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Population variation in second metacarpal sexual size dimorphism.

This paper contrasts levels of sexual size dimorphism in second metacarpal osteometric and geometric morphology in two bioculturally distinctive populations: 19th century Euro-Canadian settlers, and proto/historic central Canadian Inuit. Significant within-group sexual size dimorphism is found for all variables, though few show significant interpopulation differences. However, in every case the Euro-Canadian sample is more dimorphic than the Inuit sample. Notably, differences reside in geometric measures (total area, Imax) sensitive to variation in functional strain, and thus are interpretable in light of proximate causal models, i.e., activity profiles distinct from generalized mode of subsistence. Other proximate factors, such as nutritional stress acting to diminish Inuit sexual size dimorphism, may also play a role. However, models often cited to explain dimorphism, such as marriage practice (e.g., polygyny) or division of labor situated in mode of subsistence, do not. The higher sexual size dimorphism in the 19th century settler sample belies the notion that technological progress inevitably leads to reduced dimorphism.

Anthropology, Physical↗

Geographical distribution of diabetes among the native population of Canada: a national survey.

The prevalence of diagnosed diabetes was determined for 76% of the registered Indian and Inuit (Eskimo) population of Canada from case registers maintained by the federal agency responsible for Indian health services. A total of 5324 cases were ascertained. The age-sex adjusted rate varied among the Indians from a low of 0.8% in the Northwest Territories to a high of 8.7% in the Atlantic region. Among Inuit, the prevalence was 0.4%. Most cases occur in middle-aged or older individuals, with a higher prevalence among Indian (but not Inuit) females. An ecologic analysis was performed with the crude prevalence of individual communities regressed upon independent variables that included longitude, latitude, geographic isolation, culture area, and language family. Stepwise regressions were also carried out within the Algonkian, Athapaskan, and Eskimoan language families. For the national sample, composite language phylum-culture area predictors were used. The results in the national sample confirmed most findings in the individual language family analysis. Six predictors: latitude, Northeast-Algonkian, Northeast-Iroquoian, Subarctic-Algonkian, Plains-Siouan, and Plains-Algonkian, ranked here in decreasing order of importance, explained 48.4% of the variation in diabetes prevalence. All the named groups had rates significantly greater than found in the reference group of Arctic-Eskimoans. We conclude that the distribution of diabetes among Canadian natives is determined by both genetic and environmental factors.

Aged↗

Lung function in Greenlandic and Danish children and adolescents.

Respiratory morbidity in Inuit children is high. However, little is know regarding lung function measures in this population. The forced expiratory volumes in one second (FEV(1)) and forced vital capacity (FVC) in 888 Greenlandic Inuits (N=888) and Danes (N=477) aged 6-18 years were compared. Furthermore, associations between level of lung function and atopy and lifestyle factors were estimated in Greenlanders. The effect of height on FEV(1) and FVC was significantly different in Greenlanders and Danes, this difference in lung function increased with increasing height, and could not be explained by differences in age weight and BMI. Thus, Greenlanders taller than 130 cm had up to 300-400 ml higher FEV(1) and FVC compared with Danes of the same height. Among Greenlanders, those living in settlements had the highest levels of both FEV(1) and FVC. Greenlanders had elevated levels of FEV(1) and FVC compared with Danes. The Inuit having a shorter limb length in relation to trunk height may account for these differences. However, our finding that Greenlanders living in settlements had the highest lung function level also suggests a possible role of factors in the traditional Greenlandic lifestyle.

Adolescent↗

Can we prevent angle-closure glaucoma?

PURPOSE: Glaucoma is the second cause, after cataract, of world blindness. Approximately half is thought to be primary angle-closure glaucoma (ACG). This review asks whether ACG can be prevented on a population basis. METHODS AND POPULATIONS: Review of published information from the Inuit of Greenland, Canada and Alaska, and descriptions of recent studies in Asian populations in Mongolia, China and South-East Asia. RESULTS: The Greenland Inuit have the shallowest anterior chamber depths (ACDs) so far recorded. The proportion of blindness due to ACG was reduced from 64% to 9% over 37 years by systematic optical measurement of central ACD and the van Herick test in the older Inuit, followed by gonioscopy and prophylactic iridectomy or laser iridotomy when indicated. In Mongolia, ultrasound measurement of central ACD had good sensitivity and specificity as a screening test. A randomized controlled trial of screening and prophylactic laser is being completed. In China and South-East Asia, the mechanism of angle closure appears to be more varied and complex and its detection may require more elaborate imaging. CONCLUSIONS: The mechanism of angle closure and potential for prevention by screening are likely to have to be determined specifically for each population at risk.

Adult↗

A missense mutation in FIC1 is associated with greenland familial cholestasis.

Greenland familial cholestasis is a severe form of intrahepatic cholestasis described among indigenous Inuit families in Greenland. Patients present with jaundice, pruritus, bleeding episodes, and steatorrhea, and die in childhood due to end-stage liver disease. We investigated the possibility that Greenland familial cholestasis is caused by a mutation in FIC1, the gene defective in patients with progressive familial intrahepatic cholestasis type 1 and many cases of benign recurrent intrahepatic cholestasis. Using single-strand conformation polymorphism analysis and sequencing of the FIC1 exons, a missense mutation, 1660 G-->A (D554N), was detected and was shown to segregate with the disease in Inuit patients from Greenland and Canada. Examination of liver specimens from 3 Inuit patients homozygous for this mutation revealed bland canalicular cholestasis and, on transmission electron microscopy, coarsely granular Byler bile, as previously described in patients with progressive familial intrahepatic cholestasis type 1. These data establish Greenland familial cholestasis as a form of progressive familial intrahepatic cholestasis type 1 and further underscore the importance of unimpeded FIC1 activity for normal bile formation.

Adenosine Triphosphatases↗

Genetic epidemiology of Greenland.

The Inuit (Eskimo) gene pool is in many respects similar to that of East Asian populations. Some polymorphisms imply frequent occurrence of disorders comparatively rare in Western Europe (e.g. lactose and sucrose malabsorptions). Low frequencies of alleles for slow isoniazid acetylation and sparteine/debrisoquine oxidation indicate slow elimination of a multitude of drugs. Autoimmune disorders (e.g. rheumatoid arthritis, insulin-dependent diabetes mellitus, Graves' disease and psoriasis) are rare, possibly explained by the associations of these disorders with HLA-alleles rare in the Inuit (e.g. HLA-B8). A correspondingly high incidence of reactive arthritis may be explained by a frequent HLA-B27 allele. The prevalence of disorders due to instability of mesenchymal tissues (e.g. spondylolisthesis, osteoarthrosis, hernia, heart block) still requires a biochemical explanation. Attention is drawn to the urgency of genetic studies in the Arctic because of the accelerating hybridization of the Inuit in all circumpolar areas.

Genetic Diseases, Inborn↗

Survey of ophthalmic conditions in a Labrador community. I. Refractive errors.

Of the 745 available members of the population of Nain in Labrador 650 (87%) were screened for refractive errors and ocular disease. Refraction by retinoscopy was done in 553 and axial length measured by an optical method in 514. The results showed that the incidence of low degrees of myopia was higher in Inuit (Eskimos) and those of Mixed Inuit-Caucasian blood in the age groups 10 to 40 than in those over 40. 75% of the myopes came from 20 families in which myopia was present in 2 or more generations. Although there was no significant correlation between the refraction of parents and offspring, there were significant correlations between them for axial length. The axial lenths of the myopic eyes of the Inuit and Mixed populations were significantly longer than emmetropic and hypermetropic eyes. The younger memebers of the population were taller than their parents, and except in female Caucasians axial length showed a significant positive correlation with height. More myopes than emmetropes and hypermetropes achieved grade 8 or more in school. It is suggested that the increased incidence of myopia in the younger age groups might be due to environmental factors interfering with the process of emmetropisation in eyes with a genetic predisposition to myopia by virtue of inheriting a slightlt longer eye. Better nutrition resulting in an increase in stature may also have had some influence.

Adolescent↗

Statistical model estimating the occurrence of otitis media from temporal bone pneumatization.

In order to investigate the relationship between the pneumatization of temporal bones and the occurrence of otitis media in Greenlandic Inuit, 36 Greenlandic Inuit were examined by radiography of the temporal bones. The pneumatized cell area was measured planimetrically. All subjects answered a questionnaire on infectious middle ear disease (IMED), and an objective otologic examination was performed. Nine persons of 34 (26%) reported IMED in childhood, and there was IMED reported in all pneumatized areas below 400 mm2. Based on bilateral area measures, a polychotomous logistic regression model was applied. The occurrence of IMED was shown to be associated with smaller areas, and unilateral IMED was associated with pronounced asymmetry. The model has enabled risk assessment, and 8 persons were designated by the model as having had IMED with a sensitivity of 67% (confidence interval 30% to 93%) and a specificity of 92% (confidence interval 74% to 99%). When the model was applied to a historical anthropological Inuit material from 1700 to 1800 AD, 6 of 56 crania were designated as having had IMED. This method has improved the accuracy of estimating the occurrence of IMED in ancient populations.

Adolescent↗

Health expectancy in Greenland.

BACKGROUND: Mortality and disease patterns in Greenland have greatly changed since the 1950s. Infectious diseases have decreased markedly; chronic diseases, suicides and violent deaths have increased. METHODS: Life tables for the period 1991-95 were used and health status was derived from the 1993/94 Greenland Health Interview Survey. Health expectancy for the Inuit population of Greenland was calculated by an index suggested by Sullivan. RESULTS: Greenland Inuit women live longer than men, but the expected lifetime in self-rated good health was shorter for women than for men. Chronic disease rates are high in Greenland, and consequently many healthy life years are lost, especially because of musculoskeletal diseases. Health expectancy decreases with age, but for this Inuit population the proportion of healthy life years increases after the age of 60, especially among men. CONCLUSION: The many healthy life years lost in Greenland according to self-rated poor health and chronic diseases should be a cause for concern in public health planning in Greenland. Special attention should also be paid to future investigations of regional patterns of health in Greenland, since there is great population heterogeneity according to geography and urbanization.

Adult↗

Contribution of population surveys to the study of cardiovascular disease and diabetes in Greenland.

Two population surveys with focus on cardiovascular disease and diabetes were carried out among the Greenland Inuit in 1993-94 and 1999-2001. The number of participants was 264 (1993-94 study) and 2056 (1999-2001 survey) Inuit living in Denmark, towns in Greenland, and villages. Compared with the general population of Denmark, the Inuit had a high consumption of marine food, but regional and demographic variation was marked. Smoking prevalence was high, being approximately 70% among adults in 1999-2001. Blood pressure was lower than in Denmark and the serum lipid profile was healthier (high HDL cholesterol and low triglyceride). The risk factor pattern is consistent with neither an increased, nor a decreased cardiovascular risk profile. Longitudinal studies are needed to determine the incidence of cardiovascular diseases and diabetes, and to establish causal links between traditional risk factors and disease in this non-European population.

Adolescent↗

Invasive pneumococcal disease in Greenland.

INTRODUCTION: The purpose of the present study was to evaluate the incidence and outcome of pneumococcal infections in Greenland with special reference to serotypes. STUDY DESIGN: Retrospective study of invasive pneumococcal infections in Greenland in the period 1996-2002. METHODS: Cases were defined as patients with positive cultures of Streptococcus pneumoniae from blood and/or CSF received at the microbiological laboratory of Dronning Ingrids Hospital in Nuuk. Cultures were sent to Statens Serum Institut in Copenhagen for serotyping. Medical charts were reviewed. RESULTS: Fifty-one cases were identified. Incidence among Inuit was 54 and among non-Inuit 17 per 100,000 per year. Twenty-one patients were in the age group 35-49 years and 20 in the age group 50-64 years. Twenty patients had meningitis (incidence 6 per 100,000). Seventeen patients died (33%). Most common serotypes were 1 (6 cases) and 12F (8 cases). Mortality rate was significantly higher among patients with 12F than among others (p<0.01). No patients wit serotype 1 died. CONCLUSION: Like in Canada and Alaska, the incidence of invasive pneumococcal disease, especially meningitis, is high among the Inuit in Greenland. Young and middle-aged adults were most frequently affected. Serotype seems to be an important determinant of the outcome of invasive pneumococcal disease.

Adolescent↗

Hepatitis B and hepatocellular carcinoma in Eskimo/Inuit population.

Hepatitis B virus (HBV) is major risk factor for the development of hepatocellular carcinoma (HCC) worldwide. Serologic surveys performed in the 1970s and 1980s have demonstrated that Alaskan Eskimos, Canadian Inuit, and Greenland Inuit have very high prevalence rates of HBV. In Alaska, a high incidence of HCC in Eskimos, especially males, has been reported. Alaska Natives chronically infected with HBV have a relative risk of HCC of 148 compared to Alaska Natives who are not chronically infected. In Canada the incidence of HCC is six times more frequent in elderly Inuit than in Canadians in general. However, an elevated rate of HCC has not been found in Greenland. Primary prevention programs to prevent HCC by vaccination against HBV are being conducted in Alaska, Canada, and Greenland. In addition, in Alaska a program to detect HCC earlier by screening persons chronically infected with HBV, using semiannual alpha-fetoprotein testing, has resulted in detecting over 60% of HCC early enough for surgical resection.

Adolescent↗

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.

Age Distribution↗

Smokeless tobacco use by youth in the Canadian Arctic.

Results from a 1987 school survey in the Canadian Arctic indicate that among boys, 7% of the 5-9 age group, 12% of the 10-14 and 15-19 age groups were current users of chewing tobacco. Prevalence rates for chewing tobacco use were higher among Dene/Métis and Inuit youth. Among Dene/Métis boys, 21% of the 5-9 age group, 12% of the 10-14 age group and 11% of the 15-19 age group used chewing tobacco. Prevalence rates for Inuit boys in the corresponding age groups were 6%, 19% and 18%. In general, prevalence rates among girls were low. Dene/Métis girls were the exception to this pattern. Eight percent of Dene/Métis girls in the 5-9 and 10-14 age groups reported that they were current users of chewing tobacco. The pattern of snuff use was very similar to the use of chewing tobacco. In the total population 12% of boys in the 5-9 age group and 14% of youth in the 10-14 and 15-19 age groups used snuff. Prevalence rates for snuff use were higher in Native groups. Among Dene/Métis boys, 29% of the 5-9 age group, 20% of the 10-14 age group and 18% of the 15-19 age group used snuff. Prevalence rates for Inuit boys in the corresponding age groups were 14%, 20% and 19%. In the total population, 4% of 5-9 year old girls, 6% of the 10-14 age group and 3% of the 15-19 age group were current snuff users. Prevalence rates were highest in the Dene/Métis group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Genetic epidemiology of Greenland.

The Inuit (Eskimo) gene pool is in many respects similar to that of East Asian populations. Some polymorphisms imply frequent occurrence of disorders comparatively rare in Western Europe (e.g. lactose and sucrose malabsorptions). Low frequencies of alleles for slow isoniazid acetylation and sparteine/debrisoquine oxidation indicate slow elimination of a multitude of drugs. Autoimmune disorders (e.g. rheumatoid arthritis, insulin dependent diabetes mellitus, Graves' disease and psoriasis) are rare, possibly explained by the associations of these disorders with HLA-alleles rare in Inuit (e.g. HLA-B8). Correspondingly high incidence of reactive arthritis may be explained by a frequent HLA-B27 allele. Prevalence of disorders due to instability of mesenchymal tissues (e.g. spondylolisthesis, osteoarthrosis, hernia, heart block) are still in want of a biochemical explanation. Attention is drawn to the urgency of genetic studies in the Arctic because of the accelerating hybridization of Inuit in all circumpolar areas.

Genetic Diseases, Inborn↗

Evaluation of the body iron status of native Canadians.

The serum ferritin concentration was measured in 1417 Indians and 310 Inuit aged 1 to 89 years. The subjects were initially selected to produce a representative sample of the entire native population, but the rate of nonresponse was high, and the results reported in this paper are representative only of the people studied.In males the median serum ferritin values increased during early life and tended to plateau after the age of 30 years. In females the median values rose during childhood, tended to plateau during adolescence, increased slightly during the reproductive period, then gradually rose thereafter. Ranges of values were wide in all age groups, reflecting the variations in body iron stores. When compared with the Inuit, the Indians had a significantly higher prevalence of abnormal serum ferritin values.From an analysis of the serum ferritin values in Indians it is probable that iron stores were reduced in approximately 30% of children, 40% of adolescents, 34% of nonpregnant women of reproductive age, 11% of older women and 5% of adult males. The corresponding figures for the Inuit were 15%, 23%, 22%, 6% and 1%. In contrast, iron deficiency anemia was found in only 3% to 4% of native peoples. If "normality" requires more than small amounts of iron stores to meet physiologic needs, the results suggest a high probability of iron deficiency in 20% to 40% of native children, adolescents and nonpregnant women of reproductive age, and in 0% to 10% of other subjects; but if "normality" is defined as adequate iron stores for erythropoiesis the prevalence of iron deficiency was approximately 1% to 2% in children and adolescents, 3% to 5% in women and less than 1% in adult males.

Adolescent↗

Survey of ophthalmic conditions in a Labrador community: II. Ocular disease.

An ophthalmic examination of 87% of the resident population of Nain, Labrador (latitude 56 degrees 33'N) was carried out, and the findings in 330 Inuit, 236 persons of mixed racial ancestry (Inuit-Caucasian) and 80 Caucasians were analysed. Legal blindness was present in 1.2% of the survey population, compared with 1.6% of the study population of the Arctic Ophthalmological Survey of 1970-71. Of the age group 52 to 85 years, 10.8% were legally blind, compared with 0.6% of the same age group surveyed in the Framingham (Massachusetts) Eye Study. The leading causes of unilateral or bilateral blindness in Nain were trauma, especially in the Inuit, and spheroidal degeneration (Labrador keratopathy); neither senile macular degeneration nor diabetic retinopathy had caused legal blindness. External diseases, particularly spheroidal degeneration (which affected 19% of the population), phlyctenular keratoconjunctivitis and epiblepharon, were the commonest diagnoses in Nain. No diabetic retinopathy was detected, but evidence of toxoplasmosis was encountered. Compared with the study population of the Arctic Ophthalmological Survey, the Nain population had a higher prevalence of spheroidal degeneration and other corneal diseases.

Adolescent↗

Extension of the epidemiology of hepatitis B in circumpolar regions through a comprehensive serologic study in the Northwest Territories of Canada.

We conducted a seroepidemiologic study of hepatitis B virus (HBV) infection among 14,198 Inuit (Eskimo), Dene (Indian), and non-native inhabitants of the Northwest Territories (NWT, total 1982 population 47,053) between April 1983 and March 1985. Participants represented almost all of the NWT communities and included approximately half of the total indigenous population. Sera were screened for hepatitis B surface antigen (HBsAg) and antibody to hepatitis B surface antigen (anti-HBs) by radioimmunoassay. A total of 428 persons (3.0%) were positive for HBsAg; their mean age was 41.5 years and 68.7% were greater than 30 years old. Anti-HBs was detected concomitantly in 153 (35.7%) of these persons and present as a single marker in 2,943 sera (20.7%). Overall prevalence rates for HBsAg were marginally higher among Inuit than Dene (3.9% and 2.9%, respectively; P less than 0.05), as were rates for anti-HBs (24.5% and 21.5%, respectively; P less than 0.01). Marker rates among the 2,776 participants of other ethnic groups, predominantly whites, were distinctly lower (HBsAg 0.3%, anti-HBs 8.5%) than among Inuit or Dene populations (P less than 0.01). The prevalence of HBsAg and anti-HBs increased with each decade of life in all five geographic regions, but there were marked differences among the regions as well as among communities within regions. The greatest concentration of HBV markers was in the Baffin Region (36.0% positive for HBsAg or anti-HBs). Hepatitis B e antigen (HBeAg) was detected in only 37 of 421 persons (8.8%) positive for HBsAg; most were less than or equal to 20 years old and were clustered in a few communities with the highest HBV marker rates.

Adolescent↗