Reproducibility and validity of a 45 item food-frequency questionnaire for inuit in Greenland

Since 1993, dietary assessment has been carried out in Greenland as part of recurrent population health surveys. In preparation for the next survey in 2024, 91 participants from the survey in 2018 were selected for a validation study of the Food Frequency Questionnaire (FFQ). The 91 participants were reinterviewed 38-50 months after the first FFQ and invited to complete a food diary. As part of the 2018 survey, blood was analysed for mercury. The food diary was completed by 65 participants. The agreement between the two FFQ interviews was very good for macronutrients and fatty acids (p > 0.20), whereas the calculated intake of mercury was 22% higher in the second FFQ (p = 0.04) due to a higher intake of whale meat and muktuk (whale skin). The agreement between the second FFQ and the food diary was good for local food, imported meat and cakes/sweets/snacks but fruit and vegetables, dairy products, beverages and added sugar were significantly underreported in the food diary. Food items not included in the FFQ were identified from the food diaries. The correlation between the intake of marine mammals and blood mercury was moderate (Spearman's rho = 0.41-0.50; p < 0.0001). The results will inspire future dietary studies in the circumpolar North.

IJCH - COVID-19 in the Arctic: special issue

The Circumpolar region, comprising the Arctic territories encircling the North Pole, is home to diverse Indigenous cultures facing unique socio-economic challenges. Indigenous communities such as the Inuit, Sámi, Athabaskan, Gwitchin, and Russian Arctic groups exhibit rich traditions and adaptive practices tied to their environments. Environmental diversity, from icy tundra to boreal forests, influences livelihoods and biodiversity, while significant socio-economic disparities persist, impacting access to healthcare, education, and economic opportunities. Against this backdrop, the global COVID-19 pandemic accentuated the intersection of environment, culture, and health in remote Arctic regions, presenting distinct challenges and opportunities. Initiated by a collaborative research project led by Fulbright Arctic Initiative Alumni, this special issue of the International Journal of Circumpolar Health explores the impacts of COVID-19 on Arctic Indigenous and rural communities. Building on previous work and recommendations, the issue features community case studies, highlighting community experiences and collaborative approaches to understand and address the pandemic's effects. The authors highlight both positive and negative societal outcomes, presenting community-driven models and evidence-based practices to inform pan-Arctic collaboration and decision-making in public health emergencies. Through sharing these insights, the special issue aims to privilege local and Indigenous knowledge systems, elevates community responses to complex and multifaceted challenges, and contributes to the evidence base on global pandemic response.

The influence of Scandinavian presence on Greenlandic lactase persistence

BACKGROUND

The study aims to estimate the prevalence of lactase non-persistence (LNP) among Greenlandic Inuit and Scandinavians living in Nuuk and East Greenland. The C to T transition in LCT - 13910 (rs4988235) is an autosomal inherited variant that provides the ability to lifelong lactase production, necessary to digest milk. The transition is very common in North European populations. However, LNP has only been sparsely studied in Greenland and never in Eastern Greenland, and genotype data has not previously been reported.

METHODS

Whole blood samples were collected from 535 participants, and rs4988235 was typed using a PCR-based method. Ethnicity was defined by parents' place of birth. Results were compared between East and West Greenland and Inuit and Scandinavians using Pearson's Chi² test.

RESULTS

82.2% of the participants were Inuit, and 17.8% were of Scandinavian ancestry. Among Inuit, 88.5% had LNP compared to 7.5% among Scandinavians (p < 0.001). The prevalence of LNP in Inuit varied significantly between East and West Greenland (p < 0.001). In the capital, 67.6% of Inuit had LNP compared to 98.6% in Tasiilaq and 100% in the villages around Tasiilaq.

DISCUSSION

The difference in LNP between East and West Greenland and the Inuit and Scandinavian population found in our study suggests that the original Inuit population was lactose maldigesters. Our findings suggest that the -13910 T allele was introduced into the original Inuit population by the Danes.

Giving birth in rural Arctic Greenland results from an Eastern Greenlandic birth cohort

Eastern Greenland is one of the most remote areas in the world. Approximately 3,500 people lives in two small towns and five villages. There is limited information on birth outcomes in Eastern Greenland. A cohort of all birthing women from Eastern Greenland from 2000 to 2017 was established and pregnancy, birth, and neonatal outcomes were described. A total of 1,344 women and 1,355 children were included in the cohort where 14.5% of the women were 18 years or younger, and 36.2% were single parents. Most women, 84.8% gave birth in East Greenland and 92.9%, experienced a vaginal, non-instrumental birth. The overall caesarean section rate was 6.5%. The rate of premature births was 10.1% and 2.2% of the children were born with malformations. The rate of premature births was high, preventive initiatives such as midwifery-led continuity of care including a stronger focus on the pregnant woman’s social and mental life situation may be recommended. Organisation of maternity services in East Greenland may benefit from a strong focus on public health, culture, and setting specific challenges, including the birth traditions of the society.

Mutation of KRAS in colorectal adenocarcinoma in Greenland

KRAS mutation is one of the most frequent driver mutations in colorectal cancer (CRC) and is also a prognostic biomarker. The aim of the present study was to determine the frequency of KRAS mutations over time in the Greenlandic population diagnosed with CRC. In total, 578 patients with the diagnosis of adenocarcinoma between 1988 and 2017 were identified. The status of KRAS and the mutational subtypes of KRAS mutations were determined in 102 representative samples by the Idylla™ platform in the time periods 1988-1990, 2002-2004, and 2015-2017. The results showed that the frequency of the KRAS mutations increased significantly, from 27% in 1988-1990 to 43% in 2015-2017 (p < 0.001). Furthermore, the most frequent subtypes of KRAS mutations in Greenland were G12D (c.35G > A) with 14%, G12V (c.35G > T) with 7%, and G13D (c.38G > A) with 6%. In conclusion, this study showed that the frequency of KRAS mutations in CRC has been increasing in recent decades in the specific population of Greenland. The results of this study may be used in initiatives related to targeted therapy of CRC in specific ethnicities and in investigations focusing on the environmental factors of cancer-related somatic mutations.

Trends in Inuit health services utilisation in Manitoba: findings from the Qanuinngitsiarutiksait study

There is a notable lack of research related to trends in Inuit accessing health services throughout the land known as Canada. Given Nunavut’s reliance on specialised services provided in the Northwest Territories, Alberta, Manitoba, and Ontario, this gap is particularly problematic, making it more difficult for Nunangat to proactively plan new programs for emerging needs, and for provinces to respond to those needs. The Qanuinngitsiarutiksait study aimed to address this gap by developing detailed profiles of Inuit accessing health services in Manitoba. We used administrative data routinely collected by Manitoba agencies, to support the development of Inuit-centric services. It was conducted in partnership with the Manitoba Inuit Association, and Inuit Elders from Nunavut Canada and Manitoba. We focused on two interrelated cohorts: Kivallirmiut (Inuit from the Kivalliq region of Nunavut) who come to Winnipeg to access specialised services; and Manitobamiut (Inuit already living in Manitoba). Findings show that health services are primarily accessed in Winnipeg. Half of health services accessed by Kivallirmiut are for in-patient care at facilities with the Winnipeg Regional Health Authority. The other half are for advanced out-patient care including specialist consults. For Kivallirmiut, hospitalisation for pregnancy and birth are the most prevalent reasons for hospitalisation, followed by diseases of the respiratory system. Noteworthy, rates of hospitalisation for conditions treatable in primary healthcare for Kivallirmiut are considerably lower than those for Manitobans living in the northern part of the province (where comparable constraints exist). For Inuit adults, rates of hospitalisation for these conditions are comparable to those of Manitobans living in small communities. Inuit living in Manitoba are most often hospitalised for mental health reasons, although other reasons are nearly as prevalent. Our results support the need for more Inuit-centric health programming in Winnipeg.

Socio-demographic and substance use characteristics of unintentional injuries among Nunavik youth

This study described the distribution of unintentional injuries among Inuit youth in Nunavik, Quebec, Canada, and examined the relationship between socio-demographic factors, substance use and unintentional injuries.

A cross-sectional study design was used on data collected for the Nunavik Child Development Study (2013–2015) among eligible youth aged 16 to 21 years old. Unintentional injury occurrence and causes (last 12 months) were assessed through individual interviews. A multivariate logistic regression model tested the relationship between socio-demographic, substance use variables and unintentional injury occurrence.

Among the 199 youth who participated (94% response rate), thirty youth reported being unintentionally injured in the past 12 months , of which 50% were female. All-terrain vehicle collisions were the most frequent injuries reported (23%). The odds of being injured decreased by 62% for youth who were currently employed compared to those who were unemployed, adjusting for other socio-demographic variables (p-value = 0.04). Heavy alcohol drinking in the past 12 months was not significantly associated with unintentional injury.

This study highlights the burden of unintentional injuries among Nunavik youth and the need for future work to explore additional and diverse variables that may prevent or contribute to injuries in order to inform culturally and developmentally-appropriate injury prevention strategies.

Serum selenium levels and asthma among seafood processing workers in Greenland

Selenium levels in the Inuit population of Greenland have been declining during the last decades. The association between Selenium and asthma has been investigated previously, but with conflicting results. The objective was to measure human serum Se (s-Se) in Greenlandic seafood processing workers, to compare with levels recorded in previous decades and to establish if s-Se is associated with asthma or lung function. Data, including questionnaire answers, spirometry, skin-prick test and s-Se from 324 seafood processing workers in Greenland were collected during 2016-2017. Mean s-Se values were compared by t-test and one-way ANOVA. Associations between s-Se and asthma, symptoms from the lower airways at work and lung function were assessed using linear regression. The mean s-Se was 96.2 µg/L. S-Se was higher among non-smokers and workers living in settlements. Workers with asthma did not have s-Se levels significantly different from those of non-asthmatics. We found a positive association between s-Se levels and FEV₁ values. Selenium levels appear to continue declining in Greenland, presumably because of a more Westernised lifestyle. The health effects of declining Selenium levels remain unclear. We did not establish an association between s-Se and asthma, but we did record a positive association between s-Se and FEV₁.

Hand grip strength and chair stand test amongst Greenlandic Inuit: reference values and international comparisons

Muscle strength is an important predictor for function and mortality among older adults. We measured hand grip strength among 1442 participants aged 15+ years and carried out a 30 second chair stand test among 786 participants aged 55+ years. Neither test has been carried out among the Inuit before. We present reference values for men and women as means with standard deviations and medians with 10^th, 25^th, 75^th and 90^th percentiles. Hand grip strength was higher among men than among women (means 45.2 kg and 25.8 kg; p < 0.0001), in linear regression analyses it increased with height (β_men = 0.69; β_women = 0.46), weight (β_men = 0.24; β_women = 0.08) and body mass index (β_men = 0.56; β_women = 0.24), and decreased with age (β_men = −0.49; β_women = −0.29) and Inuit genetic ancestry (β_men = −0.96; β_women = −0.59). Chair stand score showed similar associations with sex (mean score for men and women 13.8 and 11.5; p < 0.0001), age (β_men = −0.22; β_women = −0.20) and Inuit genetic ancestry (β_men = −0.38; β_women = −0.41). The hand grip strength of the Inuit was at the same level as in European and North American populations whereas chair stand score was lower than that of a mostly white US population.

Clams and potential foodborne Toxoplasma gondii in Nunavut, Canada

The prevalence of Toxoplasma gondii exposure in Inuit living in Nunavut (20%) is twice that of the US (11%); however, routes of exposure for Inuit communities in North America are unclear. Exposure to T. gondii in humans has been linked with consumption of raw or undercooked shellfish that can accumulate environmentally resistant oocysts. Bivalve shellfish, such as clams, are an important, nutritious, affordable and accessible source of food in many Northern Communities. To date, presence of T. gondii in clams in Northern Canada has not been reported. In this study, we tested for T. gondii presence in clams (Mya truncata) that were harvested in Iqaluit, Nunavut over a 1-week period in September 2016. Of 390 clams, eight (2.1%) were confirmed to contain T. gondii DNA (≥99.7% identity), as determined using polymerase chain reaction (PCR) and sequence confirmation. Additionally, three clams (0.8%) were confirmed to contain Neospora caninum-like DNA (≥99.2% identity). While N. caninum is not known to be a zoonotic pathogen, its presence in shellfish indicates contamination of the nearshore with canid faeces, and the potential for marine mammal exposure through marine food webs. Notably, the PCR assay employed in this study does not discriminate between viable and non-viable parasites. These findings suggest a possible route for parasite exposure through shellfish in Iqaluit, Nunavut. Future research employing viability testing will further inform public health messaging on the infectious potential of T. gondii in shellfish.

Implementation of AUDIT in the treatment planning process for alcohol use disorder in Greenland

INTRODUCTION

The aim was to describe the treatment-seeking population with alcohol use disorder by means of data from the AUDIT questionnaire at referral and to evaluate and discuss if this information can be of use in treatment and service planning.

METHODS

Data from 2016 to 2018 were extracted from the National Database on Substance Abuse Treatment. The sample included 1281 individual treatment seekers from all over Greenland.

RESULTS

Mean age was 38.2 years (SD 12.1 years). Only 60.1% had a total AUDIT score suggesting dependency, and 15.5% had a harmful use. While most only drank 2-4 times a month, about 95% binge drank. Half reported loss of control at least weekly, and one of three had been unable to do what was expected of them, or needed a drink first thing in the morning weekly or more often. In two-third others had been concerned about the drinking. Users of cannabis had a higher AUDIT score, while gambling was unassociated to alcohol use. Substantial gender and regional differences were seen.

DISCUSSION

The AUDIT screening was found useful in individual and national treatment planning. Data suggested that particular focus should be given to women in treatment, and the service offered to the East Greenlandic population.

Feasibility and ethical issues: experiences and concerns of healthcare workers regarding a new RSV prophylaxis programme in Nunavik, Quebec

Background: The respiratory syncytial virus (RSV) is a major cause of hospitalisation in young Inuit children. Prophylaxis with palivizumab is routinely recommended for premature infants and those with severe pulmonary or cardiac diseases. In the fall 2016, the Quebec Ministry of Health expanded the criteria to include healthy full-term (HFT) newborns from Nunavik based on their high RSV hospitalisation rates.

Objectives: The aim of this study was to describe the impact of this programme on Nunavik health services during the first RSV season after its implementation (2016–2017) by studying challenges, concerns and needs of healthcare workers (HCWs).

Methods: An ethnographic approach was used. Semi-structured interviews focusing on HCWs experiences, and opinions to improve the new programme were conducted with 20 HCWs involved in its implementation.

Results: Main reported challenges and concerns were: additional work(over)load, lack of information and evidence about the need and efficacy of palivizumab in HFT newborns, communication issues between stakeholders, and ethical issues regarding the Inuit population.

Conclusion: The study revealed significant feasibility and acceptability issues. The programme was highly resource consuming. To address HCWs’ concerns, evidence-based data regarding palivizumab effectiveness in HFT infants, as well as consultation and involvement of Inuit population are warranted.

Non-clinical determinants of Medevacs in Nunavut: perspectives from northern health service providers and decision-makers

A medevac involves the transport of a critically ill patient, usually by plane or helicopter, to access necessary and at times life-saving care, most often only accessible in urban centres. Medevacs are commonly used in resource-limited and geographically isolated areas in Canada.

The objective of this study was to explore the determinants of medevac decision-making from the perspective of frontline care providers and decision-makers in Nunavut. For this purpose, we conducted a secondary analysis of 90 in-depth interviews.

Findings indicate that medevacs can be the result of a number of intersecting factors, including the referring and receiving provider’s experience, insufficient staffing in health centres, lack of access to diagnostic or treatment-related, and challenges related to recruitment and retention. An expanded scope of practice for frontline care providers, and a related lack of training and/or confidence in skills, only add to these challenges.

Medevacs play an important role related to managing shifting community nursing workloads, which expands and contracts in response to local needs. Attention to structural issues, putting in place virtual peer support systems, resolving vacancies left by the lag between attrition and recruitment, increasing access to training, and local diagnostic and treatment equipment, might decrease reliance of medevacs.

Piecing together the Inuit food security policy puzzle in Nunatsiavut, Labrador (Canada): protocol for a scoping review

INTRODUCTION

Inuit Nunangat is the Inuit homeland in Canada. It is comprised of four Inuit regions. Inuit residing in these areas experience greater social and economic inequities than the general Canadian population. Food security exemplifies this inequity and is a distinct determinant of Inuit health. Policy can play an integral role in health equity. However, demonstrating this role can be a complex task, especially when there are both national and regionally specific policies pertaining to each of the Inuit regions. This scoping review will focus on Nunatsiavut, located in northern Labrador. This region is situated within a complex policy space due to the national, provincial and regional governance structures, geographical location and the breadth of factors pertaining to food security. This scoping review aims to identify the range of policies pertaining to food security in Nunatsiavut and complete a directed content analysis to code each policy against the applicable dimension of food security.

METHODS AND ANALYSIS

The researchers will conduct a search strategy on the following four databases: MEDLINE (via Ovid), Embase (via Ovid), CINHAL and Scopus. A hand search of the relevant journals, conference abstracts and grey literature will be completed from April to October 2019. The following parameters will be extracted: a description of the policy, the organisation/institution that developed the policy, the definition of food security used or implied, and any stated intended targets or outcomes. The results will be compiled in a tabular form.

ETHICS AND DISSEMINATION

Ethics approval is not required as primary data will not be collected. The findings from this scoping review will be disseminated through peer-reviewed journals and public presentations. The results of this scoping review will be validated by a Nunatsiavut Government Advisory Group.

Gestational diabetes and macrosomia among Greenlanders. Time to change diagnostic strategy?

Gestational diabetes mellitus (GDM) is a serious condition associated to both maternal and offspring complications. Yet, no globally accepted consensus exists on how to test and diagnose GDM. In Greenland, the clinical criteria for testing and diagnosing GDM are adapted from Danish guidelines. The aim of this study was to estimate the prevalence of GDM among Greenlanders using both the current clinical GDM criteria and the recent WHO 2013 criteria and, further, to study the association between GDM, pre-pregnant overweight or obesity and macrosomia. A cross-sectional study of all 450 Greenlandic women who gave birth to a singleton in Nuuk within 1 year was performed. Based on an oral glucose tolerance test measuring capillary whole blood glucose, 119 women were categorised as having clinical GDM, WHO 2013 GDM or not GDM. Macrosomia defined as birth weight above 4,000 g was used as outcome variable. The prevalence of clinical GDM and WHO 2013 GDM was 0.4% (95% CI; 0-1.1) and 6.9% (95% CI; 4.5-9.2). WHO 2013 GDM, fasting blood glucose, pre-pregnant maternal overweight and obesity were associated with macrosomia. WHO 2013 GDM criteria were superior to clinical criteria in predicting macrosomia indicating that it may be time to consider the diagnostic strategy used in Greenland. Pre-pregnant overweight may also need more intensified lifestyle-intervention.

ABBREVIATIONS

GDM: Gestational diabetes mellitus; VP: venous plasma; CWB: capillary whole blood; OGTT: oral glucose tolerance test; WHO: World Health Organisation; FIGO: The International Federation of Gynaecology and Obstetrics; BMI: body mass index; GA: gestational age.

Prevalence of patients treated with anti-diabetic medicine in Greenland and Denmark. A cross-sectional register study

Diabetes mellitus is a large and growing worldwide health issue. Prior to this publication, a direct comparison of the prevalence of persons treated with anti-diabetic medicine in Greenland and Denmark has not been found. Therefore, the aim of this study is to estimate and compare the age- and gender-specific prevalence of patients treated with anti-diabetic medicine comparing Greenland and Denmark. The study was performed as a cross-sectional register study using data from population and medical registers in Greenland and Denmark. A total of 784 Greenlandic and 215,580 Danish patients treated with anti-diabetic medicine were included. The prevalence of patients aged 20-79 years treated with anti-diabetic medicine in Greenland was 2.6% (95% CI 2.4-2.8), much lower (p < 0.001) compared to Denmark with 5.2% (95% CI 5.2-5.2). The difference was less pronounced after excluding those treated with insulin and women below 45 years treated with metformin. In conclusion, this study showed a lower prevalence of patients treated with anti-diabetic medicine in Greenland than Denmark. The main reason may be a much higher prevalence of undiagnosed diabetes in Greenland, particularly among the middle-aged. Differences in awareness of diabetes and access to continued primary healthcare may be contributing factors.

Season of birth is different in Inuit suicide victims born into Traditional than into Modern Lifestyle: a register study from Greenland

BACKGROUND

There is growing evidence that living conditions at birth play a role in medical conditions later in life. Population-based studies from the Northern Hemisphere have shown that persons born in the spring or summer are at greater risk of committing suicide. A statistical correlation with light availability at birth has been observed in past research, but the cause remains unknown. Greenland is one of the most extreme of natural human habitats with regard to seasonal changes in light. The combination of rapid social changes and reliable population statistics offers a unique opportunity to make comparisons between persons born into a Traditional Lifestyle and those born into a Modern Lifestyle. The aim of this work was to assess whether season of birth differed between suicide victims born into an old or into a modern lifestyle.

METHODS

Official population and mortality registers were used. Suicide victims born (1903-1950) into the Traditional Lifestyle were compared with those born into the Modern Lifestyle (1961-1980). Rayleigh's test for circular distributions was used to assess the season of birth in suicide victims. Data regarding season of birth in the general population were collected.

RESULTS

Persons born in March-June in the Traditional Lifestyle were much less likely to commit suicide than those born during other periods of the year. This is contrary to the findings of other studies. The seasonal differences had disappeared for those born into the Modern Lifestyle. The suicide rate increased from very low rates to about 140 suicides/100 000 person-years in the 1980s.

CONCLUSIONS

The reason behind a variation in season of birth in suicide victims born into the old lifestyle is unknown. It is also unknown why the seasonal difference had disappeared with modern lifestyle. Possible influence of artificial light, nutrition, microbiota and seasonal infections are discussed. The underlying causes behind suicides may be different in traditional and modern Greenland.

Climate-sensitive health priorities in Nunatsiavut, Canada

BACKGROUND

This exploratory study used participatory methods to identify, characterize, and rank climate-sensitive health priorities in Nunatsiavut, Labrador, Canada.

METHODS

A mixed method study design was used and involved collecting both qualitative and quantitative data at regional, community, and individual levels. In-depth interviews with regional health representatives were conducted throughout Nunatsiavut (n = 11). In addition, three PhotoVoice workshops were held with Rigolet community members (n = 11), where participants took photos of areas, items, or concepts that expressed how climate change is impacting their health. The workshop groups shared their photographs, discussed the stories and messages behind them, and then grouped photos into re-occurring themes. Two community surveys were administered in Rigolet to capture data on observed climatic and environmental changes in the area, and perceived impacts on health, wellbeing, and lifestyles (n = 187).

RESULTS

Climate-sensitive health pathways were described in terms of inter-relationships between environmental and social determinants of Inuit health. The climate-sensitive health priorities for the region included food security, water security, mental health and wellbeing, new hazards and safety concerns, and health services and delivery.

CONCLUSIONS

The results highlight several climate-sensitive health priorities that are specific to the Nunatsiavut region, and suggest approaching health research and adaptation planning from an EcoHealth perspective.

Polymorphisms in phase I and phase II genes and breast cancer risk and relations to persistent organic pollutant exposure: a case-control study in Inuit women

BACKGROUND

We have previously reported that chemicals belonging to the persistent organic pollutants (POPs) such as perfluorinated compounds (PFAS) and polychlorinated biphenyls (PCBs) are risk factors in Breast Cancer (BC) development in Greenlandic Inuit women. The present case-control study aimed to investigate the main effect of polymorphisms in genes involved in xenobiotic metabolism and estrogen biosynthesis, CYP1A1, CYP1B1, COMT and CYP17, CYP19 and the BRCA1 founder mutation in relation to BC risk and to explore possible interactions between the gene polymorphisms and serum POP levels on BC risk in Greenlandic Inuit women.

METHODS

The study population consisted of 31 BC cases and 115 matched controls, with information on serum levels of POPs. Genotyping was conducted for CYP1A1 (Ile462Val; rs1048943), CYP1B1 (Leu432Val; rs1056836), COMT (Val158Met; rs4680), CYP17A1 (A1> A2; rs743572); CYP19A1 (C> T; rs10046) and CYP19A1 ((TTTA)n repeats) polymorphisms and BRCA1 founder mutation using TaqMan allelic discrimination method and polymerase chain reaction based restriction fragment length polymorphism. The χ2 -test was used to compare categorical variables between cases and controls and the odds ratios were estimated by unconditional logistic regression models.

RESULTS

We found an independent association of CYP1A1 (Val) and CYP17 (A1) with BC risk.Furthermore, an increased BC risk was observed for women with high serum levels of perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) and carriers of at least: one CYP1A1 variant Val allele; one variant COMT Met allele; or the common CYP17 A1 allele. No combined effects were seen between PFAS exposure and CYP1B1 and CYP19 polymorphisms. The risk of BC was not found significantly associated with exposure to PCBs and OCPs, regardless of genotype for all investigated SNPs. The frequency of the Greenlandic founder mutation in BRCA1 was as expected higher in cases than in controls.

CONCLUSIONS

The BRCA1 founder mutation and polymorphisms in CYP1A1 (Val) and CYP17 (A1) can increase the BC risk among Inuit women and the risk increases with higher serum levels of PFOS and PFOA. Serum PFAS levels were a consistent risk factor of BC, but inter-individual polymorphic differences might cause variations in sensitivity to the PFAS/POP exposure.

Dietary patterns in Greenland and their relationship with type 2 diabetes mellitus and glucose intolerance

OBJECTIVE

Traditional Inuit dietary patterns have been found to be beneficial for CVD but have not been investigated in relation to glucose intolerance. We examined the association between dietary patterns and type 2 diabetes mellitus (T2DM), impaired glucose tolerance (IGT) and impaired fasting glucose (IFG).

DESIGN

Cross-sectional design with a priori derived dietary patterns from an FFQ resulted in five patterns: imported meat (n 196), traditional food (n 601), balanced diet (n 126), unhealthy diet (n 652) and standard diet (n 799).

SETTING

Associations between dietary patterns and glucose-related outcomes were tested by linear and logistic regression analyses. Data included: dietary intake by FFQ, waist circumference, ethnicity, frequency of alcohol intake and smoking, physical activity, and oral glucose tolerance test results. Fasting participants and those without diagnosed T2DM were classified into normal glucose tolerance, IGT, IFG or T2DM. HOMA-IR (homeostatic model assessment-insulin resistance index) and HOMA-β (homeostatic model assessment of β-cell function) were calculated.

SUBJECTS

Data included 2374 Inuit, aged 18+ years.

RESULTS

Participants with a traditional dietary pattern had higher fasting plasma glucose (mean 5·73 (95% CI 5·68, 5·78) mmol/l, P < 0·0001) and lowest HOMA-β (48·66 (95% CI 46·86, 50·40), P < 0·0001). The traditional diet gave significantly higher odds for IFG and T2DM than the balanced diet, imported meat diet, standard diet and unhealthy diet.

CONCLUSIONS

Traditional food was positively associated with T2DM, IFG and fasting plasma glucose, and negatively associated with β-cell function, compared with a standard diet. The imported meat diet seemed the best in relation to glucose intolerance, with lowest fasting plasma glucose and lowest odds for IFG and T2DM.

Use of glycosylated haemoglobin as diagnostic tool in Greenland: prevalence of diagnosed diabetes mellitus

BACKGROUND

The prevalence of undiagnosed diabetes mellitus (DM) in Greenland has been reported very high with only 30% of cases diagnosed. In 2010, glycosylated hemoglobin (A1C) was introduced as a diagnostic tool in Greenland. However, the current use of A1c is unknown as well as the current prevalence of diagnosed DM.The aim of this study was firstly to estimate the use of A1C as diagnostic tool within the first 27 months after introducing the method and secondly to estimate the age and gender specific prevalence of diagnosed DM in Greenland in 2012.

METHODS

This study was perfomed as a cross-sectional register study using data from electronic medical records (EMR). To analyse the use of A1C as diagnostic tool:A sample amongst all Greenlanders at or above age 35 old was used to determine the number of individuals screened with A1C within a 27 month period, excluding those already known to have DM.To estimate the prevalence of diagnosted DM: Patients with DM were identified electronically using a statistic module run on data in the EMR. Age and gender specific prevalence was estimated using the Greenlandic population as of 1 January 2012 as the background population.

RESULTS

The test sample resulted in a study group of 1008 individuals from which 2.3% (23) were excluded because they were already known to have DM. Among the remaining 985, 13.6% were tested with A1C at least once during the 27 months of observation. DM was diagnosed in 7.5% (10) of the tested persons and in 1.0% of the whole group.Regarding prevalence, a total of 920 patients with diagnosed DM were identified. The total prevalence among adults aged 20-79 years old was 2.20% (95% CI: 2.05-2.34) with no significant difference between genders.

CONCLUSION

Testing for DM using A1C as diagnostic tool is used in Greenland. The prevalence of diagnosed DM in Greenland remains low although increasing. Undiagnosed DM may still be an important issue in Greenland.

Eating habits of a population undergoing a rapid dietary transition: portion sizes of traditional and non-traditional foods and beverages consumed by Inuit adults in Nunavut, Canada

BACKGROUND

To determine the portion sizes of traditional and non-traditional foods being consumed by Inuit adults in three remote communities in Nunavut, Canada.

METHODS

A cross-sectional study was carried out between June and October, 2008. Trained field workers collected dietary data using a culturally appropriate, validated quantitative food frequency questionnaire (QFFQ) developed specifically for the study population.

RESULTS

Caribou, muktuk (whale blubber and skin) and Arctic char (salmon family), were the most commonly consumed traditional foods; mean portion sizes for traditional foods ranged from 10 g for fermented seal fat to 424 g for fried caribou. Fried bannock and white bread were consumed by >85% of participants; mean portion sizes for these foods were 189 g and 70 g, respectively. Sugar-sweetened beverages and energy-dense, nutrient-poor foods were also widely consumed. Mean portion sizes for regular pop and sweetened juices with added sugar were 663 g and 572 g, respectively. Mean portion sizes for potato chips, pilot biscuits, cakes, chocolate and cookies were 59 g, 59 g, 106 g, 59 g, and 46 g, respectively.

CONCLUSIONS

The present study provides further evidence of the nutrition transition that is occurring among Inuit in the Canadian Arctic. It also highlights a number of foods and beverages that could be targeted in future nutritional intervention programs aimed at obesity and diet-related chronic disease prevention in these and other Inuit communities.

Causes and risk factors for infant mortality in Nunavut, Canada 1999-2011

BACKGROUND

The northern territory Nunavut has Canada's largest jurisdictional land mass with 33,322 inhabitants, of which 85% self-identify as Inuit. Nunavut has rates of infant mortality, postneonatal mortality and hospitalisation of infants for respiratory infections that greatly exceed those for the rest of Canada. The infant mortality rate in Nunavut is 3 times the national average, and twice that of the neighbouring territory, the Northwest Territories. Nunavut has the largest Inuit population in Canada, a population which has been identified as having high rates of Sudden Infant Death Syndrome (SIDS) and infant deaths due to infections.

METHODS

To determine the causes and potential risk factors of infant mortality in Nunavut, we reviewed all infant deaths (<1 yr) documented by the Nunavut Chief Coroner's Office and the Nunavut Bureau of Statistics (n=117; 1999-2011). Rates were compared to published data for Canada.

RESULTS

Sudden death in infancy (SIDS/SUDI; 48%) and infection (21%) were the leading causes of infant death, with rates significantly higher than for Canada (2003-2007). Of SIDS/SUDI cases with information on sleep position (n=42) and bed-sharing (n=47), 29 (69%) were sleeping non-supine and 33 (70%) were bed-sharing. Of those bed-sharing, 23 (70%) had two or more additional risk factors present, usually non-supine sleep position. CPT1A P479L homozygosity, which has been previously associated with infant mortality in Alaska Native and British Columbia First Nations populations, was associated with unexpected infant death (SIDS/SUDI, infection) throughout Nunavut (OR:3.43, 95% CI:1.30-11.47).

CONCLUSION

Unexpected infant deaths comprise the majority of infant deaths in Nunavut. Although the CPT1A P479L variant was associated with unexpected infant death in Nunavut as a whole, the association was less apparent when population stratification was considered. Strategies to promote safe sleep practices and further understand other potential risk factors for infant mortality (P479L variant, respiratory illness) are underway with local partners.

Mapping human dimensions of climate change research in the Canadian Arctic

This study maps current understanding and research trends on the human dimensions of climate change (HDCC) in the eastern and central Canadian Arctic. Developing a systematic literature review methodology, 117 peer reviewed articles are identified and examined using quantitative and qualitative methods. The research highlights the rapid expansion of HDCC studies over the last decade. Early scholarship was dominated by work documenting Inuit observations of climate change, with research employing vulnerability concepts and terminology now common. Adaptation studies which seek to identify and evaluate opportunities to reduce vulnerability to climate change and take advantage of new opportunities remain in their infancy. Over the last 5 years there has been an increase social science-led research, with many studies employing key principles of community-based research. We currently have baseline understanding of climate change impacts, adaptation, and vulnerability in the region, but key gaps are evident. Future research needs to target significant geographic disparities in understanding, consider risks and opportunities posed by climate change outside of the subsistence hunting sector, complement case study research with regional analyses, and focus on identifying and characterizing sustainable and feasible adaptation interventions.

A decade of research in Inuit children, youth, and maternal health in Canada: areas of concentrations and scarcities

Inuit Canadians are on average about 20 years younger and have a 10-year lower life expectancy than other Canadians. While there have been improvements in Inuit health status over time, significant health disparities still remain. This paper will review the peer-reviewed literature related to Inuit child, youth, and maternal health between 2000 and 2010, investigate which thematic areas were examined, and determine what proportion of the research is related to each group. Establishing areas of research concentrations and scarcities may help direct future research where it is needed. We followed a systematic literature review and employed peer-reviewed research literature on child, youth, and maternal health which were selected from 3 sources, MEDLINE, CINAHL, and the Circumpolar Health Bibliographic Database. The resulting references were read, and summarized according to population group and thematic area. The thematic areas that emerged by frequency were: infectious disease; environment/environmental exposures; nutrition; birth outcomes; tobacco; chronic disease; health care; policy, human resources; interventions/programming; social determinants of health; mental health and wellbeing; genetics; injury; and dental health. The 72 papers that met the inclusion criteria were not mutually exclusive with respect to group studied. Fifty-nine papers (82%) concerned child health, 24 papers (33%) youth health, and 58 papers (81%) maternal health. The review documented high incidences of illness and significant public health problems; however, in the context of these issues, opportunities to develop research that could directly enhance health outcomes are explored.

Frequent use of primary health care service in Greenland: an opportunity for undiagnosed disease case-finding

OBJECTIVES

To estimate the age- and gender-specific consultation rates of patients who availed primary health care service in Greenland and to analyse contact patterns among patients in Nuuk.

DESIGN

Observational and cross-sectional register study using data captured from the medical records.

MATERIALS AND METHODS

The number of patients specified by age and gender who had contacted the primary health care centres within the last year was identified using a statistic module applied to the electronic medical records system. The population as it was on the 1st of January 2011 was used as the background population. The age- and gender-specific consultation rates were calculated. Review of most recent contact was performed in a subsample of patients from Nuuk, and information of the type of contact and diagnoses was obtained.

RESULTS

Eighty-three percent of the population in Greenland had been in contact with the primary health care centre within the last year. Females were more frequent users than males. A subsample of 400 patients in Nuuk was identified. Personal contact was the most frequent type of consultation (75.8%), followed by telephone (14.8%) and e-mail (9.8%) consultations. Musculoskeletal symptoms accounted for the most frequent bases for diagnoses.

CONCLUSION

More than 80% of the whole population has been in contact with the primary health care system within the last year. This indicates that opportunistic case-finding of chronic diseases such as diabetes, hypertension, etc. providing a possible strategy for decreasing the number of undiagnosed cases.

The association between blood pressure and whole blood methylmercury in a cross-sectional study among Inuit in Greenland

BACKGROUND

The Inuit in Greenland have a high average consumption of marine species and are highly exposed to methylmercury, which in other studies has been related to hypertension. Data on the relation between methylmercury and hypertension is limited, especially in populations subjected to a high exposure of methylmercury. We examined the relation between whole blood mercury and blood pressure (BP) in Inuit in Greenland.

METHODS

A cross-sectional population-based study among adult Inuit in Greenland was performed in 2005-2009. Information on socio-demography, lifestyle, BP, blood samples and clinical measurements was obtained - the latter after overnight fasting. BP was measured according to standardized guidelines. Whole blood mercury concentration was used as a marker of exposure. The analyses were restricted to Inuit aged 30-69 years with four Greenlandic grandparents (N = 1,861). Multivariate regression analyses with inclusion of confounders were done separately for men and women with the omission of participants receiving anti-hypertensive drugs, except for logistic regression analyses of the relation between mercury and presence of hypertension (yes/no).

RESULTS

The mean whole blood mercury level was 20.5 μg/L among men and 14.7 μg/L among women. In multivariate analyses adjusted for confounders, diastolic BP decreased with increasing mercury concentration. In men diastolic BP decreased significantly for each four-fold increase in mercury concentration (Beta = -0.04, standard error = 0.01, p = 0.001), while no relation between mercury and diastolic BP was found among women. For systolic BP, a similar non-statistically significant result was seen only for men (Beta = -0.02, standard error = 0.01, p = 0.06). A relation between mercury and hypertension was only found in men; the odds ratio for hypertension was 0.99 (95% CI: 0.98-0.99). No relation between quintiles of mercury and hypertension was found. The relationship between mercury and BP parameters may be non-linear: In analyses of quintiles of mercury the overall effect of mercury on BP parameters was only statistically significant for diastolic BP among men (Wald test, p = 0.01), however pairwise comparisons showed that some quintiles were not statistically different. This result is supported by LOESS modelling.

CONCLUSIONS

No adverse associations between whole blood mercury and blood pressure were found. With increasing whole blood mercury concentrations, diastolic BP and the risk of hypertension decreased among men in the study: this may be explained by confounding by exercise or unknown factors.

Vitamin D deficiency among northern Native Peoples: a real or apparent problem?

Vitamin D deficiency seems to be common among northern Native peoples, notably Inuit and Amerindians. It has usually been attributed to: (1) higher latitudes that prevent vitamin D synthesis most of the year; (2) darker skin that blocks solar UVB; and (3) fewer dietary sources of vitamin D. Although vitamin D levels are clearly lower among northern Natives, it is less clear that these lower levels indicate a deficiency. The above factors predate European contact, yet pre-Columbian skeletons show few signs of rickets-the most visible sign of vitamin D deficiency. Furthermore, because northern Natives have long inhabited high latitudes, natural selection should have progressively reduced their vitamin D requirements. There is in fact evidence that the Inuit have compensated for decreased production of vitamin D through increased conversion to its most active form and through receptors that bind more effectively. Thus, when diagnosing vitamin D deficiency in these populations, we should not use norms that were originally developed for European-descended populations who produce this vitamin more easily and have adapted accordingly.

Prevalence of self-reported suicidal thoughts in SLiCA. The Survey of Living Condition in the Arctic (SLiCA)

OBJECTIVES

The Survey of Living Condition in the Arctic (SLiCA) is an international research project on health and living conditions among Arctic indigenous peoples. The main objective of this article is to examine the prevalence of self-reported suicide thoughts among the study population in Alaska, Greenland, Sweden and Norway.

STUDY DESIGN

Population-based survey.

METHODS

Indigenous participants aged 16 years (15 years in Greenland) and older living in traditional settlement regions in Alaska, Sweden and Norway and across the entire Greenland were invited to participate. Data were collected in three periods: in Alaska from January 2002 to February 2003, in Greenland from December 2003 to August 2006, in Sweden from spring 2004 to 2006 and in Norway in 2003 and from June 2006 to June 2008. The principal method in SLiCA was standardised face-to-face interviews using a questionnaire. A questionnaire had among other things, questions about health, education, traditional activities, ethnicity and suicidal thoughts.

RESULTS

Information about suicidal thoughts, gender and age were available in 2,099 participants between the ages of 16 and 84 from Alaska, Greenland, Sweden and Norway. Greenland had the highest rates of suicidal thoughts when adjusting for age and gender (p=0.003). When stratifying on age and gender, significant differences across countries were only found for females in the two youngest age groups. Differences in suicidal thoughts across countries could partly be explained by educational level.

CONCLUSION

Swedish respondents had less suicidal thoughts than those in any other countries. In the future, analyses of suicidal thoughts should take socioeconomic status into account as well as self-reported health, depression and anxiety.

Sources of food affect dietary adequacy of Inuit women of childbearing age in Arctic Canada

Dietary transition in the Arctic is associated with decreased quality of diet, which is of particular concern for women of childbearing age due to the potential impact of maternal nutrition status on the next generation. The study assessed dietary intake and adequacy among Inuit women of childbearing age living in three communities in Nunavut, Canada. A culturally-appropriate quantitative food-frequency questionnaire was administered to 106 Inuit women aged 19-44 years. Sources of key foods, energy and nutrient intakes were determined; dietary adequacy was determined by comparing nutrient intakes with recommendations. The prevalence of overweight/obesity was >70%, and many consumed inadequate dietary fibre, folate, calcium, potassium, magnesium, and vitamin A, D, E, and K. Non-nutrient-dense foods were primary sources of fat, carbohydrate and sugar intakes and contributed >30% of energy. Traditional foods accounted for 21% of energy and >50% of protein and iron intakes. Strategies to improve weight status and nutrient intake are needed among Inuit women in this important life stage.

Relation between methylmercury exposure and plasma paraoxonase activity in inuit adults from Nunavik

BACKGROUND

Methylmercury (MeHg) exposure has been linked to an increased risk of coronary heart disease (CHD). Paraoxonase 1 (PON1), an enzyme located in the high-density-lipoprotein (HDL) fraction of blood lipids, may protect against CHD by metabolizing toxic oxidized lipids associated with low-density liproprotein and HDL. MeHg has been shown to inhibit PON1 activity in vitro, but this effect has not been studied in human populations.

OBJECTIVES

This study was conducted to determine whether blood mercury levels are linked to decreased plasma PON1 activities in Inuit people who are highly exposed to MeHg through their seafood-based diet.

METHODS

We measured plasma PON1 activity using a fluorogenic substrate and blood concentrations of mercury and selenium by inductively coupled plasma mass spectrometry in 896 Inuit adults. Sociodemographic, anthropometric, clinical, dietary, and lifestyle variables as well as PON1 gene variants (rs705379, rs662, rs854560) were considered as possible confounders or modifiers of the mercury-PON1 relation in multivariate analyses.

RESULTS

In a multiple regression model adjusted for age, HDL cholesterol levels, omega-3 fatty acid content of erythrocyte membranes, and PON1 variants, blood mercury concentrations were inversely associated with PON1 activities [β-coefficient = -0.063; 95% confidence interval (CI), -0.091 to -0.035; p < 0.001], whereas blood selenium concentrations were positively associated with PON1 activities (β-coefficient = 0.067; 95% CI, 0.045-0.088; p < 0.001). We found no interaction between blood mercury levels and PON1 genotypes.

CONCLUSIONS

Our results suggest that MeHg exposure exerts an inhibitory effect on PON1 activity, which seems to be offset by selenium intake.

Alcohol, smoking, and drug use among Inuit women of childbearing age during pregnancy and the risk to children

BACKGROUND

Alcohol consumption during pregnancy, a known teratogen often associated with drug use and smoking is a well-known public health concern.

AIM

This study provides prevalence data for alcohol, smoking, and illicit drug use before, during, and after pregnancy among Inuit. Factors associated with alcohol use are also identified.

METHODS

Two hundred and eight Inuit women from Arctic Quebec were interviewed at mid-pregnancy, and at 1 and 11 months postpartum to provide descriptive data on smoking, alcohol, and drug use during pregnancy, and the year before and after pregnancy. Sociodemographic and family characteristics potentially associated with alcohol use were documented.

RESULTS

Ninety-two percent of the women reported smoking and 61% reported drinking during pregnancy. Episodes of binging during pregnancy were reported by 62% of the alcohol users, which correspond to 38% of pregnant women. Thirty-six percent of the participants reported using marijuana during pregnancy. Alcohol use and binge drinking during pregnancy were more likely to be reported by women who lived in less crowded houses, had a better knowledge of a second language, drank alcohol more often and in larger amounts prior to pregnancy, and used illicit drugs. Binge drinkers were more likely to be single women and to have had fewer previous pregnancies. Postpartum distress and violence were more likely to be experienced by women who used alcohol during pregnancy. Binge drinking during pregnancy was best predicted by drinking habits before pregnancy, maternal symptoms of depression, the use of illicit drugs during pregnancy, and the number of young children living with the mother.

CONCLUSIONS

These results confirm that alcohol is a major risk factor to maternal and child health in this population, underscoring the need for culturally relevant and effective prevention programs.

Protective effects of selenium against DNA adduct formation in Inuit environmentally exposed to PCBs

Dietary habits that expose populations to potential toxicants as well as protective agents simultaneously are a realistic scenario where a meaningful assessment of the interactions and net benefit or damage can be made. A group of Inuit from Salluit, Northern Canada are exposed to high levels of PCBs and selenium, both present in the Inuit traditional foods such as blubber from sea mammals and fatty fish. Blood samples were collected from 83 Inuit, 22-70 years old. Blood selenium and PCB levels were determined previously and ranged from 227 to 2069µg/L and 1.7 to 143µg/L, respectively. DNA isolated from white blood cells were analyzed by modified (32)P-postlabeling adductomics technology that detects a multitude of highly polar to lipophilic adducts. The levels of 8-oxodG adducts ranged from 470 to 7400 adducts/10(9) nucleotides. Other as yet unidentified polar adducts showed a 30 to 800-fold inter-individual variability. Adduct levels were negatively associated with PCB and selenium levels. The subjects were classified into high and low ratio groups, with respect to selenium/PCB. In the high ratio group, the coefficient of selenium is significantly negatively correlated with 8-oxodG (r = -0.38, p = 0.014) and total adducts (r = -0.41, p = 0.009) while there was no correlation within the low selenium/PCB group. This study suggests that increasing selenium has mitigating effect in reducing DNA adducts and therefore, possible negative effects of PCB were not seen. A protective effect of selenium is highlighted.

Food insecurity among Inuit women exacerbated by socioeconomic stresses and climate change

OBJECTIVES

To identify and characterize the determinants of food insecurity among Inuit women.

METHODS

A community-based study in Igloolik, Nunavut, using semi-structured interviews (n = 36) and focus groups (n = 5) with Inuit women, and key informants interviews with health professionals (n = 13).

RESULTS

There is a high prevalence of food insecurity among Inuit females in Igloolik, with women in the study reporting skipping meals and reducing food intake on a regular basis. Food insecurity is largely transitory in nature and influenced by food affordability and budgeting; food knowledge; education and preferences; food quality and availability; absence of a full-time hunter in the household; cost of harvesting; poverty; and addiction. These determinants are operating in the context of changing livelihoods and climate-related stresses.

CONCLUSION

Inuit women's food insecurity in Igloolik is the outcome of multiple determinants operating at different spatial-temporal scales. Climate change and external socio-economic stresses are exacerbating difficulties in obtaining sufficient food. Coping strategies currently utilized to manage food insecurity are largely reactive and short-term in nature, and could increase food system vulnerability to future stresses. Intervention by local, territorial and federal governments is required to implement, coordinate and monitor strategies to enhance women's food security, strengthen the food system, and reduce vulnerability to future stressors.

Climate change, health, and vulnerability in Canadian northern Aboriginal communities

BACKGROUND

Canada has recognized that Aboriginal and northern communities in the country face unique challenges and that there is a need to expand the assessment of vulnerabilities to climate change to include these communities. Evidence suggests that Canada's North is already experiencing significant changes in its climate--changes that are having negative impacts on the lives of Aboriginal people living in these regions. Research on climate change and health impacts in northern Canada thus far has brought together Aboriginal community members, government representatives, and researchers and is charting new territory.

METHODS AND RESULTS

In this article we review experiences from two projects that have taken a community-based dialogue approach to identifying and assessing the effects of and vulnerability to climate change and the impact on the health in two Inuit regions of the Canadian Arctic.

CONCLUSIONS

The results of the two case projects that we present argue for a multi-stakeholder, participatory framework for assessment that supports the necessary analysis, understanding, and enhancement of capabilities of local areas to respond and adapt to the health impacts at the local level.

Portrait of outpatient visits and hospitalizations for acute infections in Nunavik preschool children

OBJECTIVE

Inuit children from around the world are burdened by a high rate of infectious diseases. The objective of this study was to evaluate the incidence rate of infections in Inuit preschool children from Nunavik (Northern Québec).

METHODS

The medical chart of 354 children from a previously recruited cohort was reviewed for the first five years of life. All outpatient visits that led to a diagnosis of acute infection and all admissions for acute infections were recorded.

RESULTS

Rates of outpatient visits for acute otitis media (AOM) were 2314, 2300, and 732 events/1000 child-years for children 0-11 months, 12-23 months, and 2-4 years, respectively. Rates of outpatient visits for lower respiratory tract infections (LRTI) were 1385, 930, and 328 events/1000 child-years, respectively. Rates of hospitalization for pneumonia were 198, 119, and 31 events/1000 child-years, respectively.

CONCLUSION

Inuit children from Nunavik have high rates of AOM and LRTI. Such rates were higher than that of other non-native North-American populations previously published. Admission for LRTI is up to 10 times more frequent in Nunavik compared to other Canadian populations.

Effect of prenatal exposure to polychlorinated biphenyls on incidence of acute respiratory infections in preschool Inuit children

OBJECTIVE

We set out to assess whether environmental prenatal exposure to polychlorinated biphenyls (PCBs) is associated with incidence of acute respiratory infections in preschool Inuit children.

STUDY DESIGN

We reviewed the medical charts of 343 children from 0 to 5 years of age and evaluated the associations between PCB-153 concentration in umbilical cord plasma and the incidence rates of acute otitis media (AOM) and of upper and lower respiratory tract infections (URTIs and LRTIs, respectively).

RESULTS

The incidence rates of AOM and LRTIs were positively associated with prenatal exposure to PCBs. Compared with children in the first quartile of exposure (least exposed), children in fourth quartile (most exposed) had rate ratios of 1.25 (p<0.001) and 1.40 (p<0.001) for AOM and LRTIs, respectively. There was no association between prenatal PCB exposure and incidence rate of URTIs or hospitalization.

CONCLUSION

Prenatal exposure to PCBs could be responsible for a significant portion of respiratory infections in children of this population.

Guiding health promotion efforts with urban Inuit: a community-specific perspective on health information sources and dissemination strategies

OBJECTIVE

To develop a community-specific perspective of health information sources and dissemination strategies of urban Inuit to better guide health promotion efforts.

METHODS

Through a collaborative partnership with the Tungasuvvingat Inuit Family Resource Centre, a series of key informant interviews and focus groups were conducted to gather information on specific sources of health information, strategies of health information dissemination, and overall themes in health information processes.

FINDINGS

Distinct patterns of health information sources and dissemination strategies emerged from the data. Major themes included: the importance of visual learning, community Elders, and cultural interpreters; community cohesion; and the Inuit and non-Inuit distinction. The core sources of health information are family members and sources from within the Inuit community. The principal dissemination strategy for health information was direct communication, either through one-on-one interactions or in groups.

CONCLUSION

This community-specific perspective of health information sources and dissemination strategies shows substantial differences from current mainstream models of health promotion and knowledge translation. Health promotion efforts need to acknowledge the distinct health information processes of this community, and should strive to integrate existing health information sources and strategies of dissemination with those of the community.

History of Inuit community exposure to lead, cadmium, and mercury in sewage lake sediments

Exposure to lead, cadmium, and mercury is known to be high in many arctic Inuit communities. These metals are emitted from industrial and urban sources, are distributed by long-range atmospheric transport to remote regions, and are found in Inuit country foods. Current community exposure to these metals can be measured in food, but feces and urine are also excellent indicators of total exposure from ingestion and inhalation because a high percentage of each metal is excreted. Bulk domestic sewage or its residue in a waste treatment system is a good substitute measure. Domestic waste treatment systems that accumulate metals in sediment provide an accurate historical record of changes in ingestion or inhalation. We collected sediment cores from an arctic lake used for facultative domestic sewage treatment to identify the history of community exposure to Pb, Cd, and Hg. Cores were dated and fluxes were measured for each metal. A nearby lake was sampled to measure combined background and atmospheric inputs, which were subtracted from sewage lake data. Pb, Cd, and Hg inputs from sewage grew rapidly after the onset of waste disposal in the late 1960s and exceeded the rate of population growth in the contributing community from 1970 to 1990. The daily per-person Pb input in 1990 (720,000 ng/person per day) exceeded the tolerable daily intake level. The Cd input (48,000 ng/person per day) and Hg input (19,000 ng/person per day) were below the respective TDI levels at the time.

Lead sources in human diet in Greenland

Although blood lead levels have declined in Greenland, they are still elevated despite the fact that lead levels in the Greenland environment are very low. Fragments of lead shot in game birds have been suggested as an important source of dietary exposure, and meals of sea birds, particularly eider, contain high concentrations of lead. In a cross-sectional population survey in Greenland in 1993-1994, blood lead adjusted for age and sex was found to be associated with the reported consumption of sea birds. Participants reporting less than weekly intake of sea birds had blood lead concentrations of approximately 75 microg/L, whereas those who reported eating sea birds several times a week had concentrations of approximately 110 microg/L, and those who reported daily intake had concentrations of 170 microg/L (p = 0.01). Blood lead was not associated with dietary exposure to other local or imported food items.

Acute infections and environmental exposure to organochlorines in Inuit infants from Nunavik

The Inuit population of Nunavik (Canada) is exposed to immunotoxic organochlorines (OCs) mainly through the consumption of fish and marine mammal fat. We investigated the effect of perinatal exposure to polychlorinated biphenyls (PCBs) and dichlorodiphenyldichloroethylene (DDE) on the incidence of acute infections in Inuit infants. We reviewed the medical charts of a cohort of 199 Inuit infants during the first 12 months of life and evaluated the incidence rates of upper and lower respiratory tract infections (URTI and LRTIs, respectively), otitis media, and gastrointestinal (GI) infections. Maternal plasma during delivery and infant plasma at 7 months of age were sampled and assayed for PCBs and DDE. Compared to rates for infants in the first quartile of exposure to PCBs (least exposed), adjusted rate ratios for infants in higher quartiles ranged between 1.09 and 1.32 for URTIs, 0.99 and 1.39 for otitis, 1.52 and 1.89 for GI infections, and 1.16 and 1.68 for LRTIs during the first 6 months of follow-up. For all infections combined, the rate ratios ranged from 1.17 to 1.27. The effect size was similar for DDE exposure but was lower for the full 12-month follow-up. Globally, most rate ratios were > 1.0, but few were statistically significant (p < 0.05). No association was found when postnatal exposure was considered. These results show a possible association between prenatal exposure to OCs and acute infections early in life in this Inuit population.