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Time trends of persistent organic pollutants and heavy metals in umbilical cord blood of Inuit infants born in Nunavik (Québec, Canada) between 1994 and 2001.

Inuit inhabitants of Nunavik (northern Québec, Canada) consume great quantities of marine food and are therefore exposed to high doses of food chain contaminants. In this study, we report the time trends of persistent organic pollutants, mercury, and lead in umbilical cord blood of infants from three communities of the east coast of Hudson Bay in Nunavik. We analyzed 251 cord blood samples collected from 1994 through 2001 for polychlorinated biphenyls (PCBs), dichlorodiphenyl trichloroethane (DDT), dichlorodiphenyl dichloroethylene (DDE), hexachlorobenzene (HCB), chlordanes, lead, and mercury. Using an exponential model, we found strongly significant decreasing trends for PCBs (7.9% per year, p < 0.001), DDE (9.1% per year, p < 0.001), DDT (8.2% per year, p < 0.001), and HCB (6.6% per year, p < 0.01). No significant trends were detected for chlordanes. A significant reduction of lead and mercury concentrations was found, but there was no clear linear or exponential trend. The decreases observed could be explained by a decrease in food contamination, by changes in dietary habits, or, most likely, by a combination of both.

Adult↗

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.

Acute Disease↗

Lüscher color preferences of Arctic Inuit and of southern Canadians.

A comparison of color preferences based on the Lüscher Color Test was made for 21 Inuit residing within the Arctic circle and those of 49 residents of Southern Canada. These two groups have been raised in radically different physical and cultural environments. We expected that such factors could influence color preferences; however, no statistically significant differences were found in relative preferences for blue, green, red, yellow, purple, brown, grey, and black for our data based on Lüscher's scoring and those on our own scoring system independent of Lüscher's theory and scoring.

Adult↗

Pneumatization of the temporal bones in a Greenlandic Inuit anthropological material.

The degree of pneumatization of the temporal bones correlates with exposure during childhood and adolescence to infectious middle ear diseases (IMED), both acute and chronic. The pneumatized area as seen on cranial X-rays can be measured. This was applied to an anthropological material in order to develop methods for assessing ancient populations' exposure to IMED. Fifty-six Greenlandic Inuit (Eskimo) crania were examined. The crania were sexed and measured. X-rays were taken bilaterally, using the projection of Runström II, and the pneumatized area was measured planimetrically by computer. In blind trials it was found that the inter- and intraobserver variation was non-significant; that the degree of pneumatization of the temporal ossa did not reflect cranial size or sexual dimorphism; and that the pneumatized areas correlated bilaterally. Asymmetry in the size of the pneumatized areas, an indicator of exposure to IMED, was found in 5 crania (9%).

Female↗

CT-scanning of ancient Greenlandic Inuit temporal bones.

Additional morphological evidence of former infectious middle ear disease (IMED) was found by CT-scanning in 5 of 6 Greenlandic Inuit crania strongly suspected for former IMED due to earlier examination revealing either bilateral hypocellularity or asymmetry of the pneumatized area of the temporal bones. The CT-scans showed sclerosing and obliteration of the air cells and even destruction of the cellular septae, and a high degree of irregularity of the cells. Sclerosing of the surrounding bone tissue was also found. The findings in one cranium were dubious and could both be regarded as a congenital malformation or an infection in infanthood. CT-scan confirms and even adds to the results of conventional X-ray of temporal bones making hypotheses of paleopathology more reliable. The findings also support the environmental theory of pneumatization of the air cell system in the temporal bones.

Air↗

Cancers of skin, bone, connective tissues, brain, eye, thyroid and other specified and unspecified sites in Inuit.

Low rates of skin cancer, both melanoma and non-melanoma, were observed in Inuit after 20 years of observation. Tumours of the brain and central nervous system, of the thyroid, bone and connective tissues and other specified sites occurred with rates similar to those in comparison populations in Denmark, Connecticut and Canada. These findings support that neither UV and ionizing radiation from nuclear fall-out, nor pollution of herbicides and pesticides in the Arctic area have yet had any noticeable impact on cancer risk. However, unspecified and secondary neoplasms constitute 7-8% of the total Circumpolar cancer incidence and the pattern of rare cancers must be interpreted with caution. Increased diagnostic efforts with a higher precision in the future are warranted.

Adolescent↗

Neurobehavioral performance of Inuit children with increased prenatal exposure to methylmercury.

Exposure to methylmercury from marine mammals and other seafood may affect the development of the central nervous system. In a traditional Inuit community in Qaanaaq, Greenland, mercury concentrations in cord blood and maternal hair have been examined in connection with all births. We examined 43 children at age 7-12 years with a battery of neurobehavioral tests. The average mercury concentration in hair was 5.0 microg/g and 1.5 microg/g in children and mothers, respectively. Clinical neurological examination did not reveal any obvious deficits. However, neuropsychological tests showed possible exposure-associated deficits, though only in a few cases reaching statistical significance. In conjunction with data from other studies, peak latencies on brainstem auditory evoked potentials tended to be prolonged at increased exposure levels. The data from the present study therefore appears in accordance with other evidence that prenatal or early postnatal exposures to methylmercury may cause subtle neurobehavioral deficits.

Brain Stem↗

From Inuit to implementation: omega-3 fatty acids come of age.

During the past 25 years, the cardiovascular effects of marine omega-3 (omega-3) fatty acids have been the subject of increasing investigation. In the late 1970s, epidemiological studies revealed that Greenland Inuits had substantially reduced rates of acute myocardial infarction compared with Western control subjects. These observations generated more than 4,500 studies to explore this and other effects of omega-3 fatty acids on human metabolism and health. From epidemiology to cell culture and animal studies to randomized controlled trials, the cardioprotective effects of omega-3 fatty acids are becoming recognized. These fatty acids, when incorporated into the diet at levels of about 1 g/d, seem to be able to stabilize myocardial membranes electrically, resulting in reduced susceptibility to ventricular dysrhythmias, thereby reducing the risk of sudden death. The recent GISSI (Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico)-Prevention study of 11,324 patients showed a 45% decrease in risk of sudden cardiac death and a 20% reduction in all-cause mortality in the group taking 850 mg/d of omega-3 fatty acids. These fatty acids have potent anti-inflammatory effects and may also be antiatherogenic. Higher doses of omega-3 fatty acids can lower elevated serum triglyceride levels; 3 to 5 g/ d can reduce triglyceride levels by 30% to 50%, minimizing the risk of both coronary heart disease and acute pancreatitis. This review summarizes the emerging evidence of the use of omega-3 fatty acids in the prevention of coronary heart disease.

Cardiovascular Agents↗

Value orientation of the Copper Inuit.

Primary health services in the Canadian Arctic are predominantly provided by nurses whose cultural backgrounds differ from that of their clientele. As in other areas, this diversity can result in misunderstanding and conflict between the health care providers and their clients. Greater understanding of the client culture is necessary in order to identify areas in which conflict exists and to plan culturally appropriate health programs and initiatives. This study defines and describes the value orientation profile of some Copper Inuit living in the hamlet of Coppermine (Kugluktuk), Northwest Territories. Data were collected through interviews, using a modification of the Kluckhohn value orientation questionnaire. Data analysis using t-test analysis of the overall value orientations indicated a distinct value orientation profile.

Adult↗

Indications for transfer for childbirth in Inuit women at the Innuulisivik Maternity.

The Innuulisivik Maternity is a northern-based service in Povungnituk, Quebec, which serves the Inuit women of the Hudson Coast. Although most women stay in the North for childbirth, others are transferred south. This paper will describe the experience of the Innuulisivik Maternity, which uses committee-based risk assessment for transfer decisions. Data for the three-year period 1989-1991 were examined. Descriptive statistics were used to compare the observed differences in the distribution of several variables according to birthplace. Data were available for 411 women. Three hundred fifty (85.2%) of the births occurred at Innuulisivik: 44 (10.7%) women were transferred and 17 (4.1%) were nursing station births. In 80% of transfers, clinical conditions were identified which in themselves usually require transfer. Premature labor was prevalent in the transfer group. The data demonstrate that risk scoring by consensus is a viable option for northern birthing units. Finally, logistical and cultural factors should be included for meaningful risk assessment in the North.

Birthing Centers↗

Inuit myopia: an environmentally induced "epidemic"?

Among Inuit less than 30 years old the prevalence of myopia is far in excess of that of their elders. This is especially true for females. There seems to be little, if any, genetic contribution to this "epidemic" of myopia in the young. The age and sex distribution indicates the likelihood of an environmental factor, probably cultural, being responsible for the current pattern. Other data implicate school attendance as a possible etiologic factor.

Absenteeism↗

Longitudinal observations (1987-1997) on the prevalence of middle ear disease and associated risk factors among Inuit children of Inukjuak, Nunavik, Quebec, Canada.

The prevalence of middle ear disease in 2-6 year old children in 1997 was compared with that observed in 1987 in the same Inuit community in northern Quebec. Risk and protective factors associated with middle ear disease were also assessed. A total of 122 children participated. The assessments included: otological examination, cerumen sampling for analysis of organochlorine compounds, medical file review, and parent questionnaire regarding environmental and lifestyle factors. Comparison of ear examination results in 1997 and 1987 showed that there had been no change in the prevalence of chronic otitis media [9.4% to 10.8%] and proportion of ear drums with minimal scarring [45.6% to 45.4%], an increase in the proportion of normal ear drums [23.9% to 39.0%], a decrease the proportion with maximal scarring [17.8% to 2.0%] and little difference in the rate of serous otitis media [3.3% to 2.8%]. Factors found to be significantly associated with middle ear disease included: number of persons/bedroom, number of siblings with a history of ear disease, age at first, second and third visit to the nursing station for ear problems, and type of milk (formula vs. non-formula) in bottle fed children.

Anti-Bacterial Agents↗

Bronchiolitis in Inuit children from a Canadian central arctic community, 1995-1996.

During the winter and summer of 1996 two outbreaks of bronchiolitis occurred among Inuit children in the Canadian arctic community of Arviat. The epidemiology and clinical features of these epidemics were studied through a chart review of bronchiolitis cases occurring from September 1, 1995 to August 31, 1996. The attack rate over the year was 57% and the incidence was 1.25 cases per child-year at risk. The median age of cases was 9 months. Children developing bronchiolitis were more likely to be male (p = 0.006). Respiratory syncytial virus (RSV) was isolated from 17 cases occurring in January/February. The hospitalization rate during those two months was 38%, mortality was 3.3%, and demands upon local health care resources were high. Parainfluenza virus type 3 was isolated from 8 cases occurring during a second smaller outbreak in July/August. Hospitalized children were more likely to be bottle-fed (p = 0.01), and duration of hospitalization was greater for RSV positive versus negative children (p = 0.002). Among those hospitalized 22% required a second admission for the same illness. Identification of prevention strategies awaits an improved understanding of the role of agent, host and environmental factors in the pathophysiology of bronchiolitis in this population.

Arctic Regions↗

Dietary omega 3 fatty acids and gestational hypertension in the Inuit.

Blood pressure at the end of pregnancy and the incidence of pregnancy-induced hypertension were monitored in Inuit communities in the Keewatin region of the Northwest Territories. Communities with more fish and sea mammals in their diet had a lower blood pressure at the end of pregnancy and a lower incidence of gestational hypertension. The lower incidence of gestational hypertension was independent of other variables, including pregravida weight and parity. Cord blood phospholipid fatty acid analysis confirmed higher levels of eicosapentanoic acid, a fatty acid enriched in fish and sea mammals, in infants born to mothers from communities with higher fish in their diets.

Animals↗

The light at the end of the tunnel associated with the high prevalence of chronic otitis media among Inuit elementary school children in the Eastern Canadian Arctic is now visible.

Longitudinal observations made during the past two decades on the prevalence of chronic ear disease in Inuit Elementary School Children in the Eastern Canadian Arctic reveal that as the current segment of this population enters into the 1990's a significant decrease in the prevalence is occurring. While we can speculate ad infinitum why this is happening we really do not know the answer. The usual cliché is adaptation to contact, improved medical/social services, housing, diet, etc.

Child↗

Blood pressure during pregnancy in Canadian Inuit: community differences related to diet.

OBJECTIVE: To assess a possible relation between the incidence of hypertension during pregnancy and the consumption of fatty acids found in fish and sea mammals. DESIGN: Retrospective survey of pregnancy-induced hypertension; prospective diet survey. SETTING: Inuit women from seven communities in the Keewatin region of the Northwest Territories. PATIENTS: All women from Arviat (formerly Eskimo Point), Baker Lake, Chesterfield Inlet, Coral Harbour, Repulse Bay, Sanikiluaq and Whale Cove who gave birth between Sept. 1, 1984, and Aug. 31, 1987. MAIN OUTCOME MEASURES: All blood pressure measurements recorded during the pregnancy, incidence of pregnancy-induced hypertension in the seven communities, harvest of country food (food obtained from the land or sea rather than bought in a store) for six of the communities, self-reported consumption of fish, sea mammals and terrestrial mammals by a subgroup of the subjects and levels of phospholipid fatty acids in cord serum samples from a subgroup of the infants. MAIN RESULTS: Significantly lower mean diastolic blood pressure values during the last 6 hours of pregnancy were noted for the women from the three communities with a higher consumption of fish and sea mammals (78.2 [95% confidence limits (CL) 76.6 and 79.9] mm Hg) than for those from the four communities with a lower consumption of such food (81.5 [95% CL 80.1 and 82.9] mm Hg) (p less than 0.005). The relation between community diet type and blood pressure was independent of other factors. Correspondingly, the women from communities with a lower consumption of marine food were 2.6 times more likely to be hypertensive during the pregnancy than those from communities with a higher consumption of marine food (p less than 0.007). Parity (p less than 0.05) and prepregnancy weight (p less than 0.005) were also significantly associated with pregnancy-induced hypertension; however, the relation between hypertension and community diet type remained significant in logistic regression analysis (odds ratio 2.56, p = 0.03). The differences between the community groups were substantiated by the results of the diet survey, the levels of eicosapentaenoic acid (EPA) in the cord serum phospholipids and the harvest data. CONCLUSIONS: Increased consumption of fish may be beneficial for women at risk for hypertension during pregnancy. A prospective randomized trial of fish or EPA supplementation during pregnancy is warranted.

Animals↗

Right-branch bundle block in circumpolar Inuit.

The prevalence of right-branch bundle block (RBBB) has been examined in the Inuit residents of Igloolik (69 degrees 40'N, Canadian N.W.T.) over a twenty-year period. Original reports of a very high prevalence of RBBB probably reflected a selective testing of patients with chronic respiratory disease by visiting physicians. Cases of RBBB are certainly seen somewhat more frequently than in a southern community, but the majority of subjects show no more than a slight notching of the R wave of the electrocardiogram, with no appreciable broadening of the QRS complex. While a few of the more marked cases of RBBB may be attributable to chronic respiratory disease, the majority are associated with high normal values for both lung function and predicted maximal oxygen intake. The probable cause is thus a ventricular hypertrophy due to the vigorous physical activity demanded by life in a northern community rather than chronic respiratory disease. The physical demands of life in Igloolik have diminished over the past two decades, and an apparent increase in the prevalence of RBBB over this period is probably due mainly to a great awareness+ of the condition by those reading the electrocardiograms.

Adolescent↗

Inuit suicides in Greenland.

The increased frequency of suicide among Inuit in the North is reviewed and compared with an analysis of public files on suicides in Greenland 1977-86. From these files some kind of small scale "psychological" autopsy is performed, and the material is analyzed in relation to theories of socialization and acculturation.

Adult↗