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Northern infant syndrome: a deficiency state?

A syndrome is described that affected 16 Indian and Inuit infants roughly 3 months old, most of whom were born in settlements in the Canadian Arctic. The infants presented with a clinical picture that included hepatitis, hemolytic anemia, rickets and respiratory distress, a combination that resembled a syndrome first described in malnourished infants at the turn of the century by von Jaksch and Luzet. The clinical course was self-limited, and all the infants survived without sequelae. The cause of the syndrome was not determined; no infectious agents were discovered. However, low levels of vitamins A, C, D and E were found in a few infants in whom assays were done. The implications of these findings and their relation to the possible cause of this "northern infant syndrome" are discussed.

Anemia, Hemolytic↗

Disseminated tuberculoid lesions in infants following BCG vaccination.

The records of 830 consecutive autopsies at Children's Hospital, Winnipeg revealed that 26 of the 36 infants (34 Canadian Indian, 1 Inuit and 1 Caucasian) given BCG vaccine shortly after birth had tuberculoid granulomas in various sites, including the vaccination site, regional lymph nodes, liver, spleen, lung, bone marrow and salivary gland. Mycobacterium bovis, BCG type, was identified in three of the four cases in which isolation was attempted. The principal causes of death had been sudden infant death syndrome and respiratory tract infections. None of the infants had histologic evidence of an immune deficiency. However, it is possible that in two cases the dissemination of BCG was enhanced by a temporary immunologic defect induced by malnutrition.

BCG Vaccine↗

Community teamwork in nutrition education: an example in Canada's north.

The nutrition education program, sponsored by the Hudson's Bay Company, in remote northern communities, both Inuit and Indian, is described. The program identifies nutritious foods in the company's community stores by coding in the colours associated with the food groups of Canada's Food Guide. It involves the cooperation of key individuals from the community and various community agencies and organizations.

Canada↗

Peter's anomaly with congenital aphakia.

An Inuit boy was born with microphthalmia and a central corneal opacity of the right globe. Histopathologic examination revealed a central adherent corneal leukoma (Peter's anomaly) as well as absence of the lens. We are not aware of other well documented histopathologic reports of congenital aphakia and Peter's anomaly occurring in the same eye.

Aphakia↗

Proceedings of the Alaska-Russia Native Peoples Health and Social Issues Conference. May 1992, Alaska.

An Alaska-Russia Native People's Health and Social Issues Conference, sponsored by the Alaska Department of Health and Social Services, the Alaska Native Foundation, the University of Anchorage Institute for Circumpolar Health Studies, the International Scientific Center "ARTIKA" (Magadan, Russia), the Associations of Native People of Chukotka and Kolyma, and the Magadan Native Association, was held in Wasilla, Alaska in May, 1992. The conference brought together Native people, primarily health and social services workers, to discuss differences and similarities in issues and approaches, and to lay the foundation for future collaboration. The primary participants came mostly from rural villages and small regional cities, and represented Native Health Corporations, Native Associations, and villages. Additional participants came from the University of Alaska, the Alaska Department of Health and Social Services, the Indian Health Service, the Magadan Health Department, the Inuit Circumpolar Conference, and the International Union for Circumpolar Health. A Total of 39 people participated, including: eight Russian Natives (Chukchi, Even, and Siberian Yup'ik); three non-Native Russians; 18 Alaska Natives (Aleut, Athabaskan, Inupiat, Siberian Yup'ik, Yup'ik); nine non-Native Alaskans; one Canadian. The issues discussed in individual and panel presentations, and in small groups, included history, demography, settlement patterns, the cash and subsistence economies, mental and physical health (epidemiology, etiology, treatment and prevention), education, governance, culture and language. As the conference participants came to know each other better, the discussions became increasingly open, and, particularly around shared feelings of cultural oppression and loss, emotional.(ABSTRACT TRUNCATED AT 250 WORDS)

Alaska↗

Epidemiology of cancer in Alaska Natives.

In contrast to many other Native American groups in the United States, cancer incidence data are available for the Alaska Native population from 1969 to present. These data support the fact that cancer patterns in this population differ from all other U.S. populations and are most similar to Eskimos (Inuit) of other circumpolar countries. The unique cancer patterns and the distribution of the population far from sophisticated medical centers strongly impact the cost/benefit ratios of recommended cancer screening procedures. Cost/benefits of cancer screening and data showing that more than one-third of cancer cases and cancer deaths are tobacco related, necessitate that cancer control efforts in this population should focus on eradication of tobacco.

Alaska↗

[Characteristics of tuberculosis in Japan compared with those in other developed countries].

To clarify the characteristics of the tuberculosis situation in Japan, it was analysed in comparison with those in other developed countries. The results are summarized as follows: 1. The tuberculosis epidemic peaked at the end of 1910s in Eastern Japan, and in the 1940s in Western Japan. It is estimated that the annual risk of tuberculosis infection was 4% or more until the end of the World War II. Tuberculosis has spread much later and was much more prevalent up through the 1940s in Japan than in other developed countries. 2. A modern tuberculosis control programme including active case-finding, isolation of infectious cases, charge free medication and BCG vaccination was launched in 1951, and in 1961 an effective case-holding system was established. Tuberculosis incidence decreased rapidly thereafter. As the rate of decrease was almost the same as that of the Inuit (Eskimo) (Fig. 1), one might say that Japan is one of the countries where tuberculosis incidence decreased most rapidly. 3. Incidence of tuberculosis in children is 2.1 per 100,000 in 1991 which is lower than that of the U.S.A. (3.1 per 100,000). 4. Incidence of tuberculosis among the aged is much higher than that of other developed countries as shown in Fig. 3. Of course, this is mainly caused by the fact that a higher percentage of Japanese aged 55 years or more was infected with tubercle bacilli in the past.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Balancing human exposure, risk and reality: questions raised by the Canadian aboriginal methylmercury program.

Environmental contaminants such as methylmercury which bio-accumulate in aquatic ecosystems present an exposure risk to Aboriginal peoples living traditional lifestyles. The results of a 20 year testing program of methylmercury exposure levels of 38,571 Canadian Aboriginal people in 514 native communities across Canada are presented. 608 individuals had blood or blood equivalent levels over 100 micrograms/l. The highest individual level was 660 micrograms/l. The highest mean levels were found in the Inuit in N.W.T. In that same group, over 30% of women aged 15-45 years who were tested had levels over 10 micrograms/g methylmercury in hair with a mean of 16 micrograms/g, well into the 10-20 micrograms/g "risk" range defined by WHO for fetal exposure. A discussion of the management of risk from exposure to methylmercury in the Canadian Aboriginal population is presented, concentrating especially on the need to balance the theoretical basis of the risk assessment, for different population groups and for different exposure patterns, against the potential real impact on health caused by restrictive advice on consumption of traditional foods, especially fish.

Adolescent↗

Cardiovascular disease and environmental pollutants: the Arctic aspect.

Environmental pollution in the Arctic is due to long range transport from lower latitudes or to local industrial activities. Since the latter are not different from point source exposure in the rest of the world the paper focuses on the former aspect which is the main type of environmental pollution in the western Arctic. The environmental pollutants of major significance are heavy metals (mercury, cadmium, lead) and persistent organic pollutants (PCB's, pesticides) and the main exposure is through the traditional diet of sea mammals (mercury, cadmium, persistent organic pollutants) and through smoking (cadmium). There is rather strong evidence that lead is a (weak) risk factor for high blood pressure even at low levels of exposure. Apart from lead there is little evidence that the above mentioned pollutants are significantly related to cardiovascular diseases. Since the pollutants, however, are found in the traditional diet together with n-3 polyunsaturated fatty acids, monounsaturated fatty acids, and selenium which are believed to promote cardiovascular health there is an indirect link between the pollutants and cardiovascular disease. This becomes relevant when dietary guidelines are developed for arctic populations. Epidemiological evidence from Greenland relevant for this discussion is presented, i.e. i) findings from a countrywide interview survey on dietary habits which show that sea mammals are widely consumed and appreciated for health and other reasons and that there is virtually no fear of pollution, and ii) mortality results which do not support the hypothesis that the low rate of ischemic heart disease in Inuit is due to their traditional diet.

Arctic Regions↗

Measles reimmunization in children seronegative after initial immunization.

OBJECTIVE: To evaluate the success of measles reimmunization in children without measles antibody after the initial dose of measles vaccine. DESIGN AND SETTING: A prospective clinical trial in Olmsted County, Minnesota, and Northern Newfoundland and Labrador in Canada. SUBJECTS: A total of 130 healthy white, Innu, and Inuit schoolchildren. All subjects had received the post-1980 Moraten measles vaccine 4 to 11 years earlier. METHODS: Children previously identified as measles antibody seronegative or equivocal after 1 dose of measles vaccine were entered into the trial and reimmunized. Measles antibody was measured a minimum of 6 weeks later using a whole-virus IgG measles-specific enzyme-linked immunoassay (EIA). RESULTS: Of the 130 children reimmunized, 106 (81.5%) became measles antibody seropositive, but 24 children (18.5%) remained seronegative. Younger age at initial immunization (<13 months vs > or = 13 months) was significantly associated with lack of seropositive antibody levels following reimmunization (odds ratio, 3.9; 95% confidence interval, 1.5-9.7). In addition, antibody levels after reimmunization were significantly reduced with increasing time since initial immunization (P=.001). CONCLUSIONS: After 2 doses of measles vaccine, 98.2% of all subjects in this study were seropositive for measles antibody, despite the fact that almost 20% of children did not have measurable antibodies 4 to 11 years following a first dose. These findings suggest that the current public health policy recommending a 2-dose measles immunization strategy, with the second dose given at school entry, will provide high levels of immunity in the community.

Antibodies, Viral↗

Recent fertility and mortality trends among aboriginal and nonaboriginal populations of central Siberia.

We examine mortality and fertility patterns of aboriginal (primarily Evenki and Keto) and Russian (i.e., nonaboriginal) populations from the Baykit District of Central Siberia for the period 1982-1994. Mortality rates in the aboriginal population of Baykit are substantially greater than those observed in the Russians and are comparable to levels recently reported for other indigenous Siberian groups. Infant mortality rates average 48 per 1000 live births among Baykit aboriginals, three times greater than the Russians of the district (15 per 1000 births) and more than double the rates for Inuit and Indian populations of Canada. Similarly, crude death rates of the Baykit aboriginals are twice as high as those observed in either the Baykit Russians or the Canadian aboriginal populations (13 vs 6-7 deaths per 1000 individuals). Birth rates of the indigenous population of Baykit are higher than those of the Russians (33 vs. 15 births per 1000 individuals) but are comparable to those of Canadian aboriginal groups. Violence and accidents are the leading causes of adult male mortality in both ethnic groups, whereas circulatory diseases have emerged as the prime cause of death in women. The greater male mortality resulting from violence and accidents is a widely observed cross-cultural phenomenon. The emergence of circulatory diseases as a major mortality risk for women, however, appears to be linked to specific lifestyle changes associated with Soviet reorganization of indigenous Siberian societies. Marked declines in mortality and increases in fertility were observed in the Baykit aboriginal population during the mid to late 1980s with the government's implementation of anti-alcohol policies. The decline in mortality, however, was largely erased during the early 1990s, as the region became increasingly isolated and marginalized following the collapse of the Soviet Union. Demographic trends in the Baykit District suggest that because the indigenous groups have become more isolated, many are returning to a more traditional subsistence lifestyle.

Adult↗

Undifferentiated carcinoma of the major salivary glands.

BACKGROUND: Undifferentiated carcinoma of the salivary glands is a rare disease, the incidence of which is highest among the Inuit of Greenland and North America. It was demonstrated to be closely related to Epstein- Barr virus (EBV) infection. However, the relation of EBV to this tumor has not been studied to any great extent here in Taiwan because of the small number of cases. METHODS: Twelve cases of undifferentiated carcinoma of the salivary glands from the period 1977-1996 were retrieved from the cancer registry at National Taiwan University Hospital. The clinical data were analyzed retrospectively based on the medical records. Eleven formalin fixed, paraffin embedded tissue sections were used for in situ hybridization with an antisense probe complementary to EBV-encoded RNA 1 (EBER1). RESULTS: Ten of 12 tumors originated from the parotid gland and 2 from the submandibular gland. The patients' ages ranged from 22 to 63 years, with an average of 38.1 years. One patient was lost to follow-up, 2 patients died of metastatic disease, and the remaining 9 patients were all alive and disease free at last follow-up. The actuarial 5-year survival rate was 79.8%. In situ hybridization demonstrated EBER1 in 9 of the undifferentiated carcinomas with lymphoid stroma, but EBER1 was not demonstrated in the other 2 tumors without lymphoid stroma. CONCLUSIONS: Undifferentiated carcinoma with lymphoid stroma of the major salivary glands is closely associated with EBV. The mainstay of treatment is surgery and postoperative radiotherapy. The outcomes in this series were good except for two elderly patients who died of rapid and progressive distant metastases.

Adult↗

The Nutrition Canada Survey: a review. Statement by the Nutrition Committee of the Canadian Paediatric Society.

The data obtained through the Nutrition Canada national nutrition survey must be interpreted cautiously because of limitations in both the design of the survey and our present knowledge of the implications of the findings. The data suggest that, at present, nutritional status is suboptimal among members of the general population. However, because there is no evidence of clinically apparent malnutrition it is difficult to judge the immediate health significance of this finding. Among the Inuit, however, the data suggest that intake of vitamin C may be sufficiently low to approach the level causing clinical problems. Government should make funds available to permit analysis of the data to be completed and investigative studies to be undertaken to assess the health significance of the findings.

Adolescent↗

The human health programme under AMAP. AMAP Human Health Group. Arctic Monitoring and Assessment Program.

The human health programme of the first phase of AMAP was planned at an international meeting held in Nuuk, Greenland, October 1992. As the most vulnerable period to adverse effects of contaminants is during fetal development, it was decided to concentrate on analyses of umbilical cord blood and maternal blood. The programme was designed as a core programme in which 150 sample pairs should be collected in each of the 8 arctic countries and analyzed for persistant organic pollutants (POPs) and heavy metals (mercury, lead and cadmium). As some essential elements such as copper, zinc and selenium interfere with heavy metal toxicity these elements should also be analyzed. Additional analyses such as nickel and arsenic in urine, mercury in hair, and POPs in breast milk could be incorporated regionally according to specific local conditions. Radionucleides were not a major focus in the human programme as this issue was be dealt with by AMAP's radiation group. Implementation of the programme was a problem in most of the countries due to lack of funding. However, an offer from Canada to analyze all contaminants in 50 samples from each country enabled the first comparative circumpolar study of human exposure to contaminants to be completed. The study confirmed that in general the most important source of exposure to both POPs and mercury is food of marine origin and that Greenlanders and Inuit from the Canadian Arctic, due to their traditional lifestyle, are among the most highly exposed populations in the Arctic. This is not a result of local pollution in Greenland and Canada, but is due to long range transport of persistent contaminants through the atmosphere and their biomagnification in the marine food chain. For these reasons the most important recommendation of the first AMAP assessment is that priority should be given to the expeditious completion of negotiations to establish protocols for the control of POPs and heavy metals under the Convention on Long Range Transboundary Air Pollution.

Arctic Regions↗

Hepatitis B-related sequelae. Prospective study in 1400 hepatitis B surface antigen-positive Alaska native carriers.

A total 1400 hepatitis B surface antigen-positive Alaska natives, 824 men and 576 women of all ages, were followed up prospectively over a period of 7815 carrier years for the development of sequelae related to chronic hepatitis B virus infection. During the observation period, 20 cases of hepatocellular carcinoma, 14 cases of chronic active hepatitis, 8 cases of cirrhosis, and 1 case of glomerulonephritis developed in this cohort. The annual incidence of hepatocellular carcinoma was 387 per 100,000 for men and 63 per 100,000 for women. The incidence of chronic active hepatitis and cirrhosis was 193 and 107 per 100,000 in men and 158 and 95 per 100,000 in women, respectively. No cases of either essential mixed cryoglobulinemia or necrotizing vasculitis were seen. Sixty of the hepatitis B surface antigen-positive carriers died, with 13 (21.7%) of the deaths due to hepatocellular carcinoma. The leading cause of death in this group was malignant neoplasms compared with accidents in the general Alaska native population.

Adolescent↗

Pulmonary thromboembolism in American Indians and Alaskan Natives.

BACKGROUND: The rate of diagnosis of deep venous thrombosis and/or pulmonary embolism (collectively, venous thromboembolism: VTE) among patients discharged from Indian Health Service hospital care from 1980 through 1996 was considerably lower than rates reported in African Americans or whites. Expansion of the national census in 1990 to include American Indians and Alaskan Natives permits a more in-depth examination of this issue. METHODS: Combined data from the National Hospital Discharge Survey (nonfederal hospitals) and the Indian Health Service (federal hospitals) from 1996 through 2001 were used to evaluate the rate of diagnosis of VTE in American Indians and Alaskan Natives. RESULTS: The diagnosis of VTE in American Indians and Alaskan Natives, based on combined data from the National Hospital Discharge Survey and the Indian Health Service was 71 per 100,000 per year compared with 155 per 100,000 per year in African Americans (P<.001) and 131 per 100,000 per year in whites (P<.001). The rate ratio comparing the rate of diagnosis of VTE in American Indians and Alaskan Natives with African Americans was 0.46 (95% confidence interval, 0.45-0.47) and comparing American Indians and Alaskan Natives with whites it was 0.54 (95% confidence interval, 0.53-0.55). CONCLUSIONS: The observed relatively low incidence of VTE in American Indians and Alaskan Natives would seem to be due to as yet undetermined genetic factors. The possibility that American Indians and Alaskan Natives have different lifestyles that affect the rate of diagnosis of VTE cannot be excluded.

Alaska↗