High selenium exposure lowers the odds ratios for hypertension, stroke, and myocardial infarction associated with mercury exposure among Inuit in Canada.

BACKGROUND: Selenium (Se) has been reported to protect against the neurotoxicity of mercury (Hg). However, the effect of Se against Hg on cardiovascular diseases remains unclear. Inuit living in the Arctic have high exposure to both Se and Hg through their marine mammal and fish rich traditional diet. OBJECTIVE: To characterize the co-exposure of Hg and Se among Inuit in Canada and to assess the associations between Hg, Se and cardiovascular health outcomes, including stroke, hypertension, and myocardial infarction (MI). METHODS: Data was collected from the International Polar Year Inuit Health Survey (IHS) conducted in 2007 and 2008. Blood Se and Hg were measured, and self-report cardiovascular health outcomes were collected through a questionnaire interview from 2169 adults aged 18 and above. RESULTS: The mean age was 42.4years, and 38.7% of the participants were male. The geometric means (GM) of blood Se and total Hg were 319.5µg/L and 7.0µg/L, respectively. The crude prevalence of heart attack, stroke and hypertension were 3.55%, 2.36%, and 24.47% respectively. Participants were categorized into 4 exposure groups according to blood Hg (high: ≥7.8µg/L; low: <7.8µg/L), and Se (high: ≥280µg/L; low: <280µg/L). The odds ratio (OR) of cardiovascular outcomes were estimated using general linearized models. Results showed the low Se and high Hg group had a higher prevalence of cardiovascular disease (OR=1.76 for hypertension, 1.57 for stroke, and 1.26 for MI. However, the prevalence was decreased in both the high Se and low Hg group (OR=0.57 for hypertension, 0.44 for stroke, and 0.27 for MI) and the high Se and high Hg group (OR=1.14 for hypertension, 0.31 for stroke, and 0.80 for MI). CONCLUSIONS: The high Se and low Hg group had the lowest prevalence of cardiovascular outcomes, except for stroke. These results provide evidence that Se may exhibit a protective effect against Hg on cardiovascular disease.

Taima (stop) TB: the impact of a multifaceted TB awareness and door-to-door campaign in residential areas of high risk for TB in Iqaluit, Nunavut.

BACKGROUND: The incidence rate of active tuberculosis (TB) disease in the Canadian Territory of Nunavut has shown a rising trend over the past 10 years. In 2010 it was 60 times greater than the national incidence rate. The objective of the Taima (translates to "stop" in Inuktitut) TB study was to implement and evaluate a public health campaign to enhance existing TB prevention efforts in Nunavut. METHODS: A TB awareness campaign followed by a door-to-door screening campaign was carried out in Iqaluit, Nunavut. The aim of the campaign was to raise awareness about TB, and to provide in-home screening and treatment for people living in residential areas at high risk for TB. Screening was based on geographic location rather than on individual risk factors. RESULTS: During the general awareness campaign an increase in the number of people who requested TB testing at the local public health clinic was observed. However, this increase was not sustained following cessation of the awareness campaign. Targeted TB screening in high risk residential areas in Iqaluit resulted in 224 individuals having TSTs read, and detection of 42 previously unidentified cases of latent TB, (overall yield of 18.8% or number needed to screen = 5.3). These cases of latent TB infection (LTBI) were extra cases that had not been picked up by traditional screening practices (34% relative increase within the community). This resulted in a 33% relative increase in the completion of LTBI treatment within the community. The program directly and indirectly identified 5/17 new cases of active TB disease in Iqaluit during the study period (29.5% of all incident cases). CONCLUSIONS: While contact tracing investigations remain a cornerstone of TB prevention, additional awareness, screening, and treatment programs like Taima TB may contribute to the successful control of TB in Aboriginal communities.

Design and methods of the Adult Inuit Health Survey 2007-2008.

BACKGROUND: The Canadian International Polar Year (IPY) program made it possible to undertake much needed health research in 3 jurisdictions within the Canadian Inuit Nunangat (homeland) over a 2-year period: Inuvialuit Settlement Region (ISR), Nunavut Territory, and Nunatsiavut. DESIGN: The Adult Inuit Health Survey (IHS) was a cross-sectional survey and provides baseline data upon which future comparisons can be made for prospectively assessing factors leading to the progression of chronic diseases among Canadian Inuit. With the help of the Canadian Coast Guard Ship Amundsen, which was equipped with research and laboratory facilities, 33 coastal communities were visited; land survey teams visited 3 inland communities. RESULTS: The Adult IHS succeeded in obtaining important baseline information concerning the health status and living conditions of 2,595 adults living in ISR, Nunavut and Nunatsiavut. CONCLUSION: Information from this survey will be useful for future comparisons and the opportunity to link with the International Inuit Cohort, a follow-up evaluation, and for the development of future health policies and public health interventions.

Primary birthing attendants and birth outcomes in remote Inuit communities--a natural "experiment" in Nunavik, Canada.

BACKGROUND: There is a lack of data on the safety of midwife-led maternity care in remote or indigenous communities. In a de facto natural "experiment", birth outcomes were assessed by primary birthing attendant in two sets of remote Inuit communities. METHODS: A geocoding-based retrospective birth cohort study in 14 Inuit communities of Nunavik, Canada, 1989-2000: primary birth attendants were Inuit midwives in the Hudson Bay (1529 Inuit births) vs western physicians in Ungava Bay communities (1197 Inuit births). The primary outcome was perinatal death. Secondary outcomes included stillbirth, neonatal death, post-neonatal death, preterm, small-for-gestational-age and low birthweight birth. Multilevel logistic regression was used to obtain the adjusted odds ratios (aOR) controlling for maternal age, marital status, parity, education, infant sex and plurality, community size and community-level random effects. RESULTS: The aORs (95% confidence interval) for perinatal death comparing the Hudson Bay vs Ungava Bay communities were 1.29 (0.63 to 2.64) for all Inuit births and 1.13 (0.48 to 2.47) for Inuit births at > or =28 weeks of gestation. There were no statistically significant differences in the crude or adjusted risks of any of the outcomes examined. CONCLUSION: Risks of perinatal death were somewhat but not significantly higher in the Hudson Bay communities with midwife-led maternity care compared with the Ungava Bay communities with physician-led maternity care. These findings are inconclusive, although the results excluding extremely preterm births are more reassuring concerning the safety of midwife-led maternity care in remote indigenous communities.

Iron deficiency and anemia prevalence and associated etiologic risk factors in First Nations and Inuit communities in Northern Ontario and Nunavut.

BACKGROUND: Anemia is common among children in Aboriginal communities in Canada. The objectives of this study were to determine the prevalence of anemia and to identify its associated risk factors among young children in Aboriginal communities in northern Ontario and Nunavut. METHODS: 115 children from one Inuit and two Cree First Nations communities participated. We collected information on demographic and dietary factors and measured hemoglobin (Hb), ferritin (SF), serum transferrin receptor (sTfR) and Helicobacter pylori IgG antibodies. Odds ratios and 95% confidence intervals were determined to examine risk factors associated with anemia and iron deficiency (ID) and further analyzed using stepwise regression procedures. RESULTS: Prevalence of anemia (Hb<110 g/L) was 36.0%. Iron deficiency (sTfR>8.5 mg/L) was present in 27.6% of the study population. Approximately 53.3% had depleted iron stores (SF<12 microg/L). Consumption of cow/evaporated milk was the only independent risk factor associated with anemia. Infection with H. pylori and prolonged consumption of breastmilk were also associated, although not independently, with anemia. Formula intake was negatively associated with ID. INTERPRETATION: The prevalence of anemia in Aboriginal children was eight times higher than among similar populations in urban Canada and was especially high among Inuit children. ID was the major cause of anemia, but not the only one, since 10% of anemic children were not iron deficient. Given that the consumption of cow/evaporated milk was found to be a significant independent risk factor associated with anemia, public health strategies should include promotion of breastfeeding, combined with iron-rich complementary foods, while addressing socio-economic conditions that may be preventing these practices from being adopted. H. pylori may be a major contributing factor to anemia, thus improvements in water quality and sanitation also need to be considered.

Isumagijaksaq: mindful of the state: social constructions of Inuit suicide.

Inuit suicide is the most significant mental health issue in the newly created Nunavut Territory of Canada's eastern Arctic. Suicide rates in Nunavut are 6 times those of Canada's southern provinces. Consistent with other Canadian populations, males aged 15-29 years of age are most at risk. Various social constructions have been used to make sense of Inuit suicide, a phenomenon of historical interest to anthropologists, who popularized the idea of elderly Inuit voluntarily abandoning their lives to the elements so as not to burden their surviving relatives. An examination of the literature and research dealing with Inuit suicide suggests that three typologies have typically been used to explain the problem: organic or quasi-organic explanations, social explanations involving concepts of social change and social disruption, and socio-psychological models of two types; a risk assessment approach focusing on the circumstances surrounding the deceased or the person with suicidal thoughts and another dealing with norms, values, thought processes and relationships within Inuit culture. We argue that these approaches offer incomplete explanations of the current problem. Attempts to complete the picture by identifying risk factors have produced contradictory and unsatisfactory results. We conclude that the impact of colonial relations of ruling has much to do with the current problem and advocate an approach that combines narrative research and intergenerational communication with community action to address the problem. Low Inuit inuusittiaqarniq (self-esteem) is an important factor in Inuit suicide, but rather than a psychological problem, has its roots in a history of colonialism, paternalism and historical events.