High burden of symptoms reported among patients diagnosed with chronic obstructive pulmonary disease (COPD) in Greenland after introducing the COPD Assessment Test in clinical practice.

The aim was to test the internal consistency of the Greenlandic version of the COPD Assessment Test (CAT) questionnaire and to estimate the symptom burden in patients with chronic obstructive pulmonary disease (COPD) in Greenland using the CAT questionnaire. A Greenlandic version of the CAT questionnaire was developed including forward translation, reconciliation, backwards translation, and pilot test. Afterwards, a cross-sectional study of patients with COPD was conducted. The internal consistency assessed by the Cronbach α coefficient was 0.823 for the Greenlandic version of the questionnaire (n = 103). The CAT was negatively correlated to spirometry values and current smoking. In the cross-sectional study (n = 250), 81.1% of the patients experienced a high symptom burden (≥10). The main CAT score was 17 (range 0-38). The CAT was used in 9 out of 17 towns in Greenland. The Greenlandic version of the CAT questionnaire demonstrated a good internal consistency. We observed a high burden of symptoms associated with reduced lung function and active smoking status among patient diagnosed with COPD in Greenland. The questionnaire can be used in clinical practice for assessment of symptom burden in patients with COPD in Greenland and may help to increase focus on symptom control and quality of care.

Prevalence of patients using antihypertensive medication in Greenland, and an assessment of the importance of diagnosis for the associated quality of care - a cross-sectional study.

This study aimed to estimate the age- and sex specific prevalence of patients using antihypertensive medication in Greenland, and compared the quality of care between patients with and without a diagnosis for hypertension. The study was a cross-sectional study comparing patients using antihypertensive medication in 2020 (6,629 patients) and 2021 (7,008 patients), respectively. For data from 2021, patients with a medical diagnosis code were identified. Data was obtained from the Greenlandic electronic medical record. The population of Greenland was used as background population. Quality of care was evaluated based on suggested indicators by international guidelines and goals from Steno Diabetes Centre Greenland. The prevalence of patients aged ≥20 years using antihypertensive medication had increased from 16.7% in 2020 to 17.5% in 2021. The prevalence increased by age and was higher among women compared to men. In 2021, the prevalence of patients aged ≥20 years with a medical diagnosis code for hypertension was 7.9%. The use of antihypertensive medication in Greenland is common. The associated quality of care was low. However, process indicators were significantly improved when patients had a medical diagnosis code. Future focus must be on initiating initiatives ensuring that more patients are registered with a medical diagnosis code.

Risk factors observed in health care system 6 months prior completed suicide.

Ten percent of all deaths in Greenland are caused by suicide. The aim of this study was to explore if applicable risk factors could be identified among the suicide victims within the health care system up to 6 months prior to the suicide. The study was performed as an age- and gender-matched case control study including all suicides in Greenland from 2012 to 2015, based on review of medical records for risk factors including suicide ideation, suicide attempts, incidence of alcohol intoxication, incidence of violence and treatment for psychiatric illness within the 6 month period leading up to the suicide. In total, 160 cases and 160 controls were included. Presence of any risk factors were observed in around a third of all suicide cases compared a tenth among the controls. The highest odds ratios for suicide were observed for suicide ideation and suicide attempts. However, no contact with the health care system was observed for two thirds of the suicides victims. Thus, focus on suicide ideation and suicide attempts among patients could help health care professionals to assess suicide risk and initiate prevention. Additional preventive strategies targeting the majority without contact to the health care system need to be explored.

Diabetes care in the dispersed population of Greenland. A new model based on continued monitoring, analysis and adjustment of initiatives taken.

Diabetes used to be a rare condition among Inuit in Greenland. However, research in recent decades has shown a high prevalence of undiagnosed diabetes. Addressing diabetes in the geographically dispersed population of Greenland presents a challenge to the health care system. In 2008, a new model of diabetes care was introduced in Greenland that included continual monitoring, analysis, and adjustment of initiatives taken. The overall aim of this review was to review the feasibility of the monitoring of an ongoing national diabetes care programme. After ten years of observation it was clear that monitoring of such a programme based on information in electronic medical records in Greenland was feasible. It was found that the majority of the population in Greenland was in contact with the health care system. Increased diagnostic activity resulted in an increased prevalence of diagnosed diabetes. The quality of diabetes care in Greenland and the testing effectiveness of gestational diabetes were improved. Microvascular complications were frequently observed among Greenlandic diabetic patients, except for retinopathy that was as an exception. In summary, this model may improve diabetes care and potentially care for other chronic conditions in Greenland, and may also be helpful in other remote settings where chronic disease care is difficult.Abbreviations: AD: Anno Domini; ADA: American Diabetes Association; BC: Before Christ; BMI: Body Mass Index; BP: Blood Pressure; CWB: Capillary Whole Blood; EMR: Electronic Medical Record; EASD: European Association for Study of Diabetes; GA: Gestational Age; GDM: Gestational Diabetes Mellitus; FIGO: The International Federation of Gynaecology and Obstetrics; HbA1c: Glycosylated haemoglobin; IDF: International Diabetes Federation; LDL: Low density lipoprotein; NDQIA: National Diabetes Quality Improvement Alliancel; NICE: National Institute for Health and Care Excellence; OECD: Organisation for Economic Co-operation and Development; OGTT: Oral Glucose Tolerance Test; QIH: Queen Ingrid Hospital; RCT: Randomised Controlled Tria;l T1D: Type 1 Diabetes; T2D: Type 2 Diabetes; UACR: Urine Albumin Creatinine Ratio; WHO: World Health Organisation.

Prevalence and management of patients using medication targeting obstructive lung disease: a cross-sectional study in primary healthcare in Greenland.

OBJECTIVE: The aim of this study was to estimate the prevalent use of drugs targeting obstructive lung diseases among adults aged 50 or above in Greenland and to assess the use of spirometry testing among these medication users. STUDY DESIGN: Observational cross-sectional study based on reviews of electronic medical records. METHODS: The study was performed in the 6 largest primary healthcare clinics in Greenland, representing approximately 67.0% of the population in Greenland. Adults aged 50 years or above, who had at least one electronically prescribed drug targeting obstructive lung diseases within a 15-month time interval, were identified. We assessed whether a spirometry test was registered in their medical records within previous 2- and 4-year periods. RESULTS: A total of 565 persons were identified. This corresponds to a prevalent medication use of 6.1% (565/9,023) among adults aged 50 years or above. Among these medication users, 14.1% (80/565) had a spirometry test performed within 2 years. Within the 4-year period this increased to 17.9% (101/565). CONCLUSION: The use of medication targeting obstructive lung diseases in Greenland among adults aged 50 years or above is common. However, spirometry testing among medication users is low and interventions aiming to increase focus on spirometry testing should be integrated in the primary healthcare system.