 154 Blood vessel, 132, 133, 134, 137, 148, 154, 162, 163, 165 Body Composition, 14, 42, 132 Body Fluids, 15, 33, 132, 133, 139 Body Mass Index, 4, 132 Bowel, 31, 35, 129, 132, 162 Brachytherapy, 20, 132, 158 Branch, 123, 132, 137, 154, 157, 161, 163 Breakdown, 133, 139, 142 Buccal, 133, 149 Budgets, 24, 133 Bypass, 62, 133 C Calcium, 133, 135 Capillary, 8, 133, 166 Carbohydrate, 133, 143, 155 Carcinogenic, 133, 156 Cardiolipins, 130, 133 Cardiorespiratory, 22, 133 Cardiovascular, 4, 10, 23, 41, 44, 49, 59, 61, 68, 92, 93, 112, 116, 133, 160, 161 Cardiovascular disease, 4, 10, 23, 41, 59, 61, 92, 93, 116, 133 Career Choice, 18, 133 Catecholamine, 133, 154 Catheterization, 116, 133, 148 Catheters, 116, 133 Cause of Death, 15, 116, 133 Cell Death, 130, 134 Cell Division, 131, 134, 137, 151, 155, 160 Cell proliferation, 23, 130, 134 Cellulose, 134, 155 Central Nervous System, 131, 134, 142, 143, 152, 160 Cerebellar, 131, 134, 158 Cerebral, 77, 131, 134, 140, 141 Cerebral Cortex, 131, 134, 141 Cerebrovascular, 65, 131, 133, 134, 163 Cerebrum, 134 Chemotactic Factors, 134, 136 Chemotherapy, 134, 149 Chin, 134, 150 Cholesterol, 4, 9, 131, 134, 135, 137, 149 Cholesterol Esters, 134, 149 Chromatin, 130, 134 Chromosomal, 134, 159 Chromosome, 78, 134, 144, 148, 159, 160 Chronic, 5, 13, 40, 84, 117, 134, 139, 140, 147, 148, 154, 160, 162

Chronic renal, 5, 134 Chylomicrons, 135, 149 Claudication, 8, 135 Clinical Medicine, 28, 135, 156 Clinical trial, 10, 13, 17, 20, 31, 34, 37, 47, 63, 105, 115, 135, 136, 151, 157, 158 Cloning, 26, 132, 135 Cluster Analysis, 43, 135 Coagulation, 130, 133, 135, 155 Codon, 57, 135 Collagen, 116, 128, 135, 136, 141, 142, 156 Colloidal, 128, 135, 160 Community Health Centers, 53, 135 Competency, 7, 135 Complement, 27, 129, 135, 142, 149, 155 Compliance, 116, 136 Computational Biology, 105, 136 Confined Spaces, 24, 136 Confounding, 14, 21, 136 Connective Tissue, 130, 135, 136, 141, 142, 159, 162 Connective Tissue Diseases, 130, 136 Consciousness, 136, 138, 139, 157 Constriction, 136, 148, 159 Consultation, 14, 16, 40, 136 Consumption, 14, 136, 138, 153, 159 Contraindications, ii, 136 Cooperative group, 31, 136 Coordination, 52, 55, 136 Cor, 136 Cornea, 131, 137 Coronary, 62, 75, 92, 133, 137, 150, 151 Coronary heart disease, 62, 75, 133, 137 Coronary Thrombosis, 137, 150, 151 Corticosteroids, 137, 142, 156 Cortisol, 128, 137 Cortisone, 137, 156 Creatinine, 9, 137 Cross-Cultural Comparison, 9, 137 Curative, 137, 163 Cutaneous, 62, 117, 137, 149 Cytogenetics, 137, 159 Cytokine, 25, 137 Cytoplasm, 130, 137, 140, 151, 152, 159 Cytotoxic, 137, 158 Cytotoxicity, 21, 137 D Data Collection, 14, 15, 52, 54, 138, 141 Deamination, 138, 165 Degenerative, 138, 145 Deletion, 130, 138 Delivery of Health Care, 135, 138, 144

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Dementia, 9, 15, 16, 23, 33, 138, 152 Demography, 43, 138 Density, 4, 132, 138, 149, 153 Dental Care, 6, 138 Dental Caries, 6, 138 Dentition, 65, 71, 138 Developing Countries, 20, 138 Developmental Biology, 75, 138 Diabetes Mellitus, 4, 6, 18, 41, 69, 78, 92, 93, 138, 143, 144 Diabetic Foot, 8, 138 Diagnostic procedure, 114, 138 Diagnostic Services, 138, 163 Dialyzer, 138, 144 Diastole, 139 Diastolic, 4, 139, 145 Diastolic blood pressure, 4, 139 Digestion, 47, 131, 132, 139, 149, 161 Dilatation, 127, 139, 156 Diploid, 139, 155 Direct, iii, 16, 24, 27, 42, 99, 112, 135, 139, 151, 158, 162 Disease Progression, 25, 139 Disease Susceptibility, 36, 49, 139 Dislocation, 20, 139 Disparity, 15, 36, 38, 139 Domestic Violence, 79, 139 Dose-rate, 20, 139 Dreams, 84, 139 Drug Interactions, 100, 139 Drug Tolerance, 139, 164 Duct, 133, 139 Dystrophy, 33, 139 E Eating Disorders, 11, 139 Effector, 135, 139 Efficacy, 20, 36, 139, 165 Elastin, 135, 136, 139 Embryo, 127, 140, 155 Empirical, 17, 48, 53, 140 Enamel, 138, 140 Endemic, 5, 64, 140 Endotoxins, 136, 140 End-stage renal, 3, 6, 63, 93, 134, 140 Entrepreneurship, 50, 140 Environmental Health, 104, 106, 140 Enzymatic, 128, 133, 136, 138, 140, 159 Enzyme, 128, 139, 140, 141, 150, 155, 157, 159 Epidemic, 57, 79, 92, 98, 140 Epidemiological, 25, 41, 140 Epidermal, 140, 151, 166

Epidermis, 127, 132, 140, 154 Epinephrine, 127, 140, 152 Erythrocytes, 129, 140 Estrogen, 117, 140 Ethanol, 128, 140, 141 Ethnic Groups, 30, 40, 44, 62, 93, 116, 140 Evaluable patients, 47, 140 Evoke, 141, 161 Exogenous, 132, 141, 165 Extremity, 93, 141 F Family Planning, 105, 141 Family Relations, 42, 97, 141 Fat, 5, 41, 91, 132, 136, 137, 141, 148, 159, 165 Fatty acids, 128, 141 Fermentation, 128, 141 Fetal Alcohol Syndrome, 56, 141 Fetus, 127, 141, 156 Fibroblasts, 141, 147 Fibrosis, 63, 141, 160 Fistulas, 60, 141 Flushing, 59, 141 Focus Groups, 25, 141 Fold, 18, 141 Food Habits, 59, 141 Food Preferences, 141 Foot Ulcer, 138, 141 Forearm, 132, 141 Forestry, 64, 85, 141 Fractionation, 21, 141 G Gamma Rays, 141, 158 Ganglia, 131, 142, 152, 162 Gas, 128, 142, 145, 166 Gastrin, 142, 145 Gelatin, 142, 163 Gene, 19, 20, 25, 26, 72, 77, 78, 128, 132, 142, 160, 164 Gene Conversion, 72, 142 Gene Expression, 25, 142 Genetic Counseling, 22, 142 Genetic Engineering, 132, 135, 142 Genetics, 16, 22, 32, 40, 47, 63, 70, 71, 75, 78, 91, 137, 142 Genital, 142, 165 Genitourinary, 47, 142, 165 Genomics, 49, 142 Genotype, 26, 40, 142, 154 Gestational, 33, 41, 42, 91, 142 Gland, 137, 142, 153, 157, 160, 161, 163 Glomerular, 142

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Glomeruli, 142 Glomerulonephritis, 4, 142 Glucocorticoid, 142, 156 Gluconeogenesis, 143 Glucose, 4, 9, 33, 41, 42, 91, 93, 132, 134, 138, 143, 144, 147 Glucose Intolerance, 10, 93, 138, 143 Glucose tolerance, 33, 41, 42, 91, 93, 143 Glucose Tolerance Test, 42, 93, 143 Glutamic Acid, 143, 156 Glyburide, 42, 143 Glycogen, 143 Glycoprotein, 143, 162 Gonorrhea, 75, 143 Governing Board, 143, 156 Grade, 47, 143 Graft, 143, 145 Grafting, 62, 143 Grasses, 143, 145 Growth, 74, 127, 129, 130, 134, 138, 141, 143, 145, 147, 149, 152, 153, 155, 164, 165 H Hallucination, 143 Hallucinogen, 14, 143 Handicap, 19, 143 Haploid, 144, 155 Haplotypes, 26, 64, 66, 68, 144 Health Behavior, 53, 144 Health Care Costs, 94, 144 Health Education, 26, 59, 62, 89, 90, 144 Health Expenditures, 144 Health Promotion, 10, 37, 93, 94, 111, 144 Health Services, 15, 37, 38, 60, 70, 93, 138, 144, 163 Health Status, 42, 56, 144 Heart attack, 133, 144 Hematologic Diseases, 28, 144 Hematology, 28, 47, 144 Hemodialysis, 13, 138, 144, 148 Hemoglobin, 42, 129, 140, 144 Hemorrhage, 144, 162 Hepatic, 128, 143, 145 Hepatitis, 25, 48, 100, 145 Hepatocyte, 25, 145 Herbicides, 64, 85, 145 Hereditary, 8, 136, 145 Heredity, 91, 142, 145 Homicide, 74, 76, 145 Homodimer, 145, 164 Homologous, 128, 145, 160 Homosexuality, 98, 145 Hormonal, 145, 149

Hormonal therapy, 145, 149 Hormone, 44, 132, 137, 140, 142, 145, 147, 155, 159, 164 Host, 12, 25, 36, 145, 146, 166 Human papillomavirus, 66, 145 Hybridomas, 145, 147 Hydrogen, 128, 131, 133, 145, 151, 152, 157 Hydrophobic, 145, 149 Hydroxylysine, 135, 145 Hydroxyproline, 128, 135, 145 Hyperglycemia, 33, 41, 145 Hypersensitivity, 73, 145, 159 Hypertension, 4, 5, 6, 9, 61, 68, 78, 133, 137, 145 Hypertriglyceridemia, 9, 146 Hypoglycemic, 41, 146 Hypothalamus, 131, 146 Hypothermia, 73, 146 I Id, 86, 113, 122, 124, 146 Ileum, 146, 166 Immune function, 146, 164 Immune response, 26, 130, 137, 146, 149, 166 Immune system, 132, 146, 149, 165, 166 Immunity, 26, 146 Immunization, 146, 156 Immunocompromised, 19, 146 Immunodeficiency, 60, 78, 90, 110, 146 Immunodeficiency syndrome, 90, 110, 146 Immunofluorescence, 146, 151 Immunologic, 134, 146, 158 Immunology, 49, 56, 66, 70, 72, 84, 146 Immunosuppressive, 142, 146, 162 Impairment, 5, 131, 146, 150, 152 In vitro, 146, 163, 164 In vivo, 146, 162 Incontinence, 115, 116, 146 Indicative, 146, 154, 165 Infancy, 37, 146 Infant Care, 74, 147 Infant Mortality, 21, 60, 77, 147 Infarction, 147 Infection, 8, 13, 25, 90, 110, 132, 134, 138, 146, 147, 149, 152, 159, 162, 166 Infiltration, 142, 147 Inflammation, 84, 128, 130, 141, 145, 147, 155, 159, 160, 162 Ingestion, 56, 143, 147 Inhalation, 24, 127, 147 Institutionalization, 50, 147

173

Insulin, 4, 9, 18, 33, 42, 59, 74, 92, 93, 143, 147, 165 Insulin-dependent diabetes mellitus, 92, 147 Interferon, 25, 147 Interferon-alpha, 147 Interleukin-6, 78, 147 Intermittent, 116, 147 Internal Medicine, 12, 19, 62, 73, 144, 147 Interstitial, 132, 148 Intestinal, 143, 148, 149 Intoxication, 44, 148, 166 Intracellular, 147, 148 Intubation, 133, 148 Invasive, 146, 148 Involuntary, 131, 148, 151, 158 Ionizing, 128, 148, 158 Ions, 131, 145, 148 Ischemia, 8, 148 J Joint, 19, 55, 130, 148, 149, 162 K Kb, 104, 148 Keratolytic, 138, 148 Kidney Disease, 9, 18, 92, 94, 104, 115, 148 Kidney Failure, 140, 148 Kinetic, 13, 148 L Labile, 135, 148 Lens, 148, 159 Library Services, 122, 148 Ligament, 148, 157 Ligands, 27, 148 Linkages, 144, 148 Lipid, 68, 92, 130, 147, 148, 149, 165 Lipoprotein, 4, 149 Liver, 25, 128, 131, 143, 145, 149, 156, 165 Localized, 127, 138, 147, 149, 155, 160 Locomotion, 149, 155 Longitudinal study, 21, 149 Low-density lipoprotein, 149 Lupus, 116, 117, 129, 130, 149, 162 Luxation, 139, 149 Lymphatic, 147, 149 Lymphocyte, 130, 149 Lymphoid, 129, 137, 149 M Major Histocompatibility Complex, 144, 149 Malabsorption, 64, 149 Malignant, 149, 152, 158 Malnutrition, 128, 149

Medical oncologist, 31, 149 Medical Records, 5, 150 Medically Uninsured, 34, 150 MEDLINE, 105, 150 Medullary, 21, 150 Membrane, 13, 136, 138, 150, 151, 153, 154, 159, 160, 162, 165 Memory, 32, 138, 150 Mental, iv, 10, 24, 27, 28, 38, 43, 48, 52, 58, 79, 104, 106, 134, 138, 141, 150, 156, 157, 159 Mental deficiency, 141, 150 Mental Disorders, 38, 48, 150, 156, 157 Mental Health, iv, 10, 24, 27, 28, 38, 48, 52, 58, 79, 104, 106, 150, 156, 157 Mental Health Services, iv, 10, 38, 106, 150 Mentors, 12, 23, 28, 30, 31, 150 Metabolic disorder, 40, 150 Metastasis, 150, 152 Metastatic, 20, 150 MI, 4, 125, 150 Microbe, 150, 164 Microbiology, 19, 50, 127, 150 Micro-organism, 138, 150 Microtubule-Associated Proteins, 150, 152, 163 Microtubules, 150, 152, 163 Micturition, 116, 151 Midaxillary line, 151, 166 Migration, 55, 59, 64, 151 Millimeter, 151, 166 Minority Groups, 3, 27, 33, 41, 42, 45, 48, 49, 53, 151 Mitosis, 130, 151 Mixed Connective Tissue Disease, 117, 151 Modification, 34, 44, 116, 128, 142, 151, 157 Molecular, 29, 32, 33, 55, 57, 73, 77, 105, 107, 132, 136, 137, 150, 151, 152, 164, 165 Molecule, 130, 131, 133, 136, 139, 151, 158 Monitor, 16, 32, 137, 151, 153 Monocytes, 147, 151 Morphogenesis, 141, 151 Morphology, 65, 144, 151 Mucins, 151 Mucosa, 149, 151 Multicenter study, 41, 151 Muscular Dystrophies, 139, 151 Myocardial infarction, 5, 137, 150, 151 Myocardium, 150, 151

174

Native American Health

N Natural selection, 27, 40, 152 Need, 3, 6, 10, 22, 23, 39, 49, 53, 63, 89, 91, 94, 97, 98, 115, 118, 134, 143, 152, 164 Neonatal, 117, 147, 152 Neoplasms, 152, 158, 163 Neoplastic, 145, 152, 162 Nephropathy, 148, 152 Nerve, 91, 127, 131, 134, 152, 159, 160, 161 Nervous System, 27, 131, 134, 152, 162 Neuroendocrine, 152, 162 Neurofibrillary Tangles, 152, 163 Neuropathy, 93, 152 Neuropil, 152, 163 Neuropil Threads, 152, 163 Neutrons, 128, 152, 158 Nonmalignant, 39, 152 Norepinephrine, 127, 152 Nuclear, 41, 131, 141, 142, 151, 153 Nuclear Family, 141, 153 Nucleus, 30, 130, 131, 134, 137, 141, 151, 152, 153, 157, 161, 163 Nutrition Assessment, 14, 153 Nutritional Status, 74, 153 O Obstetrics, 21, 153 Oncologist, 19, 149, 153 Oncology, 15, 31, 34, 47, 153 Opacity, 138, 153 Oral Health, 36, 153 Organ Culture, 153, 164 Osmotic, 128, 153, 160 Ovary, 153, 155 Ownership, 43, 91, 153 P Palliative, 153, 163 Pancreas, 147, 153 Papillomavirus, 153 Partnership Practice, 153, 156 Parturition, 153, 154 Pathogenesis, 25, 116, 154 Pathologic, 33, 130, 137, 145, 154 Pathologic Processes, 130, 154 Patient Education, 20, 110, 120, 122, 125, 154 Pelvic, 154, 157 Pemphigus, 64, 127, 154 Peptide, 42, 128, 154, 155, 157 Pericardium, 154, 162 Periodontal disease, 36, 154 Peripheral blood, 20, 147, 154 Peripheral Vascular Disease, 8, 93, 154

Pharmacokinetic, 154 Pharmacologic, 154, 164 Pharmacotherapy, 116, 154 Phenotype, 26, 154 Phospholipids, 129, 130, 133, 141, 149, 154 Physical Examination, 9, 117, 155 Physical Fitness, 41, 155 Physiologic, 155, 158 Physiology, 47, 144, 155, 166 Plants, 21, 64, 84, 85, 143, 145, 151, 153, 155, 164 Plasma, 63, 93, 128, 129, 133, 134, 142, 143, 144, 148, 155, 160 Plasma protein, 128, 155, 160 Platelet-Derived Growth Factor, 70, 155 Platelets, 155, 160, 163 Plethysmography, 8, 155 Pneumonia, 116, 136, 155 Pollen, 73, 155 Polymorphic, 27, 155 Polymorphism, 26, 78, 155 Polysaccharide, 130, 134, 155 Posterior, 129, 131, 151, 153, 155 Postnatal, 141, 155 Practicability, 155, 165 Practice Guidelines, 106, 155 Preclinical, 33, 156 Precursor, 139, 140, 152, 156, 164, 165 Prednisolone, 156 Prednisone, 117, 156 Prejudice, 98, 156 Prenatal, 21, 74, 140, 141, 156 Presynaptic, 156, 162 Prevalence, 4, 6, 8, 9, 24, 33, 37, 38, 41, 74, 75, 92, 93, 94, 156 Primary Prevention, 6, 156 Private Practice, 37, 156 Probe, 36, 156 Program Development, 90, 156 Progression, 25, 33, 41, 156 Progressive, 134, 138, 139, 143, 151, 156 Proline, 57, 135, 145, 156 Promoter, 78, 156 Prone, 74, 156 Proportional, 7, 154, 156 Prospective study, 149, 156 Prostate, 20, 157 Protein C, 128, 130, 135, 149, 157, 165 Protein S, 132, 157, 159 Proteins, 128, 129, 130, 134, 135, 145, 150, 151, 152, 154, 155, 157, 160, 163, 164 Proteolytic, 135, 157

175

Protocol, 31, 41, 42, 44, 157 Protons, 128, 145, 148, 157, 158 Psychiatric, 38, 75, 150, 157 Psychiatry, 21, 53, 57, 58, 59, 80, 157, 166 Psychic, 150, 157 Psychoactive, 56, 157, 166 Psychopathology, 53, 157 Puberty, 11, 157 Public Policy, 105, 157 Puerperium, 153, 157 Pulmonary, 28, 49, 132, 136, 137, 148, 157, 166 Pulmonary Artery, 132, 157, 166 Pulse, 8, 151, 157 Q Quality of Life, 33, 116, 157 R Race, 48, 91, 151, 158 Radiation, 19, 20, 31, 141, 148, 153, 158, 166 Radiation therapy, 141, 158 Radioactive, 145, 153, 158 Radioimmunotherapy, 158 Radiotherapy, 20, 132, 158 Randomized, 13, 34, 42, 139, 158 Receptor, 26, 70, 127, 130, 158, 160 Recombinant, 142, 158 Rectum, 130, 142, 146, 157, 158 Red Nucleus, 131, 158 Refer, 1, 127, 133, 135, 149, 152, 158, 164 Reflex, 22, 158 Refraction, 158, 161 Regimen, 139, 154, 158 Reliability, 53, 158 Research Design, 14, 17, 38, 159 Resolving, 17, 159 Respiration, 151, 159 Retina, 131, 148, 159 Retinal, 139, 159 Rheumatism, 70, 159 Rheumatoid, 70, 159 Rheumatoid arthritis, 70, 159 Ribonuclease, 151, 159 Ribosome, 159, 164 Rigidity, 155, 159 Risk factor, 4, 5, 6, 7, 8, 11, 14, 21, 44, 59, 61, 63, 68, 75, 77, 85, 91, 92, 93, 94, 156, 159 Risk patient, 34, 159 Rod, 131, 159 Rural Population, 31, 159

S Satellite, 16, 42, 159 Schizoid, 159, 166 Schizophrenia, 159, 160, 166 Schizotypal Personality Disorder, 159, 166 Scleroderma, 70, 151, 160 Sclerosis, 70, 130, 160 Screening, 6, 8, 14, 20, 74, 75, 92, 93, 135, 160 Secretion, 147, 151, 160, 164 Segregation, 26, 142, 160 Semen, 157, 160 Sequencing, 26, 160 Serositis, 117, 160 Serotonin, 154, 160, 165 Serous, 160 Serum, 4, 13, 25, 84, 128, 129, 135, 149, 151, 160 Serum Albumin, 84, 160 Sex Characteristics, 127, 157, 160 Sexually Transmitted Diseases, 90, 160 Shame, 98, 160 Shock, 160, 165 Side effect, 99, 127, 132, 160, 164 Skeleton, 148, 160 Small intestine, 135, 145, 146, 161 Smoking Cessation, 34, 77, 161 Social Change, 43, 161 Social Environment, 158, 161 Social Medicine, 23, 161 Social Problems, 46, 161 Solitary Nucleus, 131, 161 Solvent, 21, 140, 153, 161 Somatic, 127, 151, 161 Specialist, 47, 117, 161 Species, 19, 49, 131, 140, 151, 158, 161, 162, 165, 166 Spectrum, 15, 29, 90, 161 Sperm, 134, 155, 161, 165 Spinal cord, 116, 134, 152, 158, 161, 162 Spirochete, 161, 162 Standard therapy, 42, 161 Statistically significant, 7, 161 Stimulus, 31, 143, 158, 161, 163 Stomach, 142, 143, 145, 161 Stool, 146, 162 Stress, 24, 34, 43, 48, 53, 62, 68, 116, 117, 131, 133, 137, 141, 159, 162 Stroke, 77, 91, 104, 133, 162 Subacute, 147, 162 Subclinical, 147, 162 Subcutaneous, 162, 166

176

Native American Health

Subspecies, 161, 162 Survival Rate, 39, 162 Sympathetic Nervous System, 131, 162 Symphysis, 134, 157, 162 Synapse, 127, 156, 162 Synaptophysin, 33, 162 Syphilis, 75, 133, 162 Systemic, 70, 100, 116, 129, 130, 132, 140, 147, 151, 152, 156, 158, 160, 162 Systemic lupus erythematosus, 116, 129, 130, 151, 162 Systolic, 4, 145, 162 T Tacrolimus, 79, 162 Talus, 65, 163 Tarsal Bones, 163 Tarsus, 163 Tau Proteins, 33, 152, 163 Teaching Materials, 18, 163 Telangiectasia, 20, 163 Telecommunications, 163 Telemedicine, 39, 52, 163 Terminator, 135, 163 Thalamic, 131, 163 Thalamic Diseases, 131, 163 Therapeutics, 100, 163 Thigh, 4, 163 Threonine, 57, 163 Threshold, 145, 163 Thrombopenia, 130, 163 Thromboses, 130, 163 Thrombosis, 157, 162, 163 Thyroxine, 128, 163 Tissue Culture, 25, 164 Tobacco Industry, 50, 164 Tolerance, 9, 42, 91, 93, 127, 143, 164 Tooth Preparation, 127, 164 Topical, 117, 140, 164 Toxic, iv, 137, 143, 146, 152, 164 Toxicity, 84, 139, 164 Toxicokinetics, 164 Toxicology, 24, 64, 106, 164 Toxin, 164 Training Support, 17, 164 Transcultural Nursing, 65, 69, 78, 79, 164 Transfection, 132, 164 Transforming Growth Factor beta, 70, 164 Translation, 15, 23, 40, 52, 128, 164 Translational, 15, 34, 164 Transplantation, 3, 27, 49, 58, 60, 79, 134, 146, 149, 165

Trauma, 24, 131, 163, 165 Treatment Outcome, 53, 165 Triglyceride, 146, 165 Trophic, 8, 165 Tryptophan, 135, 160, 165 Tubercle, 21, 165 Tubulin, 150, 163, 165 Type 2 diabetes, 6, 37, 40, 57, 91, 93, 115, 165 U Unconscious, 146, 165 Urbanization, 74, 165 Urea, 13, 165 Ureters, 165 Urethra, 157, 165 Urinary, 9, 116, 142, 146, 165 Urinary tract, 116, 165 Urinary tract infection, 116, 165 Urine, 9, 132, 137, 146, 151, 165 Urogenital, 142, 143, 165 V Vaccine, 72, 100, 157, 165 Vascular, 8, 138, 147, 165 VE, 37, 60, 166 Vein, 153, 159, 166 Venereal, 80, 162, 166 Venous, 130, 157, 166 Ventilation, 136, 166 Ventricle, 137, 146, 157, 162, 166 Venules, 132, 133, 166 Vertebrae, 161, 166 Veterinary Medicine, 105, 166 Viral, 25, 26, 55, 59, 166 Virulence, 164, 166 Virus, 25, 55, 59, 73, 90, 97, 110, 142, 145, 147, 166 Visceral, 131, 166 Visceral Afferents, 131, 166 W Waist circumference, 4, 166 Warts, 145, 166 White blood cell, 129, 149, 166 Withdrawal, 54, 129, 166 X X-ray, 141, 153, 158, 166 Y

Yeasts, 154, 167

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