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Flyger J, Larsen CVL, Jensen E, Niclasen B, Nielsen AS. A qualitative study of the implementation and organization of the national Greenlandic addiction treatment service. FRONTIERS IN HEALTH SERVICES 2024; 4:1219787. [PMID: 38510066 PMCID: PMC10950955 DOI: 10.3389/frhs.2024.1219787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024]
Abstract
Background Alcohol and cannabis use constitutes the major public health problems in Greenland. Thus, it is important to assess if Allorfik, a new national outpatient addiction treatment service introduced in 2016, was implemented successfully and how it is perceived. Allorfik introduced local treatment centers offering a treatment methodology (motivational interviewing and cognitive therapy) new to addiction treatment in Greenland with limited evidence from Indigenous populations such as the Greenlandic. The present study investigates the implementation of Allorfik from the perspective of those engaged in the process and the field. Methods Data consisted of transcribed interviews with 23 individuals from both Allorfik and organizations collaborating with or supposed to collaborate with Allorfik. The theme of the interviews was their perspectives on the implementation process, enablers, and obstacles in the process and how Allorfik was performing at the time of the interview. The interview guide was informed by implementation theory. The transcribed material was analyzed using a general inductive approach. Results The analysis resulted in three overall and interconnected themes, namely, implementation, collaborations, and challenges. The implementation was overall considered a success by the interviewees as all components were implemented as planned with a few adaptions, e.g., a treatment guideline update. The collaborations are considered challenging but important to all interviewees. Collaborations seem to rely on personal commitment as opposed to well-defined structures, making it unstable and vulnerable to changes in staff. One of the main challenges highlighted by the interviewees is the number of problems other than addiction among people in treatment, which makes addiction treatment and recovery difficult to achieve. Nevertheless, the high levels of other problems being treated in Allorfik highlights the need for easily accessible therapy as many find that Allorfik is the only place to turn to in times of crisis. Conclusion Allorfik seems to have been implemented in accordance with original intentions and plans for addiction treatment service but has also become more than just a service for addiction treatment with easy access in a country with vast distances and limited resources.
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Affiliation(s)
- Julie Flyger
- Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Institute of Nursing and Health Science, Ilisimatusarfik—University of Greenland, Nuuk, Greenland
| | - Christina Viskum Lytken Larsen
- Institute of Nursing and Health Science, Ilisimatusarfik—University of Greenland, Nuuk, Greenland
- Center for Public Health in Greenland, Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Else Jensen
- Institute of Nursing and Health Science, Ilisimatusarfik—University of Greenland, Nuuk, Greenland
| | - Birgit Niclasen
- Institute of Nursing and Health Science, Ilisimatusarfik—University of Greenland, Nuuk, Greenland
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
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Ottendahl CB, Seidler IK, Beck A, Pedersen CP, Bjerregaard P, Larsen CVL. Developing the ACEIG-scale: An adverse childhood experience scale for Inuit youth in Greenland. CHILD ABUSE & NEGLECT 2024; 148:106471. [PMID: 37821291 DOI: 10.1016/j.chiabu.2023.106471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/17/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) have been identified as a major public health challenge in Greenland. No previous studies have created a multi-item ACE- scale among an Arctic Indigenous population. OBJECTIVE To develop a multi-item ACE-scale among Inuit youth in Greenland (the ACEIG scale). METHODS The ACEIG scale was created with data from the 'Wellbeing among Inuit youth in Greenland'-survey. Scale items were based on a recognised ACE-scale and further adapted to the context of Inuit youth in Greenland by adding items relevant for the population. The scale was validated through item response theory (IRT) and reliability was assessed by Cronbach's alpha. RESULTS Four items relevant for Inuit youth in Greenland were added to the recognised ACE scale (bullying, death of parent, gambling problems in close family, and suicide in close relations). The scale was reduced by IRT, as three items (bullying, divorce of parents and parents passing away) exceeded the difficulty index threshold. The ACEIG scale therefore consists of 10 items: alcohol problems in close family, marijuana use in close family, domestic violence, being victim of physical violence, being victim of psychological violence, any type of sexual abuse, sexual abuse (intercourse), sexual abuse (more than once), suicide in close relations, and gambling problems in close family. Cronbach's alpha was 0.7. CONCLUSION The ACEIG scale includes 10 items with acceptable reliability. The scale can inform future screening tools to identify vulnerable youth and target interventions. Future studies should investigate the association between the ACEIG scale and health outcomes.
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Affiliation(s)
| | - Ivalu Katajavaara Seidler
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Ilisimatusarfik, University of Greenland, Nuuk, Greenland
| | - Astrid Beck
- Department of Growth and Reproduction, Copenhagen University Hospital, Denmark
| | | | - Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christina Viskum Lytken Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Ilisimatusarfik, University of Greenland, Nuuk, Greenland
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Seidler IK, Tolstrup JS, Bjerregaard P, Crawford A, Larsen CVL. Time trends and geographical patterns in suicide among Greenland Inuit. BMC Psychiatry 2023; 23:187. [PMID: 36944963 PMCID: PMC10031872 DOI: 10.1186/s12888-023-04675-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Between 1980 and 2018 Greenland has had one of the highest suicide rates in the world with an average rate of 96 suicides per 100,000 people annually. The aim of this study is to investigate suicide rates in Greenland according to age, birth cohort, period, sex, place of residence and suicide method from 1970 until 2018. METHODS Suicide rates were examined using register and census data from 1970-2018 among Greenland Inuit. Rates were calculated by Poisson regression in Stata and by use of Excel. In analyses of the period trends, rates were standardized according to the World Standard Population 2000-2025. RESULTS The suicide rate has been declining since a peak at 120 suicides per 100,000 people annually in the 1980s but remained high at a rate of 81.3 suicides per 100,000 people annually from 2015-2018. Descriptive analyses point to the decrease in male suicides as the primary factor for the overall decreasing rates while the rate among women has been increasing. Simultaneously, the proportion of women who used a violent suicide method increased from 60% in 1970-1979 to 90% in 2010-2018. The highest rates are seen among young people, especially young men aged 20-24 years and youth suicide rates increased with later birth cohorts. When the rates started to increase in the 1980s both the capital Nuuk and East Greenland had the highest rates. Since then, the rate in Nuuk has declined while the rate in East Greenland was three times the national rate from 2015-2018. CONCLUSIONS From 1970 to 1989 the suicide rate increased from 28.7 to 120.5 per 100,000 people mirroring a rapid societal transition in the post-colonial period. The rate has slowly declined from the peak in the 1980s but remains at a very high level. Young people in general are at risk, but the steady increase in the rate among women is worrying and there is a need to investigate underlying causes for this development.
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Affiliation(s)
- Ivalu Katajavaara Seidler
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
- Institute for Health and Nature, University of Greenland, Nuuk, Greenland.
| | | | - Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Christina Viskum Lytken Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Institute for Health and Nature, University of Greenland, Nuuk, Greenland
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Høilo Granheim IP, Kvernmo S, Silviken A, Lytken Larsen CV. The association between suicidal behaviour and violence, sexual abuse, and parental substance abuse among Sami and Greenlandic adolescents: the WBYG study and the NAAHS. Scand J Child Adolesc Psychiatr Psychol 2023; 11:10-26. [PMID: 37082430 PMCID: PMC10111208 DOI: 10.2478/sjcapp-2023-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background For young Indigenous people, suicide is one of the leading causes of death, and high rates in Arctic areas indicate serious health and societal concerns. More knowledge is needed, as suicidal behaviour predicts later death by suicide. The aim of this study was to investigate associations between suicidal thoughts and suicide attempts and negative life events, including violence, sexual abuse, and parental substance abuse, in Sami and Greenlandic adolescents, within and between groups and gender. Method Working samples included 442 Sami and 399 Greenlandic Inuit (15-16-year-olds), in The Norwegian Arctic Adolescent Health Study (NAAHS) and the Well-Being among Youth in Greenland (WBYG) study. Multivariable logistic regression explored associations between suicidal behaviour and violence, sexual abuse, and parental substance abuse. Results Across Indigenous groups, suicidal thoughts and attempts were significantly associated with violence and sexual abuse. The association between suicidal behaviour; especially suicidal thoughts, and sexual abuse was significant and strong among Sami females. Sami and Inuit adolescents with a history of childhood violence reported significantly more suicide attempts; the strongest association was found among Sami males. Conclusion To Sami and Greenlandic Inuit, the experiences of negative life events, such as violence or sexual abuse are significant risk factors for suicidal behaviour. Public health programmes and prevention strategies targeting youth mental health and suicide should be culturally sensitive and sensitive to gender differences in the association between negative life events and suicidal behaviour.
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Affiliation(s)
- Ida Pauline Høilo Granheim
- Department of clinical medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Siv Kvernmo
- Department of clinical medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Silviken
- Centre for Sami Health Research, Faculty of Health Sciences, UiT The Arctic University of Norway, Karasjok, Norway
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Bjerregaard P, Larsen CVL, Olesen I, Ottendahl CB, Backer V, Senftleber N, Christensen MMB, Larsen TJ, Byberg S, Hansen T, Jørgensen ME. The Greenland population health survey 2018 - methods of a prospective study of risk factors for lifestyle related diseases and social determinants of health amongst Inuit. Int J Circumpolar Health 2022; 81:2090067. [PMID: 35711125 PMCID: PMC9225753 DOI: 10.1080/22423982.2022.2090067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Since 1993, regular population health surveys in Greenland have supported and monitored the public health strategy of Greenland and have monitored cardiometabolic and lung diseases. The most recent of these surveys included 2539 persons aged 15+ from 20 communities spread over the whole country. The survey instruments included personal interviews, self-administered questionnaires, blood sampling, anthropometric measurements, blood pressure, ECG, oral glucose test, pulmonary function, hand grip strength and chair stand test. Blood samples were analysed for glucose, glycated haemoglobin (HbA1c), insulin, incretin hormones, cholesterol, kidney function, fatty acids in erythrocyte membranes and mercury, urine for albumin-creatinine ratio, and aliquots were stored at -80°C for future use. Data were furthermore collected for studies of the gut microbiome and diabetes complications. Survey participants were followed up with register data. The potential of the study is to contribute to the continued monitoring of risk factors and health conditions as part of Greenland's public health strategy and to study the epidemiology of cardiometabolic diseases and other chronic diseases and behavioural risk factors. The next population health survey is planned for 2024. The emphasis of the article is on the methods of the study and results will be presented in other publications.
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Affiliation(s)
- Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christina Viskum Lytken Larsen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark.,Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Ingelise Olesen
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | | | - Vibeke Backer
- Department of otorhinolaryngology Head & Neck surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Ninna Senftleber
- Steno Diabetes Center Greenland, Nuuk, Greenland.,Steno Diabetes Center Copenhagen, Denmark
| | | | - Trine Jul Larsen
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | | | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark.,Institute of Health and Nature, University of Greenland, Nuuk, Greenland.,Steno Diabetes Center Greenland, Nuuk, Greenland.,Steno Diabetes Center Copenhagen, Denmark
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Seidler IK, Thygesen LC, Bjerregaard P, Larsen CVL. Exploring sex-specific time trends in drinking patterns in the Greenlandic population from 1993 to 2014 - a large Arctic Indigenous population. Int J Circumpolar Health 2022; 81:2089379. [PMID: 35698457 PMCID: PMC9225729 DOI: 10.1080/22423982.2022.2089379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A drinking pattern characterised by occasional excessive drinking is a key challenge for public health in Greenland. The objective was to examine sex-specific time trends in drinking patterns among Greenland Inuit. Cross-sectional and cohort data from geographically representative health surveys in 1993, 2005–2010 and 2014 were included (n = 4,938). Drinking patterns were defined as abstainer, non-problematic and occasional binge drinking. Patterns were analysed by sex-specific crude proportions and logistical analyses according to age, birth cohort and calendar time, accounting for region and settlement type. More than half of the men and one-third of the women had an occasional binge drinking pattern, while 22.6% of females and 15.1% of men were abstainers. Abstention increased with increasing age, while occasional binge drinking decreased among men. Younger male birth cohorts were less likely to have an occasional binge drinking pattern, while the youngest females had the highest odds ratio. A drinking pattern characterised by occasional excessive use remains a key challenge for public health in Greenland with age as a strong predictor. A high prevalence of abstainers co-exists with a high prevalence of occasional binge drinking. The increased odds ratio for occasional binge drinking among younger females should be addressed further.
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Affiliation(s)
| | - Lau Caspar Thygesen
- National Institute for Health and Nature, University of Southern Denmark, Copenhagen K, Denmark
| | - Peter Bjerregaard
- National Institute for Health and Nature, University of Southern Denmark, Copenhagen K, Denmark.,University of Greenland, Nuuk, Greenland
| | - Christina Viskum Lytken Larsen
- National Institute for Health and Nature, University of Southern Denmark, Copenhagen K, Denmark.,University of Greenland, Nuuk, Greenland
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Sten KA, Højgaard EE, Backe MB, Pedersen ML, Skovgaard N, Andersen S, Albertsen N. The prevalence of patients treated for osteoporosis in Greenland is low compared to Denmark. Int J Circumpolar Health 2022; 81:2078473. [PMID: 35603589 PMCID: PMC9132399 DOI: 10.1080/22423982.2022.2078473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The study is a register-based cross-sectional study aiming to estimate the prevalence of treated osteoporosis in Greenland compared to Denmark and provide a description of the patients with osteoporosis in Greenland. In addition, the study estimates the incidence of hip fractures in Greenland from 2018 to 2020 among people aged 65 years or older. The overall prevalence of patients prescribed medication for osteoporosis among those aged 18 years or older was 0.56% in Greenland and 2.36% in Denmark (p < 0.001). Among those aged 50 years or older, the prevalence was 1.28% and 4.71% in Greenland and Denmark, respectively (p < 0.001). The prevalence increased to 3.41% and 11.18% among patients aged 80 years or older in Greenland and Denmark, respectively. The incidence of hip fractures in Greenland was 6.55 per 1,000 inhabitants in 2020 compared to 5.65 per 1,000 inhabitants in Denmark (NS). In conclusion, the prevalence of treated osteoporosis in Greenland was less than one in four of that of Denmark. The incidence of hip fractures was similar in Greenland than in Denmark. Hence, our findings suggest that a marked number of subjects with osteoporosis in Greenland go untreated.
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Affiliation(s)
| | | | - Marie Balslev Backe
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
| | - Nils Skovgaard
- Greenland Center for Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
| | - Stig Andersen
- Aarhus University, Aarhus, Denmark
- Greenland Center for Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, University of Aalborg, Denmark
| | - Nadja Albertsen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, University of Aalborg, Denmark
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Muhammad AG, Hansen FO, Gantzel RH, Rex KF, Villadsen GE, Grønbæk H, Pedersen ML. Non-alcoholic fatty liver disease in patients with type 2 diabetes in Greenland: a register-based cross-sectional study. Int J Circumpolar Health 2022; 81:2065755. [PMID: 35440282 PMCID: PMC9037206 DOI: 10.1080/22423982.2022.2065755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide due to its close association to the metabolic syndrome of type 2 diabetes mellitus (T2DM), obesity and insulin resistance. However, the prevalence and severity of NAFLD in Greenland remain unexplored. We aimed to estimate the prevalence of liver steatosis and fibrosis among Greenlanders and Danes with T2DM living in Greenland using biochemical surrogate markers. We included 1409 Greenlanders and 182 Danes with T2DM in this register-based cross-sectional study. Greenlanders had higher BMI and plasma lipid levels and lower HbA1c levels compared with Danes (p<0.05). Their median alanine aminotransferase (ALAT) levels were similar. However, more Greenlanders had elevated ALAT levels (20.5% vs. 11.5%, p<0.05). Greenlanders had lower FIB-4 scores than Danes, 0.91 (IQR: 0.66–1.27) vs. 0.97 (IQR: 0.78–1.34), without difference in FIB-4 score categories (p=0.27). The prevalence of advanced fibrosis was low in both populations (1.7–2.6%). In conclusion, Greenlanders with T2DM had better glycaemic control despite higher BMI and plasma lipids. A larger proportion of Greenlanders had elevated plasma ALAT levels, while FIB-4 scores were lower than Danes. These findings suggest that Greenlanders with T2DM may be less likely to develop liver complications than Danes with T2DM in Greenland.
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Affiliation(s)
- Abdullah Ghassan Muhammad
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Frederik Orm Hansen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Rasmus Hvidbjerg Gantzel
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Gerda Elisabeth Villadsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Nuuk, Greenland.,Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
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