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Malignant neoplasms of the lymphatic and haematopoietic system in Circumpolar Inuit.

Malignancies of the lymphatic and haematopoietic system in Circumpolar Inuit were studied as part of an international collaboration combining results from cancer registries for Alaska, Canada and Greenland. Low risk was observed for all such malignancies, including non-Hodgkin lymphoma, Hodgkin's disease, multiple myeloma and the combined leukaemias. Standardized incidence ratios (SIRs) of non-Hodgkin lymphoma ranged from 0.3 to 0.5 based on comparison populations in Connecticut (USA), Canada and Denmark. SIR of Hodgkins's disease ranged from 0.1 to 0.2. Acute leukaemias accounted for 78% of all microscopically verified leukaemias and chronic leukaemias for 6%. No clear time trends were observed except for increasing rates of the combined leukaemias among women from the first to the second half of the study period. The epidemiology of haematologic and lymphoproliferative malignancies in Inuit is comparable to results from Chinese and Japanese populations in Asia and may reflect protective environmental or genetic factors for these malignancies.

Adolescent↗

Cancer in Greenlandic Inuit 1973-1997.

OBJECTIVES: During the second half of the 20th century living conditions of the Inuit populations in the Arctic have undergone major transitions. The objective was to investigate how the cancer pattern was affected by these changes, using data from the Danish Cancer Registry and the Civil Registration System. RESULTS: In the period 1973-1997 total cancer incidence increased by 4% per 5 years for men and 6% per 5 years for women. The incidence of lung, stomach, breast and colon cancer increased in both sexes, whereas the incidence of cervical cancer decreased. CONCLUSIONS: Thus, the overall cancer incidence among Greenlandic Inuit is increasing as a result of increases in several cancers that are common in Western populations. In contrast to global trends, a significant increase in the incidence of stomach cancer in both sexes was observed.

Female↗

Hearing screening outcomes in Inuit children in Nunavik, Quebec, Canada.

OBJECTIVES: Hearing loss is highly prevalent among Inuit children in Canada. Hearing screening at kindergarten age has been carried out in Nunavik by trained Inuit technicians since 1986. In this study, we determined what percentage of children fail their initial hearing screening at age 5-6 years and compared this initial result with the last hearing test. We also report the type of hearing loss observed at the last test. METHODS: Results compiled in a clinical database were analysed. At age 5-6 years, 524 children (born 1990-1994, 84% coverage) were tested and 515 children were retested at a later date. Screening failure was defined as >22 dB pure tone average (.5k, 1k, 2kHz) in either ear. Observations on ear condition at the last test were used to determine type of hearing loss. RESULTS: Nineteen percent (101 children) failed the hearing screening at age 5-6 years and 12% failed on the later test. When those who failed the first test were retested, 58 had improved and 43 remained with a hearing loss. Twenty-one children who had initially passed the hearing screening were found to have a hearing loss at retest. The majority of the hearing losses were due to otitis media. CONCLUSION: Hearing screening and retesting remains necessary due to the high prevalence of hearing loss found in this population and the fluctuating nature of this problem.

Child↗

Otitis media and hearing loss among 12-16-year-old Inuit of Inukjuak, Quebec, Canada.

OBJECTIVES: Chronic otitis media (COM) and associated hearing loss is a frequent problem for many Inuit children in Canada. In this study, we evaluated individuals aged 12-16 years living in Inukjuak, to determine the prevalence of middle ear disease and hearing loss, and the effect of hearing loss on academic performance. METHODS: Otological examination, hearing test, medical and school file review were performed in November 1997. 88 individuals were seen. RESULTS: Otological examination revealed maximal scarring in 1.8%, minimal scarring in 34.9%, normal eardrums in 49.1% and chronic otitis media in 16.9%. There were 62 individuals whose ear exams could be directly compared with a previous exam done in 1987. Of those, there were three ears that had developed COM and 4/13 ears with COM in 1987 that had healed. Hearing tests found bilateral normal hearing in 80% (PTA <20dB), unilateral loss in 15% and bilateral loss in 5%. Hearing loss was associated with poorer academic performance in Language (p<.05). A similar trend was found in Mathematics but not in Inuttitut. CONCLUSION: Chronic otitis media remains a significant problem among the Inuit, with a prevalence of 16.9% in individuals aged 12-16 years. One in five in this age group has hearing loss, and this hearing loss impacts on academic performance.

Adolescent↗

Parkinson's disease among Inuit in Greenland: organochlorines as risk factors.

OBJECTIVES: In the present study we investigate organochlorines as possible risk factors for Parkinson's disease (PD) in an arctic population. This has never been done before. STUDY DESIGN: Case-control study of Inuit in Greenland. MATERIALS AND METHODS: Plasma from 31 PD (20 males and 11 females) (mean age 69 yr) and 122 controls (57 males and 65 females) (mean age 61 yr) was analysed for 31 PCBs and pesticides by dual-column GC-ECD and GC-NCI/MS. RESULTS: Plasma concentrations of PCBs and pesticides were markedly increased in both PD and controls. The concentrations did not differ between the PD cases and controls. However, the mean DDE concentration was higher in PD than in controls (42.1 and 15.0 microg/l, respectively, and with a wide range among the PD cases). The difference was significant for log transformed DDE values after control for age and sex (p=0.005). CONCLUSION: A few epidemiological studies indicate a possible connection between exposure to pesticides and PD. The idea that exposure to organochlorines may be an important risk factor for PD among the Inuit in Greenland requires more investigations.

Case-Control Studies↗

Risk factors for hospitalization and infection in Canadian Inuit infants over the first year of life--a pilot study.

OBJECTIVES: Inuit infants experience higher mortality and poorer health than other Canadian infants, and suffer disproportionately from bacterial and viral infections. A wide range of inter-related factors affect their health and susceptibility to infection. The objective of the study was to describe hospitalization and morbidity patterns in a cohort of 46 healthy Inuit infants from Iqaluit, Nunavut, over their first year of life. STUDY DESIGN: Risk factors for hospitalization and infections were assessed using multiple linear regression. RESULTS: Infants experienced an average of four respiratory tract infections (RTIs) annually, which accounted for half of the hospitalizations in the cohort. Some interesting trends were evident from the assessment of risk factors using multiple linear regression. Adoption was associated with adverse health effects in addition to those that would be expected due to lack of breast-freeding alone; among infants who were not breast-fed, adopted infants had three more RTIs per year than non-adopted infants. CONCLUSION: The results of this pilot study provide support for undertaking larger epidemiological studies in order to clarify the role of these risk factors, so that future preventive efforts can be informed and effective.

Adoption↗

Points of view: Inuit women's perceptions of pollution.

Inuit women's perceptions of health risks from potential contamination in the arctic food chain were investigated in 1995 through in-depth interviews with 47 women in a Canadian arctic community. This number represents 34% of the eligible participants in the population of the research community. Many of these Inuit women suggest that pollution can appear in a variety of forms, from drug and alcohol consumption to visible air and water contaminants to possible invisible contaminants in arctic wildlife. Concepts of pollution--starting with the individual body and extending to the body politic--are influenced by a complex of sociocultural factors arising from historical and contemporary community life.

Attitude to Health↗

The health of Cree, Inuit and southern Quebec women: similarities and differences.

Using the data from a number of the surveys conducted over the last 10 years by Santé Québec, this study examines the health characteristics of two populations of Aboriginal women of northern Quebec compared to those of women in the rest of the province. The northern populations had a larger proportion of young women. Aboriginal women have heavier family responsibilities than other Quebec women. Inuit women had a much higher prevalence of smoking and drug use. Alcohol consumption was less frequent in northern women, but the quantity consumed was higher compared to other Quebec women. Cree women tended to be more obese, had higher levels of blood glucose and lower levels of cholesterol. Inuit women tended to have lower rates of hypertension and higher rates of declared hearing problems and mental disorders. The similarities and differences observed among these three populations of women can assist decision-makers in setting priorities with regards to maintaining and improving their health.

Adolescent↗

Anemia and iron status in Inuit infants from northern Quebec.

The iron status and diet of Inuit infants living in northern Quebec who were part of a prospective cohort study was described. The prevalence of anemia (hemoglobin values > 2 SD below the reference mean) was 21.1% (23/109), 47.4% (55/116) and 37.7% (46/122) at 2, 6 and 12 months, respectively. The corresponding prevalence of microcytic anemia was 0.0%, 4.3% and 21.3%. At 2, 6 and 12 months, iron-deficiency anemia (serum ferritin < 10 micrograms/L coupled with anemia) was present in 1.3% (1/79), 24.4% (21/86) and 26.3% (25/95) of infants, respectively. Compared with breastfeeding, the odds ratio for iron deficiency (serum ferritin < 10 micrograms/L) for bottle-feeding with cows' milk or low iron formula was 3.02 (95% CI 1.25-7.27) at 6 months and 3.05 (95% CI 1.28-7.28) at 12 months. This study shows iron-deficiency anemia to be a problem in Inuit infants as young as 6 months old. Breastfed infants were better protected against iron deficiency than infants fed cow's milk or low-iron formula.

Anemia, Iron-Deficiency↗

Incidence of hip fracture in Alaska Inuit people: 1979-89 and 1996-99.

Review of records of the Alaska Native Medical Center in Anchorage, Alaska show that the incidence of hip fracture in Inuit women over 64 years of age was higher than the incidence in white US women in 1979-89 and had increased farther by 1996-99. The hip fracture incidence of Inuit men was higher than US men in 1996-99.

Age Distribution↗

Investigation of tuberculosis transmission in Canadian Arctic Inuit communities using DNA fingerprinting.

OBJECTIVE: To understand the transmission of tuberculosis in Inuit communities in the Baffin region of the Canadian Arctic. METHODS: Twenty-one isolates of Mycobacterium tuberculosis from 19 Inuit patients diagnosed with tuberculosis between February 1991 and September 1993 were analyzed by DNA fingerprinting. The DNA fingerprints were achieved by the standard restriction fragment length polymorphism (RFLP) technique, with subsequent probing using the repetitive insertion segment IS6110. RESULTS: The isolates could be divided into three DNA types. The DNA types generally corresponded to the geographic origins of the patients. In most instances only one DNA type of M. tuberculosis was identified in each community. This suggests that a single case was the start of each of the three clusters, most likely due to reactivation. CONCLUSIONS: The results show that molecular typing of M. tuberculosis was useful in determining the mode of transmission of tuberculosis in a remote area of the Canadian Arctic where the disease is endemic. In addition, the information provides useful information for planning interventions in this setting.

Adolescent↗

High rates of hospitalisation for bronchiolitis in Inuit children on Baffin Island.

It has been suspected that Inuit Children on Baffin Island suffer from severe, recurrent episodes of bronchiolitis, but this has never been documented previously. This study is a retrospective chart review of children less than 48 months of age hospitalised at Baffin Regional Hospital, Nunavut with a diagnosis of bronchiolitis over a one year period. This study documented that the admission rate for bronchiolitis in the first year of life was 306 per 1000 infants on Baffin Island, with an intubation rate of 12.8% in admitted children. One quarter of the infants were born prematurely, and half had their first presentation for bronchiolitis at less than 3 months of age. Ten of the 78 cases (12.8%) were identified as having a positive test for C. trachomatis by EIA, and Respiratory syncytial Virus was identified in 14 of 50 (28%) of those tested. This study documents that bronchiolitis in Inuit children on Baffin Island is a serious health concern and needs to be studied further.

Age Distribution↗

Identifying the needs of Innu and Inuit patients in urban health settings in Newfoundland and Labrador.

BACKGROUND: Labrador's Innu and Inuit live in nine small, isolated villages, and must travel to the urban centres of Goose Bay, Labrador and/or St. John's, Newfoundland for most health services. This study responds to anecdotal evidence of Aboriginal dissatisfaction with these services from the St. John's Native Friendship Centre Association (SJNFCA); it describes Aboriginal experiences and identifies relevant needs. METHODS: The study consisted of qualitative interviews (N = 143), conducted by trained local researchers, and nine focus groups. The interviews were narrative-based, appropriate to the Aboriginal culture of participants. Participants were recruited from the client list of the SJNFCA. FINDINGS: Almost all study participants experience significant difficulties including profound disorientation, language and communication difficulties, inadequate accommodations, and altered diets. Cross-cultural relations are particularly problematic for the Innu. CONCLUSIONS: These findings, and 19 recommendations made to the provincial government (8 main recommendations appear in Table II), could lead to improved services for Innu and Inuit using urban health services. Workshops in development could mean more awareness among health care practitioners.

Adolescent↗

Inuit are protected against prostate cancer.

Incidence and mortality rates for prostate cancer are reported to be low among Inuit, but this finding must be additionally supported given the difficulty of obtaining a precise medical diagnosis in the Arctic. We conducted an autopsy study in 1990-1994 among 61 deceased males representative of all deaths occurring in Greenland and found only one invasive prostate cancer. Histological data were available for 27 autopsies and revealed no latent carcinoma. Our results suggest that in situ carcinoma is rare among Inuit and that their traditional diet, which is rich in omega-3 polyunsaturated fatty acids and selenium, may be an important protective factor.

Adult↗

Iron deficiency and anemia prevalence and associated etiologic risk factors in First Nations and Inuit communities in Northern Ontario and Nunavut.

BACKGROUND: Anemia is common among children in Aboriginal communities in Canada. The objectives of this study were to determine the prevalence of anemia and to identify its associated risk factors among young children in Aboriginal communities in northern Ontario and Nunavut. METHODS: 115 children from one Inuit and two Cree First Nations communities participated. We collected information on demographic and dietary factors and measured hemoglobin (Hb), ferritin (SF), serum transferrin receptor (sTfR) and Helicobacter pylori IgG antibodies. Odds ratios and 95% confidence intervals were determined to examine risk factors associated with anemia and iron deficiency (ID) and further analyzed using stepwise regression procedures. RESULTS: Prevalence of anemia (Hb<110 g/L) was 36.0%. Iron deficiency (sTfR>8.5 mg/L) was present in 27.6% of the study population. Approximately 53.3% had depleted iron stores (SF<12 microg/L). Consumption of cow/evaporated milk was the only independent risk factor associated with anemia. Infection with H. pylori and prolonged consumption of breastmilk were also associated, although not independently, with anemia. Formula intake was negatively associated with ID. INTERPRETATION: The prevalence of anemia in Aboriginal children was eight times higher than among similar populations in urban Canada and was especially high among Inuit children. ID was the major cause of anemia, but not the only one, since 10% of anemic children were not iron deficient. Given that the consumption of cow/evaporated milk was found to be a significant independent risk factor associated with anemia, public health strategies should include promotion of breastfeeding, combined with iron-rich complementary foods, while addressing socio-economic conditions that may be preventing these practices from being adopted. H. pylori may be a major contributing factor to anemia, thus improvements in water quality and sanitation also need to be considered.

Anemia, Iron-Deficiency↗

Nursing in First Nations and Inuit communities in Atlantic Canada.

Effectively and holistically addressing the health-care needs of aboriginal people living in First Nations and nuit communities requires an understanding and a valuing of the cultural richness of the people. This article examines the programs and services provided in First Nations and Inuit health centres in Atlantic Canada and the support available for nurses working in First Nations and Inuit communities.

Accreditation↗

Management of hearing impairment in the Canadian Inuit--an update.

In recent years, the teachers in the north and the Inuit have become increasingly aware of the educational effects of hearing los frequently associated with chronic otitis media. In the Baffin Zone, N.W.T. and in Nouveau Quebec a surge of enthusiasm has surfaced to do something positive and on-going about the problem. A description of events and changes in attitude occurring among the Inuit, educators, and medical services is presented.

Canada↗

Prevalence of antibody to hepatitis A virus in a Canadian Inuit community.

To determine the prevalence of hepatitis A in a Canadian Inuit population, serum from 85% of the 850 inhabitants of Baker Lake, Northwest Territories, was tested by radioimmunoassay for antibody to the hepatitis A virus (anti-HAV). The overall prevalence of anti-HAV in the community was 71%. Exposure to the virus occurred early in life, such that by the age of 6 years 53% of the children had anti-HAV in their serum. The rate approached 100% by the age of 50 years. These findings document the ubiquitous nature of the hepatitis A virus in this northern Inuit settlement and suggest that immunoprophylaxis be considered for individuals taking short-term employment in such places.

Adolescent↗