Diverse methodological approaches to a Circumpolar multi-site case study which upholds and responds to local and Indigenous community research processes in the Arctic.

This paper outlines the methodological approaches to a multi-site Circumpolar case study exploring the impacts of COVID-19 on Indigenous and remote communities in 7 of 8 Arctic countries. Researchers involved with the project implemented a three-phase multi-site case study to assess the positive and negative societal outcomes associated with the COVID-19 pandemic in Arctic communities from 2020 to 2023. The goal of the multi-site case study was to identify community-driven models and evidence-based promising practices and recommendations that can help inform cohesive and coordinated public health responses and protocols related to future public health emergencies in the Arctic. Research sites included a minimum of 1 one community each from Canada (Nunavut,) United States of America (Alaska), Greenland, Iceland, Norway, Sweden, Finland. The approaches used for our multi-site case study provide a comprehensive, evidence-based account of the complex health challenges facing Arctic communities, offering insights into the effectiveness of interventions, while also privileging Indigenous local knowledge and voices. The mixed method multi-site case study approach enriched the understanding of unique regional health disparities and strengths during the pandemic. These methodological approaches serve as a valuable resource for policymakers, researchers, and healthcare professionals, informing future strategies and interventions.

Acoustic monitoring reveals a diel rhythm of an arctic seabird colony (little auk, Alle alle).

The child-like question of why birds sing in the morning is difficult to answer, especially in polar regions. There, in summer animals live without the time constraints of daylight, and little is known about the rhythmicity of their routines. Moreover, in situ monitoring of animal behavior in remote areas is challenging and rare. Here, we use audio data from Greenland to show that a colony of a key Arctic-breeding seabird, the little auk (Alle alle), erupts with acoustic excitement at night in August, under the midnight sun. We demonstrate that the acoustic activity cycle is consistent with previous direct observations of the feeding and attendance patterns of the little auk. We interpret this pattern as reflecting their foraging activities, but further investigation on fledging and predators is needed. The study demonstrates that acoustic monitoring is a promising alternative to otherwise demanding manual observations of bird colonies in remote Arctic areas.

The prevalence and disease course of autoimmune liver diseases in Greenland.

Autoimmune liver diseases are rare serious diseases causing chronic inflammation and fibrosis in the liver parenchyma and bile ducts. Yet, the prevalence and burden of autoimmune liver diseases are largely unexplored in Arctic native populations. We investigated the prevalence and management of autoimmune liver diseases in Greenland using nationwide cross-sectional register data and subsequent medical chart reviews validating diagnoses and extracting liver histology examinations and medical treatments. The overall prevalence of autoimmune liver diseases in Greenland was 24.6 per 100,000 (95% CI: 14.7-41.3). This was based on 7 patients with autoimmune hepatitis (AIH) (12.3 per 100,000), 3 patients with primary biliary cholangitis (PBC) (5.3 per 100,000), 4 patients with AIH/PBC overlap disease (7.0 per 100,000), and no patients with primary sclerosing cholangitis. All diagnoses were confirmed by liver histology examinations. Medical treatments adhered to internal recommendations and induced complete remission in most patients with AIH, and complete or partial remission in 1 patient with PBC and 3 patients with AIH/PBC overlap disease. One patient had established cirrhosis at the time of diagnosis, while 2 patients progressed to cirrhosis. In conclusion, the prevalence of autoimmune liver diseases was lower in Greenland than in Scandinavia and among Alaska Inuit.

Reproducibility and validity of a 45 item food-frequency questionnaire for inuit in Greenland.

Since 1993, dietary assessment has been carried out in Greenland as part of recurrent population health surveys. In preparation for the next survey in 2024, 91 participants from the survey in 2018 were selected for a validation study of the Food Frequency Questionnaire (FFQ). The 91 participants were reinterviewed 38-50 months after the first FFQ and invited to complete a food diary. As part of the 2018 survey, blood was analysed for mercury. The food diary was completed by 65 participants. The agreement between the two FFQ interviews was very good for macronutrients and fatty acids (p > 0.20), whereas the calculated intake of mercury was 22% higher in the second FFQ (p = 0.04) due to a higher intake of whale meat and muktuk (whale skin). The agreement between the second FFQ and the food diary was good for local food, imported meat and cakes/sweets/snacks but fruit and vegetables, dairy products, beverages and added sugar were significantly underreported in the food diary. Food items not included in the FFQ were identified from the food diaries. The correlation between the intake of marine mammals and blood mercury was moderate (Spearman's rho = 0.41-0.50; p < 0.0001). The results will inspire future dietary studies in the circumpolar North.

The 1919-21 influenza pandemic in Greenland.

In Alaska, the 1918-20 influenza pandemic was devastating, with mortality rates up to 90% of the population, while in other arctic regions in northern Sweden and Norway mortality was considerably lower. We investigated the timing and age-patterns in excess mortality in Greenland during the period 1918-21 and compare these to other epidemics and the 1889-92 pandemic. We accessed the Greenlandic National Archives and transcribed all deaths from 1880 to 1921 by age, geography, and cause of death. We estimated monthly excess mortality and studied the spatial-temporal patterns of the pandemics and compared them to other mortality crises in the 40-year period. The 1918-21 influenza pandemic arrived in Greenland in the summer of 1919, one year delayed due to ship traffic interruptions during the winter months. We found that 5.2% of the Greenland population died of the pandemic with substantial variability between counties (range, 0.1% to 11%). We did not see the typical pandemic age-pattern of high young-adult mortality, possibly due to high baseline mortality in this age-group or remoteness. However, despite substantial mortality, the mortality impact was not standing out relative to other mortality crises, or of similar devastation reported in Alaskan populations.

Evaluation of the efficacy of a light ration adapted to cold weather during a 20-day expedition in Greenland.

INTRODUCTION: Limiting body mass loss during military expeditions/training in the cold by providing rations containing easy-to-use, highly palatable, and familiar foods is feasible, but the bulk/weight is too high to be realistically used in a military context. We carried out an analysis of lighter rations adapted to cold weather (1,011 g, 15.7 MJ/3750 kcal) during a 20-day expedition in Greenland. METHODS: Ten French soldiers daily reported all foods and beverages consumed, the reasons they did not consume certain foods, the palatability of each consumed food, the timing of intake, and the sensation of hunger using a diary. RESULTS: Although energy intake increased in the 3rd week (vs 1st week; p = 0.015), it was insufficient to prevent the loss of body mass (-4.2 ± 1.9 kg, p = 0.002). More extensive analyses showed that 1) energy intake increased only during dinner (p = 0.024) and that hunger levels continued to increase before dinner (p = 0.029), 2) palatability increased during the 3rd week (vs 1st week) especially for savory day foods (p< 0.001), and 3) lack of hunger and lack of appeal (33 % each) were the main reasons for not consuming certain items. CONCLUSION: Soldiers placed in total autonomy during a 20-day expedition in the cold and provided rations that were slightly undersized but adapted for cold conditions, surprisingly, remained picky, leading to large losses of body mass. Our results suggest a margin for improvement to stimulate spontaneous food intake. For example, more energy-dense and savory foods during the day and the replacement of certain disliked items.

Children with otitis media in Greenland - A qualitative study of parental experiences.

INTRODUCTION: The Greenlandic population has one of the world's highest prevalence of otitis media (OM). Approximately 9-14% of all children suffer from OM during childhood. Due to the climate, lack of infrastructure, and minimal access to specialist services, the Greenlandic healthcare system operates under significant challenges. To support treatment implementation, we explored parental experiences of having a child with recurrent acute otitis media (rAOM) and chronic suppurative otitis media in Greenland (CSOM). METHODS: We applied a qualitative methodology with semi-structured interviews, to investigate parents' individual experiences. We included parents from six selected towns and settlements in Greenland, who were primary caregivers to minimum one child who had suffered from rAOM or CSOM. The interviews followed a semi-structured interview guide. RESULTS: Eight interviews were conducted with ten parents (nine mothers, one father) to 13 children (nine girls, four boys) aged two to 20 years (median age five years). We carried out a hermeneutic-phenomenological, Ricoeur-inspired text analysis of data. The first episode of OM was associated with uncertainty about the condition, including pain relief and treatment. However, recurrence led to symptom recognition and a changed disease perception among the parents: from being a simple case of childhood OM to a recognition of a chronic condition that might lead to delayed linguistic development and hearing impairment. CONCLUSION: Under difficult healthcare situations, parents represented a unique resource in care and treatment implementation. Parents often feel alone with the responsibility of care and had concerns for their child's hearing and language development, and they wished for their experiences and observations to be actively included in consultations.

Lipid-based paleoecological and biogeochemical reconstruction of Store Saltsø, an extreme lacustrine system in SW Greenland.

Polar lakes harbour a unique biogeochemistry that reflects the implications of climatic fluctuations against a susceptible yet extreme environment. In addition to polar, Store Saltsø (Kangerlussuaq, southwestern Greenland) is an endorheic lake with alkaline and oligotrophic waters that host a distinctive ecology adapted to live in such particular physico-chemical and environmental conditions. By exploring the sedimentary record of Store Saltsø at a molecular and compound-specific isotopic level, we were able to understand its ecology and biogeochemical evolution upon climate change. We employed lipid biomarkers to identify biological sources and metabolic traits in different environmental samples (shore terrace, sediment core, and white precipitates at the shore), and their succession over time to reconstruct the lake paleobiology. Different molecular ratios and geochemical proxies provided further insights toward the evolution of environmental conditions in the frame of the deglaciation history of Kangerlussuaq. The relative abundance of terrestrial (i.e., plant derived) biomarkers (odd long-chain n-alkanes, even long-chain n-alkanols, and phytosterols) in the upper half of the shore terrace versus the relatively more present aquatic biomarkers (botryococcenes and long-chain alkenones) in its lower half revealed higher lake water levels in the past. Moreover, the virtual absence of organics in the deepest section of the sediment core (32-29 cm depth) suggested that the lake did not yet exist at the northwestern shore of Store Saltsø ∼5100 years ago. According to the relative abundance of lipid biomarkers detected in the adjacent section above (29-25 cm depth), we hypothesize that the northwestern shore of Store Saltsø formed ∼4900 years ago. By combining the molecular and compound-specific isotopic analysis of lipids in a ∼360 cm sedimentary sequence, we recreated the paleobiology and evolution of an extreme lacustrine environment suitable for the study of the limits of life and the effects of climate warming.

The use of artificial intelligence to assess diabetic eye disease among the Greenlandic population.

Background: Retina fundus images conducted in Greenland are telemedically assessed for diabetic retinopathy by ophthalmological nurses in Denmark. Applying an AI grading solution, in a Greenlandic setting, could potentially improve the efficiency and cost-effectiveness of DR screening.Method: We developed an AI model using retina fundus photos, performed on persons registered with diabetes in Greenland and Denmark, using Optos® ultra wide-field scanning laser ophthalmoscope, graded according to ICDR.Using the ResNet50 network we compared the model's ability to distinguish between different images of ICDR severity levels in a confusion matrix.Results: Comparing images with ICDR level 0 to images of ICDR level 4 resulted in an accuracy of 0.9655, AUC of 0.9905, sensitivity and specificity of 96.6%.Comparing ICDR levels 0,1,2 with ICDR levels 3,4, we achieved a performance with an accuracy of 0.8077, an AUC of 0.8728, a sensitivity of 84.6% and a specificity of 78.8%. For the other comparisons, we achieved a modest performance.Conclusion: We developed an AI model using Greenlandic data, to automatically detect DR on Optos retina fundus images. The sensitivity and specificity were too low for our model to be applied directly in a clinical setting, thus optimising the model should be prioritised.

Quality of care among patients diagnosed with atrial fibrillation in Greenland.

This cross-sectional study sought to assess the prevalence of atrial fibrillation (AF) diagnosis in Greenland among various age groups and examine the corresponding quality of care. We collected data from Greenland's electronic medical records and evaluated the quality of care using six internationally recommended indicators, which are: percentage of AF patients with an assessment of smoking status within the previous year, an assessment of body mass index within the previous year, assessment of blood pressure within the previous year, measurement of thyroid stimulating hormone (TSH), treatment with an anticoagulant and percentage of patients with a measurement of serum-creatinine. We found the prevalence of AF among patients aged 20 years or older in Greenland to be 1.75% (95% CI 1.62-1.88). We found an increasing prevalence of AF with age and a greater proportion of men than women until the age of 74 years. Our study suggests that the associated quality of care could be higher as the requirement of only one of the six quality indicators was met. A lack of registration may partly explain this, and initiatives to improve the quality of care are recommended.

Hospital-based antimicrobial stewardship in Denmark, Greenland and the Faroe Islands - current landscape and barriers.

OBJECTIVES: To describe the current organization and implementation of formalized, multi-disciplinary hospital-based antimicrobial stewardship (AMS) structures in Denmark, the Faroe Islands and Greenland. METHODS: A structured electronic questionnaire was sent to all trainees and specialists in clinical microbiology (N=207) and infectious diseases (N=260), as well as clinical pharmacists (N=20) and paediatricians (N=10) with expertise in infectious diseases. The survey had 30 multiple-choice, rating-scale, and open-ended questions based on an international consensus checklist for hospital AMS, adapted to a Danish context. RESULTS: Overall, 145 individual responses representing 20 hospitals were received. Nine hospitals (45%) reported a formal AMS strategy, eight (40%) a formal organizational multi-disciplinary structure and a multi-disciplinary AMS team, and six (30%) a designated professional as a leader of the AMS team. A majority of hospitals reported access to updated guidelines (80%) and regularly monitored and reported the quantity of antibiotics prescribed (70% and 65%, respectively). Only one hospital (5%) reported a dedicated, sustainable and sufficient AMS budget, three hospitals (15%) audited courses of therapy for specific agents/clinical conditions and four hospitals (20%) had a document clearly defining roles, procedures of collaboration and responsibilities for AMS. A total of 42% of all individual respondents had received formal AMS training. Main barriers were a lack of financial resources (52%), a lack of mandate from the hospital management (30%) and AMS not being a priority (18%). CONCLUSIONS: Core elements important for multi-disciplinary hospital-based AMS can be strengthened in Danish hospitals. Funding, clear mandates, prioritization from the hospital management and the implementation of multi-disciplinary AMS structures may help close the identified gaps.

Variation in Muskox (Ovibos moschatus) Guard Hair Growth Rates: Implications for Measuring Chronological Biomarkers.

Segmental analyses of hair may be useful for measuring biomarkers over several seasons to years from a single sample. To attribute hair segments to specific time periods, a known chronological marker, or a hair growth rate, is needed. We examined guard hair growth rates of captive muskoxen (Ovibos moschatus) in Fairbanks, Alaska, USA. We sought to determine if a general growth rate could be applied across muskox populations, thus facilitating the use of segmental analyses for various biomarkers. We used archived samples from 16 muskoxen that had guard hairs sampled at six, 14, and 30 wk after shaving. We measured the lengths of 10 guard hairs per sample, calculated weekly and annual growth rates, and then fitted linear mixed-effects models to assess the effect of different covariates on hair growth rate. The period in which hair had been grown had a significant effect (P<0.05) on growth rate. Extrapolated annual hair growth rates were 277±40 mm/yr (weeks 0-6), 248±47 mm/yr (weeks 7-14), and 165±36 mm/yr (weeks 15-30), with an overall average rate of 210±14 mm/yr. These rates were significantly faster than those of free-ranging Greenland muskoxen-78 mm/yr as measured by stable isotope analyses-and varied intra-annually. This suggests that a universal growth rate cannot be generalized across muskox populations and time.

"We're the very bottom, so it's going to be hard for you to 'catch any fish' around here " understanding vulnerable Greenlanders' perspectives on cancer and barriers to screening in Denmark- A qualitative study.

BACKGROUND: Cancer is a major global health concern. Unfortunately, Indigenous populations such as Greenlanders living in Denmark, face significant disparities in cancer risk, incidence, diagnosis, care quality, and outcomes. In Denmark, vulnerable Greenlanders face challenges accessing cancer screening. The aim of this study was to explore their perceptions of cancer, barriers to participation in cancer screening, and potential for developing a tailored intervention. METHODS: This qualitative study was based on participant observations and qualitative interviews. The sample comprised 46 participants from four distinct drop-in centres. Of these, 28 were vulnerable Greenlanders (19 women and 9 men), 9 were staff members (6 women and 3 men), and 6 were relatives (4 women and 2 men). The data were analysed through inductive content analysis. RESULTS: Vulnerable Greenlanders in Denmark believed they were responsible for their own health and were generally satisfied with the healthcare system. However, they found it challenging to manage their own health and many depended on support from others. Fear of cancer and death shaped their attitudes towards screening. CONCLUSION: For vulnerable Greenlanders in Denmark participation in cancer screening programmes was positively viewed for most but could be challenging. Different intervention ideas raised by the vulnerable Greenlanders, relatives and staff members could guide the development of strategies to increase participation rates.

Drivers of contemporary and future changes in Arctic seasonal transition dates for a tundra site in coastal Greenland.

Climate change has had a significant impact on the seasonal transition dates of Arctic tundra ecosystems, causing diverse variations between distinct land surface classes. However, the combined effect of multiple controls as well as their individual effects on these dates remains unclear at various scales and across diverse land surface classes. Here we quantified spatiotemporal variations of three seasonal transition dates (start of spring, maximum normalized difference vegetation index (NDVImax ) day, end of fall) for five dominating land surface classes in the ice-free Greenland. Using a distributed snow model, structural equation modeling, and a random forest model, based on ground observations and remote sensing data, we assessed the indirect and direct effects of climate, snow, and terrain on seasonal transition dates. We then presented new projections of likely changes in seasonal transition dates under six future climate scenarios. The coupled climate, snow cover, and terrain conditions explained up to 61% of seasonal transition dates across different land surface classes. Snow ending day played a crucial role in the start of spring and timing of NDVImax . A warmer June and a decline in wind could advance the NDVImax day. Increased precipitation and temperature during July-August are the most important for delaying the end of fall. We projected that a 1-4.5°C increase in temperature and a 5%-20% increase in precipitation would lengthen the spring-to-fall period for all five land surface classes by 2050, thus the current order of spring-to-fall lengths for the five land surface classes could undergo notable changes. Tall shrubs and fens would have a longer spring-to-fall period under the warmest and wettest scenario, suggesting a competitive advantage for these vegetation communities. This study's results illustrate controls on seasonal transition dates and portend potential changes in vegetation composition in the Arctic under climate change.

The exometabolome of microbial communities inhabiting bare ice surfaces on the southern Greenland Ice Sheet.

Microbial blooms colonize the Greenland Ice Sheet bare ice surface during the ablation season and significantly reduce its albedo. On the ice surface, microbes are exposed to high levels of irradiance, freeze-thaw cycles, and low nutrient concentrations. It is well known that microorganisms secrete metabolites to maintain homeostasis, communicate with other microorganisms, and defend themselves. Yet, the exometabolome of supraglacial microbial blooms, dominated by the pigmented glacier ice algae Ancylonema alaskanum and Ancylonema nordenskiöldii, remains thus far unstudied. Here, we use a high-resolution mass spectrometry-based untargeted metabolomics workflow to identify metabolites in the exometabolome of microbial blooms on the surface of the southern tip of the Greenland Ice Sheet. Samples were collected every 6 h across two diurnal cycles at 5 replicate sampling sites with high similarity in community composition, in terms of orders and phyla present. Time of sampling explained 46% (permutational multivariate analysis of variance [PERMANOVA], pseudo-F = 3.7771, p = 0.001) and 27% (PERMANOVA, pseudo-F = 1.8705, p = 0.001) of variance in the exometabolome across the two diurnal cycles. Annotated metabolites included riboflavin, lumichrome, tryptophan, and azelaic acid, all of which have demonstrated roles in microbe-microbe interactions in other ecosystems and should be tested for potential roles in the development of microbial blooms on bare ice surfaces.

No effect of snow on shrub xylem traits: Insights from a snow-manipulation experiment on Disko Island, Greenland.

Widespread shrubification across the Arctic has been generally attributed to increasing air temperatures, but responses vary across species and sites. Wood structures related to the plant hydraulic architecture may respond to local environmental conditions and potentially impact shrub growth, but these relationships remain understudied. Using methods of dendroanatomy, we analysed shrub ring width (RW) and xylem anatomical traits of 80 individuals of Salix glauca L. and Betula nana L. at a snow manipulation experiment in Western Greenland. We assessed how their responses differed between treatments (increased versus ambient snow depth) and soil moisture regimes (wet and dry). Despite an increase in snow depth due to snow fences (28-39 %), neither RW nor anatomical traits in either species showed significant responses to this increase. In contrast, irrespective of the snow treatment, the xylem specific hydraulic conductivity (Ks) and earlywood vessel size (LA95) for the study period were larger in S. glauca (p < 0.1, p < 0.01) and B. nana (p < 0.01, p < 0.001) at the wet than the dry site, while both species had larger vessel groups at the dry than the wet site (p < 0.01). RW of B. nana was higher at the wet site (p < 0.01), but no differences were observed for S. glauca. Additionally, B. nana Ks and LA95 showed different trends over the study period, with decreases observed at the dry site (p < 0.001), while for other responses no difference was observed. Our results indicate that, taking into account ontogenetic and allometric trends, hydraulic related xylem traits of both species, along with B. nana growth, were influenced by soil moisture. These findings suggest that soil moisture regime, but not snow cover, may determine xylem responses to future climate change and thus add to the heterogeneity of Arctic shrub dynamics, though more long-term species- and site- specific studies are needed.

GWAS of lipids in Greenlanders finds association signals shared with Europeans and reveals an independent PCSK9 association signal.

Perturbation of lipid homoeostasis is a major risk factor for cardiovascular disease (CVD), the leading cause of death worldwide. We aimed to identify genetic variants affecting lipid levels, and thereby risk of CVD, in Greenlanders. Genome-wide association studies (GWAS) of six blood lipids, triglycerides, LDL-cholesterol, HDL-cholesterol, total cholesterol, as well as apolipoproteins A1 and B, were performed in up to 4473 Greenlanders. For genome-wide significant variants, we also tested for associations with additional traits, including CVD events. We identified 11 genome-wide significant loci associated with lipid traits. Most of these loci were already known in Europeans, however, we found a potential causal variant near PCSK9 (rs12117661), which was independent of the known PCSK9 loss-of-function variant (rs11491147). rs12117661 was associated with lower LDL-cholesterol (ßSD(SE) = -0.22 (0.03), p = 6.5 × 10-12) and total cholesterol (-0.17 (0.03), p = 1.1 × 10-8) in the Greenlandic study population. Similar associations were observed in Europeans from the UK Biobank, where the variant was also associated with a lower risk of CVD outcomes. Moreover, rs12117661 was a top eQTL for PCSK9 across tissues in European data from the GTEx portal, and was located in a predicted regulatory element, supporting a possible causal impact on PCSK9 expression. Combined, the 11 GWAS signals explained up to 16.3% of the variance of the lipid traits. This suggests that the genetic architecture of lipid levels in Greenlanders is different from Europeans, with fewer variants explaining the variance.

Single-cell DNA from West Greenland marine sediments suggests presence of Protoperidinium tricingulatum in the Arctic.

Spiny brown dinoflagellate cysts are commonly used as sea-ice indicators in the Arctic, but their biological affinities are not well known. We present the first indication of hitherto temperate Protoperidinium tricingulatum in the Arctic based on single-cell LSU rDNA sequencing from sediments of the Disko Bay-Vaigat Sound, West Greenland. The morphological similarity of the sequenced cyst morphotype to the sea-ice indicator Islandinium? cezare morphotype 1 is striking. The morphology of the isolated cysts, as well as those observed in the total cyst assemblage following standard palynological preparation, both resemble either I.? cezare morphotype 1 or P. tricingulatum, suggesting that the specimens may in fact be close morphological variants of the same species. In addition, nine LSU rDNA sequences were obtained from morphological variants assigned to Islandinium minutum s.l.: including both subspecies minutum and subspecies barbatum. The two subspecies could not be differentiated based on partial LSU rDNA sequencing. Overall, Arctic spiny brown dinoflagellate cyst species may be morphologically more diverse and taxonomically more complex than shown earlier and further genetic and morphological studies are needed. Importantly, the value of cysts as palaeoecological indicators depends on a sound understanding of their biological affinity and taxonomy.

Flying endoscopists in the Arctic: initiatives for quality assurance of endoscopies in Greenland.

BACKGROUND: Surgical coastal expeditions (SCEs) have been organized in Greenland for many years. They aim to provide small coastal hospitals with specialist services, such as endoscopies (SCEEs), by deploying specialist personnel, surgeons, and the necessary equipment to the hospital temporarily. The purpose of this program is to increase accessibility for patients, while simultaneously reducing the costs associated with patient transport to the central hospital. METHODS: This retrospective pilot review of medical records identified quality indicators, such as bowel cleansing (BP), cecal intubation rate (CIR), and adenoma and advanced adenoma detection rates (ADR, AADR), to investigate the status and establish a system for quality monitoring of SCEsE in Greenland. RESULTS: During two SCEs (8 working days), 89 SCEE were performed at Qaqortoq and Sisimiut Hospitals. The 60 patients who underwent colonoscopy included 32 men and 28 women with a mean age of 61 years (range 24-80 years). The unadjusted CIR was 91.7%. In eight (13.3%) examinations, bowel preparation was rated as unsatisfactory, resulting in two incomplete procedures. The ADR and AADR were 35% and 11.7%, respectively, and one cancer was detected (1.7%). CONCLUSION: The results showed satisfactory ADR, AADR, and CIR levels. However, the review also highlighted the need for increased attention to BP by developing a new procedure that considers differences due to specific eating habits in Greenland and provides much better information for patients. The review provided a snapshot of the quality of colonoscopies in Greenland, highlighting the necessity to continue this process to ensure that the quality is up to standard. Furthermore, SCE helps reduce the environmental footprint of gastrointestinal endoscopy by avoiding the need for patient air transport; instead of 77 round trips (61,830 km), only 8 (6440 km) were required.

Developing the ACEIG-scale: An adverse childhood experience scale for Inuit youth in Greenland.

BACKGROUND: Adverse Childhood Experiences (ACEs) have been identified as a major public health challenge in Greenland. No previous studies have created a multi-item ACE- scale among an Arctic Indigenous population. OBJECTIVE: To develop a multi-item ACE-scale among Inuit youth in Greenland (the ACEIG scale). METHODS: The ACEIG scale was created with data from the 'Wellbeing among Inuit youth in Greenland'-survey. Scale items were based on a recognised ACE-scale and further adapted to the context of Inuit youth in Greenland by adding items relevant for the population. The scale was validated through item response theory (IRT) and reliability was assessed by Cronbach's alpha. RESULTS: Four items relevant for Inuit youth in Greenland were added to the recognised ACE scale (bullying, death of parent, gambling problems in close family, and suicide in close relations). The scale was reduced by IRT, as three items (bullying, divorce of parents and parents passing away) exceeded the difficulty index threshold. The ACEIG scale therefore consists of 10 items: alcohol problems in close family, marijuana use in close family, domestic violence, being victim of physical violence, being victim of psychological violence, any type of sexual abuse, sexual abuse (intercourse), sexual abuse (more than once), suicide in close relations, and gambling problems in close family. Cronbach's alpha was 0.7. CONCLUSION: The ACEIG scale includes 10 items with acceptable reliability. The scale can inform future screening tools to identify vulnerable youth and target interventions. Future studies should investigate the association between the ACEIG scale and health outcomes.