Future directions for monitoring and human health research for the Arctic Monitoring and Assessment Programme.

For the last two and a half decades, a network of human health experts under the Arctic Monitoring and Assessment Program (AMAP) has produced several human health assessment reports. These reports have provided a base of scientific knowledge regarding environmental contaminants and their impact on human health in the Arctic. These reports provide scientific information and policy-relevant recommendations to Arctic governments. They also support international agreements such as the Stockholm Convention on Persistent Organic Pollutants (POPs) and the Minamata Convention on Mercury. Key topics discussed in this paper regarding future human health research in the circumpolar Arctic are continued contaminant biomonitoring, health effects research and risk communication. The objective of this paper is to describe knowledge gaps and future priorities for these fields.

Human health implications of environmental contaminants in Arctic Canada: A review.

The objectives of this paper are to: assess the impact of exposure to current levels of environmental contaminants in the Canadian Arctic on human health; identify the data and knowledge gaps that need to be filled by future human health research and monitoring; examine how these issues have changed since our first assessment [Van Oostdam, J., Gilman, A., Dewailly, E., Usher, P., Wheatley, B., Kuhnlein, H. et al., 1999. Human health implications of environmental contaminants in Arctic Canada: a review. Sci Total Environ 230, 1-82]. The primary exposure pathway for contaminants for various organochlorines (OCs) and toxic metals is through the traditional northern diet. Exposures tend to be higher in the eastern than the western Canadian Arctic. In recent dietary surveys among five Inuit regions, mean intakes by 20- to 40-year-old adults in Baffin, Kivalliq and Inuvialuit communities exceeded the provisional tolerable daily intakes (pTDIs) for the OCs, chlordane and toxaphene. The most recent findings in NWT and Nunavut indicate that almost half of the blood samples from Inuit mothers exceeded the level of concern value of 5 microg/L for PCBs, but none exceeded the action level of 100 microg/L. For Dene/Métis and Caucasians of the Northwest Territories exposure to OCs are mostly below this level of concern. Based on the exceedances of the pTDI and of various blood guidelines, mercury and to a lesser extent lead (from the use of lead shot in hunting game) are also concerns among Arctic peoples. The developing foetus is likely to be more sensitive to the effects of OCs and metals than adults, and is the age groups of greatest risk in the Arctic. Studies of infant development in Nunavik have linked deficits in immune function, an increase in childhood respiratory infections and birth weight to prenatal exposure to OCs. Balancing the risks and benefits of a diet of country foods is very difficult. The nutritional benefits of country food and its contribution to the total diet are substantial. Country food contributes significantly more protein, iron and zinc to the diets of consumers than southern/market foods. The increase in obesity, diabetes and cardiovascular disease has been linked to a shift away from a country food diet and a less active lifestyle. These foods are an integral component of good health among Aboriginal peoples. The social, cultural, spiritual, nutritional and economic benefits of these foods must be considered in concert with the risks of exposure to environmental contaminants through their exposure. Consequently, the contamination of country food raises problems which go far beyond the usual confines of public health and cannot be resolved simply by risk-based health advisories or food substitutions alone. All decisions should involve the community and consider many aspects of socio-cultural stability to arrive at a decision that will be the most protective and least detrimental to the communities.

Changes in the relative distribution and properties of smooth endoplasmic reticulum subfractions isolated from the livers of rats fed 2-acetylaminofluorene.

A marked increase in the amount and relative proportion of fraction II of the smooth endoplasmic reticulum (SER II) and a concomitant decrease in the SER I fraction were observed in the liver of male Sprague-Dawley rats fed diets containing 0.05% (w/w) 2-acetylaminofluorene (AAF) for various lengths of time (3-18 weeks). The amount of rough endoplasmic reticulum (RER), which remained at control levels after 3 weeks of AAF feeding, i.e. before the appearance of hyperplastic nodules (HPN), was clearly decreased after 18 weeks of continuous AAF-feeding (HPN present). When the rats were subjected to 4 or 5 cycles of interrupted AAF feeding, similar increases in SER II were also observed both in the homogenates of HPN-containing livers, as well as in the homogenates of HPN dissected out from the surrounding liver tissue. SER II, the predominant microsomal membrane fraction in the livers of rats fed AAF for 3 weeks, showed the highest level of induction of epoxide hydrolase. A marked elevation of the manganese-dependent enhancement of polysome binding in vitro was also observed in SER II from the livers of AAF-fed rats.

Environmental contaminants and human health in the Canadian Arctic.

The third Canadian Arctic Human Health Assessment conducted under the Canadian Northern Contaminants Program (NCP), in association with the circumpolar Arctic Monitoring and Assessment Programme (AMAP), addresses concerns about possible adverse health effects in individuals exposed to environmental contaminants through a diet containing country foods. The objectives here are to: 1) provide data on changes in human contaminant concentrations and exposure among Canadian Arctic peoples; 2) identify new contaminants of concern; 3) discuss possible health effects; 4) outline risk communication about contaminants in country food; and 5) identify knowledge gaps for future contaminant research and monitoring. The nutritional and cultural benefits of country foods are substantial; however, some dietary studies suggest declines in the amount of country foods being consumed. Significant declines were found for most contaminants in maternal blood over the last 10 years within all three Arctic regions studied. Inuit continue to have the highest levels of almost all persistent organic pollutants (POPs) and metals among the ethnic groups studied. A greater proportion of people in the East exceed Health Canada's guidelines for PCBs and mercury, although the proportion of mothers exceeding these guidelines has decreased since the previous assessment. Further monitoring and research are required to assess trends and health effects of emerging contaminants. Infant development studies have shown possible subtle effects of prenatal exposure to heavy metals and some POPs on immune system function and neurodevelopment. New data suggest important beneficial effects on brain development for Inuit infants from some country food nutrients. The most successful risk communication processes balance the risks and benefits of a diet of country food through input from a variety of regional experts and the community, to incorporate the many socio-cultural and economic factors to arrive at a risk management decision that will be the most beneficial in Arctic communities.

Characteristics of aerobic gram-negative bacteria colonizing critically ill patients.

Adherence of gram-negative bacteria (GNB) to epithelial surfaces is important for GNB colonization to occur. Pili, rodlike structures projecting from the outer membrane of GNB, and GNB surface hydrophobicity have been shown to enhance GNB adherence. We investigated the types of pili and the hydrophobicity of aerobic GNB colonizing the stomach, oropharynx, and trachea of critically ill patients. Piliation and hydrophobicity of oral, tracheal, and gastric GNB were compared with that of commensal GNB isolated from patients' rectums. Significantly more oropharyngeal than rectal GNB were piliated, and the most common type of pili present was type 1, or mannose-sensitive pili. Mannose-resistant and P pili were present less often, and no colonizing GNB had S pili. Colonizing GNB were hydrophilic rather than hydrophobic, and no differences in hydrophobicity were noted between colonizing GNB and rectal isolates. Our results suggest that pili may be important for oropharyngeal GNB colonization.