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PubMed1983

Diarrhea among infants and young children in Canada: a longitudinal study in three northern communities.

Diarrhea among neonates and their siblings was studied in 98 families living in Winnipeg, Manitoba, and in 31 native Indian families and in 15 Inuit (Eskimo) families living in isolated settlements in northern Canada. The rate of infection due to rotavirus in neonates was significantly higher and infection occurred more often in the first six months of life in the northern communities (range, 0.36 in Winnipeg to 1.07 in Eskimo Point). No protective effect of breast-feeding was discerned, since infection due to rotavirus occurred more frequently and earliest in neonatal life in Eskimo Point, the community with the highest rate of breast-feeding. In contrast, infection due to Norwalk virus was most common among the neonates of Berens River (0.15 infections per child per year), the only community with relatively unsafe water supplies. Infection due to rotavirus appears to be more frequent in the far North, whereas infection due to Norwalk virus appears to be related more to inadequate sanitation.

Child↗
PubMed1989

Trichinosis in the Canadian Arctic: report of five outbreaks and a new clinical syndrome.

Trichinosis is a serious but understudied medical problem in the Arctic. Forty-nine consecutive cases in the Inuit population of northeastern Canada are described. Most developed the disease after eating raw walrus, and the clinical presentation of most of these cases differed from previously reported descriptions of classic trichinosis due to Trichinella spiralis. Unlike the classic syndrome of a brief period of diarrhea followed by fever, myalgia, muscle weakness, and edema, the most common presentation in these cases was a prolonged diarrhea without fever and with brief muscle symptoms. High peripheral eosinophilia, high Trichinella antibody serotiters, and little direct or indirect evidence of muscle invasion in many of those with the chronic diarrheal presentation suggest a new clinical syndrome due to a different species of Trichinella seen in the Arctic or to reinfection with Trichinella.

Animals↗
PubMed1990

An outbreak of toxoplasmosis in pregnant women in northern Québec.

An ongoing screening program for toxoplasmosis identified a cluster of four women from northern Québec who, over a 4-month period, seroconverted during their pregnancy. An epidemiologic investigation was carried out in an attempt to identify the source of this infection. All potential risk factors were assessed by a questionnaire administered to 22 Inuit women who had delivered babies in the previous year. Seroconversion was significantly associated with skinning of animals for fur (P = .015) and frequent consumption of caribou meat (P = .034). Compared to seronegative women, women who were seropositive were more than four times more likely to have eaten dried seal meat (P = .067), more than six times more likely to have eaten seal liver (P = .064), and more than eight times more likely to have consumed raw caribou meat more than once per week (P = .054). These observations have contributed to the development of guidelines for the prevention of toxoplasmosis in seronegative pregnant women in this arctic region.

Adolescent↗
PubMed2001

Ethnic variability in the allelic distribution of human aryl hydrocarbon receptor codon 554 and assessment of variant receptor function in vitro.

The aryl hydrocarbon receptor (AHR) is a ligand-dependent transcriptional regulator of several genes including the cytochrome P4501 (CYP1) family as well as genes encoding factors involved in cell growth and differentiation. In mice, several polymorphic forms of the AHR are known, some of which have altered affinity for toxic and carcinogenic ligands. Remarkably little genetic variation has been detected in the human AHR gene. In studies on human AHR, Kawajiri et al. (Pharmacogenetics 1995; 5:151-158) reported a variation at codon 554 that results in an amino acid change from arginine to lysine; the frequency of the variant allele in a Japanese population (n = 277) was 0.43. We investigated the Lys554 allele in 386 individuals of various ethnic origins and found the frequency to be: 0.58 in Ivory Coast Africans (n = 58); 0.53 in a mixed African group (n = 20); 0.39 in Caribbean-Africans (n = 55); 0.32 in Canadian Chinese (n = 41); 0.14 in North American Indians (n = 47); 0.12 in French Canadian Caucasians (n = 20); 0.11 in a mixed ethnicity North American group (n = 45); 0.09 in Canadian Inuits (n = 22); and 0.07 in German Caucasians (n = 78). We expressed the human Lys554 allele in an in-vitro transcription-translation system and found that the receptor bearing the R554L substitution had an equivalent ability to that of the wild-type receptor to bind to a dioxin-responsive element following treatment with 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). The Lys554 allele also was equivalent to the wild-type receptor at stimulating CYP1A1 mRNA expression when transfected into TCDD-treated receptor-deficient mouse Hepa-1 cells. It is not yet known if any of the wide variations in allele frequency at codon 554 are related to ethnic differences in susceptibility to adverse effects of environmental chemicals.

Alleles↗
PubMed2005

Nationwide canadian study of hepatitis a antibody prevalence among children eight to thirteen years old.

BACKGROUND: Hepatitis A vaccines provide consistent, long-lasting protection and have been available for almost 10 years in Canada, but their use remains limited. It is difficult to assess their optimal utilization given that our knowledge of hepatitis A epidemiology in Canada is fragmentary. Unlike the United States, no nationwide study of hepatitis A prevalence has ever been done in Canada. Consequently we do not know the incidence of infection in children and what would be the most appropriate age for hepatitis A vaccination. OBJECTIVE: To estimate the proportion of 8- to 13-year-old children who have been infected with hepatitis A virus (HAV) and the risk factors for this infection on a nationwide scale. METHODS: Children were sampled in 10 Canadian provinces, comprising 5 regions, using random digit dialing methodology with regional stratification. Demographic data and information about risk factors for hepatitis A were collected by the telephone interviewers. Oral fluid samples were self-collected and mailed to the laboratory, where they were tested for anti-HAV IgG. RESULTS: Of 6740 contacted families with a child of required age, 1688 (25%) agreed to participate and answered the questionnaire. From these, 1074 oral fluid samples were received, and 1057 could be analyzed. Anti-HAV IgG was detected in 2.7% of subjects, with variation by region from 0.8 to 3.4%. The parents of 54 subjects (5.1%) reported that their child had previously been vaccinated against HAV. Anti-HAV IgG was present in 2.0% of unvaccinated subjects, among whom antibody prevalence was 19.4% in children born in HAV-endemic countries, 6.1% in Native children and 4.2% in travelers to endemic countries. In multivariate analysis of all subjects, the presence of anti-HAV IgG was significantly associated with birth in an endemic country, travel to an endemic country, Native status (American Indian and Inuit population), female gender and vaccination against HAV. In nonvaccinated, non-Native children born in Canada who did not travel to endemic countries, anti-HAV prevalence was 1.1%. CONCLUSIONS: The risk for hepatitis A during childhood is low in Canada. Almost all teenagers (>97%) would be at risk for infection in case of contact with HAV. Changes in immunization policy against hepatitis A should be considered.

Adolescent↗
PubMed2005

Serious adverse events associated with bacille Calmette-Guérin vaccine in Canada.

BACKGROUND: Targeted Bacille Calmette-Guérin (BCG) vaccination is offered to neonates in some First Nations and Inuit (FNI) communities in Canada. Serious adverse events associated with BCG vaccine prompted a review to assess causality. METHODS: The Immunization Monitoring Program Active (IMPACT), a pediatric hospital-based active surveillance network, reported admissions for BCG-related adverse events between 1993 and April 2002. The Canadian Advisory Committee on Causality Assessment (ACCA) reviewed the reports to assess causality. Data between 1987 and September 2002 from the Vaccine-Associated Adverse Event Surveillance (VAAES) Program, a passive national reporting system, were also reviewed. RESULTS: IMPACT identified 21 pediatric cases; 19 were Canadian-born, and 18 were FNI. Six disseminated BCG cases were identified; 5 were FNI infants who subsequently died. All had immunodeficiencies and concurrent infections. Other adverse events included 2 cases of osteomyelitis, BCG abscesses and lymphadenitis. ACCA reviewed the 21 cases and determined that 14 were very likely associated with the vaccine, including the 6 disseminated BCGs; 5 were probably associated and 1 was possibly associated with the vaccine; 1 was unclassifiable. The VAAES program identified 157 adverse events. No additional serious systemic adverse events (disseminated BCG or osteomyelitis) were identified. CONCLUSIONS: Serious BCG vaccine-associated complications continue to occur in Canada. The numbers of FNI children with disseminated disease was greater than expected from reported rates in the literature.

Adverse Drug Reaction Reporting Systems↗
PubMed1998

HLA class I and class II of the Nivkhi, an indigenous population carrying HTLV-I in Sakhalin, Far Eastern Russia.

The Nivkhi are a native people isolated in the Nogliki region of Sakhalin, Far East Russia, where our group recently recognized human T-cell lymphoma virus type I (HTLV-I) infection. In order to trace the Nivkhi's ethnic background and the HTLV-I carriers, we investigated HLA class I and II allele types of 53 Nivkhi (including four HTLV-I carriers). Major HLA class I alleles of the Nivkhi were A*24, A*02, B*40, B*48, B*27, B*35 with allele frequencies similar to the Orochon, a native people isolated in Northeast China. Major Nivkhi class II alleles were DRB1*0901, DRB1*1401, DRB1*1201, DRB1*1106 with allele frequencies similar to the Ainu in Hokkaido, Japan, but dissimilar to other Asian Mongoloids, including the general Japanese population. The same HLA class I and II allele frequencies are found in both Nivkhi HTLV-I carriers and the background population. A dendrogram of HLA class I alleles showed that the Nivkhi were closely related to the Orochon and Yakut, and remotely related to the Japanese, Ainu and other Asian Mongoloids. Interestingly, the Nivkhi were intermediately related to the Amerindians (Inuit, Tlingit and Andeans), a relationship closer than to the Japanese and Asian Mongoloids. These results suggested the Nivkhi might be related to some genetic group of Northeast Asian Mongoloids like the Orochon and Yakut, being infected with HTLV-I in the distant past before diverging into the current major Mongoloid ethnic groups.

Adult↗
PubMedDate not supplied

Tuberculous lymphadenitis in Manitoba: incidence, clinical characteristics and treatment.

BACKGROUND: Tuberculous lymphadenitis (TBL) is an important form of extrapulmonary tuberculosis (TB). Recent studies have shown an increase in TBL in Canada. OBJECTIVES: To determine the incidence of TBL in Manitoba and to identify the characteristics associated with its presentation, diagnosis and treatment METHODS: Population data from the Manitoba Health Population Registry, the First Nations and Inuit Health Branch of Health Canada, and Statistics Canada were used to calculate incidence. Case characteristics and outcomes were determined by a systematic, retrospective review of all cases between January 1, 1990 and December 31, 2000. RESULTS: One-hundred forty seven cases of TBL were identified during the study period; 77% confirmed by culture; 68% women. TBL was found in Canadian-born/nonstatus Aboriginal (12%), status Aboriginal (29%) and foreign-born (59%) populations. Incidence of TBL was 1.17 per 100,000 person years (95% CI 0.98 to 1.36). The highest incidence was in status Aboriginals over 65 years (16.85 per 100,000 person years; 95% CI 3.37 to 30.33). TBL is seen most often in Western Pacific women. The most common presentation was a single, enlarged cervical node (80%). No atypical mycobacterium was found. Drug resistance occurred in 13% of cases and only in the foreign-born. Cure rates (81%) were influenced by comorbidity and burden of TB disease. Relapse occurred in 8.1 per 1000 person years of follow-up (95% CI 1.7 to 23.7). CONCLUSIONS: Respiratory physicians, who manage the majority of TB disease in Canada, need to remain aware that TB is an important and treatable cause of enlarged lymph nodes.

Adolescent↗
PubMedDate not supplied

Fine needle aspiration biopsy findings in lymphoepithelial carcinoma of salivary gland.

OBJECTIVE: To study the fine needle aspiration cytology of lymphoepithelial carcinoma of salivary gland (LECSG). STUDY DESIGN: Needle aspirates from five primary and two metastatic LECSGs were reviewed. RESULTS: Three aspirates showed very scant cellularity with rare tumor cells originally misinterpreted as lymphohistiocytic cells. Six fine needle aspiration biopsies (FNABs) contained medium to large polygonal and spindled cells with one or more prominent nucleoli. Five aspirates also displayed a heterogeneous population of lymphoid cells, while a sixth had much necrotic debris and only a few lymphocytes admixed with tumor cells. CONCLUSION: In the clinical setting of an Inuit or Chinese patient with a salivary gland mass, an FNAB with these features should suggest the possibility of LECSG.

Adult↗
PubMed2000

Common and rare ABCA1 variants affecting plasma HDL cholesterol.

Mutations in ABCA1, a member of the ATP-binding cassette family, have been shown to underlie Tangier disease (TD) and familial hypoalphalipoproteinemia (FHA), which are genetic disorders that are characterized by depressed concentrations of plasma high density lipoprotein (HDL) cholesterol. An important question is whether common variants within the coding sequence of ABCA1 can affect plasma HDL cholesterol in the general population. To address this issue, we developed a screening strategy to find common ABCA1 variants. This strategy involved long-range amplification of genomic DNA by using coding sequences only, followed by deep sequencing into the introns. This method helped us to characterize a new set of amplification primers, which permitted amplification of virtually all of the coding sequence of ABCA1 and its intron-exon boundaries with a single DNA amplification program. With these new sequencing primers, we found 3 novel ABCA1 mutations: a frameshift mutation (4570insA, A1484S-->X1492), a missense mutation (A986D) in a TD family, and a missense mutation (R170C) in aboriginal subjects with FHA. We also used these sequencing primers to characterize 4 novel common amino acid variants in ABCA1, in addition to 5 novel common silent variants. We tested for association of the ABCA1 I/M823 variant with plasma HDL cholesterol in Canadian Inuit and found that M823/M823 homozygotes had significantly higher plasma HDL cholesterol compared with subjects with the other genotypes. The results provide proof of principle of the effectiveness of this approach to identify both rare and common ABCA1 genomic variants and also suggest that common amino acid variation in ABCA1 is a determinant of plasma HDL cholesterol in the general population.

ATP Binding Cassette Transporter 1↗
PubMed1994

An evaluation of legal outcome following pretrial forensic assessment.

This paper constitutes the first stage of data analysis in a larger controlled study designed to assess the effect of a forensic psychiatric assessment on legal disposition defined in three ways: 1. the number of days spent in custody prior to trial; 2. the number of sentenced days of incarceration; and 3. the conviction rate. A historical cohort design was used to follow two cohorts of individuals remanded, pretrial, to Southern Alberta Provincial Correctional Centres between 1988 and 1989. The study cohort consisted of all offenders detained who received a forensic psychiatric assessment. The comparison cohort consisted of a random sample of persons detained who did not undergo a forensic assessment. Because of small numbers, individuals below the age of 18 and women were excluded from study. This paper compares socio-legal characteristics of study and comparison subjects in order to better understand forensic psychiatric referral patterns and identify potentially confounding factors that would need to be controlled in subsequent analyses of legal outcomes. No differences were noted with respect to educational level but forensic subjects were found to be slightly older (average of 31 years compared to 29 years). Aboriginal peoples (Native Indian, Inuit and Metis) were three times more common among non-forensic offenders. Forensic patients were more likely to have had a prior forensic assessment but less likely to have a prior criminal detention. In addition, forensic patients were three times more likely to be charged with a crime against a person and counted more offenses in the target episode than comparison subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Seroprevalence of hepatitis A infection in a low endemicity country: a systematic review.

BACKGROUND: In Canada--a low endemicity country, vaccines for hepatitis A virus (HAV) are currently recommended to individuals at increased risk for infection or its complications. Applying these recommendations is difficult because the epidemiology of HAV infection is poorly defined, complex, and changing. This systematic review aimed to 1) estimate age-specific prevalence of HAV antibody in Canada and 2) evaluate infection-associated risk factors. METHODS: MEDLINE (1966-2005) and EMBASE (1980-2005) were searched to identify relevant studies for the systematic review. Archives for the Canada Diseases Weekly Report (1975-1991) and Canada Communicable Disease Report (1992-2005) were searched for relevant public health reports. Data were abstracted for study and participants' characteristics, age-specific prevalence, and risk factors. RESULTS: A total of 36 reports describing 34 unique studies were included.The seroprevalence in Canadian-born children was approximately 1% in ages 8-13, 1-6% in 20-24, 10% in 25-29, 17% in 30-39, and increased subsequently. In age groups below 20 and 20-29, age-specific seroprevalence generally remained constant for studies conducted across geographic areas and over time. Compared to Canadian-born individuals, subjects born outside Canada were approximately 6 times more likely to be seropositive (relative risk: 5.7 [95% CI 3.6, 9.0]). Travel to high risk areas in individuals aged 20-39 was associated with a significant increase in anti-HAV seropositivity (RR 2.8 [1.4, 5.5]). Compared to heterosexuals, men having sex with men were only at a marginally higher risk (adjusted odds ratio 2.4 [0.9, 6.1]). High risk for seropositivity was also observed for Canadian First Nations and Inuit populations. CONCLUSION: Results from the current systematic review show that in this low endemicity country, disease acquisition occurs in adulthood rather than childhood. The burden of disease is high; approximately 1 in 10 Canadians had been infected by ages 24-29. The increase in prevalence in young adults coincides with disease importation and increasing frequency of risk factors, most likely behavioral-related ones. Gaps in seroprevalence data were identified rendering the application of current immunization recommendations difficult. A nationwide prevalence survey for all Canadians is needed. This is essential to quantify the effectiveness of current recommendations and conduct cost-effectiveness evaluations of alternative immunization programs, if necessary.

Age Factors↗
PubMed2005

Fertility in four regions spanning large contrasts in serum levels of widespread persistent organochlorines: a cross-sectional study.

BACKGROUND: Persistent organochlorine pollutants (POPs) may interfere with reproductive function but direct evidence in humans is very limited. METHODS: Fertility was examined in four regions with contrasting blood levels of POPs. Pregnant women and their partners in Warsaw (Poland), Kharkiv (Ukraine) and Greenland were consecutively enrolled during antenatal visits. Swedish fishermen and their spouses were recruited separately and independently of current pregnancy. Lipid adjusted serum concentrations of 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153) and 1,1-dichloro-2,2-bis (p-chlorophenyl)-ethylene (DDE) were available for both partners. Time to pregnancy interviews were obtained among 2269 women and 798 men provided a semen sample. RESULTS: Inuits had high levels of both POP markers, Swedish fishermen were high in CB-153 but low in DDE, men from Kharkiv were high in DDE and low in CB-153 while men from Warsaw were low in CB-153 and had intermediate DDE levels. Compared to Warsaw couples, fecundability was reduced among couples from Kharkiv [adjusted fecundability ratio (FR) 0.64 (95% CI 0.5-0.8)] and elevated in Swedish fishermen families [FR 1.26 (95% CI 1.0-1.6)]. Adjusted geometric means of sperm counts and morphology did not differ between regions while sperm motility was higher in men living in Warsaw. CONCLUSION: We observed regional differences in time to pregnancy and sperm motility that may be related to regional differences in POP blood levels, but other interpretations are also plausible. In particular, differences in access to safe contraception and in the prevalence of contraceptive failures are most likely to bias comparisons of time to pregnancy.

Biomarkers↗
PubMed2004

Ketogenic diets and physical performance.

Impaired physical performance is a common but not obligate result of a low carbohydrate diet. Lessons from traditional Inuit culture indicate that time for adaptation, optimized sodium and potassium nutriture, and constraint of protein to 15-25 % of daily energy expenditure allow unimpaired endurance performance despite nutritional ketosis.

Journal Article↗
PubMed2003

Cultural selves.

Recent cross-cultural studies of child development reveal that child rearing, while strikingly culturally variable, is everywhere designed to make the child's experience of important lessons constant, to link those lessons to emotional arousal, and to connect them to evaluations of the child's goodness and badness. These claims are illustrated from research on Americans, Chinese, Germans, Gusii (Kenya), Ifaluk (Micronesia), and Inuit (Baffin Island). These three universal features of child rearing accomplish what is a highly specialized task. Constancy of experience alters synaptic connections to grant the pattern of their firing especially high-resolution, so that the lessons to be learned are unmistakable ones. Accompanied by emotional arousal, these lessons are especially motivating and unforgettable. Brought home with evaluations of the learner's goodness and badness, these lessons are even more motivating and unforgettable. Children get the point of the lesson, enact it once they get it, and remember to enact it on subsequent occasions. Cultural models of child rearing, thus, exploit the neural capacities of the children so reared, to achieve a result, human adulthood, that could not be accomplished by the human brain alone. From exposure to these practices result distinctive cultural selves. These selves are partly implicit, based on the largely unmarked practices designed to make children's experience of important lessons constant and these lessons arousing, and partly explicit, based on the labeling and other marking that connects these lessons to evaluations of children's goodness and badness. The conscious, self-reflective self that emerges from such explicit evaluation lays the basis for identity-everywhere profoundly culturally shaped, infused with powerful evaluative meanings, and itself highly motivating.

Child↗
PubMed2002

Pentachlorophenol and hydroxylated polychlorinated biphenyl metabolites in umbilical cord plasma of neonates from coastal populations in Québec.

Concentrations of polychlorinated biphenyls (PCBs), hydroxylated metabolites of PCBs (HO-PCBs) and octachlorostyrene (4-HO-HpCS), and pentachlorophenol (PCP) were determined in umbilical cord plasma samples from three different regions of Québec. The regions studied included two coastal areas where exposure to PCBs is high because of marine-food-based diets--Nunavik (Inuit people) and the Lower North Shore of the Gulf of St. Lawrence (subsistence fishermen)--and a southern Québec urban center where PCB exposure is at background levels (Québec City). The main chlorinated phenolic compound in all regions was PCP. Concentrations of PCP were not significantly different among regions (geometric mean concentration 1,670 pg/g, range 628-7,680 pg/g wet weight in plasma). The ratio of PCP to polychlorinated biphenyl congener number 153 (CB153) concentration ranged from 0.72 to 42.3. Sum HO-PCB (sigma HO-PCBs) concentrations were different among regions, with geometric mean concentrations of 553 (range 238-1,750), 286 (103-788), and 234 (147-464) pg/g wet weight plasma for the Lower North Shore, Nunavik, and the southern Québec groups, respectively. Lower North Shore samples also had the highest geometric mean concentration of sum PCBs (sum of 49 congeners; sigma PCBs), 2,710 (525-7,720) pg/g wet weight plasma. sigma PCB concentrations for Nunavik samples and southern samples were 1,510 (309-6,230) and 843 (290-1,650) pg/g wet weight plasma. Concentrations (log transformed) of sigma HO-PCBs and sigma PCBs were significantly correlated (r = 0.62, p < 0.001), as were concentrations of all major individual HO-PCB congeners and individual PCB congeners. In Nunavik and Lower North Shore samples, free thyroxine (T4) concentrations (log transformed) were negatively correlated with the sum of quantitated chlorinated phenolic compounds (sum PCP and sigma HO-PCBs; r = -0.47, p = 0.01, n = 20) and were not correlated with any PCB congeners or sigma PCBs. This suggests that PCP and HO-PCBs are possibly altering thyroid hormone status in newborns, which could lead to neurodevelopmental effects in infants. Further studies are needed to examine the effects of chlorinated phenolic compounds on thyroid hormone status in newborns.

Diet↗
PubMed2006

Molecular assay for detection of the common carnitine palmitoyltransferase 1A 1436(C>T) mutation.

BACKGROUND: Carnitine palmitoyltransferase 1A (CPT1A) deficiency is a metabolic disorder that occurs at a key checkpoint of fatty acid metabolism. A new form of CPT1A deficiency caused by a mutation at nucleotide 1436 (C>T), resulting in an amino acid substitution of leucine for proline at position 479 (P479L), has been isolated in Canadian First Nations and Inuit populations. The present study offers a molecular method for assessing CPT1A 1436 (C>T) mutation status. METHODS: CPT1A-deficient fibroblasts from four patient fibroblast cell lines and ten patient peripheral blood spots were all analyzed by polymerase chain reaction (PCR) coupled to restriction endonuclease (RE) treatment. Genomic DNA was PCR-amplified and treated with an RE specific for normal DNA. CPT1A 1436 (C>T) mutations were identified by resistance to RE treatment. RESULTS: The RE-PCR assay identified homozygosity for the 1436 (C>T) mutation in four fibroblast cell lines and nine blood spots with CPT1A enzyme deficiency. In addition, the assay identified one blood spot that corresponded to the heterozygous genotype. CONCLUSIONS: RE-PCR assay for the 1436 (C>T) mutation provides a rapid assay for the diagnosis of CPT1A deficiency resulting from this mutation. The assay will have utility in screening populations with a high prevalence of this genotype.

Amino Acid Substitution↗
PubMed2006

Working in Canada's subarctic: circumpolar medicine.

Medical practice in Churchill is a challenging and rewarding form of wilderness medicine. If any reader is interested in learning more about Churchill or would like to consider visiting or even taking a health care position here, the following resources and contacts are available: The website for Churchill Independent Travel (www.creighton.edu/hutchens/church_travel.html) gives a complete list of options for those wishing to plan their own trip. The Arctic Medicine Conference is a medical conference with talks in Zoonoses, Dentistry, Entomology, and Travel Medicine hosted by Wilderness Medicine in Manitoba (www.skylarkmedicalclinic.com). The JA Hildes Northern Medical Unit is responsible for providing qualified physicians and nurse practitioners to staff northern Manitoba. For those who are interested, please contact Michelle Vandenbroeck at 1(204)789-3711 for information in working in Churchill or other parts of the Hudson Bay Inuit communities (www.umanitoba.ca/faculties/medicine/units/ northern_medical_unit). 1,000 Places to See Before You Die, by Patricia Schultz, is a recent bestseller that gives information about polar bear safaris.

Arctic Regions↗