15th International Congress On Circumpolar Health M CO

Transcription

15th International Congress
On Circumpolar Health
Call
Congress | August
5-10, 2012 | Fairbanks, AK, USA
15THToINTERNATIONAL
CONGRESS
ON CIRCUMPOLAR HEALTH
WWW.ICCH15.COM
C/O VISIONS MEETING & EVENT MANAGEMENT
999 E. TUDOR RD., STE. 200
ANCHORAGE, AK 99503
CALL TO CONGRESS:
THEME
Circumpolar Health Comes Full Circle
WHEN
August 5–10, 2012
WHERE
Fairbanks, Alaska, USA
WEBSITE
www.icch15.com
15TH INTERNATIONAL CONGRESS
ON CIRCUMPOLAR HEALTH
ABSTRACT BOOK
AUGUST 5–10, 2012 | FAIRBANKS, AK, USA | WWW.ICCH15.COM
Supported
By:
SponsoRED BY:
Jointly
Organized
Jointly
organizedBy:
by:
International Union for
Circumpolar Health
Cover photo © Fairbanks Convention & Visitors Bureau
Table of Contents
Monday Oral Presentations. . . . . . . . . . . . . . . . . . . . Pages 11-25
15:30 - 17:00
Chronic Diseases #1 - Cancer 1
Trends in Mucosal Head and Neck Cancer in
Alaska Native People. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
HPV and Oropharyngeal Cancer in Greenland. . . . . . . . . . . . . . . . . . . 11
HPV Genotypes Detected in Cervical Cancers from
Alaska Native Women, 1980-2007. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Engaging First Nations Women in the Development of
Culturally Safe Human Papillomavirus Screening. . . . . . . . . . . . . 12
Evaluation of Serum Procathepsin B and Cystatin B as
Possible Biomarkers of Ovarian Cancer. . . . . . . . . . . . . . . . . . . . . . . 12
Primary Care Provider Follow Up Attitudes After Abnormal
PSA in Alaska’s Frontier. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Research in the North #1 - Regional Health Status
Health Systems Serving Inuit Communities Across the Arctic. . . . 13
Health and Mental Health of Young Aboriginal Children
Living Off Reserve in Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Trends in Mortality Among Alaska Native People: 1980-2008. . . . 14
The Mortality Rate Of The Working Age Population In
The Republic of Sakha (Yakutia) As a Result Of The
Social Hygiene Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Health Status of Children in Republic Sakha (Yakutia) . . . . . . . . . . . 15
Healthy Families #1 - Injury Epidemiology and Interventions
Toward Successful Aging
The RISC Project: Injury in Aboriginal Communities in
British Columbia, Canada. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Osteoporosis is Common in Old Age in Greenland and
Treatment is Scarce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Successful Aging Through the Eyes of Alaska Natives:
Exploring Generational Differences Among Alaska Natives . . . 16
Spatio-Temporal Analysis of Non-Fatal Falls in Alaska,
1991 - 2009. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Alaska Strong Women Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Health Services #1 - Rural Workforce
Innovative Primary Care Delivery in Rural Alaska: A
Review of Patient Encounters Seen by Community
Health Aides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
True Value and Values the Use of Available Human
Resuorces to Meet Health Care Needs. The Community
Health Aide Program, Dental Health Aide Therapists
and Behavioral Health Aides. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Building a Program to Support Nursing Practice in
Remote Northern Settings in Quebec. . . . . . . . . . . . . . . . . . . . . . . . 18
The Characteristics of Arctic Nursing in Greenland. . . . . . . . . . . . . . 18
Behavioral Health #1 - Tobacco
Growing Up Tobacco-Free In Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Smoking Cessation in Nunavut, Canada: What Do Inuit
Have to Say About Quitting?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
The Significance of Smoking on Daily Life in a Greenland
Village - Interview with Smokers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Contrasting Social Norms and Policies Around
Secondhand Smoke in Different Regions of Alaska. . . . . . . . . . . 20
Distance Education for Tobacco Reduction with Inuit
Frontline Health Workers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Infectious Diseases #1 - Respiratory Infections
Response of Aboriginal Infants to Pertussis Vaccine
Components: Results of a Controlled Comparison Study. . . . . . 21
Changes in Seasonality of Respiratory Syncytial Virus
(RSV) in a Southwest Region of Alaska (1994-2010). . . . . . . . . . . 21
Risk Factors for Respiratory Viral Infections in Children
in Greenland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Lower Respiratory Tract Hospitalizations in Alaska Native
Children Compared with Other American Indian/Alaska
Native Children and the General US Child Population. . . . . . . . . 22
The Cost of Lower Respiratory Tract Infections Hospital
Admissions in the Canadian Arctic. . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Nutrition #1 - Diet, Nutrition and Health: Cardiovascular
and Diabetes
Arctic Medical Health, Disease and Nutrition: The Challenges
and the Joys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Healthy Communities #1 - Climate Change Processes
Assessing the Effects of Climate Change on Health and
Lifestyle in Sub-Arctic Areas in Sweden - The Northern
Sweden Population Health Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
The Local Environmental Observer Program (LEO) A
Community-Based Network for Surveillance of
Climate Change Effects on Public Health. . . . . . . . . . . . . . . . . . . . . 24
Community-Based Sentinel Surveillance Informs
Climate Change Adaptation in Alaska. . . . . . . . . . . . . . . . . . . . . . . . 24
Animistic Pragmatism and Native Ways of Knowing:
Adaptive Strategies for Responding to Environmental
Change and Overcoming the Struggle for Food in
the Arctic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Climate Change and Potential Health Impacts of Infectious
Diseases in the Circumpolar North: Formation of an
International Circumpolar Surveillance Climate Change
and Infectious Disease Working Group . . . . . . . . . . . . . . . . . . . . . . 25
Tuesday Oral Presentations . . . . . . . . . . . . . . . . . . . Pages 26-44
10:30 - 12:00
Innovative Approaches to Colorectal Cancer Screening in a
High Risk Population of Alaska Native People . . . . . . . . . . . . . . . . 26
Cystatin C and Lactoferrin Concentrations in Biological
Fluids as Possible Prognostic Factors in Eye Tumor
Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
The Incidence Rate and Risk Factors of Gastric Cancer
in Siberian Population. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
40-Year Trends in Cancer Incidence Among Alaska Native
People, 1969-2008 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Readers’ Theatre: A Communication Tool for Colorectal
Cancer Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Behavioral Health #2 - Alcohol Use, Policy and Prevention
Association of ADH1B, ADH1C, PDYN and DRD4
Gene Polymorphisms with Alcoholism in Russian
Population of West-Siberian Region. . . . . . . . . . . . . . . . . . . . . . . . . . 28
Violence and Alcohol Related Emergencies in the
Greenlandic Health Care System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Attitudes Toward Harm Reduction and Abstinence-Only
Approaches to Alchohol Misuse Among Alaskan
College Students. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Towards an Evaluation Framework for Community-Based
FASD Prevention and FASD Support Programs . . . . . . . . . . . . . . . 29
Do Local Alcohol Prohibition Policies Reduce Alcohol-Related
Harm in Remote Indigenous Communities?. . . . . . . . . . . . . . . . . . 29
Alcohol Policy in Canada’s North: Implications for
FASD Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
History/Anthropology - History/Anthropology
Control, Convenience and Profit: Applying the Western Diet
to Inuit Populations in the Eastern Arctic, 1935-1959 . . . . . . . . . 30
Quality and Quantity of Food Served in Alaska Territorial
Hospitals and Orphanages, 1948-1950. . . . . . . . . . . . . . . . . . . . . . . 30
Health Aspects of Arctic Exploration: Based on the Research
Files of Dr. Robert Fortuine Donated to the University
of Alaska Anchorage Consortium Library in 2006. . . . . . . . . . . . . 31
Healthy Families #2 - Child and Adolescent Health
The Silent Infection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Youth Challenges and Resilience: Story Themes from
Young People in Rural Alaska. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
“You Don’t Have to Look Pretty for Whales:” Youth Resilience
and Strength in a Contemporary Yup’ik Context in Alaska. . . . . 32
1
Table of Contents
Pathway to Hope: Healing Child Sexual Abuse in Tribal
Communities - An Alaska Native Curriculum Addressing
Multigenerational Trauma Through Community
Empowerment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Infectious Diseases #2 - Tuberculosis
Genetic Susceptibility to Tuberculosis in Greenland Use of the Greenlandic Family Relations Database. . . . . . . . . . . . 33
Programme Implications of Genomic Epidemiologic
Analysis of Tuberculosis Transmission Patterns . . . . . . . . . . . . . . . 34
Tuberculosis as Cause of Death – Do Patients Die of or
With TB in Greenland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Elevated Rates of Tuberculosis in First Nations and Inuit
Communities in Canada - A Public Health Crisis . . . . . . . . . . . . . . 34
The Epidemiology of Tuberculosis in Alaska, 2000-2010. . . . . . . . . 35
Tuberculosis in Greenland - Current Situation. . . . . . . . . . . . . . . . . . . 35
Healthy Communities #2 - Communicating Environmental
Health Threats
In Search of Health Effects of a Plane Crash with Nuclear
Weapons in 1968 Near Thule Air Base, Greenland. . . . . . . . . . . . . 36
The Northway Wild Food and Health Project: a Pilot Study
of Local Resources, Their Uses, and Health Along the
Alaska Highway. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Managing Environmental Risks: MeHg Contamination in
Subsistence Fish and the Case for a Place-Based Approach . . . 37
Densely Woven Adversities: Sociotoxicology of Lead
Exposure in Mining Communities. . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Risk Communication and Trust in Decision-Maker Action: A Case
Study of the Giant Mine Remediation Plan. . . . . . . . . . . . . . . . . . . 37
Climate Change and Contaminants: Environment Impacts
That Affect Inuit Health and Wellbeing. . . . . . . . . . . . . . . . . . . . . . . 38
Research in the North #2 - Community-Based
Invervention Research
Commonalities in Coping with Stressful Situations Across
Alaska Native Culture, Geography, and Context . . . . . . . . . . . . . . 38
The Meaning of Coping in Yup’ik Communities Facing
Rapid Cultural Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Moving from Understanding to Intervention: Dissemination
and Community Planning in Rural Yup’ik Communities. . . . . . . 39
Responsible and Ethical Conduct of Research with Indigenous
Populations: Listening to the Voices of the People. . . . . . . . . . . . 39
Health Services - Workforce Development
“It’s Our Voices” Cancer-Related Digital Stories by Alaska’s
Community Health Workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Adapting Online Learning for Canada’s Northern Public
Health Workforce. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Developing a Blended Face-to-Face/Virtual Self-Directed
Learning Community among Alberta First Nations
Health Promoters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
‘Double Culturedness’ a Pre-Requisite for Inuit Nurses. . . . . . . . . . . 41
Specialist Education for Medical Doctors in Greenland. . . . . . . . . . 42
The Manitoba Network Environment for Aboriginal Health
Research (NEAHR) Program: Building Research Capacity
in Indigenous Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Nutrition #2 - Food Security: Problems & Solutions 1
An Integrative Approach to Food, Culture, and
Human Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Understanding Food Security in Rural Alaska . . . . . . . . . . . . . . . . . . . 43
Food Insecurity and Perceived Health in
Greenlandic Schoolchildren. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Hunger in Urban Alaska: The Daily Lives of Pantry Users. . . . . . . . . 43
The Boy Who Wanted Moose Soup: Bridging the Cultural
Food Gap. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
2
Tuesday Oral Presentations . . . . . . . . . . . . . . . . . . Pages 44-61
15:30 - 17:00
Chronic Diseases #3 - Body Weight, Metabolic Syndrome,
and Youth
Prenatal and Early Life Risk Factors for Obesity at Age 3 in
Alaskan Children from the PRAMS 2005-6 and
CUBS 2008-9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Comparison of Stature and Obesity Among Preschool-Age
Children Living in Canada and Greenland Using CDC,
IOTF and WHO Cutoffs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Immune Pathology of Type 2 Diabetes in First Nation Youth. . . . . 45
Cytokine Responses in Relation to Chronic infection and
BMI Among Inuit in Greenland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Prenatal and Early Life Risk Factors Birth Weight and Risk
of Diabetes Among Greenland Inuit . . . . . . . . . . . . . . . . . . . . . . . . . 46
Behavioral Health #3 - Mental Wellness
Consequences of Energy Drink Use Among Native and
Non-Native Alaskan College Students. . . . . . . . . . . . . . . . . . . . . . . . 46
The Adolescent´s Experience of Loneliness and its
Associations with Self-Rated Health and Well-Being.
Northern Finland Birth Cohort Study 1986. . . . . . . . . . . . . . . . . . . 47
“Meahcceterapiija”, Adapting Family Treatment to an
Indigenous Sami Population. Camping Out With
the Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Sami Value Patterns. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Inuit Wellness In Action: An Update on the Alianait
Mental Wellness Action Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Healthy Communities #3 - Health Impact Assessments
Health Impact Assessment: The North Slope Experience. . . . . . . . . 48
Community Initiated Health Evaluation – A
Collaborative Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Impact of Recurrent Natural Disasters in Mongolia:
Dzuds and Nomadic Herders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Institutionalization of Health Impact Assessment in Alaska. . . . . . 49
Enhancing Health Impact Assessment Methodologies for
Polar Communities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Infectious Diseases #3 - The Pneumococcus
Invasive Pneumococcal Disease Epidemiology in the
Canadian North, 2000 to 2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Molecular Epidemiology of Invasive Pneumococcal Disease
Due to Serotype 19A in Alaska: 1986-2010. . . . . . . . . . . . . . . . . . . 51
General Morbidity as Risk Factor for Invasive Pneumococcal
Disease in Greenlanders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Pneumococcal Antibodies in Dried Blood Spot Samples
as a Method for Large-Scale Sero-Surveillance . . . . . . . . . . . . . . . 51
Antibiotic Prescription, Vaccine Use, Serotype Distribution
and Antimicrobial Resistance of Nasopharyngeal
Streptococcus Pneumoniae Over 10 Years in Four
Villages in Rural Alaska. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Health Services #3 - Medical Services
Culturally and Linguistic Adjusted Health Services for the
Indigenous Sami Population in Norway. . . . . . . . . . . . . . . . . . . . . . 52
Frequent Use of Primary Health Care Service in Greenland:
An Opportunity for Case-Finding. . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Health & Medical Response to the 2011 Kuskokwim River
Flooding in Crooked Creek, AK. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Application of Quality Measures Improves Transfusion
Service Documentation in Rural Alaska . . . . . . . . . . . . . . . . . . . . . . 53
First Nations Governance and Management of a Regional
Physician Services Model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Tribal Implementation of Patient-Centered Medical Home
Model in Alaska Accompanied by Decreased Emergency
Room Visits and Hospitalizations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Research in the North #3 - Community Engagement in Research
Community Members as Co-Researchers: Building Stronger
Connections in a Community-University Partnership. . . . . . . . . 55
Table of Contents
Storytelling in a Digital Age: Digital Storytelling as an
Emergent Participatory Narrative Method for
Climate-Health Research and Promotion. . . . . . . . . . . . . . . . . . . . . 55
Using Community-Based Participatory Research Design and
Indigenous Methodology to Improve Diabetes Treatment
and Care for Aboriginal People in Fort Smith, NWT. . . . . . . . . . . 56
Everyday Life of Reindeer Herding. Building a Research
Study Regarding Factors that May Affect Mental Health
in the Sámi Reindeer Herder Population of Norway. . . . . . . . . . . 56
Climate Change and Impact on Communities,
Community-Based Research Project with Elders and Youth . . . 56
Healthy Families #3 - Social Determinants in Maternal Health
Women`s Health in the Norwegian High North . . . . . . . . . . . . . . . . . 57
Social Determinants of Inuit Women’s Sexual & Reproductive
Health: Community Based Research on the Tundra. . . . . . . . . . . 57
Learning To Mother Then and Now: A Review of Maternal
Socialization in Arctic Villages of Northwest Alaska. . . . . . . . . . . 58
Development of an Online Prenatal Health Magazine for
Expecting Parents in Nunavut, Canada. . . . . . . . . . . . . . . . . . . . . . . 58
Women’s Perspective on Illness in Being Screened for
Cervical Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Nutrition #3 - Food Security, Culture and Human Health: Problems
and Solutions 2
Food Security in Alaska: Challenges, Opportunities, and
Benefits of Local Food Production and Distribution. . . . . . . . . . . 59
An Inuit Perspective on Food Security in the Alaska Arctic:
Building a Framework on How to Assess Change in
the Arctic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Food Security in the Kenai Peninsula of Alaska: What
Role for Locally Caught Seafood?. . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Gathering Strength: Collaborative Action and Evidence
Based Strategies Targeting the Issue of Food Insecurity
in Nunavut. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Bridging Perspectives of Communities, Research, Policy and
Practice to Improve the Food Security of Aboriginal People
in Canada. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Wednesday Oral Presentations. . . . . . . . . . . . . . . . . . . . . . Pages 61-82
10:30 - 12:00
Chronic Diseases #4 - Body Weight, Metabolic Syndrome
and Youth
Diabetes and Metabolic Syndrome in a Multiethnic
Population in Northern Norway. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Diabetes is a Risk Factor for Tuberculosis in the Inuit
Population of Greenland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Genetic Polymorphisms in Carnitine Palmitoyltransferase
1A Gene Are Associated with Variation in Body
Composition and Fasting Lipid Traits in Yup’ik Eskimos . . . . . . . 62
Modifiable Risk Factors for Non-Traumatic Lower
Extremity Amputations Among Alaska Native People
with Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
ANTHC Diabetes: A Model for Integrated Diabetes
Prevention and Care in Alaska. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Prevalence of Obesity and Associated Metabolic Factors
Among Alaska Native People: The Western Alaska Tribal
Collaboration for Health (WATCH) Study . . . . . . . . . . . . . . . . . . . . . 63
Research in the North #4 - Research Methods 1
Describing an Approach to Multi-Site, International,
Interdisciplinary and Participatory Research: Methods Used
in Circumpolar Indigenous Pathways to Adulthood (CIPA) . . . . 63
Are You Rich?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
“What Makes Life Good?” Understanding and Developing a
Quality of Life Measure for Alaska Native UAF Students
Using a Strengths-Based & Collaborative Approach. . . . . . . . . . . 64
A Collaborative Approach to Community-Based Subsistence
Use Surveys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Are We Measuring the Right Things in the Right Ways?
Local Perspectives on the Influence of Environment on
Community Health in Northern Saskatchewan, Canada.. . . . . . 65
Traditional Healing #2 - Oral Abstracts
“I Believe in God and I Believe in Our Own Powers and the
Native Ways”: Understanding the Significance of Culture
and Tradition to Alaska Native Cancer Survivorship. . . . . . . . . . . 66
Living Crystals of Tundra. Kamlanie (Throat Singing) of
Itelmen Shamans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Brightening Our Home Fires. Photovoice on
Women’s Wellness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Culturally Appropriate Cancer Support - Healing Circle for
Alaska Native Cancer Survivors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Health Services #4 - Health Policy
The Circumpolar Health Systems Review - Next Step. . . . . . . . . . . . 68
The Health Care Reform - The Necessary Change. . . . . . . . . . . . . . . . 68
Policy Development As A Reference Tool For
Partnership Development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Inuit Language Legislation and Health Service Provision for
Pharmaceutical Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Consultation and Remediation in the North: Meeting
International Commitments to Safeguard Health
and Well-Being. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
“Sámi Dearvvašvuodasiida” - Bringing Together Specialist
Health Services for Sami People Under One Roof. . . . . . . . . . . . . 70
Behavioral Health #4 - Domestic Violence
Intimate Partner Violence in the Canadian Circumpolar
North: Perspectives from a Literature Review and a Media
Watch in the Northwest Territories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Friendships & Dating: Preventing Interpersonal Violence for
Adults with Developmental Disabilities in Alaska. . . . . . . . . . . . . 70
Inflicted Head Trauma Among Children in Alaska: A
Population-Based Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Maternal Screening for Domestic Violence in the Pediatric
Setting: Physicians’ Practices and Perspectives . . . . . . . . . . . . . . . 71
The Healing Constellation: A Framework for Understanding
and Trauma in Alaska Native Women. . . . . . . . . . . . . . . . . . . . . . . . . 72
Healthy Native Families: Preventing Violence at All Ages . . . . . . . . 72
Nutrition #4 - Changing Diets: Nutrition and Assessment
Traditional Food Activity Workbook for Alaska Native Youth. . . . . 72
Dietary Intake of Vitamin D in a Northern Canadian Dene First
Nation Community. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Younger Inuit Adults and Preschoolers Have Lower
Traditional Food and Vitamin D intake which reflects in a
Lower Vitamin D Status Compared to Older Adults. . . . . . . . . . . 73
Greater Consumption of Polyunsaturated Fatty Acids are
Related to Increased Lean Mass and Decreased Visceral
Adiposity in a Multi-Ethnic Sample of Children. . . . . . . . . . . . . . . 74
Quantifying Dietary Intake Among Yup’ik Eskimos Using
Factor Analysis of Food Frequency Questionnaires . . . . . . . . . . . 74
Infectious Diseases #4 - Helicobacter pylori
H. Pylori-Associated Disease Burden in a Northern
Canadian Community: Comparing Medical Records and
Community-Based Screening. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Prevalence of Helicobacter Pylori and Atrophic Gastritis in
the Population of the Industrial Center of Eastern Siberia. . . . . 75
Hygienic Behaviors and Prevalence of Helicobacter Pylori
Infection in Aklavik, Northwest Territories, Canada . . . . . . . . . . . 75
Adherence and Barriers to H. pylori Treatment in Arctic
Canada: Preliminary Findings from a Randomized Trial . . . . . . . 76
Is There a Need for a Multicenter Arctic Study of Helicobacter
Pylori Infection and Gastric Cancer?. . . . . . . . . . . . . . . . . . . . . . . . . . 76
Problems with the Epidemiologic Transition Model:
Structural Inequality, H. Pylori Bacteria, and Stomach
Diseases in Aklavik, NWT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
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Table of Contents
Healthy Families #4 - Women’s Healthcare Through the Continuum
Factors Influencing Red Blood Cell Folate levels of Canadian
Inuit Women of Child Bearing Years: Results from the
2007-2008 Inuit Health Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Prenatal Alcohol Exposure among Alaska Native /
American Indian Infants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Maternal Overweight or Obesity and Prenatal Weight
Gain in Alaska, 2009-2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Dietary Intakes of Energy and Macronutrients by Lactating
Women of Different Ethnic Groups Living in Yakutia. . . . . . . . . . 78
Incidence of Postpartum Depressions in Nuuk; Greenland. . . . . . . 79
Reproductive Health Factors Among Alaska Native Women:
The Alaska Education and Research Towards Health
(EARTH) Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Healthy Communities #4 - Climate Change Effects
Tundra Warming and Access to Primary Care Services by the
Native Reindeer Herders in the Russian Arctic. . . . . . . . . . . . . . . . 80
Morbidity and Mortality Associated with Unintentional Falls
Through the Ice in Alaska. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Examining the Climatic and Environmental Determinants of
Mental Health: A Case Study from Nunatsiavut, Labrador,
Canada. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Facing the Limit of Resilience: Perceptions of Climate Change
Among Reindeer Herding Sami in Sweden. . . . . . . . . . . . . . . . . . . 81
Comparing Perceptions of Climate Change to Observational Data
from the Sami Region of Northern Sweden . . . . . . . . . . . . . . . . . . . . . 81
Wendesday ORal Presentations . . . . . . . . . . . . . . Pages 82-101
15:30 - 17:00
4
Chronic Diseases #5 - Cardio-pulmonary Disease 1
Major Depression Predicts 16-years Risk of Myocardial
Infarction Incidence in Russian Female Population . . . . . . . . . . . 82
Evolution and Clinical Characteristics of Coronary
Atherosclerosis in Natives of North Asia. . . . . . . . . . . . . . . . . . . . . . 82
Clinical and Instrumental Parameters Patients with
Coronary Atherosclerosis Indigenous and Non-Indigenous
Inhabitants of Yakutia (The North-Eastern Part of Siberia). . . . . 83
Cold-Related Cardiorespiratory Symptoms Among Subjects
With and Without Hypertension: The National Finrisk
Study 2002. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Coronary Heart Disease and Hyperlipidemia Were
Associated with NAFLD in Siberia. Results of Open
Multicenter Prospective Study DIREG_L_01903. . . . . . . . . . . . . . . 84
Healthy Communities #5 - Residential Environmental Health
Indoor Air Quality in Rural Alaskan Homes. . . . . . . . . . . . . . . . . . . . . . 84
Bedbugs in the Last Frontier: Strategies, Challenges, and
Opportunities for Collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Sustaining Access to Safe Drinking Water and Sanitation for
Promoting Local Well-Being in Alaska Native Villages. . . . . . . . . 85
Exploring Alternatives to Regulating Small Drinking Water
Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Washeteria Closures, Infectious Disease, and Community
Health in Rural Alaska A Review of Clinical Data in
Kivalina, Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
The State of Health Hardware in Housing for Aboriginal
Australians - Just More Houses is Not Enough. . . . . . . . . . . . . . . . 86
Health Services #5 - Mental Health Services
Culturally Appropriate Mental Health Services in
Canada’s North. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
The Ethical Toolkit: Medical Morality and the Local
Worlds of Indigenous Front-Line Health Care. . . . . . . . . . . . . . . . . 87
Ayaangwaamiziwin: A First Step Toward Making First
Nations Communities Healthier. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Academic-Community Partnerships in Rural and Frontier
Communities: Improving Services for Children with
Autism and Other Developmental Disabilities in Alaska. . . . . . . 88
Informal and Formal Mental Health and Wellness Support
in the North: Qualitative Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Informal and Formal Mental Health Support in the North:
Survey Phase. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Healthy Families #5 - Preventing Infant Mortality
Dying to Be Counted: Challenging Indigenous Infant
and Child Mortality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Postneonatal Mortality Among Alaska Native Infants -Alaska, 1989-2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Understanding the Causes of Infant Mortality in Nunavut. . . . . . . 90
The Healthy Native Babies Project. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Carnitine Palmitoyltransferase 1A p.P479L Variant and
Unexpected Infant Death in Nunavut, NWT and Yukon . . . . . . . 91
Evidence for an Association Between Infant Mortality
and Homozygosity for a Carnitine Palmitoyltransferase 1
A Genetic Variant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Nutrition #5 - Changing Diets: Measurements and Risks
The Changing Face of Subsistence in Polar Communities:
Methodologies for Assessing Health Related Effects. . . . . . . . . . 92
Stable isotope Biomarkers of Traditional and Market Food
Intake in the Yup’ik Eskimo Population: The CANHR
Stable Isotope Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Alanine Stable Carbon Isotope Ratios in Human RBC: a
Powerful New Biomarker of Sugar-Sweetened Beverage
(SSB) Intake. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Vitamin D Concentrations and Functional Polymorphisms
in the Vitamin D Binding Protein (VDBP) and the Vitamin D
Receptor (VDR) in a Northern Canadian Dene Population. . . . . 93
Dermal Vitamin D Production Suggested in Man at 70oN. . . . . . . . 93
Infectious Diseases #5 - Sexually Transmitted Infections
Sexually Transmitted Infection Screening Practices Among
Physicians and Community Nurses in Yukon, Canada. . . . . . . . . 94
Different Boats for Different Folks: HPV Related Disease
Prevention Equity for Indigenous Peoples Globally. . . . . . . . . . . 94
The HPV Vaccine: Knowledge, Attitudes, and Perceptions
of Alaska Native Parents and Daughters. . . . . . . . . . . . . . . . . . . . . . 94
A Pilot Study of Ciprofloxacin Resistant Neisseria
Gonorrhoeae in the Population of Nuuk, Greenland. . . . . . . . . . 95
‘I Want the Kit’ - Free At-Home STD Testing in Urban
and Rural Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
“If I Had a Hammer...”: Tools for HIV/Sexually Transmitted and
Blood Borne Infection (STBBI) Outreach Program Planners. . . . 96
Healthy Communities #6 - Occupational Health 1
Work-Related Fatalities in Alaska: Two Decades. 1990-1999,
and 2000-2009. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Nomadic Herder Children’s Injuries in Mongolia. . . . . . . . . . . . . . . . . 97
Mechanisms of Regulation and Interaction of
Pituitary-Adrenal and Pituitary-Thyroidal Systems in
Healthy Men and Men with Vibration Disease. . . . . . . . . . . . . . . . 97
Occupational Safety and Health of Arctic Disaster and
Oil Spill Response Workers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Research in the North #5 - Research Ethics and Registries
Doing the Right Thing! A Model for Building a Successful
Hospital Based Ethics Committee in Nunavut . . . . . . . . . . . . . . . . 98
Sami Health Research in Norway: Is There a Need for
Indigenous Sensitive Guidelines?. . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Register Resources in Greenland – Unique Nationwide
Tools for Health Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Access to Genetic Resources and Benefit Sharing:
Implications for Research in Canada’s North. . . . . . . . . . . . . . . . . . 99
The Alaska Area Specimen Bank: A Tribal-Federal
Partnership to Maintain and Manage a Resource
for Health Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Human Biobanks in Research: Recent Studies of Health
Effects of Metals, and Plans for Persistent Organic
Pollutants. Experiences and Plans in Northern Sweden. . . . . 100
Thursday Oral Presentations . . . . . . . . . . . . . . . . . . . . . . Pages 101-118
10:30 - 12:00
Chronic Diseases #6 - Lifestyle and Intervention
Objective Measurement of Physical Activity in Yup’ik Eskimos
Using a Combined Heart-Rate Movement Monitor . . . . . . . . . 101
Table of Contents
Helping Ourselves to Health: Addressing Factors that
Contribute to Obesity Among Alaska Native People. . . . . . . . 101
Overweight in Greenland - a 45 years Follow-Up. . . . . . . . . . . . . . 102
Improving Disparities in Diabetes Care in Rural Native
Communities: Experiences from Alaska and Hawai’i . . . . . . . . 102
Stable Isotope Markers of Sweetened Beverage
Consumption: Their Relationships with Biomarkers of
Chronic Disease Risk in a Yup’ik Eskimo Study Population. . . 102
Depression and Type 2 Diabetes Mellitus Among Alaska
Native and American Indian People in Primary Care. . . . . . . . 103
Research in the North #6 - Research Methods 22
The Greenland Health Research Community. . . . . . . . . . . . . . . . . . 103
Validation of Household Illness Diaries as Tools to Assess
Impact of Health-Related Intervention. . . . . . . . . . . . . . . . . . . . . 103
Comparison Between the International Physical Activity
Questionaire (IPAQ-long) and Combined Accelerometry
and Heart Rate Monitoring in Greenland. . . . . . . . . . . . . . . . . . . 104
Household Movement Patterns in Rural Alaska:
Considerations for Study Design. . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Logical Framework Analysis: The Case for Geographic
Information Systems in Northern Risk Communication. . . . . 105
Health Services #6 - Oral Health
Alaska’s Dental Health Aide Program . . . . . . . . . . . . . . . . . . . . . . . . . 105
Prevalence and Risk Factors of Parental-Reported Early
Childhood Caries Among Manitoba First Nations Children:
Results from the RHS Phase 2 (2007/08). . . . . . . . . . . . . . . . . . . . 105
A Collaborative Effort in Oral Health in a Remote Northern
Health Region. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
A Comprehensive Multi-Level Strategy to Reduce Oral Health
Disparities Among Alaska Native Children. . . . . . . . . . . . . . . . . . 106
Infectious Diseases #6 - Hepatitis
Inactivated Hepatitis A Vaccine Immunogenicity: 17 Year
Follow-up of an Alaska Native Prospective Cohort. . . . . . . . . . 107
Treatment of Hepatitis C in Alaska Native and American
Indian Persons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Exploring the Role of Immune-Mediated Destruction
During Chronic Hepatitis B Infection. . . . . . . . . . . . . . . . . . . . . . . 107
Clinical Burden of Chronic Hepatitis B Carriage in Greenland.
A Population-Based Longitudinal Study. . . . . . . . . . . . . . . . . . . . 108
Long-Term Follow-up of Chronic Hepatitis B Virus Carriers
in the Canadian North. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Clinical Management of Chronic Hepatitis B Infection in
Alaska Native People: Outcome and Effectiveness of
Surveillance for Early Detection of Hepatocellular
Carcinoma and Antiviral Therapy to Prevent Cirrhosis. . . . . . . 109
Healthy Communities #7 - Environmental Contaminant
and Toxin Threats
Human Health vs. Lifestyle and Environment in Greenland:
Genetics, Biomarkers and Effects – an Overview. . . . . . . . . . . . 109
Health Risks of Populations Living in the Arctic. . . . . . . . . . . . . . . . 110
Sled Dogs as Indicators of Climate Change and Resultant
Contaminant Fate and Transport Along the Yukon River. . . . 110
Tissue Type and Food Processing Considerations for Hg
Exposure via Marine Subsistence Foods in Alaska. . . . . . . . . . . 110
Community-Based Research and Policy Engagement to
Protect Environmental Health on St. Lawrence
Island, Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Healthy Families #6 - Health Defects and Genetics
Estimating Birth Defects Prevalence in Alaska: Enhanced
Passive Surveillance and Revised Estimates for
Sentinel Conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
10 Year Review of Congenital Anomalies in Yukon. . . . . . . . . . . . . 112
Genetic History of Ethnic-specific Diseases in Siberian
Yakut Population. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Evidence for an Association Between Clinical Outcomes
and a Carnitine Palmitoyltransferase 1A Genetic Variant. . . . 113
Social Determinants of Health - Social Determinants of
Circumpolar Health
Health and Other Characteristics of Aboriginal Children
Who Have Ever Been Removed From Their Homes. . . . . . . . . . 113
Self-Rated Health Among Indigenous Adolescents:
Similarites and Differences in Associated Risk and
Protective Correlates Among Greenlandic Inuit and
Norwegian Sami . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Associations Between Household Social Structure and
Self-Reported Psychological Symptoms and Problem
Behaviours Among Inuit: Evidence from Greenland. . . . . . . . . 114
Seeing the Forest for the Trees: Assessing the Social and
Physical Determinants of Circumpolar Population Health. . . 114
Acculturation and Self-Reported Health Among the
Iñupiat, Kalaallit, and Sami of Norway. The SLiCA Study. . . . . 115
Climate Change Assessment and Adaptation Planning for
the Health Sector: Bridging the Gap Between Federal
and Local Approaches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Behavioral Health #5 - Suicide Risk Factors
Suicide in Alaska: Exploring Inter- and
Intra-Regional Differences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Community Perspectives on Protective and Contributing
Factors in Alaska Native/American Indian Suicide . . . . . . . . . . 116
High Prevalence of Medicine Induced Attempted Suicides
Among Females in Nuuk, Greenland. . . . . . . . . . . . . . . . . . . . . . . 116
Development of Suicidality Among Sami Reindeer Herders
as a Result of Work-Related Stress. . . . . . . . . . . . . . . . . . . . . . . . . . 117
Suicide Among Young Alaska Native Men: Community
Risk Factors and Alcohol Control. . . . . . . . . . . . . . . . . . . . . . . . . . . 117
An Exploration of Suicide Risk Factors in Alaska 2003 – 2006:
Combining the Alaska Trauma Registry and Alaska Injury
Prevention Center Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Friday Oral Presentations . . . . . . . . . . . . . . . . . . . Pages 118-130
10:30 - 12:30
Chronic Diseases #7 - Cardio-pulmonary Disease 2
Saturated Fatty Acids are Associated with CVD Risk Factors:
The GOCADAN Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Personal Anxiety and 16-years Risk of Myocardial Infarction
in Female Population in Russia. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Arterial Hypertension at Sick of the Ischemic Heart
Disease at the Age of 60 Years Also is More Senior,
Living in Yakutia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Influence of Low Social Support on 16-Years Risk of
Myocardial Infarction in Russian Female Population. . . . . . . .
The Therapy of Patients with Chronic Heart Failure, Efficacy
and Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Infectious Diseases #7 - Haemophilus Influenza
Modeling Insights into Haemophilus Influenzae Type B
Vaccination Programs in Alaska Natives. . . . . . . . . . . . . . . . . . . .
No Evidence of Increasing Haemophilus Influenzae Non-B
Infection in Australian Aboriginal Children. . . . . . . . . . . . . . . . .
Invasive Disease Due to Haemophilus Influenzae Srotype a
(Hia) in the Canadian North, 2000 to 2010. . . . . . . . . . . . . . . . . .
Haemophilus Influenzae Serotype A: Characterization of a
Significant Bacterial Pathogen in The North. . . . . . . . . . . . . . . .
Research in the North #7 - Cold Climate Physiology
To the Evaluation of the Polar Electrojets Influence on
Physiological Parameters of a Man at Phonic
Conditions While Using Unmedical
Heliomagnitoprotective Remedies. . . . . . . . . . . . . . . . . . . . . . . . .
Acute Human Metabolic Response in Cold Environment . . . . . .
Health Services #7 - Telemedicine
Enhancing Technology Uptake in Health Practitioners on
First Nations Reserves in Alberta Canada. . . . . . . . . . . . . . . . . . .
Perspectives on Telemedicine Chronic Disease in Alaska
Native and Native Hawaiian Populations. . . . . . . . . . . . . . . . . . .
Telemedicine in Nenets Autonomous Okrug:
Contemporary Reality and Future. . . . . . . . . . . . . . . . . . . . . . . . . .
Updates on the Utility of Tele-Health in Labrador . . . . . . . . . . . . .
“It Can’t Be Done”...Overcoming Barriers to Deliver Digital
Xray to TB Clients in Nain, Nunatsiavut. . . . . . . . . . . . . . . . . . . . .
Evaluation of Pipaluk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
118
118
119
119
119
120
120
121
121
121
122
122
123
123
123
124
124
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Table of Contents
Nutrition #6 - Changing Diets: Health Communication
Rural Nutrition Services: Building Community Capacity in
Health Promotion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Communicating About Healthy Eating in the Context of
Today’s
Arctic Food Supply. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
The Antioxidant Level of Alaska’s Wildberries: High, Higher,
and Highest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
“Norton Sound is Our Refrigerator”: Linkages Between
Ocean Health and Human Health, as Described by Marine
Mammal Hunters of the Bering Strait Region. . . . . . . . . . . . . . . 126
Store Outside Your Door Intiative. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Culturally-Appropriate Boating Safety in Arctic Alaska:
Use of White Float Coats in Whaling Communities. . . . . . . . . . 126
Commercial Fishing in Alaska, 2000-2009. . . . . . . . . . . . . . . . . . . . . 127
Injury Rates in Southwest Alaska: The Impact of Variations
in Income from Commercial Fishing . . . . . . . . . . . . . . . . . . . . . . . 127
Maritime Disasters and Occupational Fatalities in Alaskan
Arctic Waters, 1986-2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Work-Related Aviation Fatalities in Alaska: 2000-2010. . . . . . . . . 128
Behavioral Health #6 - Suicide Prevention
The Village Wellness Project: Building Community Resilience
and Preventing Suicide in Rural Alaska. . . . . . . . . . . . . . . . . . . . . 129
Cultural Intervention for Suicide Prevention: The Qunagsvik
Projects with Indigenous Youth in Alaska. . . . . . . . . . . . . . . . . . . 129
Intervention Among Alaska Native People: An Evaluation
of ASIST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
The Role of Community Consultations in Suicide Prevention
Research in Labrador. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
The Huslia Wellness Team Documentary: Suicide Prevention
Through Community Empowerment. . . . . . . . . . . . . . . . . . . . . . . 130
Monday POSTER SESSIONS . . . . . . . . . . . . . . . . . . . . . . Pages 131-158
6
Behavioral Health
M1 - Academic Performance and Alcohol Use among
Urban and Rural Alaskan College Students. . . . . . . . . . . . . . . . . . . .
M2 - The Effect of Factors of Unhealthy Lifestyle (Tobacco
Smoking and Alcohol Use) on Hormonal and Metabolic
Characteristics of Young Men. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M3 - Perceptions of Needs Regarding FASD Across the
Province of British Columbia, Canada. . . . . . . . . . . . . . . . . . . . . .
M4 - Coordinating Fetal Alcohol Syndrome Interventions
in Alaska. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M6 - Trends in Fetal Alcohol Syndrome Prevalence in Alaska:
Setting Surveillance Standards to more Accurately Assess
Trends and Evaluate Preventive Strategies . . . . . . . . . . . . . . . . .
M7 - Measuring Attitudes Toward Alchohol Misuse
Interventions in Alaskan College Students . . . . . . . . . . . . . . . . .
M8 - Association Between Daylight, Temperature, and
Alcohol Consumption Among Alaska College Drinkers . . . . .
M9 - Epidemiological Portrait of Behavior Problems Among
Inuit Children: Preliminary Results . . . . . . . . . . . . . . . . . . . . . . . . .
M10 - Examining Tlingit Conceptions of Gendered Geography
in Alaskan Circumpolar Communities. . . . . . . . . . . . . . . . . . . . . .
M11 - Addictive Disorders in Female with Borderline
Personality Organization in Siberian North. . . . . . . . . . . . . . . . .
M12 - Yellowknife Street Outreach Community Consultation. .
M13 - The Prevalence of Emotional and Conduct Disorders in
Native Children of the North. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M15 - Lifetime Problem Gambling among Greenland Inuit –
Do Childhood Conditions and Sociodemographic Factors
Contribute to the Problem?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M16 - Traditional Living and Subsistence as Protective Factors
Against Suicide: Perceptions of Alaska Native University
Students from Rural Alaska. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M17 - Embrace Life: A Celebration of Inuit Life and Culture on
Parliament Hill. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M18 - Engaging Inuit Youth in Tobacco Use Reduction Using
Video Stories on Quitting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
131
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131
132
132
133
133
134
134
134
135
135
136
136
137
137
M19 - The Effect of Iqmik Derived Metals on ROS
Generation and Cytokine Response in Human Gingival
Epithelial Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
M20 - Chronic Diseases and Alaska Native Tobacco Use:
An ANTHC Initiative to Improve Services. . . . . . . . . . . . . . . . . . . 138
M21 - Tobacco Use Prevalence – Disentangling
Associations between Alaska Native, Socio-Economic
and Rural Disparities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
M22 - Are More Smokers Using Smokeless Tobacco Products?
Evidence of “dual use” in Alaska. . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
M23 - A Study of Tobacco Use or Exposure and Cotinine
Measurement among Alaska Native Women During
Pregnancy and Infants During the First Year of Life . . . . . . . . . 139
M25 - Two Partnership Efforts for Village Based Teaching
on Health and Domestic Violence. . . . . . . . . . . . . . . . . . . . . . . . . . 140
Health Services
M26 - Management of Chronic Obstructive Lung Disease
in the Primary Health Care System in Greenland. A
Feasible Indicator for Primary Health Care. . . . . . . . . . . . . . . . . . 140
M27 - Electronic Access to Inuktitut Medical Terms for
English Speaking Clinicians. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
M29 - Presentation of National Centre for Mental Health . . . . . . 141
M31 - Frontier Extended Stay Clinics: A New Provider Model. . . 141
M32 - Standardization and Update of Anesthetic
Equipment in Coastal Greenland. . . . . . . . . . . . . . . . . . . . . . . . . . . 142
M33 - Emergency Care and Transportation of the Seriously
Ill in Greenland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
M34 - Creating an Integrated Chronic Disease Management
Strategy: Lessons from Canada’s Northwest Territories. . . . . . 143
M35 - Delivering Quality Palliative Care North of the
Arctic Circle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
M37 - Demonstration of Robotic Telemedicine. . . . . . . . . . . . . . . . 143
M38 - Portable Remote Presence Device for Point-of-Care
Health Care Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
M40 - The Development of an International Academic
Network in Indigenous Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
M41 - Enhancing Cancer Education Through the Arts:
Building Connections with Alaska Native People,
Cultures, and Communities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
M42 - Digital Storytelling: Blending Traditional and Modern
Ways of Learning for Health Promotion in Alaska Native
Communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
M43 - Providing for the Unique Health Needs of the Peoples
of the Arctic by Assuring and Integrating Access to
Population Relevant Information on Past, Present and
Future Research and Health Related Publications
and Media. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
M44 - Empowering Alaska’s Community Health Workers
with Wellness Education: An Ecological Approach. . . . . . . . . . 146
M45 - The Prevention and Treatment of Diabetes in
Rural Alaska, A Course for Community Health Aide/
Practitioners. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
M46 - Relationships, Heart, and Soul: Emancipatory Holistic
Learning Towards Village Health and Well Being. . . . . . . . . . . . 147
M47 - Diploma in Arctic Specialized Nursing. . . . . . . . . . . . . . . . . . 147
M48 - Delivering Health Care Training to Rural Alaska
By Distance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
M49 - Electronic Community Health Aide Manual (eCHAM) From Paper To Electronic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Research in the North
M50 - Lessons from the Field: Doing Community-Based
Participatory Research (CBPR) in Canada’s Arctic. . . . . . . . . . . . 148
M51 - Challenges in Conducting Northern CommunityDriven Research Created by Differing Knowledge
Systems and World Views: a Researcher’s Perspective. . . . . . . 149
M52 - Budgetary Considerations in Developing Respectful
CBPR Partnerships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
M53 - ‘My Word:’ Storytelling and Digital Media Lab:
The Evolution of an Inuit-Owned Digital Media and
Research Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Table of Contents
M55 - Collaborative Tools for Process Evaluation of
Developing Community-University Partnerships. . . . . . . . . . .
M56 - Intergenerational Dialogue Exchange and Action
(IDEA): Participatory Research to Bridge Gaps Between
Generations in Rapidly Changing Arctic Communities. . . . . .
M58 - Susceptibility to Hypoxia and Breathing Regulation
Changes After Short-term Cold Exposures . . . . . . . . . . . . . . . . .
M60 - Glucose Transporter 4 Expression in White Blood
Cells of Young and Old Sled Dogs. . . . . . . . . . . . . . . . . . . . . . . . . .
M62 - Reflecting Back as we Move Forward: Lessons
Learned from a Collaborative Research Project in
Nunavut, Canada. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M63 - Alaska Native People’s Perceptions,
Understandings and Expectations for Research Involving
Biological Specimens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M64 - Lessons in Health Policy Research in Alaska Native
Villages of the Arctic North: Confessions of a
Reformed Optimist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M65 - Navigating the Cultural Geography of an Indigenous
Community’s Attitude Toward Genetic Research is
Dependant Upon a History of Fostered Trust. . . . . . . . . . . . . . .
M66 - Health Research Review by Tribal Organizations
in Alaska. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M68 - Health State of Native Small in Numbers People
of Republic Sakha (Yakutia). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M69 - Will the Gap in Life Expectancy and Mortality
Between First Nations and All Others Manitobans
(Canada) Ever Close?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M70 - Injury Mortality Between First Nations and All
Other Manitobans (Canada): A Sub-Regional Profile. . . . . . . .
M71 - Ethnic Discrimination and Bullying in Relation to
Self-reported Physical and Mental Health in Sami
Settlement Areas in Norway : The SAMINOR Study. . . . . . . . . .
M72 - The Changing Gender Composition of the
Russian North. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
M73 - Fostering Transformative Inquiry. . . . . . . . . . . . . . . . . . . . . . .
M74 - Highlights of Findings from
the Canadian IPY Adult Inuit Health Survey 2007 – 2008. . . .
M76 - Research Methods: Using the Theory of Planned
Behavior to Increase Proposal Submissions.. . . . . . . . . . . . . . . .
M77 - Adapting Survey Methodology to Improve
Response Rates for Rural Providers: A Case Study from the
Alaska Tribal Health System (ATHS). . . . . . . . . . . . . . . . . . . . . . . . .
M78 - The Formation of a Multicenter Collaboration
Involving Three Studies of Cardiovascular Disease and
Type 2 Diabetes in Western Alaska Native Populations:
The WATCH Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
150
151
151
151
152
152
153
153
154
154
155
155
155
156
156
156
157
157
158
Tuesday Poster SESSIONS. . . . . . . . . . . . . . . . . . Pages 158-184
Chronic Diseases
T1 - Ethnic Differences Body Mass Index (BMI) in Children
Yakutiya (Sakha Republic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T2 - Cancer in Chukotka, 1961-2010 . . . . . . . . . . . . . . . . . . . . . . . . . .
T3 - A Men’s Cancer Survivorship Retreat in Alaska. . . . . . . . . . . .
T4 - Cancer in Northern Populations Workgroup . . . . . . . . . . . . . .
T5 - Immunological Features of Acute Leukemia In Siberia. . . . .
T7 - Serological Markers of Atrophic Gastriris May
Determine the Risk of Gastric Cancer in a
Population-Based Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T8 - Features of Cellular and Humoral Immunity in
Patients with Chronic Leukemia In Siberia. . . . . . . . . . . . . . . . . .
T9 - Arterial Hypertension (AH) in Children of the North. . . . . . .
T10 - Some Cardiovascular Diseases Risk Factors in
Natives of Chukotka. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T11 - Monitoring Hearings Migrants - Northerners with
Diseases Cardiovascular System . . . . . . . . . . . . . . . . . . . . . . . . . . .
T13 - Prevalence of Coronary Heart Disease (CHD) and it’s
Associations with CHD risk factors in The Western
Alaska Tribal Collaborative for Health (WATCH) Study. . . . . . .
158
159
159
159
160
160
160
161
161
162
162
T14 - Prevalence of Arterial Hypertension Among
the Newly Arrived Population and Aboriginal
Population of Extreme North. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T15 - Readaptation of Patients with Arterial Hypertension,
Residing in the Far North for a Long Time to New Climate
Conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T16 - Risk Factors of COPD Development in Citizens
of the Central Zone of the Sakha Republic (Yakutia) . . . . . . . .
T17 - The Peculiarities of Components Shares of Body
Mass in Male Migrants to the Extreme North, Arterial
Hypertension Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T18 - Strategies for Curbing the Type 2 Diabetes
Epidemic: Is SMBG the Answer?. . . . . . . . . . . . . . . . . . . . . . . . . . . .
T19 - Working Together to Achieve Healthier
Weights in Yukon Communities. . . . . . . . . . . . . . . . . . . . . . . . . . . .
T20 - Obesity Studies in the Circumpolar Inuit:
A Systematic Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T21 - Diabetes Prevalence in Western Alaska Native
People: The Western Alaska Tribal Collaborative for
Health (WATCH) Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T22 - Some Blood Lipid Profile Features of the
Population of Siberia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T23 - Hormonal Status and Prevalence of Endocrine
Diseases in Workers of Diamond Company “YakutAlmaz”.. . .
T24 - Features of Lipid-Metabolic Disorders Among
Indigenous Small in Numbers People of Yakutia
with Arterial Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T26 - The Prevalence and Morbidity of Diabetes in
the Sacha (Yakutia) Republic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T27 - Diabetes Mellitus in Asian Part of Russia. . . . . . . . . . . . . . . . .
T28 - The Peculiarities of Food Allergy According to
the Level of Respiratory Tract Affection in East
Siberia Inhabitants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T29 - Risk Factors for Rheumatoid Arthritis in
Predisposed Indigenous North American Populations. . . . . .
T30 - Provision of Rheumatology Care for the
Alaska Native Population. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T31 - Prevalence of GERD Symptoms at Schoolchildren of
Indigenous Tyva Population. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T32 - Experience with Cochlear Implants for
Greenlanders with Deafness Living in Greenland. . . . . . . . . . .
T33 - Factors of Pterygium Generation in
Population of Tyva Republic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T34 - Features of Redox Status in Cases of
Bronchial Obstruction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T35 - The Ethnic Differences of Stroke in Yakutia. . . . . . . . . . . . . . .
T36 - Preventable Blindness: A New Approach
to Screening for Primary Angle Closure (PAC). . . . . . . . . . . . . . .
T37 - Life Quality and Improvement Ways of
Medico-Social Aid to Celiac Children. . . . . . . . . . . . . . . . . . . . . . .
T38 - Some Results of 30 Years Stroke Morbidity
Monitoring in Siberia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T39 - Association of Psoriases and Asthma with
the IL-4 and IL-10 Gene Polymorphism in Siberian. . . . . . . . . .
T41 - The Prevalence of Barrett’s Esophagus in the
Population of Eastern Siberia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Healthy Families
T42 - Creating Healthy Partnerships in Nunavut for
Sexual Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T43 - Acculturation Among Sami - What Indicators
Are of Value?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T45 - “Healthy Mind is a healthy life:” Alaskan Native
Experiences of Acculturation, Enculturation, and Coping . . .
T46 - Living in Two Worlds: Alaska Native Experiences of
Acculturation, Stress, Academic Success, and
Well-Being in the Rural-to-Urban Transition to College. . . . . .
T50 - Prenatal Screening in Greenland. . . . . . . . . . . . . . . . . . . . . . . .
T51 - Phenotypic Peculiarities of Heart and Vessels Structure
in Newborn Infants Under Polar Region Conditions. . . . . . . . .
T53 - Reproductive Health Profile of the Children Living
of the Northern Region of Yakutia. . . . . . . . . . . . . . . . . . . . . . . . . .
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163
163
164
164
165
165
166
166
166
167
167
167
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168
169
169
169
170
170
171
171
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172
172
172
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7
Table of Contents
T54 - Teaching Children About Health Through
Genograms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T55 - Novel Mutation in ATP13A2 Widens the
Spectrum of Kufor-Rakeb Syndrome (PARK9). . . . . . . . . . . . . . .
T56 - Hearing Loss among Greenlandic Children
and Adolescents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T57 - Role of Structured Water in the Regualion
of Fluidity of the Phospholipid Layer of the Erythrocyte
Membranes int eh Children of Evenkia. . . . . . . . . . . . . . . . . . . . .
T58 - Recurrent Abdominal Pain (RAP) in
Schoolchildren in Evenkia in Accordance with
Rome Criterion III (ROMEIII). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T60 - Epidemiolgoy of Erosive-Ulcer Diseases in GastroDuodeum Area in Populations of Siberia Schoolchildren. . . .
T61 - Features of Functioning of Cardiovascular System
at Schoolchildren with Various Somatotypes in Tyva. . . . . . . .
T63 - The Fatty Acids Composition in Erythrocyte
Membrane and Ventricular Ectopy in Siberian
Adolescents with Structurally Normal Hearts. . . . . . . . . . . . . . .
T64 - Immunologic Parameters at Severe Bronchial
Asthma in Children of Krasnoyarsk Territory (Siberia) . . . . . . .
T65 - Severe Bronchial Asthma in Children of
Krasnoyarsk Territory: Clinical Anamnesis Peculiarities. . . . . .
T66 - Epidemiology of Erosive-Ulcer Diseases in GastroDuodenum Area in Populations of Siberia Schoolchildren. .
T67 - Peculiarities of Goitrous Endemy in Children
and Adolescents of Nenets Autonomous Area. . . . . . . . . . . . . .
T68 - Infant Mortality: Persistent Differences Between
First Nations and All Other Manitobans (Canada). . . . . . . . . . .
T71 - Associations Between Maternal Age and Infant
Health Outcomes in Yakutsk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T72 - Regional Differences in Folic Acid Knowledge
and Folic Acid use among Canadian Women. . . . . . . . . . . . . . .
T73 - Health Protection of Pregnant Women. . . . . . . . . . . . . . . . . .
T74 - Low Birth Weight in Siberian (Tuva) Newborns is
Associated with Decreasing Erythrocyte
Membrane Fluidity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T75 - Modern Conception About Women Fertility in
the Republic of Sakha (Yakutia). . . . . . . . . . . . . . . . . . . . . . . . . . . .
History/Anthropology
T76 - Health Aspects of Arctic Exploration: Based on
the Research Files of Dr. Robert Fortuine Donated
to the University of Alaska Anchorage Consortium
Library in 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T77 - Medical Records of Sami Psychiatric Patients
in the Age of Scientific Racism. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Social Determinants of Health
T78 - Repairing the Holes in the Net: Women, Homelessness
and Mental Health in Canada’s three Northern Territories. . .
T79 - Ethnic Discrimination and Psychological Distress:
a Study of Sami and Non-Sami Populations in Norway. . . . . .
T80 - The Polar Bear in the Room: Diseases of Poverty in
the Arctic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Services
T81 - Outcomes for Orthopedic and Psychiatric Medevacs
Sent to the Stanton Territorial Hospital Emergency
Department in Yellowknife. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
T82 - To the Evaluation of the Polar Electrojets
Influence on Physiological Parameters of a Man at
Phonic Conditions While Using Unmedical
Heliomagnitoprotective Remedies. . . . . . . . . . . . . . . . . . . . . . . . .
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183
184
184
Wednesday PosterS . . . . . . . . . . . . . . . . . . . . . . Pages 185 -213
8
Nutrition
W1 - Store Outside Your Door: Traditional Foods,
Contemporary Chef. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
W2 - Alaska Native Traditional Foods for Health
Digital Storytelling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
W3 - Seasonal and Annual Variation in Intake of
Traditional Marine Food by a Yup’ik Eskimo
Population: a Sequential Dietary Record from
Hair Stable Isotope Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
W5 - Iodine Deficiency in Teenagers and Adults in
West Siberia in 1995-2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
W6 - Effect of Fish Oil Consumption on Coagulation
in Yup’ik Eskimos. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
W7 - Fisheries to School: a Model for Promoting Food
Security in Alaska Native Communities. . . . . . . . . . . . . . . . . . . . . 186
W8 - Knowledge Sharing about Inuit Food Security
in Canada. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Healthy Communities
W10 - www.arctichealth.org: Corralling Wide-Ranging
Information on Arctic Climate Change. . . . . . . . . . . . . . . . . . . . . 187
W11 - Changing Climate, Changing Health, Changing
Stories: Climate-Health Research and Promotion in
Rigolet, Nunatsiavut, Labrador, Canada. . . . . . . . . . . . . . . . . . . . 188
W12 - The Impact of Climate Change on the Tick-Borne
Encephalitis and Salmonellosis in the Arkhangelsk
Region, Northwest Russia: WHO Study. . . . . . . . . . . . . . . . . . . . . 188
W14 - Paralytic Shellfish Poisoning — Southeast
Alaska, 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
W15 - Development of Circumpolar Medicine in
Russian North. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
W19 - Community Water Fluoridation in Alaska
Communities: Lessons Learned. . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
W20 - Renewable Energy and Sustainable Communities:
Alaska’s Wind Generator Experience in Rural and
Remote Regions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
W21 - Inuit Environmental Health Guides. . . . . . . . . . . . . . . . . . . . . 190
W22 - Extension Disaster Education Network- Sharing
Resources to Reduce the Impact of Disasters. . . . . . . . . . . . . . . 190
W23 - Roles of Cuisine and Aesthetics in Shaping
Human Relationships with Freshwater Resources,
Examples from Communities Near the Bering Strait . . . . . . . . 191
Infectious Diseases
W24 - HCC in Greenland – a Serious Problem?. . . . . . . . . . . . . . . . . 191
W25 - The Changing Epidemiology and Etiology of
Hepatocellular Carcinoma between 1969 and 2011
in Alaska Native People. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
W26 - Fatal Pulmonary Hypertension in a Patient with
Chronic Hepatitis D.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
W27 - The Prevalence and Long Term Outcome of
Occult Hepatitis B Virus Infections in Community
Based Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
W28 - Genetic Diversity of Hepatitis B Virus Genotypes
B6, D and F among Circumpolar Indigenous Individuals. . . . 193
W29 - Unique Immune Regulatory KIR Gene Cluster
Patterns May Influence Hepatitis C Virus Infection
Profiles in Aboriginal Peoples. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
W30 - Hepatitis B, D and C among Inuit migrated to
Denmark and in High Endemic Greenland . . . . . . . . . . . . . . . . . 194
W32 - Assessing the Longevity of Protection of the
Current 2-dose Hepatitis A Vaccine in Children. . . . . . . . . . . . . 194
W33 - Serological Approaches for the Measurement of
Type Specific Antibodies to Haemophilus Influenzae
Type A (Hia). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
W34 - Emergence of Invasive Haemophilus Influenzae
Type a Disease in Northern Ontario Aboriginal
Population. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
W35 - The Occurrence of [Alpha]-1,6-Glucan in
Clarithromycin-Resistant Canadian Helicobacter
Pylori Isolates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
W36 - Community-Driven Research on Helicobacter
Pylori Infection in the Canadian Arctic: The Old Crow
H.Pylori Project. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
W37 - H. Pylori Incidence and Re-Infection in a Canadian
Arctic Community. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
W38 - Helicobacter Pylori Infection in Evenkia Schoolchildren
of Families with Predisposition to Ulcer Disease. . . . . . . . . . . . 197
Table of Contents
W39 - Association Between Untreated Water Consumption,
H. pylori Status and Gastritis Observed in a Northern
Canadian Community. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
W40 - The Incidence of Gastric Cancer Biomarkers in
Elderly Residents of Yakutsk, Depending on the Age
and Ethnic Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
W42 - The Risk Factors of Gastroduodenal Bleedings in
Patients with Liver Cirrhosises in Inhabitans of
Eastern Siberia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
W43 - Untreated Water and Helicobacter Pylori:
Perceptions and Behaviours in a Northern Canadian
Community. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
W44 - Immune Response to Vaccination Under
Extreme North Conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
W45 - Antimicrobial Resistance: Can Collaboration
and Partnerships Make a Difference?. . . . . . . . . . . . . . . . . . . . . . . 199
W46 - Review of Human Echinococcosis in Alaska,
1990-2009. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
W48 - Infectious Disease Hospitalizations among
Alaska Native People, 2001-2009. . . . . . . . . . . . . . . . . . . . . . . . . . . 200
W49 - US Centers for Disease Control and Prevention’s
Travel Restrictions and Intervention Activity: A Five Year
Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
W50 - Port of Entry Operations in Alaska: Examples of
Travel-Related Infectious Disease Prevention and
Response Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
W51 - Parasitic Zoonoses and Veterinary Public Health
in Northern Saskatchewan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
W52 - Boils in the Bush: Culture, Epidemiology, and
Community Acquired Methicillin Resistant
Staphyloccocus Aureus in Southwest Alaska . . . . . . . . . . . . . . . 202
W53 - Incidence and Prevention of Resistant
Microorganisms in Greenland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
W54 - Comparison of Nasopharyngeal Flocked Swabs
and Nasopharyngeal Wash Collection Methods for
Respiratory Virus Detection in Children Using Real-Time
Reverse Transcriptase Polymerase Chain Reaction. . . . . . . . . . 203
W55 - The Peculairities of Neutrophil Granulocytes Activity
in Patients with Polypous Rhinosinusitis in East Siberia
Inhabitants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
W56 - The Peculairities of Immune, Metabolic and Cytokine
Status in Rhinosinusitis of Allergy Genesis in East Siberia
Inhabitants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
W57 - Ethnic Peculiarities of Chlamydiosis Prevalence in
Bronchial Asthma Patients of Eastern Siberia. . . . . . . . . . . . . . . 204
W58 - Ethnic Peculiarities of Mycoplasmosis Prevalence in
Bronchial Asthma Patients of Eastern Siberia. . . . . . . . . . . . . . . 205
W59 - Clinical Peculiarities of Mycoplasmosis, Chlamydiosis
in Bronchial Asthma in East Siberia Inhabitants. . . . . . . . . . . . . 205
W60 - Clinical Diagnostics of Community-Acquired
Pneumonia Caused by Mycoplasma Pneumoniae or
Chlamydophila Pneumoniae in Siberian Children. . . . . . . . . . . 205
W61 - Impact of Conjugate Vaccine and Antimicrobial
Prescribing on Resistance of Streptococcus Pneumoniae
Carriage in Alaskan Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
W62 - The International Circumpolar Surveillance
Interlaboratory Quality Control Program for Streptococcus
pneumoniae, 1999-2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
W63 - Country Update on HIV Infection, Greenland . . . . . . . . . . . 207
W64 - Increasing Awareness and Education of the
Human Papilloma Virus (HPV) in Yukon, Canada. . . . . . . . . . . . 207
W65 - Cellular Reprogramming by a Viral Protein. . . . . . . . . . . . . . 208
W66 - Partner Notification for Sexually Transmitted
and Bloodborne Infections in Isolated and Remote
Communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
W67 - Human Papillomavirus Infection and the Association
with Abnormal Pap Findings in Yukon, Canada. . . . . . . . . . . . . 208
W68 - High Chlamydia Rates in Yukon, Canada: Fact
or Fiction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
W69 - Host Factors Associated with HPV Infection in
Inuit Women of Northern Quebec . . . . . . . . . . . . . . . . . . . . . . . . . 209
W70 - Tuberculosis in the Sakha Republic (Yakutia). . . . . . . . . . . . 210
W71 - Inuit Tuberculosis, Past and Present: When Will it End? . . 210
W73 - Developing Tuberculosis Control Program
Performance Indicators in Nunavut, Canada. . . . . . . . . . . . . . . . 211
W75 - Surveillance of Tuberculosis Diagnosis in the
Sakha Republic (Yakutia) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
W76 - Molecular Epidemiology of Tuberculosis in the
Nunavut Territory in Canada. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
W77 - Establishing an International Circumpolar
Collaborative Tuberculosis Surveillance Working Group . . . . 212
Healthy Families
W78 - Promoting Sexual Health and Healthy
Relationships through Youth-led Drama, Role-Playing,
and Vignettes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
9
10
Monday, August 6, 2012
Duckering Room 252
moderators: J. Kelly & K. Young
Trends in Mucosal Head and Neck
Cancer in Alaska Native People
AUTHOR: A. Steinberg
Alaska Native Medical Center
This talk presents epidemiologic data from the Alaska
Native Tumor Registry. It compares the incidence rates
of head and neck mucosal squamous cell carcinoma in
Alaska Natives with those of whites in mainland United
States over two 15 year periods, from 1979-1993 and from
1994-2008. The incidence rate is higher in US whites than
among Alaska Natives. It also examines the incidence rate
of this cancer in the different subsites of the head and
neck over the two time periods, finding no significant
change in the incidence over time. Infection with highrisk types of human papilloma virus has recently been
identified as a risk factor for head and neck cancer. The
pathophysiology of the progression from HPV infection
to cancer is reviewed along with the other primary risk
factors, tobacco and alcohol use. The conclusion is drawn
that prevention is the key to improved health and that this
can be accomplished through a combination of vaccination
and tobacco and alcohol use cessation programs.
[email protected]
HPV and Oropharyngeal Cancer in
Greenland
AUTHORS: M. Avnstorp , R.G. Jensen , E.N.
Garnaes2, M.H. Therkildsen3, B. Norrild4, C. von
Buchwald2, P. Homoee2
1
2
University Hospital Rigshospitalet 1, Dept. ENT, Righospitalet 2,
Dept. Pathology, Rigshospitalet 3, Copenhagen University 4
Introduction: HPV is associated with cancer of the
head and neck, especially cancer of the tonsils and base of
the tongue (oropharyngeal cancer). HPV is known to cause
cervical cancer, which is found in a higher rate in Greenland
compared to Denmark and the US. Sexual partners of
women with cervical cancer have a higher risk of head
and neck cancer due to oral sexual transmission of HPV.
We investigated the incidence of HPV in oropharyngeal
cancer patients in Greenland. Methods: The Danish
Civil registration system, the Danish cancer registry and
hospital-based registries were used to identify Greenlandic
patients who underwent surgery for oropharyngeal cancer
between 1994-2010. p16 immunohistochemistry was
performed on sections cut from formalin fixed, paraffin
embedded tissue blocks. The expression of p16 slides
were evaluated by a specialized pathologist. HPV PCR
with GP5+/6+ and MY09/11 primers was performed on
genomic DNA isolated from the paraffin tissue blocks.
Results: p16 immunohistochemistry was positive in 16 of
33 (48.5%) of Greenlandic patients with oropharyngeal
cancer. Among males 54.2% (13/24) were p16-positive
while 33.3% (3/9) of females were positive. Of patients
surgically treated between 1994-2000, 33.3% (4/12) were
positive, while 57.1% (12/21) surgically treated between
2001-2010 were positive. The PCR results will be presented
at the conference. Conclusion: The prevalence of p16
found in Greenlandic patients with oropharyngeal cancer
is similar to the level found among European Caucasians.
Interestingly a higher rate of p16 is found in males compared
to females and the incidence seems to have increased
over the last 15 years. In Greenland only girls are HPVvaccinated as prophylaxis against the associated cervical
cancer. A vaccination of the male population in Greenland
should be considered, because they, like the female
population, are in high risk of being infected with HPV.
MONDAY ORAL
15:30 - 17:00
[email protected]
HPV Genotypes Detected in Cervical
Cancers from Alaska Native Women,
1980-2007
AUTHORS: J. Kelly1, E. Unger2, E. Dunne2, N.
Murphy3, J. Tiesinga3, K. Koller1, A. Swango-Wilson1,
L. Markowitz2, M. Steinau2, T. Hennessy2
Alaska Native Tribal Health Consortium 1, CDC 2, ANMC 3
Background: Human Papillomavirus (HPV)
vaccine prevents cervical pre-cancers and cancers caused
by HPV types 16 and 18 in uninfected women. The
prevalence of HPV infection in cervical cancer specimens
from Alaska Native (AN) women was previously reported
at 83% for HPV types 16 or 18 and over 40% for multiple
HPV types. This study serves to provide the baseline for
measuring impact of the quadravalent vaccine on infection
of HPV types 16 and 18 among AN women. Methods:
AN women ages 18 and older who had a diagnosis of
invasive cervical cancer between 1980-2007 were identified
from the Alaska Native Tumor Registry. Pathology
numbers were used to identify formalin-fixed, paraffin
embedded archived specimens. Terminal serial sections
were viewed for confirmation of histology, and four
remaining sections were tested using Linear Array HPV
Genotyping Test (Roche Diagnostics); if negative, tested
further using the INNO-LiPA HPV Genotyping Assay
(Innogenetics). All specimens were tested for a minimum
36 HPV types. Results: Of 62 cervical cancer specimens
evaluated, 57 (91.9%) contained one or more HPV types
and were included in the analysis. Multiple HPV types
were present in 8 (14%) of the cancers assayed. Of 15
11
MONDAY ORAL
oncogenic HPV types assayed, 10 were detected. One or
more HPV oncogenic types were detected in 56 (98%) of
the specimens, most often HPV type 16 (54%) or type 18
(16%), alone or in combination with other types. Thirtyeight (61.2%) cancers contained HPV types 16 or 18 only,
and eighteen (29%) contained an oncogenic type other
than type 16 or 18. Six (10%) cancers contained HPV
types 16 or 18 plus another oncogenic type. Conclusion:
Approximately two-thirds (61.2%) of the archived cervical
cancers had detectible HPV types 16 or 18 that could be
prevented today with HPV vaccine. The remaining cancers
contained an oncogenic type that would not be prevented
by the current vaccine and provide evidence to support
continued Pap screening for the detection of cervical cancer.
[email protected]
Engaging First Nations Women in the
Development of Culturally Safe Human
Papillomavirus Screening
AUTHORS: I. Zehbe1, M. Maar2, A. Nahwegahbow3
Thunder Bay Regional Research Institute 1, Northern Ontario School
of Medicine 2, School of Public Health, University of Waterloo 3
12
First Nations women are widely under-screened for HPV
infection and cervical cancer. This may be due to issues
around screening for a sexually transmitted infection.
These issues may include experiences of stigmatization,
feelings of shame, and fear of lack of privacy when results
are reported in very small communities. Any HPV research
in First Nations communities must be done in a sensitive,
respectful, and culturally appropriate way, preferably
involving community members themselves. In studying
ways to promote HPV and cervical cancer screening in
First Nations communities in Ontario, the authors of this
paper used a participatory action research (PAR) approach,
which involves collaboration between the research team
and the people the research is supposed to benefit. The
authors also used First Nations scholar Willie Ermine’s
concept of ethical space—where groups with separate
worldviews come together to recognize differences and
negotiate mutual understanding—in their approach
to working with the communities. Through a series of
engagements with community members to introduce,
develop, and refine the proposed research, the authors were
able to create a study that was both scientifically sound and
accepted by the community. A pilot study was completed
in one First Nations community with a larger, randomized
trial scheduled to begin in ten additional communities
involving up to 1,000 women. Although the PAR/ethical
space approach may be more time- and resource-intensive,
involving local women, health care providers, leaders, and
other community members helps ensure acceptance by and
benefit to the First Nations communities involved in research.
15:30 - 17:00
Please note that the entire article will be published in the
Journal of Aboriginal Health.
[email protected]
Evaluation of Serum Procathepsin B and
Cystatin B as Possible Biomarkers of
Ovarian Cancer
AUTHORS: T. Korolenko1, G. Elena1, L. Valentina2,
E. Tsykalenko2, K. Loktev1
Institute of Physiology SB RAMS 1, Novosibirsk Medical University 2
Proteases of different classes (cysteine, serine, aspartate,
matrix metalloproteases) are universally involved into tumor
growth and metastazing. Cysteine proteases (cathepsin B)
and their endogenous inhibitors, cystatins, have been shown
to implicate in tumor invasion (Cavala-Medved et al.,
2005). Searching of new tumor biomarkers is perspective
among mature forms of proteases, their enzymatically
inactive proforms and endogenous inhibitors of proteases.
The aim: to evaluate procathepsin B and endogenous
inhibitor cystatin B as possible tumor biomarkers in ovarian
tumors compared to the commonly used tumor biomarker
CA-125. Methods used: Procathepsin B was measured
with help of commercial kit for human procathepsin B
(R&D, USA); CA-125 with commercial kit (Vector,
Koltsovo, Novosibirsk Region, Russia). Statistical analysis:
appropriates separate one-way ANOVAs were performed
(Statistica 7 Program); t-test was used for the comparison
between some groups means difference. Results: CA-125,
cancer antigen-125, is a protein that is found at levels in
most ovarian cancer cells that are elevated compared to
normal cells The woman with ovarian cancer (13 patients),
benign ovarian tumor (9 patients) were under investigation;
40 healthy persons were used as a control. It was shown that
serum procathepsin B elevation (p= 0.00001) was equally
significant in ovarian cancer as standard biomarker CA125 (p= 000001); whereas serum cystatin B level was less
effective as ovarian cancer biomarker (p=0.044). In benign
ovarian tumors serum procathepsin B (p=0. 00093) and CA125 (p=0.00369) had similar value as tumor biomarkers.
If one compare the ovarian cancer vs benign ovarian
tumors the increase of CA-125 (p=0.0167) was more
significant vs procathepsin B (p=0.038); simultaneously,
serum cystatin B level was significantly increased
(p=0.0014). Conclusion: One can conclude that serum
procathepsin B is perspective as new tumor biomarker in
ovarian cancer. Cystatin B seems important in differential
diagnostic of ovarian cancer and benign ovarian tumors.
[email protected]
15:30 - 17:00
Research in the North #1 - Regional Health Status AUTHORS: S. Kelley1, J. Tilburt2, K. James2,
C. DeCourtney1
Health Systems Serving Inuit
Communities Across the Arctic
Alaska Native Tribal Health Consortium 1, The Mayo Clinic 2
AUTHOR: L. Ellsworth
Prostate cancer is the most common non-skin cancer
in men in the United States. The incidence of prostate
cancer among Alaska Native men is lower than the U.S.
population. Although screening for prostate cancer remains
controversial, most U.S. medical organizations recommend,
that if prostate specific antigen (PSA) is abnormal, patients
should receive timely follow up care regardless of the lack
of clear definitions of “appropriate” and “timely.” Alaska’s
geography and tribal health system program availability
impact test follow up. We surveyed primary care physicians,
and mid-level practitioners practicing in the Alaska Tribal
Health System (ATHS) to identify attitudes toward and
practices surrounding timely and appropriate follow-up care
after abnormal PSA. Coordinators administered surveys to
assess provider demographics, practice features, and attitudes
toward follow up procedures for abnormal PSA. A clinical
scenario was provided with questions: most appropriate/
reasonable timeframe for follow up, for the follow up to
occur, and perceived barriers in achieving a timely response
to PSA abnormality. Of the 221 providers surveyed, 114
responded (52%). Regarding follow up actions: “repeat
PSA testing” (44%), “arranged for follow-up visit to discuss
test results” (25%), “refer the patient to urology for prostate
biopsy” (23%), and “other” (8%). Half (49%) thought a
reasonable timeframe for follow up was <30days. Most
providers (81%) believed follow up action should occur <
60 days. Factors identified as exerting a and influence on
timeliness of follow up included “overall care coordination”
(90%), patient initiative (90%), patient’s pressing social
issues (82%), other life-threatening comorbidities (81%), as
well as fishing/hunting seasons(72%), difficulty arranging
follow-up (71%), lack of on-site specialist (69%). Primary
care providers practicing within the ATHS encounter
barriers in follow-up after abnormal PSA testing. If
cancer screening tests with uncertain mortality benefit
are routinely offered, systems of care should support
timely follow up for abnormalities from those tests.
Inuit Circumpolar Council-Canada
[email protected]
Duckering Room 352
moderatorS: E. Provost & L. Ellsworth
MONDAY ORAL
Primary Care Provider Follow Up
Attitudes After Abnormal PSA in
Alaska’s Frontier
The Inuit are an indigenous people totaling about 160,000
and living in four countries across the Arctic – Canada,
Greenland, USA (Alaska) and Russia (Chukotka).
Although the health challenges confronting the Inuit are
in many cases similar across the Arctic, the responses to
these challenges vary in accordance with the types of health
systems in place in each of the four countries. Although
there have been significant improvements in Inuit health
and survival over the past 50 years, stark differences persist
between the key health indicators for Inuit and those of
the national populations in the USA, Canada and Russia
and between Greenland and Denmark. On average, life
expectancy in all four countries is lower for Inuit. Infant
mortality rates are also markedly different with up to three
times more infant deaths than the broader national average.
Underlying these statistical differences are a range of
health, social, economic and environmental factors which
have affected Inuit health outcomes. This inequity between
Inuit and broader national populations is consistent with
the poor health status of indigenous peoples globally.
It is increasingly recognized that these differences are
due to a range of factors – physical, psychological and
social and reflect broader contexts including historical,
economic and environmental. It is also a reality that gaps
between indigenous and non-indigenous peoples are not
only clear in health status, but also in socioeconomic
status, education, employment, environmental and social
health and most other social determinants of health.
Improving health outcomes and meeting the health
needs in each of the four countries has varied in line
with each country’s economic and political framework,
as well as the different health systems. This presentation
will provide an overview of those systems with particular
relevance to the Inuit populations in each country.
[email protected]
Health and Mental Health of Young
Aboriginal Children Living Off Reserve
in Canada
AUTHORS: C. Werk, X. Cui
Alberta Centre for Child, Family, and Community Research
Early child health is important for future child development.
13
MONDAY ORAL
Understanding the determinants of health can be used to
inform policies and/or service delivery. The determinants
of health and mental health of young Aboriginal children
living off-reserve in Canada were assessed using the 2006
Statistics Canada Aboriginal Children’s Survey. This project
was conducted at the Research Data Center (University of
Alberta) in collaboration with Alberta Human Services.
An iterative process was used where researchers had
meetings with ministry representatives throughout the
analysis process to ensure ministry relevance. Aboriginal
children had high overall ratings of health. Children
identified as First Nations had lower ratings of excellent
or very good health than children identified as Métis or
Aboriginal ancestry. A number of measures were found to
be related to health ratings of young Aboriginal children
including birth weight, income, housing conditions,
maternal education, and daily consumption of milk
and vegetables. Mental difficulty scores were related to
living situations including high number of moves, living
in a rental home, regular smoke in the home and living
with single or foster parents. Younger parental age, lower
maternal education, having ever gone hungry, and high
daily screen time were also related to high mental difficulty
scores of young Aboriginal children. Aboriginal children
whose parents provided them with an opportunity to watch
and learn or told stories to them daily were less likely to
have high mental difficulty scores. The most important
finding was that once other measures were controlled for,
Aboriginal identity was not predictive of either the health
or mental health of young Aboriginal children indicating
that other modifiable measures are more important for
the health and mental health of these children. Results
are being shared with ministries to help improve service
delivery to young Aboriginal children living in Alberta.
[email protected]
Trends in Mortality Among Alaska
Native People: 1980-2008
AUTHORS: E. Provost1, G. Day2, P. Holck3
Alaska Native Tribal Health Consortium 1, Ersham Consulting, Inc. 2,
Peak Enterprises 3
14
Monitoring health status is essential to policy discussions,
program development, and outcome evaluation. This report
will explore the leading causes of death among Alaska Native
people statewide for 2004-2008 as well as trends in those
leading causes between 1980 and 2008. This descriptive
analysis is based on Alaska Bureau of Vital Statistics death
certificate data. Some of the key findings include: • For
2004-2008, the top three leading causes of death were:
Cancer (20.4%), Heart Disease (14.3%), and Unintentional
Injury (13%). • During this same time period, the leading
cause of years of potential life lost before the age of 75
was unintentional injuries. • There have been significant
15:30 - 17:00
reductions in the following causes of death since 1980: allcause mortality (16%), chronic liver disease (36%), heart
disease (38%), unintentional injury (47%), pneumonia and
influenza (51%), and homicide (70%). • There have been
significant increases for the following causes of death since
1980: alcohol abuse related mortality (34%) and chronic
obstructive pulmonary disease (119%). • There have been
no significant changes in the following causes of death since
1980: cancer and suicide. This presentation will provide
population level mortality data for Alaska Native people
living in Alaska in order to assist tribal leaders, tribal program
administrators, health planners, and others to work toward
the elimination of premature deaths and thus contribute
to improving the health status of Alaska Native people.
[email protected]
The Mortality Rate Of The Working
Age Population In The Republic of
Sakha (Yakutia) As a Result Of The
Social Hygiene Factors
AUTHORS: A. Egorova, S. Chugunova
The Yakuskt Scientific Centre of Complex Medical Problems
The mortality rate in the working age population of the
Republic of Sakha (Yakutia) is 1.5 times higher during
1990-2010 as compared to previous. In this study we
analysed the possible reasons for the increase in the
mortality rate. The main reasons for the increase in the
mortality rate are external factors such as injuries, food
poisoning, and diseases of the circulatory system.
The mortality rate in the Republic of Sakha (Yakutia)
as a result of the external factors has increased 1.3 times.
Mortality from accidents, food poisoning, and injury are
greater than the mortality from murder, suicide, drowning,
and transport injuries. The mortality rate of the Aboriginal
population is twice as high as that of the migrant
population. The violation of the traditional lifestyle, the lack
of government support in the agro-industrial complex, and
low wages were the main causes of the psycho-emotional
disorders in the population which manifested itself in the
increase of the murders, suicides and drowning.
The mortality rate of the working age population due to
the diseases of the circulatory system has increased two
times. The main causes of death as a result of the diseases
of the circulatory system are myocardial infarction (7-14%),
alcoholic cardiomyopathy (6-30%), and cerebrovascular
violations (16-19%). Myocardial infarction and alcoholic
cardiomyopathy mainly affect the migrant population.
Because the majority suffering from diseases of the circulatory
system are the migrant population and the mortality rate
of the working age population has more than doubled, it
[email protected]
Health Status of Children in Republic
Sakha (Yakutia)
AUTHORS: V. Egorova, N. Savvina, E. Son
North-Eastern Federel University
At present, assessment of the demographic situation and the
development of guidelines addressing mortality, high birth
rates, an effective migration policy recognizes a government
priority. Among these values, the leading positions are
occupied by children’s health, education and environment.
By 2010, the primary structure of morbidity among
children under 17 years Republic Sakha (Yakutia), the
first place was occupied by respiratory diseases - 1311.6
to 1000 child population, the second largest disease of the
digestive system - 163.2, third in diseases of the skin and
subcutaneous fiber - 110.5.
The increasing of children and adolescents morbidity in
the period 2006-2010 observed in many types of disease,
but the highest growth rates observed in diseases of the
nervous system, diseases of the eye and adnexa, diseases
of the musculoskeletal system, the significant growth of
socially significant diseases.
It should be noted that the health of children living in
rural areas, much worse than the children of citizens. Thus,
healthy children living in urban areas was 36.9%, whereas
in rural areas - 29.02%.
In the structure of morbidity of the first year of life is
dominated by respiratory diseases (1133.2 per 1000
children), perinatal complications (303.9), diseases of the
nervous system and sense organs (2476.3), diseases of the
digestive system (175.9).
It should be noted that a significant proportion of disease
is formed at school age. The study of dietary intake
of students found in violation of the structure of their
food (energy, protein, vitamin and mineral deficiency,
biological inferiority) that serves as a major cause of
alimentary-dependent diseases. Thus, over the past 5 years
have substantially increased the number of children are
overweight. Adolescents aged 15-17 years the incidence of
obesity increased from 8.5 to 13.2 per 1,000 population.
Conclusion. Thus, it is clear that at the present time for
a radical improvement to the health of children should
be integrated address their most pressing problems of
organizing the health of women and children using new
technologies for prevention, diagnosis, treatment and
rehabilitation.
In this regard, further accelerating the development
of scientific bases of child health and improving their
efficiency is a priority issue that should be addressed at
the interagency level.
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could be concluded that the mortality rate of the migrant
population has contributed to this increase. Similarly, the
Aborgine population has significantly contributed to the
increase in the mortality rate as a result of external factors.
15:30 - 17:00
[email protected]
Healthy Families #1 - Injury Epidemiology and
Interventions Toward Successful Aging
Duckering Room 347
moderatorS: T. Sundbury & A. George
The RISC Project: Injury in Aboriginal
Communities in British Columbia,
Canada
AUTHORS: A. George1, C. Lalonde2, A. Jin1,
M. Brussoni1, R. McCormick1, I. Ishyama1
University of British Columbia 1, University of Victoria 2
The project Injury in British Columbia’s Aboriginal
Communities: Building Capacity while Developing
Knowledge aims to expand knowledge on injury rates
among Aboriginal communities in British Columbia,
Canada, to gain an understanding of community differences,
and to identify community-level risk and protective factors.
The project studies injuries using techniques of disease
surveillance. It engages Aboriginal communities in the
planning and implementation of surveillance activities
and in the interpretation and use of the resulting data.
Injury incidence rates in the Aboriginal population
greatly exceed those found in the non-Aboriginal
population; however, variability appears to exist between
Aboriginal communities which may be more important for
understanding implications for prevention. The analysis of
risk and protective factors extends the work of Chandler &
Lalonde (1998) who observed that community efforts to
preserve and promote Aboriginal culture and to maintain
local control over community life are strongly associated
with lower suicide rates. We apply the same model to the
more general case of injury rates, using administrative
records of deaths, hospitalizations, ambulatory care
episodes and worker compensation claims due to injuries,
to identify communities that have been especially successful
in maintaining low rates of injury. We hypothesize that
our data will observe differences in injuries rates among
First Nation communities in British Columbia and that
those differences are attributable to the same risk and
protective factors as found in earlier work on youth suicide.
[email protected]
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MONDAY ORAL
Osteoporosis is Common in Old Age in
Greenland and Treatment is Scarce
AUTHORS: A. Jakobsen, P. Laurberg, S. Andersen
Aalborg University Hospital
Osteoporosis is a debilitating condition characterized by
fractures, pain and premature death. We aimed to describe
factors with influence on the risk of osteoporosis in
Greenland. We selected women born in 1934-42, 1945-47,
1956, and men born in 1956. We sent out a questionnaire
in Greenlandic and Danish on risk factors for osteoporosis.
It included family history, smoking habits, alcohol intake,
presence of disease, sun exposure, intake of dairy products,
age at menopause, and number of falls. Additional
questions were frequency of back pain, history of fracture,
intake of vitamin D and calcium supplements, use of
anti-osteoporotic drugs, steroids and other drugs. The
questionnaire was sent to 317 subjects in Nuuk and 181
responded (57.1%). Responders in Greenlandic (39.2%)
were more frequent in the oldest age group (64.4%;
p<0.001). More women in the younger group were smokers
(60.6% vs. 35.0%; p=0.022) while limited sun exposure
was reported by more older women (62.8% vs. 94.4%;
p=0.003). Family history of osteoporosis (15%), premature
menopause (17.9%), alcohol and milk intake did not differ
between groups. Fall within the last year was reported by
42.4% with fewer falls in the oldest age group (21.9% vs.
50.0%; p=0.005). Frequency of fragility fractures increased
with age (5.7% vs. 24.3% vs. 30.4%; p=0.02) and age 70
years or above predicted the risk of an osteoporotic fracture
(p=0.004; OR, 95%-CI: 4.5, 1.6-12.2) when adjusted for
smoking, gender and falls. The use of anti-osteoporotic
drugs was low (3.4%) while 28.8% took supplements
with calcium and vitamin D. In conclusion, age is a
dominating risk factor for fragility fracture. Osteoporosis is
common in old age in Greenland and treatment is scarce.
[email protected]
Successful Aging Through the Eyes of
Alaska Natives: Exploring Generational
Differences Among Alaska Natives
AUTHOR: J. Lewis
University of Alaska Fairbanks
16
There is very little research on Alaska Native (AN) elders
and how they subjectively define a successful older age. The
lack of a culturally-specific definition often results in the use
of a generic definition that portrays Alaska Native elders
as aging less successfully than their White counterparts.
However, there is a very limited understanding of a diverse
array of successful aging experiences across generations.
This research explores the concept of successful aging
15:30 - 17:00
from an Alaska Native perspective, or what it means
to age well in Alaska Native communities. An adapted
Explanatory Model (EM) approach was used to gain
a sense of the beliefs about aging from Alaska Natives.
Research findings indicate that aging successfully is based
on local understandings about personal responsibility and
making the conscious decision to live a clean and healthy
life, abstaining from drugs and alcohol. The findings also
indicate that poor aging is often characterized by a lack
of personal responsibility, or not being active, not being
able to handle alcohol, and giving up on oneself. Most
participants stated that elder status is not determined by
reaching a certain age (e.g., 65), but instead is designated
when an individual has demonstrated wisdom because of
the experiences he or she has gained throughout life. This
research seeks to inform future studies on rural aging that
prioritizes the perspectives of elders to impact positively on the
delivery of health care services and programs in rural Alaska.
[email protected]
Spatio-Temporal Analysis of Non-Fatal
Falls in Alaska, 1991 - 2009
AUTHORS: T. Sunbury1, N. Nix2
Institute for Circumpolar Health Studies 1, University of Alaska
Anchorage 2
Objectives: In contrast to the lower-continental
United States, falls are the leading cause of non-fatal
hospitalized injuries for most age groups in Alaska.
The rate of unintentional falls is increasing and while
previous studies have identified regional and demographic
differences, further research is needed to examine trends
and variation in non-fatal hospitalized falls to ameliorate
this growing public health burden. The purpose of this
study was to provide further investigation of smaller-scale
(local) analysis of spatial characteristics and identify any
spatial-temporal trends. Methods. The study population
consisted of Alaska Trauma Registry (ATR) patients from
1991 – 2009 that were hospitalized for slips/falls listed as
cause of injury. We examined demographic, injury location,
injury type, severity, and outcome characteristics by age and
gender. Results. From 1991–2009, 28,943 patients were
hospitalized with fall-related injuries. Overall, females
made up 60% of all hospitalized fall-related injuries.
Males were more likely than women to be involved in an
occupational-related fall (p < 0.0001), alcohol-related falls
(p < 0.0001), and have more severe injuries (p < 0.0001),
across age groups. Exploratory spatial analysis showed
more falls in southeast Alaska, with more occupationalrelated falls in northern and interior Alaska. Temporal
trends suggested more falls occurred during winter months.
Conclusions. Alaska hospitalization rates from falls
differed by age and gender in the mechanism, injury type,
and injury severity. Further study into the circumstances
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[email protected]
Alaska Strong Women Program
AUTHOR: L. Tannehill
University of Alaska Cooperative Extension Service
It is essential to remain strong in older adulthood to
maintain an independent and vibrant lifestyle. Research
has shown that regular strengthening exercises can help
to prevent frailty and falls as well as reduce the risks of
chronic diseases such as diabetes, arthritis, heart disease,
and osteoporosis. Exercise with weights has been shown to
improve sleep and reduce depression. The StrongWomen
Program, an evidence-based strength-training program
developed by Dr. Miriam Nelson at Tufts University, has
been operating in community sites located throughout
Alaska since 2004. Community sites included Native
health clinics, churches, and community centers. These
programs targeting middle-age and older women and
men have been successful in our urban, rural and bush
communities. Trained volunteers provide the leadership
and instruction for the StrongWomen programs. The
exercises in this program require a minimum of lowcost equipment, making it affordable for the community
sites. Participants report feeling more energetic and have
improved bone density, strength, balance, and mobility.
The social aspect is attractive to participants as well.
[email protected]
Health Services # 1 - Rural Workforce Duckering Room 342
moderators: T. Heart & T. Nancarrow
Innovative Primary Care Delivery
in Rural Alaska: A Review of Patient
Encounters Seen by Community
Health Aides
AUTHORS: C. Golnick1, E. Asay2, D. Van Liere1,
E. Provost2, C. Bosshart3, J. Rounds-Riley3, K. Cueva4,
T. Hennessy5
Alaska Native Tribal Health Consortium 1, Alaska Native Tribal
Health Consortium, Alaska Native Epidemiology Center 2, Alaska
Native Tribal Health Consortium, Community Health Aide
Training Program 3, University of Alaska, Anchorage 4, CDC, AIP 5
Objectives: This study is a systematic description
of the clinical practice of primary care health workers
in rural Alaska communities. For more than 50 years,
Community Health Aides and Community Health
Practitioners (CHA/Ps) have resided in and provided care
for the residents of their communities. This is the first
program review of the scope of medical conditions seen
by Alaska’s Community Health Workers in their remote
communities. Study Design: Retrospective observational
review of administrative records for outpatient visits
seen by CHA/Ps in 150 rural Alaska communities
(approximate population 47,370). Methods: Analysis
of electronic records for outpatient visits to CHA/Ps in
rural clinics from October 2004 through September 2006.
Data included all outpatient visits from the Indian Health
Service National Patient Information Reporting System.
Descriptive analysis included comparisons by region, age,
sex, clinical assessment and treatment. Results: 272,242
visits were reviewed. CHA/Ps provided care for acute,
chronic, preventive, and emergency conditions at 176,957
(65%) visits. 95,285 (35%) of records did not include a
diagnostic code, most of which were medication-related
encounters. The most common diagnostic codes reported
were: pharyngitis (11%), respiratory infections (10%), otitis
media (8%), hypertension (6%), skin infections (4%), and
chronic lung disease (4%). Respiratory distress and chest
pain accounted for 75% of all emergency visits. Conclusions:
CHA/Ps provide a broad range of primary care in remote
Alaskan communities whose residents would otherwise be
without consistent medical care. Alaska’s CHA/P programs
could serve as a health-care delivery model for other
remote communities with health care access challenges.
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surrounding slips/falls is needed to fully understand
the injury disparities and to adapt and implement
prevention programs. Different recommendation for
prevention strategies need to focus on more specific
risk factors by geographical location and seasonality.
[email protected]
True Value and Values the Use of
Available Human Resuorces to Meet
Health Care Needs. The Community
Health Aide Program, Dental Health
Aide Therapists and Behavioral
Health Aides
AUTHORS: L. Putnam, G. Bell, E. Allgair
Yukon-Kuskokwin Health Corporation
The Health Aide program is a realistic approach to providing
health care to remote and underserved communities by
MD’s,PA’s,FNP,Dentists,Psychologists and Psychiatrists.
The Community Health Aide program development
started in the late 1950’s in responce to the TB epidemic.
Because the Members of the medical community were able
to recognise the skills inhearent in the native and inability
to provide care with existing medical models the above
programs evolved.The major difference in the method of
delivering health care is that it is a system that does with
rather than to or for.Members of the native community
are able to prove quality care in their home village.This is
also a more immediate and cost effective.The effectiveness
17
MONDAY ORAL
of the program was recognised on the floor of the Senate
S.Res 526 April 22,2008. The presentation at the Congress
would consist of a short history,training, scope of practice
and supervision of each program.This should be followed
by Health Aides speaking about why they became Health
Aides and what it is like to pratice in their village.Other than
providing care another value is the cooperative effort of a
group of professionals as a team.This has lead to increased
respect for individuals having different values and cultures.
[email protected]
Building a Program to Support Nursing
Practice in Remote Northern Settings in
Quebec
AUTHORS: A. Robitaille1, J. Desrochers1,
M. St-Gelais1, S. Auger2, M. Monger2, K. Roy3, K.
Verville3, F. Noel4, N. Bobbish4, L. Murray5, M. Buck6,
L. Crelinsten7, M. Maurice8, G. Pekeles1
The Montreal Children Hospital 1, CSSS Basse-Côte-Nord 2, Centre
de Santé Inuulitsivik 3, Cree Board of Health and Social Services of
James Bay 4, McGill University Health Centre 5, The School of
Nursing, McGill University 6, The McGill Simulation Centre 7,
Centre de Santé Pakuashipi 8
18
The Distant Teaching and Learning Centre (DTLC) was
developed in 2010 by The Northern Health Program of
The Montreal Children’s Hospital to respond to request
from remote regional health boards. The DTLC has
developed a learning and training program to improve
the quality of practice and retention of nurses. The
specific goals are to support 5 aspects of an autonomous
advanced nursing practice in remote settings: clinical
examination, adapted intervention to the realities, clinical
monitoring, communication skills and crisis management.
Thus far, the program has focused on four domains: first
line care, emergencies, woman and child health, mental
health. The program is divided into 6 learning modalities
adapted to different learning needs, ranges of professional/
personal experiences and technological capacities: 1) Biweekly 2 hours videoconference/webinar sessions, from
September to June; 2) A web platform developed as a
central communication tool, where e-learning courses,
e-forum, documentation and clinical video vignettes can
be found; 3) Access to certification in traumatology and
emergency care; 4) Clinical practica organized in the
settings of operating room, birthing center and emergency
department; 5) Northern Days at the McGill Simulation
Centre for hands-on workshops; 6) A mentorship program
enhancing knowledge exchange between northern and
southern clinicians. Up to now, more than 60% (n= 150)
of the nurses in these regions have participated in one
or more of the activities delivered by the DTLC. Other
health and social services professionals have occasionally
joined the group. Seventy eight percent of participants
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found videoconference program relevant to their practice
and 73% believed that the content would improve their
nursing practice. This presentation will describe the
content of the program, preliminary evaluations and
plans for a more rigorous evaluation over the next 2 years.
[email protected]
The Characteristics of Arctic Nursing in
Greenland
AUTHORS: L. Hounsgaard1, A.B. Jensen2,
J. Praest Wilche3
University of Greenland 1, National Hospital Queen Ingrid 2, Health
Department 3
Background: The requirements for evidence-based
clinical nursing and for the Bachelor degree in Nursing to
be research-based results in a need to identify characteristics
of Arctic nursing as a basis for the further development
of knowledge in this field. Objective. The objective is to
identify existing nursing expertise as it is practiced in urban
and village settings as a basis for further development. The
following questions are to be answered: What nursing
actions are performed? How do nurses describe their
practice? What nursing actions are documented and how is
it done? and How do nurses develop competences locally?
Materials and Methods: The study is designed
as an ethnographic field study. An initial literature search
was carried out that focused on Arctic nursing and the
education of health staff. The results of the search are
included in the analysis of the empirical evidence from
the fieldwork. The informants were 12 nurses from four
villages and four towns in Greenland. They were followed
by participant observation from between one and five days
and interviewed from a semi-structured interview guide.
The interviews included detailed questions based on the
results from the participant observations. In addition,
the nurses’ records were registered in nursing journals.
The analysis of the interview data was conducted on
three analysis levels: naive reading, structural analysis,
and critical interpretation using a phenomenologicalhermeneutic text analysis method. Results. The analytical
work is ongoing and is expected to be completed before
the conference. It is expected that the results will help
to identify experiential knowledge as developed locally
by nurses and their colleagues. This knowledge should
contribute to identifying requirements for qualifications
in Arctic nursing practice and thereby point to areas
in need of research-based knowledge development.
[email protected]
Gruening Room 206
moderators: E. Petersen & C. Carry
Growing Up Tobacco-Free In Alaska
AUTHORS: C. Dalena, K. Doster
Alaksa Native Tribal Health Consortium
Audience: Coordinators and administrators working
in any of the following areas will likely benefit from
this presentation: -Tobacco prevention and cessation
-Community development -Programs for underserved
and rural populations Key Points: Collaboration between
community health organizations and community
educational institutions can be successful partnerships
working to increase systems that address tobacco use. The
following core concepts were instrumental in developing
this community based initiative: 1. Training community
based staff around the impacts and risks of tobacco use
on children, families and communities. 2. Implementing
tobacco screening and intervention in a community
program. 3. Partnering to raise community awareness 4.
Culturally relevant project activities and modifications
are necessary to meet the unique individual needs of
community based tobacco intervention programs. These
key points will be demonstrated by sharing about the
Growing Up Tobacco-Free In Alaska project, which is
a community initiative that weaves the expertise of the
Alaska Native Tribal Health Consortium (ANTHC) with
the community experience of the Rural Alaska Community
Action (RurAL CAP) Head Start Program to increase
systems that address tobacco use in 24 rural Alaskan
communities. Presenters will describe the collaborative
community initiative, discuss core concepts, share samples
of project activities, present project measures and current
outcomes and discuss future implementation and systems
change possibilities. The audience will leave with innovative
ideas on how to develop partnerships that are collaborative
and implement best practice solutions around tobacco
treatment while providing services to disparate populations.
[email protected]
Smoking Cessation in Nunavut,
Canada: What Do Inuit Have to Say
About Quitting?
AUTHORS: M. J. Costello1, J. Garcia1, P. McDonald1,
M. Doucette2, A. Kronstal2, A. Korgak2, M. Charron2,
G. Osborne2, I. Sobol3
University of Waterloo 1, Government of Nunavut 2, Government of
Manitoba 3
Objectives: To report on Nunavummiut Inuit attitudes
toward quitting smoking and their experiences with
quitting. Perceived barriers to quitting are also reported.
Methods: A qualitative study that consisted of 26 focus
groups and 5 individual interviews was conducted from
May to June 2010 with 113 participants aged 16 years and
over, from 3 communities in Nunavut. Results: Participants
indicated there was interest within their communities to
quit smoking; however, actual quitting was less common
than desirable. Most common reasons for wanting to quit
included the risk of developing smoking-related health
effects, knowing someone who suffered from a smokingrelated health effect, the cost of cigarettes, and having
been told to quit by a medical doctor. Many reported it
was difficult to quit and stay quit; relapse was considered
common. Those who had tried to quit often reported doing
so on their own using various distraction techniques (e.g.,
keeping busy, chewing gum, playing sports). Some had also
tried nicotine replacement therapies (e.g., nicotine gum or
patches). Most common barriers to quitting included the
social acceptance and widespread use of tobacco. Emotional
triggers such as boredom, stress, and depression, as well
as nicotine dependence or addiction were also reported
as barriers. Many indicated few formal quitting supports
were available within their communities to help those
who wanted to quit; however, family, friends and Elders
were perceived as important supports. Conclusions: These
findings provide insight into the barriers Inuit face when
trying to quit smoking in Nunavut and will help to inform
the development of more culturally appropriate smoking
cessation interventions within the Territory.
MONDAY ORAL
Behavioral Health # 1 - Tobacco 15:30 - 17:00
Already a media campaign has been implemented in
Nunavut to create a local dialogue on smoking, encourage
quit attempts, and support those who choose to quit.
[email protected]
The Significance of Smoking on Daily
Life in a Greenland Village - Interview
with Smokers
AUTHORS: A.B. Jensen1, L. Hounsgaard2
Dronning Ingrids Hospital, Nuuk 1, Greenland Institute of Nursing
and Health Science, University of Green 2
Background: Smoking-related conditions, such
as COPD, cardiovascular disease and lung cancer, are
common in Greenland. Factors such as age, gender,
cigarette use, restricted smoking at home and socioeconomic determinants are well-known predictors for
smoking and smoking cessation. From 1999 and through
to 2005, the fall in the number of smokers stagnated and
in 2005 66% of the adult population were smokers, despite
widespread smoking cessation campaigns. It is therefore
imperative to identify the factors that influence the lack of
smoking cessation to enable better targeting of preventive
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MONDAY ORAL
work with smoking.
Objectives: To investigate the meaning of smoking
on the daily life of unskilled residents of a small town in
Northern Greenland.
Materials and Methods: An ethnographic
field study is being undertaken, including participant
observation and semi-structured interviews with health
professionals and smokers. The analysis of the empirical
data is being conducted on three analysis levels: naive
reading, structural analysis and critical interpretation, using
a phenomenological-hermeneutic text analysis method.
Results: Having time on one’s hands can be a factor
in smokers remaining as smokers. It appears that smokers
nowadays consider themselves to be stigmatised. This may
be one reason for wanting to stop smoking. Smokers ask for
how to quit and ask for help to give up smoking in terms
of medical treatment for withdrawal symptoms. It appears
that male and female smokers have different perceptions
when they evaluate their health as being bad. For women
it is frequently based on stress, and for men on physical
illness. Serious illness or being pregnant appear to be
triggers to consider giving up smoking. Severe withdrawal
symptoms and knowledge about how one gives up smoking
are barriers to participants achieving their goal.
Conclusion: Prevention initiatives should be
targeted at all smokers and a smoking cessation service
should be developed, where smokers are supervised and
receive medical treatment for withdrawal symptoms.
[email protected]
Contrasting Social Norms and Policies
Around Secondhand Smoke in Different
Regions of Alaska
AUTHORS: E. Peterson1, J. Dilley2, M. Bobo3,
K. Pickle2
State of Alaska Department of Health & Social Services 1, Program
Design & Eval Svcs, Multnomah Cty/OR Hlth Authority 2, State of
Alaska DHSS, Tobacco Prevention & Control 3
20
Creating laws and policies that protect the public from
exposure to secondhand smoke (SHS) is a highly effective
tobacco control intervention. Formal policies can be
enacted by independent facilities, or on a municipal or
statewide level that covers all facilities. SHS exposure
might also be limited by social norms, where communities
have “unwritten rules” that smoking around other people
is not acceptable. In Alaska, most communities are rural
and many are not incorporated as municipalities. Some
may have few buildings where the community gathers. To
determine whether there were differences in the presence
15:30 - 17:00
of current policies (formal or informal), and social norms,
the Alaska Tobacco Prevention and Control Program
developed a series of questions about the presence of three
facilities that are commonly found even in very small
communities (schools, hospitals and clinics), and whether
smoking was allowed there. These questions were added
to the 2011 Alaska Behavioral Risk Factor Surveillance
System (BRFSS), an ongoing statewide telephone healthfocused survey of Alaska’s adult population. The BRFSS
already contained questions about SHS exposure and
perceived harm of SHS exposure. We used preliminary data
to explore differences among urban, hub and rural Alaska
communities: presence of facilities, whether people thought
there were rules that banned smoking, whether they had
seen others smoking in those facilities, perceived smoking
prevalence in the community, perceived harm of SHS, and
exposure to SHS. Many rural communities do not have
large numbers of public buildings where policies could be
enacted. Our findings suggest that the policies and social
norms that protect nonsmokers from secondhand smoke are
not as strongly in place in Alaska’s rural communities. This
may mean that protective policies have not been adopted as
readily, or that design and dissemination of policies needs to
be adapted to be more relevant to rural Alaska communities.
[email protected]
Distance Education for Tobacco
Reduction with Inuit Frontline Health
Workers
AUTHORS: C. Carry, R. Collins, M. Hammond,
D. Kinnon, J. Killulark, J. Nevala
National Aboriginal Health Organization
Purpose: This project reviewed the literature on
promising practices in tobacco reduction, and offered
a distance education course for Inuit frontline health
workers – mainly Community Health Representatives
(CHRs) – in four Inuit regions of Canada. Description
The project, funded by Health Canada, was co-ordinated
by Inuit Tuttarvingat of the National Aboriginal Health
Organization (NAHO) for the Inuit Tobacco-free
Network (ITN). The ITN Advisory Group provided
guidance during conference calls, confirming that processes
were appropriate for the target group. Participants
identified their areas of interest in tobacco reduction in
a self-assessment of competencies (pre-test). They chose
community activities and used their training materials
to prepare and implement these projects. Training and
support was provided through individual phone calls
and e-mail. Observations After contacting 33 potential
participants, 28 were selected and 27 (96%) completed the
course. The mean score for pre-tests was 72% (range: 38%98%). At the end, we gave a repeat pre-test allowing for
open book reference to correct any incomplete or incorrect
15:30 - 17:00
[email protected]
Infectiuous Diseases #1 - Respiratory Infections
Salisbury Theatre
moderators: T. Thomas & M. Lem
Response of Aboriginal Infants to
Pertussis Vaccine Components: Results
of a Controlled Comparison Study
AUTHORS: M. Lem1, D. Scheifele2, S. Halperin3,
C. Lajeunesse2, M. Dawar4, R. McCormick5
First Nations and Inuit Health, Health Canada 1, Vaccine Evaluation
Center, BC Children’s Hospital 2, Canadian Center for Vaccinology,
Dalhousie University 3, Vancouver Coastal Health Authority 4,
Aboriginal Health Research Network, UBC 5
Background: Canadian Aboriginal populations experience
rates of pertussis more than double that of the general
population. Outbreaks continue to occur in Canada
and may involve significant morbidity. Socio-economic,
environmental and biologic factors may contribute to
this increased risk, however whether vaccine responses
are altered in Aboriginal infants is undetermined because
vaccine studies rarely focus on this population. We report
one of the first Canadian studies to assess vaccine responses
of Aboriginal infants. Objective: To compare immune
responses of Aboriginal and non-Aboriginal infants to
pertussis vaccine antigens following completion of the
primary immunization series. Methods: Healthy infants
were enrolled prior to 2 months of age to receive 3 doses (at
2, 4 and 6 months of age) of DTaP.IPV.HB.Hib (Infanrix
hexaTM, GSK Canada) vaccine from one commercial lot.
A single blood sample was drawn 30-48 days after the final
vaccination and tested for antibodies to acellular pertussis
vaccine components (pertussis toxoid [PT], filamentous
hemagglutinin [FHA], and pertactin). Aboriginal infants
were enrolled and followed at 5 First Nations health
centers in southern BC and non-Aboriginal infants in
metropolitan Vancouver. Results: Evaluable blood samples
were obtained from 68 Aboriginal and 96 non-Aboriginal
infants. Rates of seropositivity were equivalent between
Aboriginal and non-Aboriginal infants for PT (67/68
[98.5 %] vs. 95/96 [99.0%]) and FHA (68/68 [100%]
vs. 96/96 [100%]). Geometric mean titers (GMT) were
slightly higher in Aboriginals versus non-Aboriginals for
PT (44.3 [36.2-54.2] vs. 43.7 [37.6-50.9]) and FHA (74.5
[60.5-93.5] vs. 65.6[57.0-75.4]). For pertactin, Aboriginals
had statistically lower rates of seropositivity (57/68 [83.8%]
vs. 91/96 [94.8%], P=0.02) and slightly lower GMTs (30.8
[23.1-41.1] vs. 33.5 [28.0-40.0]) Conclusions: Routine
pertussis immunization resulted in similar antibody
responses to vaccine compone in Aboriginals as in other
infants. These results provide reassurance to health
service providers engaged in routine immunization and
pertussis outbreak control in Aboriginal communities.
MONDAY ORAL
answers, resulting in a mean improvement of 28% (range:
2%-62%). Practice implications To keep tobacco control on
the agenda, CHRs need ongoing one-on-one telephone
support, relevant resources, and networking using the
ITN website and e-mail listserv. Numerous competing
factors relegate tobacco control to the backburner in
isolated communities, but distance education with
practice-based learning objectives provides a promising
solution. Conclusions Distance education done in this way
provides an accessible and appropriate method to sustain
tobacco reduction activities in remote communities. It
has potential for training in other competencies for First
Nations, Métis and Inuit frontline health workers as
well, but requires diligent follow-through. We should not
expect it to be simply a cheap alternative to face-to-face
training. However, distance education does double duty by
consolidating “learning” and “doing” in a real-life setting.
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Changes in Seasonality of Respiratory
Syncytial Virus (RSV) in a Southwest
Region of Alaska (1994-2010)
AUTHORS: R. Singleton1, D. Bruden2, S. Bentley1,
T. Hennessy2
Alaska Native Tribal Health Consortium 1, AIP/CDC 2
Introduction: Between 1994-2004, rates of lower
respiratory tract hospitalization among children 10% of all
submitted specimens. Results: Since 1994-2004, a period
when RSV rates declined (178 to 107 per 1000 infants < 1
year of age), RSV rates have remained stable at 97 per 1000
infants (2005-7) and 99 per 1000 infants (2008-10). In the
first eight years of surveillance (1994-2002), the average
length of the RSV season was 32 weeks which decreased
to 19 weeks more recently (2003-2010). The average
offset of the RSV season shifted 2 weeks between the 2
surveillance periods (May 8-14 [94-02] to May 22-28 [0310]. The onset of the RSV season, however shifted from
an average of Oct 11-17 (94-02) to not starting until Jan
10-16 (03-10). Conclusions: In this southwest region of
rural Alaska, the RSV rate among infants < 1 year of age
has remained stable in recent years. However, the length
of the RSV season has been shorter and started later in
the last 8 years of surveillance. Accordingly, the palvizumab
administration season for high risk infants has been adjusted.
[email protected]
21
MONDAY ORAL
Risk Factors for Respiratory Viral
Infections in Children in Greenland
AUTHORS: A. Koch1, M. Andersson1, L. Nielsen1,
P. Homoe2, J. Wohlfahrt1, M. Melbye1
Statens Serum Institut 1, Main University Hospital 2
Background: Respiratory tract infections (RTI) are
highly prevalent in Greenlandic children. Yet, very little
is known about virus causing these infections and risk
factors for such. Methods: An open cohort of children
aged 0-4 years was formed in Sisimiut, West Greenland,
and followed for 2 years 1996-98 by regular visits. In case
of symptoms of upper or lower RTI and regularly at ½
year intervals irrespectively of symptoms nasopharyngeal
aspirates were taken and stored frozen until analysis by
PCR for 12 respiratory virus (Rhinovirus, Adenovirus, RSV,
hMPV, Influenzavirus, Parainfluenzavirus, & Coronavirus
species). Effects of a number of environmental risk factors
were estimated using a GEE model. Results: 963 isolates
in 2202 aspirates were identified. Most were rhinovirus
(in 24% of samples) and adenovirus (in 19% of samples),
followed by RSV (in 4% of samples). Rhinovirus and
adenovirus were identified throughout the whole period,
while RSV clearly appeared in epidemics. Risk factors
for any virus were young age, calendar period, living in a
town versus a settlement, increasing number of persons in
sleeping room, and attending childcare centre, while breast
feeding was protective. In contrast, ethnicity (Greenlandic
/Danish ethnicity), size of family, number and age of
siblings, smokers in household, and hygienic factors were
not associated with viral infections. The risk factor pattern
for RSV differed from those of Rhinovirus and Adenovirus
as breast feeding and living in a settlement did not appear
to be protective. Conclusion: The overall risk factor
pattern for respiratory virus infections in Greenlandic
children reflects susceptibility (young age and lack of
breastfeeding) and close exposure to many people (living in
a town, number of persons in sleeping room and attending
childcare centre). While Rhinovirus and Adenovirus
are endemic in Greenland, RSV occurs in epidemics,
and in those periods appear to infect children broadly.
[email protected]
15:30 - 17:00
Lower Respiratory Tract Hospitalizations
in Alaska Native children Compared with
Other American Indian/Alaska Native
Children and the General US Child
Population
AUTHORS: R. Singleton1, R. Holman2, A. Folkema3,
J. Redd4, C. Steiner5, T. Hennessy6
Alaska Native Tribal Health Consortium 1, NCEZID, Centers for
Disease Control 2, NCEZID 3, Indian Health Service 4, Agency for
Healthcare Research and Quality 5, Arctic Investigations Program Centers for Disease Control 6
Objective: To compare trends in lower respiratory
tract infection (LRTI) hospitalization rates among
Alaska Native (AN) children residing in Alaska with
other American Indian/Alaska Native (AI/AN) children
and the general US population of children <5 years of
age. Study Design: Retrospective analysis of trends and
hospitalization rates for LRTI hospitalizations in 19982008 among AI/AN children <5 years of age using the
Indian Health Service (IHS) direct and contract care
inpatient data, and among the general population of US
children <5 years of age using the Nationwide Inpatient
Sample. Results: The 2006-2008 LRTI hospitalization
rate for AN children <5 years of age (41.2 per 1,000/year)
was 21% lower than the 1998-1999 rate, but remained
3-fold higher than the general US children rate (13.8, 95%
CI: 12.8-14.8). The highest rate was for AN infants < 1
year of age (136.4) which was higher than rates for AI/
AN infants from other IHS regions (20.9 to 82.4) and the
general US infant population rate (37.1, 95% CI: 34.340.0). The rate disparity between AN infants and the
general US infant population was greatest for pneumonia;
the AN infant pneumonia hospitalization rate (71.4) was
5.5 fold higher than the general US infant pneumonia
rate (12.7, 95% CI: 11.8-13.6). Conclusions: The LRTI
hospitalization rate for AN children, particularly for infants
with pneumonia, remains substantially higher than that for
AI/AN children living in other IHS regions and for the
general US child population. Closing this gap will require
cooperation with tribal corporations to address housing
and sanitation inequities, as well as ensure continued
improvement in immunization rates and access to care.
[email protected]
22
AUTHORS: A. Banerji1, M. Young2, D. Rosselli3,
V. Panzov4
University of Toronto 1, IWK Health Centre 2, Pontificia Universidad
Javeriana 3, Applied Health Research Centre, St. Michael’s Hospital 4
Background: Lower respiratory tract infections
(LRTI) are one of the most significant health concerns
for infants who reside in the Canadian Arctic and are the
largest health expenditure for this population. The cost of
LRTI has not been estimated before. The objectives of this
study was to estimate and compare the costs related LRTI
admissions in the Canadian Arctic among Northwest
Territories (NWT), Nunavut and Nunavik. Methods This
is a hospital-based surveillance of infants less than 1 year
of age, from Northwest Territories (NWT), Nunavut and
Nunavik that were admitted to 4 regional and 5 tertiary
hospitals from January 1st 2009 to June 30th 2010. The
costs associated with each admission were obtained from
the hospitals, governments and airlines and the physician
fee schedules. Costs included daily hospital ward or ICU
admission, physician fees, transportation to the hospital.
Total and average costs and costs per 1000 live births
were compared for LRTI admissions across the regions.
In addition the rates of admission and costs per 1000 live
births were calculated as well. The costs were based on 2011
Canadian dollars. Results: The rates of admission for NWT,
Nunavut and Nunavik were 37, 249, and 445 per 1000 live
births respectively. The total costs and average costs for were
$1.43 million and $12,000, $10.3 million and $33,904, and
$2.8 million and $16,600 for NWT, Nunavut and Nunavik
respectively. The total costs for LRTI in the first year of life
per live birth was $1,277, $9,772 and $11,092 for the above
regions respectively Conclusion: LRTI admissions are very
expensive in the Canadian Arctic. However there are major
differences in the rates of admission, and the costs of LRTI
admissions per live births. Efforts to reduce admissions
for LRTI would have a major impact cost savings.
[email protected]
Nutrition #1 - Diet, Nutrition and Health:
Cardiovascular and Diabetes Research in the North
McGown
moderators: L. Duffy & S. Ebbesson
Arctic Medical Health, Disease and
Nutrition: The Challenges and the Joys
MONDAY ORAL
The Cost of Lower Respiratory Tract
Infections Hospital Admissions in the
Canadian Arctic
15:30 - 17:00
AUTHORS: L. Duffy1, C. Gerlach1, S. Ebbesson1,
K. Young2, E. Dewailly,3 P. Byerregard4, K. Dunlap,
A. Godduhn, A. Reynolds
University of Alaska Fairbanks 1, University of Toronto 2, Centre
Hospitalier Universitaire de Québec 3, National Institute of Public
Health 4
Since the establishment of the International Union on
Circumpolar Health and the initiation of the International
Congresses on Circumpolar Health, there has been a
tremendous growth in both clinical and basic research
addressing the health disparities of northern people
in relation to their diet and environment. Changing
lifestyles, food systems and global contaminants have
contributed to an increase in the diseases of civilization
-- type 2 diabetes, cardiovascular disease (CVD), stroke
and metabolic syndrome. However, apparent differences
in their impact within different populations has led to
a questioning of global generalizations in respect to
individual health and the community health of indigenous
populations. While northern populations continue
to be under researched in relation to the impacts of
cardiovascular disease, diabetes and metabolic syndrome,
exciting research is underway related to these diseases as
well as food security and sustainable subsistence in general.
In this symposium Kue Young, Eric Dewailly, Peter
Byerregard, Sven Ebbesson, S. Craig Gerlach and others
will discuss their research, presenting both the history of
discovery and the future questions that need answering.
[email protected]
Healthy Communities #1 - Climate Change Processes Schaible Auditorium
moderatorS: M. Brubaker & B. Evangård
Assessing the Effects of Climate Change
on Health and Lifestyle in Sub-Arctic
Areas in Sweden - The Northern Sweden
Population Health Study
AUTHORS: U. Gyllensten, Å. Johansson, S. Enroth,
I. Jonasson
Uppsala University
Health care and research in circumpolar populations
are often limited due to poor infrastructure, although
23
MONDAY ORAL
such populations may have special medical needs. The
Northern Sweden Population Health Study (NSPHS) is
a study that combines a detailed survey of the lifestyle and
health conditions of the community with basic research
into determinants of non-communicable disease. The
NSPHS is part of the European Network on Special
Populations (EUROSPAN), focusing on remote, rural,
populations from across Europe. NSPHS is a populationbased, cross-sectional study of the populations in the
Karesuando, Soppero and Vittangi areas north of the
Arctic Circle in northern Sweden. People in this area
either lead a traditional, subsistence-based, lifestyle mainly
based on reindeer herding, hunting and fishing, or a
lifestyle similar to other western European countries. The
study measures a broad spectrum of environmental (e.g.
occupation, diet, physical activity and daylight exposure)
and genetic (e.g. single-nucleotide polymorphisms) factors
of relevance for health risk. A comprehensive set of health
indicators and diagnoses of cardiovascular, orthopedic and
metabolic diseases has been collected. The state-of-the-art
laboratory analysis of blood lipids comprising hundreds
of lipid species will give unique insights into the human
metabolism under extreme living conditions. Of particular
importance are the consequences of climate change on
lifestyle and health status of the population. Among
the project health deliverables are a thorough health
investigation with counselling for individual participants
and information meetings discussing the results on a
community level. The results of the study and the particular
medical issues of people in these area will be described.
[email protected]
The Local Environmental Observer
Program (LEO) A Community-Based
Network for Surveillance of Climate
Change Effects on Public Health
AUTHOR: M. Brubaker
Alaska Native Tribal Health Consortium
24
In the early 1990s the Tribal Office of the U.S.Environmental
Protection Agency established a novel program for
American Indian and Alaska Native tribal governments and
organizations. The idea was to fund development of tribal
environmental management programs with the intent of
increasing capacity for community level improvements to
environment and public health. Today the Indian General
Assistance Program (IGAP) supports local environmental
professionals and programs in over 200 communities
across Alaska. This network of environmental professionals
is the backbone of a new climate change surveillance
program developed by the Alaska Native Tribal Health
Consortium. The Local Environmental Observer or LEO
program is providing rural Alaska communities with the
15:30 - 17:00
tools to improve monitoring for events such as extreme
weather, damage to environmental health infrastructure,
dangerous ice conditions, and to perform surveillance
for outbreaks of illness in wildlife used for subsistence.
The program uses an internet-based survey for posting
observations on monthly Google Maps which are archived
to provide a lasting record of the observations. In addition
to documenting the impacts of climate change across
Alaska, the network is also improving communication, and
connecting local environmental managers with agencies
that can provide technical assistance and resources. This
presentation provides an overview of LEO as a model for
community-based climate change monitoring in Alaska.
[email protected]
Community-Based Sentinel
Surveillance Informs Climate Change
Adaptation in Alaska
AUTHORS: D. Driscoll, T. Sunbury
Institute for Circumpolar Health Studies
Residents of the circumpolar north must adapt to the
environmental effects of climate change, in part by enhancing
local capabilities and capacities to reduce adverse health
impacts. Effective adaptations will require measurement
of environmental effects and associated health outcomes at
the local level. This presentation describes a communitybased sentinel surveillance system to capture structured
observations of environmental changes and human health
impacts in three ecologically distinct regions of Alaska. A
cohort of more than 60 study participants representing 8
communities across Alaska were asked to provide monthly
surveillance surveys for a period of 12 months. Structured
thematic sections included community observations on
local weather (12 items), hunting and harvesting (8 items),
food and water safety (7 items), and general health and air
quality (6 items). The survey included open-ended text
fields for each theme and for general observations. Study
participants in each region described increased adverse
health effects from environmental changes potentially
associated with climate change. For example, participants
in Southeast Alaska reported increased incidence of
paralytic shellfish poisoning (PSP) from warming waters,
Interior Alaska residents reported increased reactive airway
disease associated with pollen and smoke inhalation, and
participants in Northwestern Alaska reported food insecurity
associated with a decline in subsistence food sources. Study
results were presented in each study community, and
climate change vulnerabilities and adaptation strategies
were assessed in a participatory manner using a qualitative
value-jury approach. Community adaptations included
both effect-oriented strategies, or those that attempt to
reduce environmental effects, and cause-oriented strategies,
or those that attempt to reduce community exposure to
[email protected]
Animistic Pragmatism and Native Ways
of Knowing: Adaptive Strategies for
Responding to Environmental Change
and Overcoming the Struggle for Food
in the Arctic
AUTHORS: R. Anthony, C. Walker
University of Alaska Anchorage
Future-regarding norms appear to be an essential
ingredient in motivating adaptive management strategies
in the wake of climate change. These norms have always
played a part in the “ecosophy” or ecological-philosophy of
Alaska Native Peoples in the Arctic, such as the Inupiat
of Seward Peninsula. This kind of animistic pragmatism
reflects “distributed cognition,” a special source of practical
wisdom that spans over thousands of years and which
has been instrumental in the Inupiat’s struggle to survive
and thrive in harsh and evolving environments. Native
elders have been the embodiment of trans-generational
distributed cognition – collective memory, norms,
information, knowledge, technical skills, and experimental
adaptive strategies. They are human “supercomputers,”
historical epistemologists and moral philosophers of a sort,
who use narrative, a form of moral testimony to help their
communities face challenges and seize opportunities in the
wake of an ever-changing landscape. Here, I will tease out
the nature of this “ecosophy” in terms of pragmatism and
then show why this form of pragmatism is necessary for
problematizing multi-scalar, intergenerational, uncertain
and complex environmental challenges like climate change.
The “ecosophy” of the Inupiat of Seward Peninsula,
offers examples of “focal practices” which are essential
for environmental education. These focal practices instill
key virtues, namely, humility, gratitude, self-reliance,
attentiveness, responsibility, and responsiveness that are
necessary for subsistence living. Through ancient narratives,
community dwellers are encouraged to aspire to be good
persons and to fulfill their roles as community members.
These roles often revolve around the procurement of food
in a sustainable way and with due reverence to the agencies
of the animals harvested. This variant of pragmatism can
provide insights into how the metaphysics of dichotomies
may be dismantled in order to promote future regarding
norms that are mindful of more eco-centric interactions
with nature. Alaska Native ecosophy as animistic
pragmatism can challenge the dominant reductive
streak in contemporary environmental and food ethics.
[email protected]
Climate Change and Potential Health
Impacts of Infectious Diseases in the
Circumpolar North: Formation of an
International Circumpolar Surveillance
Climate Change and Infectious Disease
Working Group
MONDAY ORAL
those effects. This study demonstrates the effectiveness of
sentinel surveillance systems for informing climate change.
15:30 - 17:00
AUTHORS: A. Parkinson1, B. Evengard2
Centers for Disease Control & Prevention 1, Umea University Hospital 2
The Arctic, like most other parts of the world, has warmed
substantially over last few decades. It is well known that
temperature and humidity also affect the incidence of many
infectious diseases in both animal, insect and bird species.
Warmer temperatures may allow infected host animals
species to survive winters in larger numbers, increase
in population and expand their range of habitation thus
increasing the opportunity to pass infections on to other
animals and humans.The impact of these changes on human
disease in the Arctic is unknown. Pathogens of circumpolar
concern include Brucella, Toxoplasma, Trichinella,
Clostridium botulinium, Francisella tularensis, and West
Nile virus, while Puumalavirus, Tick borne encephalitis
virus and Borrelia are of particular concern in Sweden,
Norway, Finland, and northern regions of the Russia
Federation. The impact of climate change on the incidence
of Echinococcus, rabies virus, Giardia, Cryptosporidium are
of concern in the US Arctic (Alaska) and northern Canada,
while the reemergence of Anthrax and leptospirosis remain
a risk in some regions of northern Russian Federation.
At a meeting in Copenhagen, September 19, 2011 an
International Circumpolar Surveillance Climate Change
and Infectious Disease Working Group was formed to
share information on climate sensitive infectious diseases
in the North. The purpose of the meeting was to identify
and coordinate potential cross border collaborative
surveillance or research activities that would allow the
monitoring of climate sensitive diseases of concern that
have the potential to spread. Members consist of subject
matter experts from all eight Arctic Countries, WHO and
ECDC. Priority areas of collaboration identified include:
sharing standardized surveillance and seroprevalence
information between countries on diseases of common
concern; detection of climate sensitive infectious agents
in hunter killed wildlife; and the generation of a “white
paper” on climate sensitive infectious diseases in the Arctic.
[email protected]
25
Tuesday, August 7, 2012
10:30 - 12:00
Duckering Room 252
moderators: J. Kelly & K. Young
Innovative Approaches to Colorectal
Cancer Screening in a High Risk
Population of Alaska Native People
TUESDAY ORAL
AUTHORS: D. Redwood, E. Provost
Background: Cancer is the leading cause of death
among Alaska Native (AN) people, and colorectal cancer
(CRC) is the leading cause of new cases of cancer. Alaska
Native people are disproportionately affected by colorectal
cancer; experiencing almost twice the incidence and mortality
as U.S. Whites. Although CRC screening is an effective way
to reduce CRC mortality, AN screening prevalence varies
significantly between regions of the state, from 23% to 67%,
with a median of 51%. Goals and Objectives: Over the
past decade, the Alaska Native Tribal Health Consortium
(ANTHC) has worked to improve CRC screening prevalence
through the provision of direct screening services, policy
and systems changes, provider education, and community
outreach. Methods: Projects have included the development
and implementation of a flexible sigmoidoscopy training
program for rural mid-level providers; the provision of
itinerant endoscopy services at rural tribal health facilities;
the development and implementation of a CRC screening
Patient Navigator project; the creation and use of a CRC
first-degree relative database to identify and screen relatives
of CRC patients; research studies to test new screening
modalities; and the creation and dissemination of multimedia
materials and health resources for CRC screening promotion
among the Alaska Native population. Conclusions: CRC
screening rates have increased 102% from 2000 to 2011 due
to the multi-component activities of the ANTHC and its
partner rural tribal health organizations. Lessons learned
from past projects include the need for patient navigation and
to address capacity and systems barriers. Further research and
programs should address barriers to screening and expand
the CRC screening options available to Alaska Native
people. These efforts will increase CRC screening prevalence
and, ultimately, decrease the excess morbidity and mortality
caused by CRC among the Alaska Native population.
[email protected]
Cystatin C and Lactoferrin
Concentrations in Biological Fluids as
Possible Prognostic Factors in Eye Tumor
Development
26
AUTHORS: T. Korolenko1, D. Maria2, T. Alexander2
Institute of Physiology SB RAMS 1, S. Fyodorov Eye Microsurgery Complex 2
The increased number of eye tumors was registered recently,
not only in countries with high insolation, but also in the
Northern countries, including Russia (6-8 cases per million
of population). Cystatin C, endogenous inhibitor of cysteine
proteases, plays the important protective role in several
tumors. Lactoferrin was shown to express anti-antitumor as
well as antiviral activities. The aim: to investigate the role of
cystatin C locally, in biological fluids and serum in eye tumor
development compared to lactoferrin, revealing anti-tumor
activity. Methods used: 35 patients with benign eye tumors
and melanoblastoma choridea were under examination
(undergoing surgical treatment). Serum, tear fluid, intraocular
fluid, obtained from anterior chamber of eye in patients with
enucleated eye with melanoblastoma horioidea were studied
Cystatin C concentration was measured by commercial
ELISA kits for humans (BioVendor, Czechia), lactoferrin
level– by “Lactoferrin-strip D 4106” ELISA test systems
(Vector-Best, Russia). Results were expressed as nmol/
ml (cystatin C) and ng/ml (lactoferrin). Results. Cystatin
C concentration in serum of healthy persons was higher
as compared to tear and intraocular fluids. In patients with
melanoblastoma choridea serum cystatin C level decreased,
while cystatin C concentration was similar in tear fluid of the
both eyes. Lactoferrin level in tear fluid of healthy persons
was significantly higher vs its serum level. Serum lactoferrin
decreased in patients with eye tumor. As compare to healthy
persons increased lactoferrin concentration in tear fluid was
noted both in patients with benign and malignant eye tumors.
Conclusion. Serum cystatin C level seems more informative
index as a possible prognostic factor in eye tumors, whereas
local level of cystatin C in eye fluids was not changed
significantly in patients with melanoblastoma choridea.
Cystatin C and lactoferrin concentrations in biological fluids
as possible prognostic factors in eye tumor development.
[email protected]
The Incidence Rate and Risk Factors of
Gastric Cancer in Siberian Population
AUTHORS: V. Tsukanov1, N. Butorin2, E. Kasparov1,
O. Amelchugova1, A. Vasyutin1
SRI MPN SD RAMS 1, Khakassian Republican Hospital 2
Aim: To study incidence and risk factors of gastric cancer
and atrophic gastritis prevalence in inhabitants of Siberia.
Methods. Gastric cancer incidence was estimated on the
basis of regional oncological clinics and prosectoriums
data from 1999 till 2009 in population of various regions
of Siberia. In the same regions the prevalence of atrophic
gastritis was studied by cross-section method. 689
Europoids, 533 Khakases, 493 Evenks and 414 Tuvins
underwent upper digestive tract endoscopy with biopsy
from antrum, lesser and major curvature, morphological
research and screening of H. pylori. Morphological
[email protected]
40-Year Trends in Cancer Incidence
Among Alaska Native People, 1969-2008
AUTHORS: J. Kelly, T. Schade, S. White,
R. Ashokkumar, M. Starkey
Introduction: Cancer is the leading cause of death
among Alaska Native people. Incidence data from diagnosis
years 1969 to 2008 allow for the analysis of incidence
rates, trends over time and rate comparisons with other
populations. Methods: The Alaska Native Tumor Registry
(ANTR) has data on cancer in Alaska Native people who
are of Alaska Native or American Indian heritage, meet
eligibility requirements for Indian Health Service benefits,
and were residents of Alaska at the time of diagnosis. The
ANTR is a contributing member of the National Cancer
Institute Surveillance, Epidemiology and End Results
(SEER) Program and follows SEER data collection and
coding standards. Cancer incidence rates for other US
populations are from SEER Stat, a public-use data source.
Statistical differences in rates were determined by comparing
rate confidence intervals (p=0.05). Results: In the 40 years
from 1969-2008, more than 9,000 Alaska Native men and
women were diagnosed with invasive cancer. The most
frequently diagnosed cancers among Alaska Native men
are: lung, colon/rectum, prostate, stomach, kidney, and oral
cavity/pharynx. Among Alaska Native women the leading
cancers are: breast, colon/rectum, lung, corpus and uterus,
kidney, non-Hodgkin lymphoma and stomach. The top 3
cancers among both men and women account for more than
50% of the total cancer burden. Current five year rates for
lung cancer in Alaska Native men and women continue to
increase and are significantly higher than US White rates.
Colorectal cancer rates, nearly two times the US White
rates, may be on the decline, although tests for trend did not
result in statistical significance. The incidence rate for breast
cancer in Alaska Native women was once half the rate of
US White women during years 1974-1978, increased during
years 1979-1998, and remains at the same level of US Whites.
[email protected]
Readers’ Theatre: A Communication Tool
for Colorectal Cancer Screening
AUTHORS: M. Cueva1, M. Dignan2, R. Kuhnley1
Alaska Native Tribal Health Consortium 1, University of Kentucky 2
Colorectal cancer (CRC) is the second leading cause of
cancer death for Alaska Native and American Indian
people. Alaska Native people have nearly twice the rate of
CRC mortality and incidence as the U.S. White population.
Purpose. ‘What’s The Big Deal?’ a 25-minute Readers’
Theatre script was developed with and for Alaska Native and
American Indian Community Health Workers (CHWs) and
the people in their communities to provide CRC screening
information, increase comfort with talking about CRC, and
encourage recommended CRC screening exams. Readers’
Theatre integrates oral tradition, language, and culture
into a dynamic story that engages participants in an active
process of reading and listening. Methods. Grounded within
Indigenous methodologies of community engagement, two
concurrent approaches to script development were utilized
during a six-month time period. Approximately 20 people
including cancer survivors, their families and caregivers,
medical providers, and Community Health Workers
provided individual comment on the script as it was being
written and revised. Additionally, 38 CHWs as part of four
cancer education workshops read, critiqued, and assisted
with script revisions. Using humor and story, a playwright
brought life to six characters who address common concerns
related to colorectal cancer screening. Results. During April
2010 – March 2011, 94% (161/172) of participants from 11
Readers’ Theatre completed a written evaluation. 90% (145)
of participants reported feeling more comfortable talking
about CRC. “I felt it was a fun way to get people to talk
about this [colorectal cancer screening] in a non-embarrassing
setting.” 77% (124) wrote healthy changes they planned to
make. Conclusions. “[Theatre] gave us a new way to talk with
patients and family.” “-a great way to lighten the mood on
such a serious topic.” Readers’ Theatre was associated with
increased knowledge, comfort talking about CRC, and served
as a catalyst for positive intent to change behavior . “Readers’
Theatre gave us a new way to talk with patients and family.”
[email protected]
TUESDAY ORAL
research included microscopic examination after staining
by hematoxylin and eosine with the description of results
using visual-analog scale (Dixon M.F. et al, 1996). Results.
The gastric cancer incidence among Europoids of various
Siberian regions was not differed from all-Russian
parameters and amounted to 30 per 100,000. The gastric
cancer incidence in Mongoloids had expressed dependence
on ethnic factors and reached 20,2 per 100,000 in Evenks,
18,2 in Khakases, 50,7 in Tuvins. The prevalence of H. pylori
in all populations was identical and varied about 90%. H.
pylori Cag A strains were registered in 59,6% of Europoids,
in 36,4% of Evenks, in 44% of Khakases and in 60% of
Tuvins. The prevalence of smoking tobacco was about 70%
n male and 30% in female. Systematic use salted fish and
pickled vegetables, strong alcohol were registered in 50%
of the population. The prevalence of atrophic gastritis was
higher in Europoids and Tuvins in comparison to Evenks
and Khakases. The prevalence of intestinal metaplasia in
gastric mucosa was very high in Tuvins. Conclusion. The
incidence and risk factors of gastric cancer in inhabitants of
Eastern Siberia are very high and depend on ethnic factors.
10:30 - 12:00
27
Behavioral Health #2 - Alcohol Use,
Policy and Prevention
10:30 - 12:00
Duckering Room 352
moderators: M. Skewes & N. Pollock
TUESDAY ORAL
Association of ADH1B, ADH1C, PDYN
and DRD4 Gene Polymorphisms with
Alcoholism in Russian Population of
West-Siberian Region
AUTHORS: A. Marusin, K. Simonova, N. Bokhan,
V. Stepanov
Institute of Medical Genetics, SB RAMS
Alcoholism is the widely-distributed addictive distress
with polygenic inheritance and heritability of 30-60%.
Fife polymorphic loci in ADH1B (rs1229984), ADH1C
(rs1789920), PDYN (rs2235749 and 68 bp VNTR in
3’-UTR), DRD4 (120 bp VNTR in 5’-UTR) gene were
investigated in alcoholics (n=238) and control group
(n=365). The observed genotype frequencies correspond
to expected in Hardy-Weinberg equilibrium for all loci of
both groups. The statistically significant low LD observed
between ADH genes. LD coefficients (d) were -0.014
in controls and -0.010 in alcoholics (p=0.02 and 0.06,
accordingly). Strong LD for PDYN gene polymorphisms
were detected (p<10^-6; d=0.082, and 0.070 in control
and alcohol groups, respectively). Reduced risk of alcohol
dependence was revealed for ADH1B*A allele carriers
(OR=0.42; (95%) CI 0.23-0.79; p=0.003) and elevated
risk was detected for ADH1C*C allele carriers (OR=1.42;
(95%) CI 1.09-1.85; p=0.008). No associations of DRD4
and PDYN gene polymorphisms with alcoholism were
shown. This work was supported by the Russian Foundation
for Basic Research (project no. 11-04-98069-r_sibir’_a).
[email protected]
Violence and Alcohol Related
Emergencies in the Greenlandic Health
Care System
AUTHORS: J. Wilche1, J. Nexøe2, B. Niclasen1, A.
Kjeldsen1, C. Færgemann3, A. Munk4, J. Lauritsen3
Ministry of Health, Government of Greenland 1, Research Unit
Og General Practice, Institute of Public Healy 2, Accident Analysis
Group, Odense Universities Hospital 3, Audit Projest Odense,
Research Unit of General Practice, Ins 4
28
Objectives: The purpose of this study was to describe
emergencies admitted to the Greenlandic Health Care
System and to which extent were admissions caused by
alcohol abuse or violence. Furthermore we examined to
which extent data on emergencies in Greenland could
be registered in a reliable way by simple means. Study
design. Descriptive, non-interventional study. Methods.
Registration of alcohol and/or violence associated
emergencies were presented to 15 out of 17 Greenlandic
health districts in the 17-days period from 21 May to 7
June 2010. Results: In the registration period of 17 days,
2,403 emergencies were registered. In 10% of cases the
patients were clinically alcohol intoxicated. When reason
for presentation were mental or social problems, attempted
suicide, accidents, or violence 24%, 50%, 15% and 59%
were intoxicated respectively. Alcohol intoxication was
significantly more often associated with advanced treatment
(e.g. evacuation, hospitalisation, or follow up by doctor or
nurse). Conclusions. This study confirms that violence and
alcohol related emergencies put a considerable strain on the
Greenlandic Health Care System. Due to short theduration
of observation we have not been able to describe the
actual size of the problem in detail. Nor was it possible
to estimate whether this problem is more pronounced
in Greenland than in other countries such as Denmark.
[email protected]
Attitudes Toward Harm Reduction
and Abstinence-Only Approaches
to Alchohol Misuse Among Alaskan
College Students
AUTHORS: M. Skewes1, V. Gonzalez2
University of Alaska Fairbanks 1, University of Alaska Anchorage 2
Alcohol misuse among college students in Alaska results
in negative health consequences. Brief harm reduction
interventions have proven highly effective at reducing
alcohol use in college students in the Lower 48. Harm
reduction aims to reduce the consequences of alcohol use
without requiring complete abstinence and may be preferred
by college students. To design or adapt the most effective
intervention for Alaskan college students who misuse
alcohol, it is important to understand students’ attitudes
toward different treatment programs and philosophies.
This study involved the assessment of students’ attitudes
toward harm reduction (HR) and abstinence-only (AO)
strategies for alcohol treatment. A sample of 243 Alaskan
college students completed questionnaires to assess their
attitudes toward treatment, understanding of alcoholism,
self-efficacy for drinking moderately, current alcohol use
behavior, and alcohol-related problems. Thirty percent of
the sample met criteria for “hazardous drinking” as defined
by the World Health Organization. On average, both
hazardous drinkers and non-hazardous drinkers preferred
HR to AO approaches, and non-hazardous drinkers rated
both approaches higher than did hazardous drinkers.
More favorable attitudes toward HR were predicted by
lesser belief in the disease model of alcoholism (ß = -.20,
p < .05), younger age (ß = -.22, p < .05), and greater selfefficacy for moderation (ß = .14, p < .05). More favorable
attitudes toward AO were predicted by greater belief in
the disease model (ß = .09, p < .05), older age (ß = .22,
p < .05), and being female (ß = -.12, p < .05). These
findings suggest that a harm reduction intervention may
be preferable for younger drinkers with greater self-efficacy
for moderation and lesser belief in the disease model of
alcoholism. The present study constituted an important
first step toward selecting an alcohol misuse intervention
that is likely to be effective for students in Alaska.
[email protected]
AUTHORS: M. Van Bibber1, C. Hubberstey1,
N. Poole2, D. Rutman1, S. Hume1
Nota Bene Consulting Group 1, BC Centre of Excellence for Women’s
Health 2
This presentation will share findings from the “Toward
an Evaluation Framework for Community-based FASD
Prevention Programs” project, which aims to identify
promising evaluation methods and create common
evaluation frameworks and tools for FASD prevention and
supportive intervention programs serving pregnant women
and mothers, and youth and adults living with FASD. The
importance of strong evaluation in the development and
delivery of FASD-related programs and services cannot be
overstated. Our project came about following recognition
of a growing desire to share what has been learned about the
design and delivery of FASD prevention and intervention
programming – i.e., what works, for whom, and in what
context - and to build understanding about various
approaches to evaluation. The project’s approach is highly
collaborative and has been guided by a 13-person national
Advisory Committee. Following an extensive review of
existing frameworks, methods and indicators of success
being used by FASD prevention and support programs, in
fall 2011 the project team facilitated day-long consultations
with program providers and researchers in three regions of
Canada. We received input on key outcomes, indicators, and
respectful and effective approaches and tools for collecting
evaluation and outcome data. Based on information
gathered to date, the team has created three Conceptual
Maps (one for FASD Prevention programs, one for FASD
Supportive Intervention programs, and one for FASD
programs in Aboriginal communities). The Maps have
been developed as tools for conceptualizing evaluation and
describing the connection between program philosophy
and program approaches/activities, formative outcomes,
and client, community, and systemic outcomes. In this
conference session, we will present the conceptual roadmaps,
and session participants will be invited to share feedback
and discuss their experiences of promising practices in
evaluation – particularly within a Northern and systemic
outcomes. In this conference session, we will present the
conceptual roadmaps, and session participants will be
invited to share feedback and discuss their experiences of
promising practices in evaluation – particularly within a
Northern and systemic outcomes. In this conference session,
we will present the conceptual roadmaps, and session
participants will be invited to share feedback and discuss
their experiences of promising practices in evaluation –
particularly within a Northern and Indigenous context,
as well as the policy-related and ethical implications for
FASD program development, delivery and evaluation.
[email protected]
Do Local Alcohol Prohibition Policies
Reduce Alcohol-Related Harm in Remote
Indigenous Communities?
AUTHOR: N. Pollock
TUESDAY ORAL
Towards an Evaluation Framework for
Community-Based FASD Prevention and
FASD Support Programs
10:30 - 12:00
Memorial University of Newfoundland
Background: Historically, the relationship between
Indigenous people and alcohol has been fraught with
notoriety. While some individuals and communities
experience few or no difficulties related to alcohol,
others experience a high burden of alcohol-related harm.
The responses to misuse often include detoxification,
AA, counselling, and residential or land-based healing
programs. In some cases, communities have exercised local
policy options to restrict alcohol availability to in an effort
to reduce alcohol-related harm. Restrictions range from
limiting the hours of sale to the prohibition (or ‘banning’)
of alcohol possession. Remote and northern communities
appear to have varied success with alcohol bans. Despite
this, some continue to implement alcohol control policies.
This paper reviews the epidemiological literature on alcohol
prohibition in remote Indigenous communities to better
understand the effects of this policy on population health.
Methods: The epidemiological literature was reviewed to
address two questions related to Indigenous population
health: (1) what are the effects of local alcohol prohibition
on alcohol-related harm in remote communities?; and (2)
what are the methodological challenges for research on
community alcohol prohibition? Results: Although research
is limited, evidence suggests local prohibition may reduce
alcohol-related harms. Remote Indigenous communities
that banned alcohol have experienced reductions in
alcohol-related mortality, outpatient visits for alcoholrelated morbidity, aeromedical retrievals for serious injury,
and violent crime. Communities with restrictions that have
alcohol access in neighboring regions do not appear to
experience a reduction in harms. The majority of the studies
included were cross-sectional and retrospective, often with
a limited sample size, a range of study periods, and varied
comparison groups and periods. Conclusion: Research
that examines the relationship between local alcohol
29
prohibition and Indigenous population health is limited.
The available data suggests that alcohol restrictions may
contribute to reductions in alcohol-related harm in remote
communities, though more comprehensive study is required.
TUESDAY ORAL
History/Anthropology - History/Anthropology
Duckering Room 347
moderators: D. Driscoll & S. Chatwood
Alcohol Policy in Canada’s North:
Implications for FASD Prevention
Control, Convenience and Profit:
Applying the Western Diet to Inuit
Populations in the Eastern Arctic,
1935-1959
AUTHORS: T. Nathoo1, N. Poole1, A. Haché2
AUTHOR: A. Dutheil
British Columbia Centre of Excellence for Women’s Health 1, Centre
for Northern Families 2
University of British Columbia
[email protected]
Fetal Alcohol Spectrum Disorder (FASD) is a term
used to describe the range of harms that can result from
prenatal alcohol exposure. Affecting approximately 1% of
the population, it is considered a leading known cause of
developmental disability in Canada. While comprehensive
data on rates of FASD and alcohol use during pregnancy in
northern communities is lacking, limited evidence suggests
that rates in many communities are above the national
average and many communities report ongoing concerns
with high rates of alcohol and other substance misuse.
The Canada FASD Research Network’s Action Team on
FASD Prevention from a Women’s Health Determinants
Perspective works collaboratively with researchers, service
providers and policy advisors across Canada’s provinces
and northern territories. Prevention activities to address
FASD began in late 1970s and 1980s. These early efforts
tended to be child-centred and focused on warning women
of the dangers of alcohol consumption during pregnancy.
This simplistic approach has proved to be of limited value
as general alcohol use and FASD rates are intertwined
with broader determinants of women’s and children’s
health, including overall health, nutrition, experiences of
violence and trauma, and access to sexual and reproductive
health services and prenatal care. Developing alcohol
policies which incorporate a focus on women may be
an effective FASD prevention strategy for northern
communities. Areas of policy-making might include
monitoring trends and influences on women’s alcohol
use, minimizing alcohol advertising that targets women
and youth, and the delivery of culturally appropriate and
gender-sensitive alcohol education. As well, communitydriven alcohol policy which involves women in the policymaking process may be a particularly effective approach
for the north. Examples of community-based alcohol
policy and women- and girl-centred education materials
from other jurisdictions and countries will be presented
and ththeir applicability to the northern context discussed.
[email protected]
30
10:30 - 12:00
Since transitioning to western dietary practices, rates of
chronic illness such as cardiovascular disease and diabetes
have been steadily increasing in Inuit populations. Some
studies have shown that when Inuit consumed a traditional
diet, instances of cardiovascular disease, cancer, and type
2 diabetes were practically negligible. The purpose of this
paper is to examine the historical events and attitudes of
corporations, colonial officials and health care professionals
who contributed to rapid changes in Inuit diet, and
subsequently, Inuit health. I will delineate how changes
to traditional diets were motivated by concepts such as
capitalism, control and convenience, instead of informed
by nutritional concerns. To outline the history of health
and nutrition so, I will utilize historical primary documents
from doctors, nutrition specialists, traders, religious leaders
and national and territorial government personnel who
worked in the eastern Arctic from the 1930s-1960s.
Given that Health Canada’s “four food group” approach
has undergone little change since originating in a time
period that disregarded culture, health and the colonial
impacts of applying western diets to Inuit populations,
I will use contemporary examples to also make a
case for reformulation of Health Canada’s approach.
[email protected]
Quality and Quantity of Food Served
in Alaska Territorial Hospitals and
Orphanages, 1948-1950
AUTHOR: P. Easton
Florida International University, Miami FL
This paper presents a summary of my work as the Alaskan
Territorial Dietary Consultant in 1948-1950. The 64
year old reports document struggling morale and weak
nutritional aspects of food services in hospitals (n =21)
and orphanages (n=26) in the post-war pre-statehood era.
Contributing factors included: food procurement via yearly
summer delivery. Food requisitioned 18 months in advance.
A 200 day supply at one facility consisted of rancid peanut
butter, 30 days of meat, 100 days of canned vegetables (all
corn and spinach), 121 days of evaporated milk, 200 days of
10:30 - 12:00
papers, notably in the areas of the impact of disease on
Alaska history, Alaska Native traditional medicine, and
medical aspects of arctic exploration. This poster reflects
the work begun during my sabbatical in the fall of 2010.
Work has continued on this project with one product
being a master bibliography, created using RefWorks, of
references Dr. Fortuine collected during his career. The
master bibliography is searchable by subject, author, title,
or keyword. This poster will demonstrate how to access
these references and will provide a listing of the range of
subjects Dr. Fortuine researched during his long career.
The frequent turnover of personnel with short contracts
hindered carryover of information. Hospital personnel
reported appreciation for diet instruction based on native
food patterns. On-site visits by the territorial dietitian
applauded efforts to improve food supply and diet quality
such as gardening projects by large orphanages and
encouraged staff training and community involvement.
AUTHORS: R. Jensen1, A. Koch2, P. Homøe1
[email protected]
Health Aspects of Arctic Exploration:
Based on the Research Files of Dr. Robert
Fortuine Donated to the University of
Alaska Anchorage Consortium Library
in 2006
AUTHOR: K. Murray
Dr. Robert Fortuine was a well-known and highly respected
medical historian. He wrote on the history of medicine in
the Arctic regions for his entire career. Dr Fortuine was
named Alaska Historian of the Year in 1990 for his book
“Chills and Fever: Health and Disease in the Early History
of Alaska” and again in 2005 for his book “Must We All
Die? Alaska’s Enduring Struggle with Tuberculosis.” He
was an Adjunct Professor of Medicine at the University of
Alaska Anchorage from 1989-2008 and was also a Fellow of
the Arctic Institute of North America, a founding member
of the American Society for Circumpolar Health, and a cofounder of the Amundsen Educational Center in Soldotna
(a Christian vocational school for Alaska Natives). He
wrote six books, edited and co-edited two proceedings of
international conferences, and collaborated on three major
published bibliographies on the health of the indigenous
peoples of North America. In addition, he published many
[email protected]
Healthy Families #2 - Child and Adolescent Health
Duckering Room 342
moderators: R. Singleton & R. Jensen
TUESDAY ORAL
peaches in heavy syrup, but a 2 years butter supply. Funding
sources for nongovernmental institutions varied greatly
and dire conditions were common particularly in winter
months. Community hospitals had debts; others struggled
to feed children on the allotted 32 cents per person per day.
Military surplus commodities were haphazardly distributed
inconsistent of need. Vast quantities of bricklike powdered
skim milk were everywhere. Problems with equipment,
storage space and potable water also threatened food
quality. The Territorial Nutrition Unit was organized under
the leadership of Christine Heller to respond to hospital
and orphanage requests for dietary services to prevent
crisis situations. The Unit developed and distributed
buying guides for institutional orders, a diet manual with
instructions appropriate for three different foodways, native
food resources listed by geographic areas, and recipes for
using local plants, such as greens and rosehips. Community
classes, home visits with public health nurses and Federal
School Lunch programs evaluations were performed.
The Silent Infection
Rigshospitalet University Hospital 1, Statens Serum Institute 2
Background: Chronic suppurative otitis media (CSOM) is
a frequent cause of hearing loss and affects 65-330 million
people worldwide mainly in the developing part of the
world and among Indigenous populations such as the Inuit.
There is a lack of basic epidemiological knowledge on the
natural history and the long-term outcome of CSOM.
Objective: To examine the long-term chronicity of CSOM
and estimate the proportion of individuals affected by
CSOM in Greenlandic Inuit. Methods: Follow-up study
(2009) on a population-based cohort of 591 children
originally examined 1993-94 at 3-8 years age. Follow-up
was attempted among 348 individuals still living in the
study area. Video otoscopy and tympanometry was used.
Results: Of 226 participants (65% of those contacted,
median age 22 years) 28 persons (12%) had present CSOM
or had been surgically treated. Eleven were new cases of
CSOM not seen in 1993-94. Of those with CSOM in the
initial study 39% had healed spontaneously. The cumulative
incidence of CSOM was 17%. Eighty persons (35%) at
follow-up had present CSOM, undergone ear-surgery or
sequelae in the form of circular atrophy or myringosclerosis.
Conclusions: The proportion of spontaneous healing and
the findings of new cases show that CSOM is a dynamic
disease on both the individual as well on the population
level. Nearly every fifth child in Greenland has had CSOM
at some point in childhood. In contrast to the Canadian
Inuit and other high-risk Indigenous populations no ear
or hearing programs have been established in Greenland
to date. The morbidity of children with draining ears and
the risk of an associated permanent hearing loss has yet
to be fully acknowledged by Greenlandic health system.
[email protected]
31
Youth Challenges and Resilience:
Story Themes from Young People in
Rural Alaska
AUTHORS: L. Wexler1, L. Joule2, J. Garoutte,
J. Maziotti1
TUESDAY ORAL
University of Massachusetts Amherst 1, NWAB 2
Using young people’s stories to describe challenges, and
more importantly, their strategies for getting through them,
the presentation will share preliminary findings from an
Alaskan community that was part of the IPY, Circumpolar
Indigenous Pathways to Adulthood (CIPA) study. The
inquiry was built around the notion that circumpolar,
indigenous young people live at the intersection of global
youth culture, rapid and imposed social change and
economic scarcity. Young people’s stories can provide us
with glimpses into the shared understandings that support
certain capabilities, values and conduct, while also giving
us a sense of how larger, structural forces -- social policies
and allocation of resources -- shape young people’s lives.
To learn more about these processes, we describe the
everyday experiences (challenges and triumphs) and life
stories of our youth participants. In the telling, young
people clarify the kinds of ideas, relationships, practices
and resources they rely on to get through both ordinary
and profound difficulties, and the subjectivities that make
some resilience strategies viable and meaningful for them.
We identify main themes found in the interviews across
participants, and describe certain concepts that occur in
gendered patterns. Using composite narratives, dominant
and gendered themes are described in context, so that
audience members can better appreciate our participants’
situated understandings. These depictions are intended
to illustrate the ways that young people are creatively
responding to rapid and imposed social change as they
tackle challenges that are very different from those faced
by their parents and grandparents. The intergenerational
discontinuity means that young people must rely on
some traditional understandings, while simultaneously
finding innovative ways to deploy them in the context of
their everyday lives. Careful analysis of these trends offer
some perspectives on individual and community resilience
in respond to colonial forces and rapid social change.
[email protected]
“You Don’t Have to Look Pretty for
Whales:” Youth Resilience and Strength in
a Contemporary Yup’ik Context in Alaska
AUTHORS: S. Rasmus, J. Allen, T. Ford
32
This IPY study funded by the National Science Foundation
10:30 - 12:00
explores stress and resilience in the lives of circumpolar
Indigenous youth from different five communities. The
purpose of the project is to focus on ways that youth in the
arctic are successfully navigating a pathway to productive
adulthood, despite experiencing significant challenges
related to their status as indigenous people in a globalizing
context. The project has the goal of bringing together
researchers already working in arctic communities on
issues related to youth, health and prevention to conduct a
comparative, collaborative study of youth strengths across
the circumpolar north. This presentation briefly reviews
relevant resilience theory and research, with particular
attention to arctic indigenous youth. Social determinants of
health and resilience in Indigenous circumpolar settings are
described, as are emergent Indigenous resilience frameworks.
We focus here on findings from one circumpolar site, in
Southwest Alaska and life histories of 25 Yup’ik youth,
ages 11-18 years, We identify contexts that challenge them,
ways that they overcome challenges, and the strengths
and resources they access at the community level. Our
findings highlight instances of community resilience and in
particular, cultural continuity and its relationship to youth
self-reports of wellbeing. The results describe ecologies of
stress and resilience specific to Yup’ik contexts and setting.
From the youth life stories we identify local mechanisms
linking cultural continuity of traditional relationships;
to family, to peers, and to animals, to contemporary
youth resilience and survival strategizing in Alaska.
[email protected]
Pathway to Hope: Healing Child Sexual
Abuse in Tribal Communities - An
Alaska Native Curriculum Addressing
Multigenerational Trauma Through
Community Empowerment
AUTHOR: D. Payne
Alaska Summit Enterprise Inc.
The “Pathway to Hope: Healing Child Sexual Abuse”
curriculum is a unique Native designed approach developed
for Tribal communities in Alaska that has been recognized
internatlly as a community based initiative addressing
child victimization issues. This curriculum was funded by
the Office for Victims of Crime, US Department of Justice
and was completed in 2008. More than 250 individuals in
Alaska and 120 in Lower 48 Tribes have completed the 3 day
Training of Tribal Community Faciliators. The curriculum
and a 40 minute, 2 part video were developed through
the guidance of a diverse Native advisory group with the
goals of 1) Raising awareness about child sexual abuse and
the impact of sexual abuse over the lifetime of the child
victim; 2) Motivate participants to recognize and report
suspected sexual abuse, including an awareness of offender
behaviors; 3) to support healing strategies for child sexual
Key components of Pathway to Hope Training of
Tribal Community Facilitators 3 day curriculum are: A.
Understanding the impact of multi-generational and
historical trauma on safety of children now B. Recognizing
that there are “protections” that prevent us from (1)
believing that children are sexually abused, (2) holding
abusers accountable for their behavior, and (3) ending child
sexual abuse C. Understanding how children experience
sexual abuse and learning situations and characteristics
of people who abuse children sexually D. Evaluating
community readiness to end denial about child sexual
abuse and begin healing by (1) identifying knowledge
about child sexual abuse, (2) identifying resources available
to address child sexual abuse, and (3) identifying attitude
of Tribal and spiritual leaders about child sexual abuse
E. Developing community ownership strategies to end
silence about child sexual abuse using FOUR ACTION
STRATEGIES that are seqential: a.) Coming together
to celebrate and honor our children; b.)Teaching adults
and children about personal safety; c.) Setting community
standards about safety and protection of children; and
d.) Healing and support for children when victimized F.
Promoting healing and support for children victimized by
sexual abuse through (1) culturally appropriate responses
by the criminal justice system; (2) culturally relevant,
supportive services for child and non-offending family
member, and (3) community, extended family, education
system and family support for child’s healing long-term.
[email protected]
Infectious Diseases #2 - Tuberculosis
Gruening Room 206
moderatorS: J. McLaughlin & M. Lem
Genetic Susceptibility to Tuberculosis
in Greenland - Use of the Greenlandic
Family Relations Database
AUTHORS: B. Soborg, M. Melbye, J. Wohlfahrt,
M. Andersson, A. Koch
Statens Serum Institut
Tuberculosis (TB) occurs 100 times as frequently
in Greenland as compared with Denmark. It is well
documented that susceptibility to tuberculosis varies and
that genetic factors are involved, but the high infection
pressure and common social conditions within a household
complicate the separation of the genetic contribution.
However, the Greenlandic Family Relations Database
(GFRD) and the Greenlandic Tuberculosis Register
contains information on family relations and tuberculosis
cases in Greenland through 50 years, respectively. Linkage
of the two registers gives unique opportunities to examine
genetic susceptibility to tuberculosis. Methods: Through
linkage of the GFRD and the Greenlandic Tuberculosis
Register (TB cases identified 1955-2010) a prospective
dynamic cohort with 2.018.878 person years follow up was
formed, where persons born in Greenland contribute with
time from Jan 1st, 1972, and either until Dec 31st, 2010,
until date of TB, or until loss to follow-up. The familiar risk
of TB was estimated by calculation of Incidence rate ratio
(IRR) of TB for persons with a TB relative as compared with
persons without. IRR were adjusted for age, gender, and
calendar period. Results: In total, 54.382 persons had a case
of TB in their family. We observed a more than twenty-fold
increased incidence rate of TB in relatives to TB patients
within the first two years of diagnosis of the index TB case
(IRR: 21.3; 95% confidence interval, 17.4-26.1), but, after
these initial two years, the incidence rate remained only
marginally increased (IRR: 1.73; 95% confidence interval,
1.50-2.01). Conclusion:Rather than suggesting a general
genetic susceptibility the marked increased incidence rate
specifically in the first two years following diagnosis of
the index case suggests shared social and environmental
factors to be important. A degree of genetic susceptibility
may be present within families of TB cases, but remain
inferior to the importance of environmental factors.
TUESDAY ORAL
abuse victims and their non-offending family members;
and 4) Assist Native communities in developing strategies
to positively influence community support for child victims
by preparing participants to conduct community education
about child sexual abuse. The PATHWAY TO HOPE –
HEALING CHILD SEXUAL ABUSE curriculum is
based on the following beliefs: 1. Indigenous People/Tribal
Communities must take responsibility for the safety and
healing of children 2. Indigenous People/Tribes must have
ownership of social problems as well as the development
of solutions to those problems 3. Reclaiming and reviving
cultural values, beliefs, practices to heal children and those
victimized as children must begin with understanding
historical trauma and in multi-generational dialog 4.
Ongoing mentoring and support for “Indigenous couriers
of community change” is essential for Tribal communities
to achieve long-term change in attitudes and responses
toward children who were victims of sexual abuse.
10:30 - 12:00
[email protected]
33
10:30 - 12:00
Programme Implications of Genomic
Epidemiologic Analysis of Tuberculosis
Transmission Patterns
AUTHORS: M. Lem , J. Gardy , J. Johnston ,
P. Tang2, V. Cook2, S. Rempel1, A. MacNaughton1,
E. Brodkin3, S. Ho Sui4, S. Jones5, L. Shah6,
K. Elwood2, F. Brinkman4, R. Brunham2
TUESDAY ORAL
1
2
First Nations and Inuit Health, Health Canada 1, BC Centre
for Disease Control 2, Fraser Health Authority 3, Simon Fraser
University 4, Michael Smith Genome Sciences Centre 5, McGill
University 6
BACKGROUND Canadian Aboriginal populations
experience TB rates 5-30 times higher than the general
population. Socioeconomic determinants, mobility, and
barriers to health services play key roles in this inequity.
Genome sequencing yields valuable insights with
implications for TB control strategies. METHODS
Data from epidemiologic investigation of a large TB
outbreak (contact tracing and social network analysis)
were complemented with genome sequencing of 32 M.
tuberculosis outbreak isolates and four historic isolates from
the same area with matching genotype. Epidemiological
and genomic data were integrated empirically. Findings
were reviewed in the context of improvements to current
TB investigation and control tools and policy. RESULTS
Genome sequencing helped identify the following: 1.
The organism was not significantly different from other
circulating strains and the factors leading to the outbreak
were host behavioral, social and environmental factors; 2.
Identification of lineages and transmission events beyond
the resolution of RFLP/MIRU-VNTR can inform the
development of next-generation outbreak investigation
tools and accurate correlates of transmission; 3.
Combinations of traditional contact tracing, social network
analysis, genotyping and genome sequencing provide layers
of information useful for cross-validation; 4. Proactive
identification of high transmission potential communities,
social groups and locations is possible. CONCLUSION
Genome sequencing of TB outbreaks yields additional
insights into transmission dynamics and patterns
which will improve contact tracing and social network
analysis. Genomic data may confirm, disprove or identify
transmission relationships. Real time sequencing can be a
useful outbreak investigation tool if cost issues are overcome.
[email protected]
34
2
Tuberculosis as Cause of Death – Do
Patients Die of or With TB in Greenland
AUTHORS: T. Skifte1, F. Stenz1, T. Rendal2,
M. Pedersen3
The National Board of Health 1, Queen Ingrids Hospital 2, Queen
Ingrid Primary Health Care Centre 3
Background: In the 1980-ies no death was reported
with or by tuberculosis (TB) in Greenland. Despite several
efforts aiming at disease control, incidence of TB has
increased, averaging a rate of 132 /100,000 inhabitants
yearly in 2000-2009. The highest incidence in 40 years was
reported in 2010 (116 cases), reaching 205 cases /100,000.
Corresponding to the rising number of cases, the number
of deaths by TB seems to have increased. In 2000-2009
death certificates indicate that one of 20 notified cases dies
of TB. The corresponding mortality rate is 6.2 /100,000
inhabitants, which is still lower than the WHO average
mortality rate (15 deaths /100,000). The health care system
in Greenland is modern, free of charge and includes free
medication. For decades TB has been recognized highly
preventable and treatable. Real life cases prove this is not
always the case. Some cases might not be successfully
treated due to co-factors. Could some deaths be prevented?
Objective: The aim of this study was to analyse if TB
was the primary cause of death among all cases of death
with TB reported the primary cause in 2000-2010, and
further to explore the existence of contributory factors.
Method: All cases of death with TB as primary cause of
death were identified using the national register of death
and death certificates. Information about age, comorbidity,
compliance, medication, social factors, location, smoking,
alcohol use, patient and doctors delay were obtained
reviewing medical records. Results: 35 cases of death with
TB as primary cause of death were identified. Results from
reviewing medical records will be presented. Conclusion:
The study might clarify if patients die of TB as primary
cause of death or with TB as result of diseases or other
factors. Areas for improving TB care might be revealed.
[email protected]
Elevated Rates of Tuberculosis in First
Nations and Inuit Communities in
Canada - A Public Health Crisis
AUTHOR: G. Thomas
Issue: Elevated rates of tuberculosis (TB) in Aboriginal
populations in Canada persist in spite of the many
policies introduced throughout the 20th century. In the
North, the problem is of even greater concern. In 2009,
while the incidence rate per 100,000 for new active and
re-treatment cases for the Canadian population as a
whole was at 4.7, the rates for the Yukon, the NWT and
[email protected]
The Epidemiology of Tuberculosis in
Alaska, 2000-2010
AUTHORS: M. Cooper, K. Martinek, D. Fearey,
J. McLaughlin
State of Alaska
BACKGROUND: In spite of great improvements over the
past 50 years, Alaska has continued to experience among
the highest rates of tuberculosis (TB) in the United States.
Various factors account for this, including a large pool of
latent TB infection (LTBI), Alaska’s unique geography and
the lack of a robust infrastructure in many parts of the state.
Historically there have been higher rates of TB in certain
regions, and in Alaska Native and Asian/Pacific Islander
populations. There have been isolated cases of multiple
drug resistant (MDR) TB. METHODS: We analyzed both
national data from the Centers for Disease Control and
Prevention, and data from the Alaska TB Control program.
Clinical, demographic and epidemiologic data were
interpreted. RESULTS: Alaska continues to have among
the highest rates of tuberculosis in the United States, with
no noticeable downward trend, while the rate of tuberculosis
in the United States has shown a steady decline. The
Southwest and Northern regions continue to experience
the highest rates, as do Alaska Native and Asian/Pacific
Islander populations. There were four cases of MDR-TB in
2010. The introduction of a short course treatment regimen
for LTBI, the capability to perform rapid TB detection in
Alaska and an alternative to TB skin testing utilizing the
interferon gamma test emerged in 2010, and will likely
benefit of great benefit. CONCLUSIONS: While rates of
tuberculosis have decreased markedly in Alaska over the
past 60 years, Alaska continues to have among the highest
rates of tuberculosis in the United States. Making further
progress will require new ideas and approaches, and careful
introduction of new treatment and diagnostic modalities
which promise to aid in the goal of tuberculosis control.
[email protected]
Tuberculosis in Greenland – Current
Situation
AUTHORS: T. Rendal1, F. Stenz2, T. Skifte2,
V. Thomsen3, K. Ladefoged
Queen Ingrids Hospital 1, National Board of Health 2, International
Reference Laboratory of Mycobacteriology , SSI 3
TUESDAY ORAL
Nunavut collectively were 112.7. Yet, politicians continue
to recommend the same policy actions as solutions.
Methods: Literature review of TB using website databases,
articles, reports and surveillance data; thematic analyses of
governance and public policy processes in Canada. Results:
The federal government has been implementing policies
and programs to eliminate TB since the 1930s. Yet, even
with the most recent National Tuberculosis Elimination
Strategy, the rates of incidence of TB remains elevated in
these communities. Aboriginal peoples account for 17%
of the disease burden for TB in Canada although they
represent only 3.5% of the total population. Conclusions:
It is evident that current policy initiatives do not work. A
possible contributing factor is the Canadian political policy
environment where the delivery of health care is a complex
jurisdictional issue in First Nations and Inuit communities.
The federal government provides programs in these
communities only as a “matter of policy”. But the elevated
rates of TB in these communities is a signal that we need to
look at the policy drivers that influence policymakers, and
we need to identify and isolate those factors in communities
where the incidence of TB is increasing as compared to
communities where it is not increasing. This evidence
should then be used to influence future policy directions.
10:30 - 12:00
Background: Tuberculosis is an ongoing and
increasing public health issue in Greenland. In 1985, the
incidence reached the lowest registered level of 25/100.000.
Since then, the incidence has increased steadily, reaching a
peak of 205/100.000 in 2010. A new National Tuberculosis
Strategy was adopted in the fall of 2011 and is in the process
of implementation. Objective: To describe the tuberculosis
epidemiology in Greenland and identify current and
potential obstacles for the success of the new National
Strategy. Method: TB notification data was collected from
the National Board of Health and culture verification data
was collected from the International Reference Laboratory
of Mycobacteriology at Statens Serum Institut in
Denmark. Additionally, data from the annual screening of
school children in the years 2007-2011 has been collected
and analysed. Results: In 1998-2001 65% of all culture
confirmed cases were smear positive and 0.5% were drug
resistant. In 2008-2011 64% of all culture confirmed cases
were smear positive. Drug resistance remains low, although
the first case of MDR-TB was registered in 2010. In 20082011 eight per cent of the schoolchildren included in the
annual screening tested positive for latent tuberculosis
infection.
Conclusions: The high percentage of smear positive
cases shows that continued and increased focus on early
detection of active disease and thorough contact tracing
are essential. Treatment of detected cases is most likely
effective, as little drug resistance is registered, but the
emergence of a single MDR-TB case is cause for concern.
The high prevalence of latent tuberculosis infection among
schoolchildren shows that active disease transmission is
ongoing and further supports the need for increased awareness.
[email protected]
35
Healthy Communities #2 - Communicating
Environmental Health Threats
10:30 - 12:00
Salisbury Theatre
moderators: J. Berner & P. Bjerregaard
TUESDAY ORAL
In Search of Health Effects of a Plane
Crash with Nuclear Weapons in 1968
Near Thule Air Base, Greenland
AUTHORS: P. Bjerregaard1, I. Dahl-Petersen2,
I. Olesen3, A.B. Kjeldsen1, B. Niclasen1
Greenland Government 1, University of Southern Denmark 2,
University of Greenland 3
In 1968 a US aircraft carrying four nuclear bombs crashed
on the sea ice near Thule Air Base in Northern Greenland.
Radioactive material was spread in the environment and
can still be detected despite of intensive cleaning activities.
The local population has repeatedly voiced their concern
about a changing disease pattern which is feared to be
related to radioactive irradiation. In 2010 the Greenland
Government initiated a comprehensive population health
survey in the neighbouring communities of Avanersuaq.
A similar survey in the rest of Greenland during 20052009 was used for comparison. The survey in Avanersuaq
consisted of three parts: a qualitative study of local people’s
concerns in relation to the radioactivity, a register analysis
of mortality and cancer incidence, and a health examination
study. In addition, all inhabitants were offered an individual
medical check-up. The qualitative interviews showed
concern about the health of seals and other prey, which
are the local staple food. Knowledge about radioactive
contamination was confused with knowledge about other
contaminants (mercury, POPs) in the marine mammals.
In particular skin diseases were attributed to radioactivity.
A general lack of information was lamented. Neither the
register study nor the health examination study showed
any signs of disease that could be related to exposure to
radioactivity, but an increased prevalence of life style related
conditions was found relative to other parts of Greenland.
The results have been presented to the local people at
community meetings, through the local radio, and in reports
in Greenlandic and Danish language. It is our impression
that most people were much relieved by learning that
radioactivity is not a cause of their diseases. A noticeable
interest in the life style related conditions was present but
must be sustained by continued support from the local
health centre and the municipal offices in distant Ilulissat.
[email protected]
36
The Northway Wild Food and
Health Project: a Pilot Study of Local
Resources, Their Uses, and Health Along
the Alaska Highway
In review with Rural and Remote Health:
January, 2012 (http://www.rrh.org.au)
AUTHORS: A. Godduhn1, C. Marunde2, P. Hyslop2,
R. Gallen2, J. Fix2, H. Fix2, L. Duffy3
UAF Department of Chemistry and Biochemistry 1, Northway
Health Study Team 2, University of Alaska Fairbanks 3
Objectives: Northway, Alaska is a small mostlyAthabascan community with a large World War II defense
site located near the Alaska Highway. The Northway
Wild Food and Health Project (NWFHP) comprised two
pilot studies: the Northway Wild Food Study (NWFS)
to investigate contaminants in local resources, and the
Northway Health Study (NHS) to explore possible
relationships between resource uses and health over time.
This paper describes the context, methods, limitations, and
results of the NHS.
Design: The retrospective cohort NHS proceeded with
the tentative assumption that people reliably know the
general food and water sources and health conditions of
people they live(d) with. NHS data (total n=325) represent
general unverified personal knowledge that was often
second hand.
Methods: In 2009, questionnaires and interviews were
used to collect existing and historic household information
regarding resource uses and health problems over time.
Odds for seven reported disorders were compared between
reported users versus reported non-users of seven resources
with a two-tailed Fisher’s Exact Test in SAS.
Results: Known historic contamination of local
food and water resources with petroleum, pesticides, the
ingredients of Agent Orange, and chlorinated byproducts
of disinfection is neither well documented nor quantifiable.
NHS comparisons found complex associations. Reported
resource users showed a higher reported incidence of
several general problems, including all-cancer and thyroid-,
reproductive-, metabolic-, and cardiac disorders.
Conclusion: The studies lack detail and verification.
However, they are consistent with each other and
with extensive toxicological and epidemiological
literature. The project documents the legitimacy of
local concerns and perceptions. This paper postulates
that the situation represents a legacy of toxic exposure
over decades, via multiple variable and interactive
pathways, including complexity that precludes the
establishment of “cause and effect” relationships.
10:30 - 12:00
Additional research is needed to test that general
assertion and the composite implications of the findings.
Densely Woven Adversities:
Sociotoxicology of Lead Exposure in
Mining Communities
Managing Environmental Risks: MeHg
Contamination in Subsistence Fish and
the Case for a Place-Based Approach
AUTHORS: S. Moodie, L. Krain, J. Agnew
AUTHORS: P. Loring, L. Duffy
Lead exposure in mining communities can be pervasive and
persistent, with the potential to affect a myriad of health
outcomes of exposed residents. The harmful effects of lead
on child neurocognitive and behavioural development have
been extensively characterised, however, most studies do
not look at social health effects. We propose a framework
to name and articulate the impact of contaminant
exposures in a broad context of social health. We have
defined three new terms under the overarching concept of
“sociotoxicology”: “sociocontaminant” for an individual’s
social health effects; “socioaccumulation” to describe the
accrual of densely woven adversities within the family, peer
group, school and community; and “sociomagnification” to
describe the intergenerational and community level social
impact of lead. The case study is situated in the community
of Kellogg, Idaho, located adjacent to the Bunker Hill
Mine Superfund site. These terms are relevant to social
health effects of other contaminants, including alcohol.
[email protected]
Effective management of environmental risks such as
food and water contamination requires both high quality
scientific information and effective, informed social policy.
Not only must health practitioners and policymakers
recognize the complexities of human health as a social
phenomenon, they must also negotiate the vagaries of
uncertainty, precaution, and ethics in their implementation
of public health guidelines and advisories. For example,
some health practitioners in Alaska have argued against
implementation of US Environmental Protection
Agency and World Health Organization’s standardized
consumption advisories for methylmercury (MeHg) in
fish, in favor of place-based approaches to evaluating
and communicating risk. They stress the importance of
traditional subsistence foods and lifestyles, along with
other local environmental, economic, and cultural drivers
and determinants environmental health. Such place-based
approaches have been successful in improving health
outcomes in Alaska and elsewhere. Nevertheless, debate
continues regarding the validity and ethics of placebased approaches to developing and communicating
standards and advice for managing environmental risks.
Recent critiques suggest that place-based approaches to
environmental health represent an undesirable kind of
regional “exceptionalism:” the implication of which is
that precaution, in respect to acting on the best available
objective science, is undermined by attention to subjective
local values. In this paper we comment on this debate,
a debate rooted in concerns regarding the delineation
between science-based and policy-based decisionmaking. Our experience with the social and ecological
dimensions of MeHg contamination of fish and game in
Alaska and elsewhere offer three considerations regarding
the potential benefits available through place-based
approaches: 1) they can contribute to the accuracy and
systematic characterization of risks and their relationship
to multiple direct and indirect health outcomes; (2) they
are more likely to inform actual changes in behavior; and
(3) they afford greater transparency to the risk management
process and therefore facilitate environmental justice.
We recommend a two-tiered approach that blends statebased and place-based environmental risk management.
[email protected]
TUESDAY ORAL
Johns Hopkins Bloomberg School of Public Health
[email protected]
Risk Communication and Trust in
Decision-Maker Action: A Case Study of
the Giant Mine Remediation Plan
AUTHORS: C. Jardine1, L. Banfield2, S. Genuis1,
S. M. Driedger3, C. Furgal4
University of Alberta 1, Oulu University/McMaster University 2,
University of Manitoba 3, Trent University 4
Social and individual trust in decision-makers is known to
play a profound role in the effectiveness of the dialogue
around and acceptability of decisions for risk actions. A
common evaluative framework has been developed to
assess the impact of risk communication activities on public
trust across three case studies involving First Nations, Inuit
and Metis peoples in Canada. One of these case studies
involves the Giant Mine Remediation Plan. Giant Mine
is a former gold mining operation located near Yellowknife
in the Northwest Territories, Canada. Over 50 plus years
of operation, it produced more than 7 million ounces of
gold, and 237,000 tonnes of toxic arsenic trioxide dust.
When activity at the mine ceased, the Government of
Canada entered into a Cooperation Agreement with the
Government of the Northwest Territories to remediate
the site. The Remediation Plan, developed using a team
of external experts, is based on the “frozen block method”,
whereby areas around and within each of the underground
37
TUESDAY ORAL
chambers will be frozen using thermosyphons. Through
entering into an unprecedented partnership with the City
of Yellowknife and a local environmental advocate, the
Yellowknives Dene First Nation was successful in forcing the
proposed remediation plan to undergo a full environmental
assessment. Key informant interviews and discussions
with community members were used to explore various
perspectives on this issue. The results illustrate how various
factors have intersected to produce community distrust of
(and lack of cooperation with) the risk remediation process:
(1) a historical legacy of mistrust between the community
and responsible agency; (2) limited community control
over the risk decision; (3) a consultation process that
involved complex and overwhelming information; and (4) a
perceived bypassing of regulatory process. The implications
of lack of trust in achieving a satisfactory resolution
to this ongoing issue of remediation will be discussed.
[email protected]
Climate Change and Contaminants:
Environment Impacts That Affect Inuit
Health and Wellbeing
AUTHOR: E. Loring
Inuit Tapiriit Kanatami
38
Objectives: 1.Understand the impacts of contaminants
and climate change on Inuit 2.Communicating sensitive
environmental health information to youth and Inuit
3.Learning about environmental health in Canada’s Arctic
There is a growing concern among Inuit about the impacts
on environment, health and culture from global changes
such as climate change and environment contaminants.
To date, the focus on this subject has been oriented on
biophysical changes and impacts in the environment and
little attention has been given to the potential impacts
on public health in northern communities. Community
members speak of new dangers resulting from variable
weather and ice conditions they have not experienced
before and Health professional are issuing advisories to
eliminate consumption of some traditional foods because
of contaminant levels. As ecological change accelerates
-- longer sea-ice free seasons, fewer marine mammals to
hunt, accelerated coastal erosion etc. -- Inuit find it more
and more difficult to adjust and adapt. These changing
conditions represent challenges to the livelihoods and
culture of Inuit living in Canada. ITK has been very active
in pursuing an aggressive response to climate change. Inuit
recognize the need to work at all levels of government and
society to effect abatement and mitigation. The ability to
adapt has never been more important for Inuit than it is
today. Environmental changes -- of all kinds -- are coming
at a rate and to an extent that may exceed the threshold of
Arctic peoples’ capacity to respond. Yet, Inuit are not content
to be portrayed as the victims of climate variability and
10:30 - 12:00
change; we want the opportunity to be part of the solution.
[email protected]
Research in the North #2 - Community-Based
Intervention Research
McGown
moderator: I. Rivkin
Commonalities in Coping with Stressful
Situations Across Alaska Native Culture,
Geography, and Context
AUTHORS: E. Lopez, I. Rivkin, S. Johnson
Alaska Native communities are currently coping with
stressors such as increased rates of chronic disease and
behavioral health issues which are quite different from
those experienced historically. In developing culturally
grounded interventions that draw from strengths and
resources available to cope with stress, and ultimately
improve quality of life, it is important to understand how
stressors and coping responses might be affected by a
community’s history, culture, and geography. Nevertheless,
to gain a broader understanding of commonality in how
different Alaska Native communities deal with stressors
that vary from those that were prominent in the past, it
is important to begin to synthesize findings from studies
that represent Alaska Native diversity. Here we describe
and discuss the similar coping strategies reported by
individuals who participated in two distinct communitybased interview research projects. The Yup’ik Experiences
of Stress and Coping Project explored Yup’ik people’s
experiences with stressful situations and how they cope
in two rural communities located in Southwest Alaska.
The Understanding Cancer Survivorship Project engaged
cancer survivors from the Alaska Interior Region’s semiurban area of Fairbanks North Star Borough in sharing
their stories of coping with cancer, treatment and the
uncertainty of survivorship. Across these projects and
communities, several similar coping strategies were
described, and included: talking with others, finding
a new purpose in helping others, accepting help from
others, turning to family and friends for support, finding
strength in spirituality, engaging in traditional activities,
living a healthy lifestyle, and giving up alcohol and drug
use for survival. Implications for interventions to address
different kinds of stressors in diverse Native communities
are discussed. Such intervention development must be
guided by common strengths and resources that many
communities draw from, and must be adaptable to the
unique cultural contexts and specific to the stressors and
challenges experienced within these diverse communities.
[email protected]
The Meaning of Coping in Yup’ik
Communities Facing Rapid Cultural
Change
AUTHORS: S. Johnson1, I. Rivkin2, E. Lopez2,
E. Orr3, J. Trimble4
Many Alaska Native communities experience a disproportionate
burden of stress, as evidenced by disparities in many indicators
of mental and physical health. Coping strategies of Native
individuals and communities, however, are an area awaiting
further and continued exploration by researchers and
communities alike. The CANHR Yup’ik Experiences of Stress
and Coping project explored Yup’ik people’s understanding of
both stress and coping through 60 semi-structured interviews
analyzed using elements of a grounded theory approach. ‘On
the ground’ stressors included traumas, day-to-day challenges
and cultural changes that affect Yup’ik individuals, families,
and communities. Yup’ik participants’ understanding of
coping often included communication, actively dealing with
problems to work them out, doing something to feel better,
and utilizing traditional wisdom. Coping strategies included
talking with friends and family, getting support from family,
finding joy in being with children, attending to parental
responsibilities, spirituality and religion, helping others,
asking for help, getting counseling, engaging in subsistence
and other cultural activities, and avoiding alcohol and drug
use. Participants also discussed barriers to coping such as not
having a safe place to talk, not enough privacy, and a lack of
services. Results were disseminated to the communities and
used to begin development of stress reduction interventions
with the collaboration and guidance of Yup’ik community
members. The meaning and methods of coping that project
participants discussed highlight the resilience and strengths
of rural Yup’ik communities, and can inform culturally
attuned interventions utilizing these inherent resources.
[email protected]
Moving from Understanding to
Intervention: Dissemination and
Community Planning in Rural Yup’ik
Communities
AUTHORS: I. Rivkin1, S. Johnson2, E. Lopez3,
J. Allen3, E. Orr2, J. Trimble4
University of Alaska Fairbanks 1, UAF Center for Alaska Native
Health Research 2, UAF Center for Alaska Native Health Research
& Dept of Psych 3, Western Washington University, Dept of Psych 4
Many Alaska Native communities in the Circumpolar
North shoulder a disproportionately high burden of stress,
because of historical trauma and rapid changes in culture
and lifestyle patterns. The CANHR Yup’ik Experiences
of Stress and Coping project originated from rural Yup’ik
communities’ concerns about stress and its effects on
health. It was designed collaboratively with two Yup’ik
communities to address their priority concerns. It was
aimed at understanding the stressful experiences that
affect Yup’ik communities, coping strategies used to deal
with these stressors, and the role of traditional practices
in coping, to inform culturally responsive interventions.
This presentation describes work in the transition from
disseminating project findings to beginning intervention
planning. We highlight the importance of community
participation, some of the challenges encountered, and
strategies we used to address these challenges. Continuing
community guidance was critical. Community-wide
presentations and discussions of emerging research
findings on stress and coping were followed by smaller
Community Planning Group meetings. During these
meetings community members further contextualized
project findings and discussed implications for intervention
priorities and activities. This process applied community
expertise to interpretation of findings, and facilitated
translation of results and community priorities into
grant applications and intervention plans. Challenges
included translation of meaning across languages,
funding limitations and uncertainties, and the long
timelines involved in moving from formative research and
community assessment to intervention in the face of urgent
and evolving community needs. Strategies to address some
of these concerns included disseminating findings that had
practical value, planning for sustainability, and integrating
local cultural knowledge and understanding. The research
findings inform continuing work within our partnership
as we develop culturally-based strategies for a multilevel community intervention with three intervention
targets: to address stress, to facilitate connection between
generations, and to prevent substance abuse and depression.
TUESDAY ORAL
University of Alaska Fairbanks 1, Center for Alaska Native
Health Research & Dept of Psych 2, Center for Alaska Native
Health Research 3, Western Washington University, Department of
Psychology 4
10:30 - 12:00
[email protected]
Responsible and Ethical Conduct of
Research with Indigenous Populations:
Listening to the Voices of the People
AUTHORS: J. Trimble1, J. Allen2, I. Rivkin2,
E. Lopez2
Western Washington University 1, University of Alaska Fairbanks 2
The objective of the presentation is to raise points to
encourage ethical decision making for research with
indigenous communities in the Circumpolar North that
reflect their unique historical and socio-cultural realities.
The presentation will focus on the ethical issues that
arose in the design of an intervention guided by formative
39
TUESDAY ORAL
10:30 - 12:00
community based participatory research (CBPR) in rural
Alaska Native communities. Four ethical dimensions
guide culturally sensitive research: (1) applying a cultural
perspective to the evaluation of research risk and benefits;
(2) developing and implementing culturally respectful
informed consent procedures; (3) constructing culturally
appropriate confidentiality and disclosure policies; and
(4) engaging in community and participant consultation
with a standard of “principled cultural sensitivity.” In this
presentation, we describe case examples epitomizing ethical
concerns within the first and final of these dimensions.
There is increasing distrust that circumpolar communities
are expressing towards researchers; many community
members are intolerant and unforgiving of past research
efforts for a variety of valid reasons. Many ethnocultural
community leaders now demand that research occur
under their direction and control. Under this direction,
many communities are expressing interest in intervention
research that addresses priority concerns and provides
direct benefit to community members. The long timelines
involved in formative research to build understanding for
intervention development and uncertainties in the lengthy
grant application process can pose ethical dilemmas
regarding risk and benefit. A more central conflict between
institutional and community worldviews in the intervention
research enterprise highlights need for “principled cultural
sensitivity”. Investigators are faced with the formidable
responsibility of ensuring their procedures are scientifically
sound, culturally valid, and morally just. Responsible
intervention research must incorporate indigenous
knowledge and expertise through a community-guided
process. Researchers should be prepared to collaborate, share
results that have practical value, and accept the conditions
imposed by the community in gaining access to respondents. [email protected]
Health Services - Workforce Development
Room 301
[email protected]
Adapting Online Learning for Canada’s
Northern Public Health Workforce
AUTHORS: K. MacDougall1, H. Robinson1,
J. Rossiter1, M. Bell2
moderators: R. Johnson & H. Moller
Public Health Agency of Canada 1, Marnie Bell Consulting 2
“It’s Our Voices” Cancer-Related Digital
Stories by Alaska’s Community Health
Workers
Canada’s North is a diverse, sparsely populated land
where inequalities and public health issues are evident,
particularly for Aboriginal people. The North’s public
health workforce is a unique mix of professional and
paraprofessional workers. Few have formal public health
education. From 2009-2012, the Public Health Agency of
Canada (PHAC) collaborated with a Northern Advisory
Group to strengthen public health capacity in Canada’s
three northern territories. The strategy used continuing
education modules of PHAC’s Skills Online program to
enhance the core competencies of the northern public
health workforce. Challenges were associated with variable
technological infrastructure across the North and diverse
educational and cultural backgrounds of public health
workers. PHAC conducted pilots in 2008 and 2010 with
AUTHORS: L. Revels, M. Cueva, R. Kuhnley
40
The five-day cancer education course was developed with
and for Alaska’s CHWs in 1999 to provide basic cancer
information and is continually updated to respond to
CHWs’ expressed needs. Recently, digital storytelling,
which uses technology and storytelling to support
culturally relevant cancer health messaging, was included
in the cancer education course. Methods: Between May
2009 and May 2011, six courses were provided in which
57 participants created their own 2-3 minute digital story
to tell their personal cancer health message. Digital story
topics included the importance of recommended screening
exams, tobacco cessation, cancer survivorship, and loss, grief
and end-of-life comfort care, and self care for themselves
as patient providers. Course participants shared cultural
perspectives about cancer, reflecting their traditional values,
language, traditions, ways of knowing, intergenerational
knowledge transmission and other cultural attributes. “By
sharing my story it may encourage others to share their
story.” “Storytelling makes it easier to hear the message - it
touches people’s hearts.” Results: On written post-course
evaluations, 100% of participants reported that combining
digital storytelling with cancer education supported their
learning. Digital storytelling brings the power of the media
into the voices and hands of community members to increase
cancer knowledge, provide an opportunity to facilitate
patient and community cancer dialogues, attend to the
silence and fears around cancer conversations, and promote
cancer awareness and risk reduction. In course evaluations,
CHWs described their experience with digital storytelling.
“In digital storytelling our community members lend
their natural storytelling abilities to help educate others.”
Alaska has a unique network of Community Health
Workers (CHWs) including Community Health Aides/
Practitioners, Behavioral Health Aides, and Community
Health Representatives who are community residents
chosen by their tribes to provide health care in Alaska’s
178 rural communities. CHWs have requested cancer
information to supplement their basic medical training.
Results demonstrate that appropriate adaptations to online
professional development can provide practical, accessible
means for a wide range of Northern / Aboriginal public
health workers to acquire core competencies for public health.
[email protected]
Developing a Blended Face-toFace/Virtual Self-Directed Learning
Community among Alberta First Nations
Health Promoters
AUTHORS: K. Zakariasen1, C. Sarin2, A. Neufeld2
University of Alberta 1 Health Canada irst Nations and Inuit Health
Branch Alberta 2
The First Nations reserve communities in Alberta are
widely distributed creating logistical/financial challenges
for face-to-face (f-to-f ) meetings of community healthcare
personnel. However, such meetings can provide excellent
venues for professional development, program planning,
idea sharing/generation, problem solving and developing
support networks. In 2011, the Alberta Health Promoter
Initiative (HPI) began planning for what we hoped would
become a blended f-to-f/virtual strategy for group selfdirected professional development. A successful model for
ongoing professional development could serve as a blended
group-engagement model to address other topics as well.
The FNIHB-funded Virtual Communities of Practice
Project made available to HPI workshops on leadership and
organizational change, or other professional development
workshops of their choice. HPI opted for a leadership/
change all-day workshop held in September 2011. Topics
covered were emotional intelligence, exemplary leadership
practices and whole-systems change taught primarily
through active learning exercises/group discussions. Post-
workshop participant evaluations indicated a strong desire
for 1) more intensive immersion in these topics, particularly
the application of exemplary leadership practices,
components of emotional intelligence and positive change
facilitation in communities, and 2) a facilitated leadership
book study club on The Truth About Leadership. In
response, HPI scheduled a second f-to-f all-day workshop,
and the initial session of a monthly virtual book study
club, both for February 2012. Our preliminary findings
thus far, as interpreted through organization development
concepts, are: 1) f-to-f provides an excellent environment
for active shared learning, is particularly effective for
building relationships in groups and with facilitators, but is
limited by cost/logistics, 2) virtual is cheaper, allows more
frequent interactions, but it’s potential is limited if f-to-f
relationship building doesn’t come first and isn’t ongoing,
and 3) self-directed learning/work builds trust, initiative
and capabilities, and facilitates an openness to using blended
f-to-f/virtual approaches to enhance group interactions and
effectiveness.Project development and evaluation is ongoing.
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Northern / Aboriginal public health workers using adapted
content and delivery modalities to assess their accessibility
and appropriateness for the North. The findings were
informative and similar to findings of Skills Online pilots
with international learners in developing countries. Online
learning is effective in bridging the geographical barriers in
remote locations. Incorporating content on Northern and
Aboriginal health issues facilitates engagement in learning.
Employer support facilitates the recruitment and retention
of learners in an online program. The facilitator must be
flexible and able to use modified approaches to support and
measure knowledge acquisition and application, especially
for First Nations, Inuit and Metis learners. Based on these
results, PHAC conducted a third pilot in 2012 engaging
a group of Inuit paraprofessionals fully supported by
their employer. PHAC increased relevance of content
to Inuit and Northern public health issues. Facilitators
used videoconference and teleconference to lead weekly
discussions to augment the online self study component.
10:30 - 12:00
[email protected]
‘Double Culturedness’ a Pre-Requisite
for Inuit Nurses
AUTHOR: H. Møller
Lakehead University
In Arctic Canada and Greenland it is not possible to receive
university education in health in the local languages, taught
by local instructors; nor is secondary education often taught,
by local instructors, in local languages. This circumstance
places specific demands on Inuit in order to enroll, thrive
in, and complete university education in health. The
objective of this paper is to discuss the experiences of Inuit
who are educated in nursing programs located in the Arctic
but dominated by EuroCanadian and Danish culture
and language. The design of the research was qualitative
and ethnographic in nature. It was conducted through
12 months of fieldwork between August 2007 and June
2009 in five Greenlandic and two Nunavut communities.
Methods used included observation, participant
observation, interviews, questionnaires and document
review. Results include that to complete a university
based nursing education, Inuit must have the ability to
communicate in at least two languages and cultures, the
ability to negotiate and interact with at least two ways of
being in the world and two ways of learning and teaching,
and the ability to negotiate and relate to at least two ways
of perceiving the body, health and disease. This ‘double
culturedness’ makes Inuit nurses and students very valuable
for the Arctic healthcare systems. That it is necessary to be
‘double cultured’ in order to become educated in the Arctic
is, however, problematic.
41
Listening to Inuit nurses’ experiences and ideas and basing
recommendations for change in primary and secondary
educational institutions on these, may allow instructors
with no background in the local languages and cultures
to serve Inuit in such a way that more are able to enter
and succeed in secondary and post secondary education.
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[email protected]
Specialist Education for Medical Doctors
in Greenland
AUTHOR: G. Mulvad
Primary Health Center Nuuk
Medical Doctors have the opportunity for specialist training
as General Practitioners in Greenland. After completing
medical school in Denmark, physicians can take some part of
their training in Greenland. Specialist programs for doctors
changed at the end of 2003 in Denmark. Specialist training
is now almost the same length of time for all specialties.
After basic training, the doctor regardless of specialty choice
goes through introduction training, specialist education and
a range of academic courses. Unlike other medical specialties
that require staying in very specialized departments, the
clinical part of specialist training in General Practice can
take place in Greenland. This specialist education is for 5
years. The medical doctors stay 2½ years at two different
district centres in Greenland and 2½ years in different
specialist departments at the National Hospital in Nuuk.
At present there are 13 doctors with 5 years contracts with
the Greenland Health System for training as specialists in
General Practice. The training program focuses on general
clinical training and the research training in the specialty.
As part of the research training physcians in the program
are expected to conduct a research project that focuses
on an important health condition in Greenland. The
importance of this training and research program for the
Greenlandic Public Health will be described. Other Health
Education program in Greenland will be mentioned.
[email protected]
The Manitoba Network Environment
for Aboriginal Health Research (NEAHR)
Program: Building Research Capacity in
Indigenous Health
AUTHORS: C. Cook1, L. Diffey1, B. Elias1,
J. Bartlett1, S. Bruce1, M. Anderson DeCoteau1,
K. Fowke1, J.Hansen2, M. Hart1, K. Harlos3, K. Avery
Kinew4, J. Lavoie5, B. Lavallee1, J. Mignone1
42
University of Manitoba 1, University College of the North 2,
University of Winnipeg 3, Assembly of Manitoba Chiefs 4, University
of Northern British Columbia 5
This session will describe the evolution of a research
10:30 - 12:00
capacity development model for the Manitoba Network
Environment for Aboriginal Health Research (NEAHR)
program at the University of Manitoba. The program
was originally established as the Aboriginal Capacity and
Developmental Environments (ACADRE) program in
2001, and in 2008 evolved into the next phase under the
NEAHR initiative of the Canadian Institutes of Health
Research (CIHR). Prior to the establishment of the
ACADRE program in Canada, few First Nations, Inuit and
Métis students pursued a career in health research and there
was limited supports for those who entered the field. The
ACADRE/NEAHR programs have been instrumental,
through a network of programs across Canada, in fostering
a cohort of health researchers that are emerging as role
models and mentors. Building on the foundation of health
researchers mentored through ACADRE, the NEAHR
expands the horizons for indigenous health researchers to
include national and international research relationships.
Students entering this field often find they are faced with the
challenge of walking in two worlds: the Western scientific
environment and the paradigm of Indigenous knowledge.
Learning about research at this intersection necessitates
an approach that helps prepare emerging researchers to
not only thrive in both environments but also to empower
them to break new ground and discover new approaches
to conducting research. The Manitoba NEAHR, through
focused academic mentorship supports and relevant
cultural supports and cultural mentorship supports, assists
undergraduate and graduate students to not only succeed
academically but also to engage in respectful research
partnerships with communities to address the health
priorities of Manitoba’s First Nations and Metis peoples.
[email protected]
Nutrition #2 Food Security: Problems & Solutions 1
Schaible Auditorium
moderator: C. Gerlach
An Integrative Approach to Food,
Culture, and Human Health
AUTHORS: C. Gerlach, P. Loring
Multiple climatic and socioeconomic drivers have come
in recent years to interfere with the ability of Alaska’s
‘bush’ communities to achieve food security with locally
available food resources. Livelihoods historically centered
on the harvest of wild, country foods, are transitioning to
a cash economy, with increasing reliance on industrially
produced, store bought foods. While commercially
available foods provide one measure of food security,
availability and quality of these foods is subject to the
vagaries and vulnerabilities of a global food system: access
[email protected]
Understanding Food Security in
Rural Alaska
AUTHOR: J. Smith
Valencia College Medical Campus
Food security survey of five rural Alaska villages with
populations less than 1,000, reported 37% of families with
women of child bearing age “worried about having enough
food,” and 15% reported “hunger.” Food secure women
reported mean BMI of 28.0; compared to a mean BMI
of 30.7 of those reporting food insecurity. In surveys of
Elder health in two other Alaska villages with populations
less than 1,000, “hunger” was reported by 20% of Elder
households; 17% reported “didn’t have enough to eat” and
26% reported “food didn’t last and we couldn’t get more.”
Harvested foods contributed 64%-54% of total protein
in rural survey villages, compared to 42%-25% in urban
communities of Anchorage and Fairbanks demonstrating
the increased dependence on harvested foods in rural Native
communities. Food Basket Costs for Alaska Communities
(Fall 2011) as a percentage of annual household income
for Anchorage, Fairbanks and Juneau was 10-13%, similar
to the reference city of Portland, OR. Regional AK hub
communities of Bethel, Nome, Unalaska, and Sitka were
15-20% of annual household income. Data for two small
communities with population less than 1,000 were 60% for
Selewick and 23% for King Salmon. USDA measures of
2010 levels food security reported mean rates of hunger in
Alaska similar to rates reported in the continental United
States (11.6% AK to 14.5% US). Communities with
populations less than 1,000 were not sampled separately.
Food insecurity for US families may be influenced by
availability of funds to purchase foods. In contrast,
rural Alaskan responses were linked to availability to
preferred traditional foods shared by extended family
members, in addition to high food cost. Rates of food
insecurity reported in Alaska Native villages may be
indicators of anxiety about social changes in socialization
of the community’s youthful meat harvesters and
possible interruption in the sharing of traditional foods.
[email protected]
Food Insecurity and Perceived Health in
Greenlandic Schoolchildren
AUTHORS: B. Niclasen, C. Schnohr, S. Arnfjord
HBSC Greenland
It is widely accepted that food insecurity in the family
is significantly associated with a range of indicators of
poor health, poor well-being, and poor health behaviours.
It is therefore highly interesting to explore children and
adolescents own perception of what food insecurity
mean to their health and wellbeing. Food insecurity have
frequently been demonstrated in families with children
in Canadian Arctic populations to an extent as high as
70%, while food insecurity in Greenlandic adults has been
reported to be much lower, about 10%. Food insecurity
among school children has been monitored since 2002 in
Greenland as a part of the WHO supported investigation,
Health Behaviour in School-aged Children (HBSC). In
2010 in total 2,254 children in grade 5.-10 participated
in the investigation by answering the questionnaire. This
was more than 40% of all Greenlandic schoolchildren in
these grades. Food insecurity is measured by the question:
Some young people go to school or to bed hungry because
there is not enough food at home. How often does this
happen to you (Always, Often, Sometimes, Never). In total
68% of the children newer experienced food insecurity
in the home, while 17 % of children experienced it
“Always” or “Often”. Results from closer analysis on the
associations between food insecurity, and perceived health
and well-being in Greenlandic school children are given.
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is dependent on one’s ability to pay; more importantly,
perhaps these foods often do not fulfill many of the roles
that country foods have played in these communities and
cultures. This transition is having severe consequences for
the health of people and viability of rural communities, yet
in ways not always tracked by conventional food security
methodologies and frameworks. This paper expands the
discussion of food security, premised on an integrative
model of health that links sociocultural, ecological,
psychological, and biomedical aspects of individual and
community health. We use the Alaska case to illustrate that
if food security is to be understood as a matter of human
health, then our definitions of and designs for food security
must recognize food’s multifaceted and often regionally
nuanced role in creating positive health outcomes.
10:30 - 12:00
[email protected]
Hunger in Urban Alaska: The Daily Lives
of Pantry Users
AUTHORS: T. Burke, C. Ramirez, K. Howard
The phrase “food security” means many things in the
arctic. It refers to subsistence and climate change, and the
challenge of maintaining healthy animal populations; it
refers to the threat of natural and human-made disasters,
and the challenge of importing southern foods across
great distances. It also refers to hunger; to the challenges
to eating a healthy diet that are related most directly to
poverty, and the various governmental and charitable
sources of assistance. In this presentation, we are most
43
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concerned with the last meaning of the phrase. We report
on findings from some 30 in-depth interviews with urban
Alaskans who use food pantries. In partnership with Food
Bank of Alaska, Alaska’s only statewide charitable antihunger organization, and other Anchorage NGOs, we
expand on the statistical findings of the 2010 Hunger
Study. We provide glimpses into the everyday lives and
coping strategies of a diverse group of food-assistance
recipients living in Alaska’s largest city. Themes related
to culture in the broadest sense – the multiple meanings
of food and perceptions of the proper ways to eat and
share – complicate the administrative categories used
to delineate “food secure” and “food insecure” families.
[email protected]
The Boy Who Wanted Moose Soup:
Bridging the Cultural Food Gap
AUTHORS: C. DeCourtney1, K. Salmonson2,
S. Kelly1
Alaska Native Tribal Health Consortium 1, Seattle Children’s
Hospital 2
44
The Alaska Native Tribal Health System (ANTHC)
oversees healthcare for the Alaska Native people through
a system of primary care clinics and hospitals and a
tertiary care hospital in Anchorage. Alaska Native adults
and children often must travel outside Alaska for cancer
treatment and other specialty services for extended
lengths of time. Twelve year old Joe (Yup’ik Eskimo),
from a remote village in Alaska, underwent a successful
liver transplant at Seattle Children’s Hospital (SCH).
Afterwards, he refused to eat all food offered. He wanted
moose soup. Wild moose is not available in Seattle nor can
it be purchased. Nora Nagaruk (Inupiaq), MD, from the
village of Unalakleet, while recovering from a transplant
for cancer, craved nutrient-rich wild Alaska berries, but was
not allowed to eat them unless they were boiled. Methods:
SCH’s nurse liason (Salmonson) and the ANTHC cancer
program director (DeCourtney) established an ongoing
relationship to assist children and families. Salmonson
contacted DeCourtney expressing her concern regarding
Joe’s recovery. Results: DeCourtney offered moose from her
freezer and contacted co-workers. Within two days a “care”
package of moose, salmon, seal oil, and other wild foods
was shipped to Seattle. Each item came with a personal
story e.g. moose came from DeCourtney’s husband who
has cancer. Joe’s mother made moose soup at the Ronald
MacDonald House kitchen. Joe smiled and began to
eat and heal. He returned home to his village. SCH and
ANTHC are now working together to establish a broader
system to assist patients with traditional foods which
vary, depending on where they live in Alaska. Conclusion:
Bridging the cultural gap by recognizing the importance
of providing non-standard nutrient rich food that people
have subsisted on for generations is important to optimize
healing from cancer and other illnesses. These foods not
only provide important nutrients, but also provide comfort.
[email protected]
15:30 - 17:00
Chronic Diseases #3 Body Weight, Metabolic Syndrome, and Youth
Duckering Room 252
moderator: M. Mau
Prenatal and Early Life Risk Factors
for Obesity at Age 3 in Alaskan
Children from the PRAMS 2005-6
and CUBS 2008-9
AUTHORS: J. Wojcicki1, M. Young2,
K. Perham-Hester2, P. de Schweinitz3, B. Gessner
UCSF 1, Alaska Department of Health and Social Services 2, Tanana
Chiefs Conference 3
Background: Overweight and obesity affect
approximately one third of all American youth ages 2-19
years, and are especially prevalent in American Indian and
Alaskan Native children. Methods: Using a retrospective
observational cohort study design, we analyzed linked data
from the 2005-2006 Alaska Pregnancy Risk Assessment
Monitoring System (PRAMS), a survey of mothers of
newborns (mean age=3.5 months), the 2008-2009 Alaska
Childhood Understanding Behaviors Survey (CUBS),
a 3-year follow-up of PRAMS respondents, and birth
certificate records. Results: The prevalence of obesity at
age 3 years was 24. 9% including 42.4% among Alaskan
Native/American Indian children. Maternal sociodemographic and prenatal variables that were associated
with increased risk for child obesity at age 3 included
unmarried status at birth, prenatal smoking, participation
in WIC, unintended pregnancy, and an increased number
of stressful life events experienced during the 12 months
before delivery (1.96±0.15 versus 1.62 ±0.09; p=0.04).
Months of breastfeeding was lower among mothers of
obese versus non-obese children (9.2 ±0.7 versus 12.1 ± 0.4
months, p<0.01). Additional postnatal risk factors included:
depressive feelings (36.5% in mothers of obese children
versus 27.0% in mothers of non-obese children; p=0.03),
and smoking during the postpartum period (26.5% versus
13.5%; p<0.01). Child risk factors at age 3 years included
reported drinking of sodas, sweetened or fruit drinks
(excluding 100% fruit juice) (40.0% versus 30.1%; p=0.03)
and the child witnessing violence or abuse (8.2% versus
2.4%; p<0.01). Risk factors were similar in Alaskan Native/
American Indian children when analyzed separately.
Conclusion: Prenatal and postnatal environmental and
socioeconomic risk factors for early childhood obesity
exist in Alaska. The degree to which identified risk factors
reflect causal associations merits further evaluation.
[email protected]
Comparison of Stature and Obesity
Among Preschool-Age Children Living in
Canada and Greenland Using CDC, IOTF
and WHO Cutoffs
McGill University 1, Greenland Institute of Health Research 2, Laval
University 3, University of Toronto 4
Objectives: The present study reports stature and
adiposity measures in preschool-age Inuit children living in
the Arctic regions of Canada and Greenland. We compare our
findings to three reference standards in order to evaluate the
ability of current international guidelines to describe healthy
growth in Inuit children. Methods: We compare stature and
obesity measures using cutoffs from the Centers for Disease
Control, International Obesity Task Force and World Health
Organization references. The sample is comprised of 1121
Inuit children (554 boys and 567 girls) ages 3-5 years living
in Nunavut (n=376) and Nunavik (n=87), Canada, in the
capital city of Nuuk, Greenland (n=86) and in Greenland’s
remaining Towns and Villages (n=572). Results: Greenland
Inuit children were significantly taller than their Canadian
counterparts, with greatest height and weight observed among
children from Nuuk. Overall prevalence of stunting was low
with the three cutoffs yielding similar values for height-forage z-scores. Obesity prevalence was higher among Canadian
Inuit children than their Greenland counterparts. Prevalence
of overweight and obesity differed widely depending on
the reference used. IOTF and WHO guidelines yielded
a pattern of very high overweight prevalence and lower
obesity prevalence when compared with CDC guidelines.
Conclusions: Geographic variability in mean stature values
between Canadian and Greenlandic samples likely reflects
differences in both genetic admixture and socioeconomic
status. Obesity prevalence is high among both Canadian and
Greenland Inuit preschoolers, with children living in the city
of Nuuk exhibiting lower obesity prevalence than children
living in either Nunavut of Nunavik, Canada or Greenland’s
towns and villages. Varying obesity prevalence may reflect
varying degrees of food security in remote locations as well
as issues such as stature and sitting height which have not
been well-studied in young Inuit children. WHO cutoffs
are in part related to the age of our sample. Future crossvalidation with direct and indirect measures of adiposity, and
studies of associated metabolic and other health effects, will
determine which reference is most closely associated with
negative health outcomes in this circumpolar population.
[email protected]
Immune Pathology of Type 2 Diabetes in
First Nation Youth
AUTHORS: J. Rempel, J. Packiasamy, E. Sellers,
M. Collister, B. Wicklow, H. Dean
University of Manitoba
First Nation children are subject to increasing rates of type
2 diabetes (T2D). In T2D, pro-inflammatory immunity
disrupts insulin signaling. Here, we seek to understand
the immune pathology of childhood T2D in First
Nation peoples. We hypothesize that peripheral blood
mononuclear cells (PBMC) from First Nation youth with
T2D will demonstrate an enhanced immune reactivity to
lipids compared to cells from youth without T2D. PBMC
are being isolated from age and BMI matched First Nation
youth with and without T2D to assess cellular reactivity to
toll like receptor (TLR)4 and 2 ligands, lipopolysaccaride
(LPS, 20 and 2 ng/ml) and pam3CSK4 (20 and 2 ng/ml)
respectively. Responses to palmitate fatty acid (200 and
20 uM) are also being determined. Culture supernatants
are being evaluated for cytokine production at 24 hr. Our
preliminary results indicate that in T2D, PBMC produce 5
fold more interleukin (IL)-1beta and tumor necrosis factor
(TNF)-alpha in response to LPS and pam3CSK4 than cells
from control individuals. IL-6 synthesis was not influenced
by T2D. Low quantities of palmitate (20 uM) activated
cells from the T2D cohort; whereas in the absence of T2D
cells required 200 uM of fatty acid to react, suggestive of
a lower activation threshold in the T2D cells. Although
anti-inflammatory IL-10 production was enhanced
with T2D, the ratios of IL-1beta or TNF-alpha to antiinflammatory IL-10 were on average 2-3 fold greater in
T2D as compared to the absence of T2D, indicative of an
enhanced pro-inflammatory environment. It is hoped that
these studies will result in an understanding of the biology
behind T2D in First Nation children, leading to improved
interventions and renewed hope for this population.
TUESDAY ORAL
AUTHORS: T. Galloway1, B. Niclasen2, G. Muckle3,
K. Young4, G. Egeland1
15:30 - 17:00
[email protected]
Cytokine Responses in Relation to
Chronic infection and BMI Among Inuit
in Greenland
AUTHORS: N. Nielsen1, B. Søborg2, M. L. Børresen2,
M. Andersson2, A. Koch2
National Institute of Publich Health, Copenhagen 1, Statens Serum
Institut 2
Objectives: The mechanisms behind the high burden
of infection in the Circumpolar region are not fully
understood. Genetic status may predispose to increased
susceptibility to infection, and immunological factors may
also contribute. It has been discussed whether Inuit may
45
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have impaired immune reactivity to infection. The study
evaluated the general cytokine responsiveness in Inuit
in Greenland, and examined the association between
stimulated specific and non-specific cytokine responses and
chronic infections (Mycobacterium tuberculosis infection
(MTI) and chronic otitis media (COM)) and BMI.
Methods: The prevalence of MTI, overweight and
obesity was assessed among 385 school children and
243 adults, and the prevalence of COM was assessed
among the children. A subsample of 400 individuals (263
children and 137 adults) donated a venous blood sample
for examination of cytokine responses. Whole blood was
stimulated with two specific antigens and one non-specific
mitogen, and cytokine concentrations were measured
in culture supernatant. Associations between cytokine
concentrations, chronic infections and BMI were estimated
by linear regression.
Results: The prevalence of MTI, COM, overweight
and obesity was high. After PHA stimulation, children
with MTI had 2.7 times higher IL-10 concentration than
those without (P=0.01), and girls had 80% higher IL-10
concentration than boys (P<0.01). PPD stimulated IFNγ
and TNF concentrations were strongly elevated among
children (PIFNγ < 0.001 and PTNF < 0.001) and adults
(PIFNγ < 0.001 and PTNF < 0.01) with MTI compared to
those without. Adult women had significantly lower IFNγ
(P=0.03) and TNF (P=0.04) than men. TNF was positively
correlated with BMI in children (P=0.01), and IL-10 was
positively correlated with BMI in adults (P=0.0004) after
PPD stimulation.
Conclusion: We found cytokine patterns similar
to those reported from other immune competent study
populations.The study did therefore not support the suggestion
that Inuit may have impaired immune reactivity to infection.
[email protected]
Prenatal and Early Life Risk Factors
Birth Weight and Risk of Diabetes
Among Greenland Inuit
AUTHORS: M. E. Jørgensen1, D. Witte1, K. BorchJohnsen2, P. Bjerregaard3
Steno Diabetes Centre 1, University of Southern Denmark 2,
National Institute of Public Health 3
46
BACKGROUND: Several studies reported inverse
associations between birth weight and diabetes in
adults. However, in non-white populations the relation
between birth weight and diabetes tends to be positive.
OBJECTIVE: We examined the association between birth
weight and adult diabetes among Greenlandic participants
in the Inuit Health in Transition Study from 2005-2010.
15:30 - 17:00
DESIGN: A total of 3108 adults participated in the
study. The participants received a standard 75 g OGTT,
and diabetes was diagnosed according to WHO criteria
from 1999. Birth weight was ascertained directly from
birth records. Data on birth weight were available on 1197
participants aged 18-61 y. The association between birth
weight and markers of glucose intolerance were analysed in
linear and log-quadratic models adjusted for sex, age, and
body mass index (BMI). RESULTS: In this relatively young
cohort, 6% had diabetes, and additionally 12% had Impaired
Glucose Tolerance (IGT) or Impaired Fasting Glycemia
(IFG). Among women there was a negative although not
statistically significant association between birth weight
and diabetes, IGT and IFG. No association was seen among
men. Despite a positive association between birth weight
and BMI and waist circumference, there was a significant
negative linear association between birth weight and plasma
glucose with a decrease of 0.07 mmol/l and 0.19 mmol/l for
fasting and 2-hour p-glucose per kilogram of birth weight.
Furthermore, a negative association was found between
birth weight and markers of insulin resistance with an 18
% decrease in fasting insulin per kilogram of birth weight,
whereas no association was found with indices of betacell dysfunction. CONCLUSIONS: Our data indicate
that low birth weight and early life factors may play a role,
independently of obesity, in the development of insulin
resistance and glucose intolerance among Greenland Inuit.
[email protected]
Behavioral Health #3 - Mental Wellness
Duckering Room 352
moderator: L. Wexler
Consequences of Energy Drink Use
Among Native and Non-Native Alaskan
College Students
AUTHORS: M. Skewes1, A. Vasquez1, V. Gonzalez2
University of Alaska Fairbanks 1, University of Alaska Anchorage 2
Energy drinks (e.g., Rock Star®, Red Bull®) are marketed
toward young people and their consumption is common
among college students (Malinauskas et al., 2007). The
active ingredient in energy drinks is caffeine, which provides
a temporary burst of energy but may result in health
consequences, including dependence (Berger et al., 2011).
Energy drink use is associated with health-risk behaviors
including substance use, sexual risk taking, and aggression
among White but not Black college students (Miller, 2008).
The present research examines the influence of energy
drink use on alcohol problems and risky health behaviors
among Alaska Native (n = 51) and non-Native (n = 241)
college students in Alaska. Controlling for age, gender, and
past-30 day alcohol use, energy drink consumption was
positively associated with scores on the Alcohol Disorders
[email protected]
The Adolescent´s Experience of
Loneliness and its Associations with
Self-Rated Health and Well-Being.
Northern Finland Birth Cohort
Study 1986
AUTHORS: A. F. Rönkä1, A. Taanila2, A. Rautio3,
V. Sunnari4
University of Oulu 1, Institute of Health Sciences, University of
Oulu 2, Thule Institute, University of Oulu 3, Faculty of Education,
University of Oulu 4
Loneliness is a multidimensional experience, which is
inherent, cross-cultural and universal part of the human
condition. For some, the experience of loneliness becomes
a chronic condition and left untended, loneliness has
serious negative consequences to both one’s mental and
physical health and well-being. Rise of individualism,
loss of communality and the less stable family structures
seem to deepen the loneliness experiences. The aims
of this study are to examine the prevalence of, and
gender differences in, experiences of loneliness and to
examine which factors are associated with the loneliness
experience of 16 year old adolescence in Northern Finland
Birth Cohort 1986 (n=9479). The data covers the three
northernmost provinces of Finland. Much of loneliness
research has been done in psychiatry and psychology
within three theoretical traditions; social need, cognitive
and behavioral/personality traits theories. We consider
these theories too narrow and thus more multidimensional
approach is needed. Theoretically we see the loneliness
experience a phenomenon that encompasses emotional,
social and contextual dimensions. The study is quantitative
and the used method is logistic regression analysis. The
results are analyzed in gender sensitive way. According to
the preliminary results, 213 (3,2 %, out of n= 6681) of the
adolescents were highly lonely. Out of those 74 were boys
and 139 girls.
Logistic regression analysis was performed to assess
the association of certain factors on the experience of
loneliness separately for boys and girls. Six out of the
14 independent variables made up a unique statistically
significant contribution to the model. The major factors
associating with being lonely for both genders were: not
having close friends, feelings of not being loved, victim of
bullying, feelings of unhappiness, sadness or depression,
dissatisfaction of life and for girls, poor self-rated health.
Surprisingly, the context where one was living (ruralurban) was not associated with the loneliness experience.
[email protected]
“Meahcceterapiija“, Adapting Family
Treatment to an Indigenous Sami
Population. Camping Out With the
Family
AUTHORS: T. Laiti, Ø. Sørbye, T. Solbakk
TUESDAY ORAL
Identification Test, (ß = .24, p < .001; R2 = .30), Young
Adult Alcohol Consequences Questionnaire (ß = .25, p
< .001; R2 = .11), and Short Alcohol Dependence Data
questionnaire(ß = .23, p < .001; R2 = .16). There were no
significant energy drink by ethnicity interactions. Further,
energy drink use was positively associated with smoking (ß
= .30, p < .001; R2 = .16), suicidal ideation (ß = .19, p < .01;
R2 = .047), and sexual risk taking (ß = .12, p < .05; R2 =
.15) among both Native and non-Native students. Further
research is needed to explore reasons for these associations
and should assess whether energy drinks are typically
consumed on their own or in conjunction with alcohol.
15:30 - 17:00
Sami National centre for Mental Health (SANKS)
The Family unit at the Sámi National Centre for
Mental Health (SANKS, Northern Norway) provides
a 4 weeks family treatment for Sámi families from
all over Norway, and sámi or non sámi families from
the Finnmark region. Working on a daily basis in a
family unit facilitates immediate reflection on observed
behaviour and interaction and enhances the effect of
therapy. We wanted to develop treatment methods more
in accordance with the population’s own traditions and
culture by carrying out therapeutic interventions in a
context outside of a traditional institutional setting. The
inspiration for meahcceterapiija comes from America;
“Wilderness therapy”, which was developed especially for
delinquent adolescents. The purpose was to strengthen
trust, respect and intimacy. The method is also used,
although in a smaller scale, with families. Despite some
similarities, “Meahcceterapiija“is based on a significantly
different content. In “Meahcceterapiija“we use familiar
natural areas, where people feel safe, they can rest and
focus inward and on each other. In “Meahcceterapiia“, the
family therapists camp out in nature with the family during
3 days. In Sámi families narratives are still an important
part of family culture. Sitting around the campfire, we
focus on the family history and cultural traditions. Around
the campfire we invites parents to tell stories about the
family, about supernatural events and forces.We also play
games together. The therapists can observe and understand
more of the family interaction, and can work directly
with situations that occur. Participating in practical tasks
enhances self-esteem and pride, through developing
greater independence and self control, comradeship,
working alliances, trust in others, communication and
problem solving capacity. Feedback from families is mainly
positive and they say that they get better contact with
the therapists during and after the “Meahcceterapiija”.
[email protected]
47
Sami Value Patterns
AUTHOR: K. L. Hansen
TUESDAY ORAL
Centre for Sami Health Research, Universtity of Tromsø
48
Objectives: To study and contrast personal values in ethnic
minority (Sami) and ethnic majority (Ethnic Norwegian)
populations in Norway. Study design: A population-based,
cross-sectional study called the SAMINOR study was carried
out in 2003-04 in areas of populations with mixed ethnicity.
Method: From 24 municipalities, a total of 12,623 subjects
between the ages of 36 and 79 were included in the analysis
of personal values. The survey instrument consisted of a 19item questionnaire and the analysis was based on responses
from 10,268 Ethnic Norwegian and 2,355 Sami participants.
Associations between personal value variables were assessed
using principal component analysis. Conclusion: Four distinct
value patterns where identified in the Sami population. The
four dimensions reflect important aspects of today’s Sami
society.
Results: From the 19 values, Sami respondents held the
following five personal values in the highest regard: being in
touch with nature; harnessing nature through fishing, hunting
and berry-picking; preserving ancestral and family traditions;
preserving traditional Sami industries and preserving and
developing the Sami language. On the other hand, Sami
respondents’ least important values included modern Sami
art and the Sami Parliament (Sametinget). Four dimensions
associated with values were identified: “Traditional Sami
Values”, “Modern Sami Values”, “Contact with Nature” and
“Feeling of Marginalisation”. Traditional and Modern values
were both characterised by significantly higher scores among
females, the lowest age bracket and those who considered
themselves Sami (not including those who considered
themselves to be of mixed Sami/Ethnic Norwegian
background). Within the Traditional Sami Values dimension,
higher scores were also recorded in participants who were
married or cohabiting, living within the Administrative Area of
the Sami Language, satisfied with ‘way of life’ and members of
the Laestadian Church. The Modern Sami Values dimension
was also characterised by higher scores among participants with
high household incomes. The Contact with Nature dimension
was characterised by significantly higher proportions of Sami
(excluding participants of mixed Ethnic Norwegian/Sami
background), married or cohabitants, and participants content
with their way of life; age, living area and household income
was found to be insignificant variables within this dimension.
Feeling of Marginalisation was characterised by: significantly
greater proportions of males; of working age; living outside
the Administrative Area of the Sami Language; considering
oneself to be Sami (excluding mixed ethnic background);
low household income; and dissatisfaction with way of life.
[email protected]
15:30 - 17:00
Inuit Wellness In Action: An Update on
the Alianait Mental Wellness Action Plan
AUTHOR: E. Ford
Inuit Wellness In Action: Alianait Mental Wellness
Action Plan from the macro to the micro! The Alianait
Inuit specific Mental Wellness Task group was formed
to develop an Inuit Mental Wellness Plan to support the
First Nations and Inuit Wellness Advisory Committee’s
(MWAC) “Strategic Action Plan for First Nations and
Inuit Mental Welllness”. The Alianait Task Group is
comprised of representatives from Inuit Tapiriit Kanatami
(ITK), First Nations and Inuit Health Branch (FNIHB)
of Health Canada, land claim organizations, national Inuit
organizations and governments with Inuit populations.
The Alianait Inuit-specific Mental Wellness Task Group
created an Action Plan for Inuit mental wellness in 2007
in partnership with the four Inuit land claim regions
which identified five priority goals. Nationally Inuit define
mental wellness as an all-inclusive term encompassing
mental health, mental illness, suicide prevention, violence
reduction and reduction of substance abuse and addictions.
What does an Inuit specific Mental Wellness Action Plan
look like in motion for addictions and suicide prevention?
This presentation will examine the action plan in two
specific areas of Inuit Mental Wellness: addictions and
suicide prevention. For addictions the Action Plan informs
the development of an Inuit Nunangat Addictions process
in the context of Alianait and the federal renewal of the
National Native Alcohol and Drug Abuse Program. For
suicide prevention the development of the National Inuit
Suicide Prevention Strategy uses Alainait Action Plan as a
creative cornerstone. Both specific areas under discussion
will examine how this Action Plan informs movement
at the community, regional and national levels. As well
how all three levels work in concert to produce results
for Inuit in their communities, regions and nationally
in both a suicide prevention and addictions context.
[email protected]
Healthy Communities #3 - Health Impact Assessments Duckering Room 342
moderators: J. McLaughlin & M. Brubaker
Health Impact Assessment: The North
Slope Experience
AUTHOR: H. Dingman
North Slope Borough
The North Slope Borough, a local municipal government
for eight remote communities on the North Slope of
15:30 - 17:00
Alaska, implemented the first Health Impact Assessment
Program in Alaska in 2008 for the purpose of analyzing
public health impacts to human health from oil and gas
proposals and projects in the environmental impact
assessment process. Since then, various health impact
assessments have been drafted for the NSB for various
proposals and projects, and a baseline community health
assessment is near completion, which is a necessary
component in analyzing impacts to human health. The
presentation will describe specific HIAs completed
for the NSB, their intended outcomes (implemented
mitigation measures) and both the benefits of the HIA
process thus far and the challenges faced by the NSB.
between local, regional, and federal entities. It is hoped
that illustration of this process will encourage other
communities to initiate health evaluations based on local
issues and that lessons learned can be applied in addressing
a wide range of emerging Arctic health challenges.
Community Initiated Health Evaluation
– A Collaborative Response
Objective: This study was to determine the human health
impact of dzuds in Mongolia. A dzud is when a summer drought
is followed by an extremely harsh, colder winter with excessive
snow and ice. These natural disasters occurred from 1999-2002
and in 2010. Recurrent dzud events have a devastating effect
on nomadic herding families and their traditional lifestyle in
Mongolia. Study Design: An extensive literature review was
conducted of international articles and reports from 1999 to date, in both English and Mongolian. We examined the
impact of dzud on human health from several perspectives:
agricultural, Nutrition and Food Security;mental health,
employment, and migration. Results: Three consecutive years
of dzud occurred from 1999-2002 with another one in the
winter of 2009/2010. Dzuds severely affected over 15 of the 21
provinces in Mongolia. In 2010, more than 7 million livestock
died due to starvation and freezing. The herder families’
primary food source and security was decimated; leading to
hunger, iron deficiency, and malnutrition. Increased stress
among herders was common and often presented as depression,
post-traumatic stress, and suicide/suicidal tendencies. As a
result loss of entire livelihoods in the countryside increased
the migration of herding families to urban areas. Conclusions.
Extreme winters exacerbate the usual harsh socioenvironmental conditions in Mongolia. Adverse experiences,
i.e., dzuds, can have a cumulative effect on nomadic herders
and their traditional lifestyles. Future research is needed to:
1) Elucidate effective strategies to prevent and mitigate the
detrimental effects of dzuds; 2) Identify concurrent impacts
on nomadic herders and their families; and 3) Determine the
longitudinal effect(s) of the disaster experience on herders.
AUTHORS: M. Brubaker, J. Bell1, M. Hawley2,
D. Bruden3, T. Thomas1
Alaska Native Tribal Health Consortium 1, Maniilaq Association 2,
Centers for Disease Control and Prevention 3
Kivalina is an Inupiat village of about 400 people located
on a Northwest Alaska barrier island. It is vulnerable to
storm surge, erosion and flooding; exacerbated recently
by climate change-driven delays in winter-sea and-shore
ice formation, and permafrost thaw. The village has no inhome piped water or sewage; the “Washeteria” is the only
facility providing public showers, laundry facilities and flush
toilets. In October 2004, a storm damaged the washeteria
septic system resulting in frequent and prolonged facility
closures, particularly during winter months. In 2009 the
Alaska Native Tribal Health Consortium (ANTHC) in
conjunction with the Maniilaq Association, the Northwest
Arctic Borough, the City of Kivalina and the Native Village
of Kivalina performed a health impact assessment, with a
focus on climate change. Residents expressed concern about
the health consequences of severe storms and washeteria
closures, and queried whether these could be measured by
evaluating the type and number of visits to the Kivalina
Clinic. To address these concerns a process was developed
that engaged a range of local, regional and federal health
partners.
The city and tribal governments requested that the
Maniilaq Association provide ANTHC with ICD9 diagnosis codes for all village clinic visits between
2003 and 2009. Village administrators provided dates of
washeteria closures and the Maniilaq Medical Center
provided de-identified data electronically on all Kivalina
Clinic visits between 2003-2009. The U. S. Centers
for Disease Control, Arctic Investigations Program
assisted in performing statistical analyses. A community
initiated health evaluation resulted in collaborations
Impact of Recurrent Natural Disasters in
Mongolia: Dzuds and Nomadic Herders
AUTHORS: N. Nix1, N. Myagmarjav2
University of Alaska Anchorage 1, Mongolian Development Institute
of Mongolia 2
TUESDAY ORAL
[email protected]
[email protected]
[email protected]
Institutionalization of Health Impact
Assessment in Alaska
AUTHORS: P. Anderson, Joe McLaughlin,
S. Yoder
State of Alaska
Key Words: Health Impact Assessment, Institutionalization,
49
TUESDAY ORAL
HIA funding Background: Health Impact Assessment
(HIA) provides a strategic opportunity to incorporate
health into public decision-making. As of 2012, more
than 130 HIAs have been initiated or completed in the
United States. Further adoption of HIA is limited by a lack
of sustainable funding strategies and long-term oversight.
Institutionalization of HIA is one solution to this problem.
The State of Alaska has institutionalized an HIA program
within the Department of Health and Social Services
through interagency cooperation, sustainable funding
arrangements, and long-term oversight. Program History:
Internationally, HIA has been performed extensively
by governments, industry, as well as large lending
organizations, and HIA practice in the United States has
developed rapidly. HIA work began in Alaska during 2004
when the North Slope Borough conducted two HIAs
for resource development projects on the North Slope.
In 2008, a conference on HIA was held in Anchorage,
Alaska that included experts from federal agencies, state
and local governments, regional health corporations, the
Alaska Native Tribal Health Consortium, and expert
HIA practitioners from the international arena. Program
Structure and Collaborative Relationships: The State
of Alaska HIA program consists of a program manager
and master’s-level epidemiologist. The program oversees
contract work on 10 large resource development projects in
AK and maintains relationships with state, federal agencies
as well as tribal health organizations. Program Funding:
The State HIA program is funded by state general funds
and through reimbursable services agreements with
other state agencies. In addition, the HIA program uses
contractors provided by the state agencies that request
the HIA. Program Accomplishments: The HIA program
currently oversees HIA work on 10 large-scale natural
resource development projects related to gold, copper,
oil and gas, and coal. The program also maintains and
updates the HIA Toolkit and a website dedicated to HIA.
[email protected]
Enhancing Health Impact Assessment
Methodologies for Polar Communities
AUTHORS: S. Phillips1, G. Krieger1, K. Lyncoln1,
P. Anderson2
NewFields, LLC 1, Alaska DHS HIA Program 2
50
Framework health impact assessment (HIA) methodologies
have been developed and published for large extractive
industry projects. Internationally, this effort has been
dominated by projects in the humid tropics, particularly in
sub-Saharan Africa and SE Asia where there is a strong
focus on infectious diseases, particularly vector-borne.
In our experience, while the general HIA framework is
appropriate for polar communities, there are a significant
number of unique issues that must be addressed in order
15:30 - 17:00
for the HIA to produce meaningful benefits for project
proponents, host communities and regulatory/permitting
agencies. Key issues for polar communities include
subsistence practices, bioaccumulation and direct effects of
potentially hazardous materials and social determinants of
health (SDH). Potential impacts to subsistence activities
include effects on quantity, quality (actual and perceived)
and access. Strategies for investigating these effects will be
discussed. Bioaccumulation concerns will focus heavy metals
including food pathways. Other important toxicological
issues will include non-threshold contaminants such as
respirable particulate matter (PM), i.e., PM2.5 and PM10.
Assessing project-related causation for impacts to the social
determinants of health is controversial and challenging.
A transparent causation analysis is imperative so that
there is a clear definition of roles and responsibilities. As
part of our ongoing work with the State of Alaska HIA
Program, we will present and share “lessons learned” and
new methodologies developed as part of an ongoing series
of Alaska extractive industry and water resources projects.
[email protected]
Infectious Diseases #3 - The Pneumococcus
Gruening 206
moderators: M. Moore & A. Koch
Invasive Pneumococcal Disease
Epidemiology in the Canadian North,
2000 to 2010
AUTHORS: J. Lourenco, S. Desai, I. Martin
Public Health Agency of Canada
Background: Through the International Circumpolar
Surveillance (ICS) network, population-based surveillance
on invasive pneumococcal disease (IPD) has been
conducted in Northern Canada since 1999. Seven-valent
pneumococcal conjugate vaccine (PCV7) was introduced
in Northern Canadian regions from 2002 to early 2007,
followed by 10-valent vaccine (PCV10) in 2009/10 and
13 valent vaccine in 2010/11. A 23-valent polysaccharide
vaccine (PPV23) was introduced in the 1980/90s for
special populations and adults 65 years and older. Methods:
A standardized form containing demographic and clinical
information was completed for all reported IPD cases.
Isolates were sent to a reference laboratory for confirmation,
serotyping, and antimicrobial resistance testing. Results:
From 2000 to 2010, 433 IPD cases were reported (average
36 cases per year). Incidence was greatest among infants
less than two years of age and those 65 years and older,
with an average incidence of 133 and 67 cases per 100,000
population, respectively. After a peak in incidence in 2008,
rates among infants have declined. Incidence was four times
greater among Aboriginals compared to Non-Aboriginals
(33.8 versus 8.5 cases per 100,000 population). The case
[email protected]
Molecular Epidemiology of Invasive
Pneumococcal Disease Due to Serotype
19A in Alaska: 1986-2010
AUTHORS: K. Rudolph, M. Bruce, L. Bulkow,
T. Zulz, A. Reasonover, M. Harker-Jones,
D. Hurlburt, T. Hennessy
Arctic Investigations Program
Background: After the introduction of the 7-valent
pneumococcal conjugate vaccine in Alaska, the incidence of
disease due to nonvaccine serotypes, particularly serotype 19A,
increased. The aim of this study was to describe the molecular
epidemiology of IPD due to serotype 19A in Alaska.
Methods: IPD data were collected from 1986 - 2010 through
population-based laboratory surveillance. Isolates were
serotyped by the Quellung reaction and MICs determined
by broth microdilution. Genotypes were assessed by MLST.
Results: Among 3294 cases of laboratory-confirmed IPD,
2926 (89%) isolates were available for serotyping, of which 233
(8%) were serotype 19A. Across all ages, the proportion of IPD
caused by serotype 19A increased from 3.0% (63/1823) prePCV7 (1986-2000) to 15.4% (170/1103) post-PCV7 (20012010) (p<0.001); among children <5, the proportion increased
from 5.0% (39/776) to 33.0% (76/230) (p<0.001). The annual
incidence rate of IPD due to serotype 19A increased from 0.73
cases pre-PCV7 to 2.56 cases/100,000 persons post-PCV7
(p<0.001); rates among children <5 increased from 4.84 cases
to 14.1 cases/100,000 persons (p<0.001). In the pre-PCV7
era, 18% (16/105) of all isolates with reduced susceptibility
to penicillin were serotype 19A; post-PCV7, 64% were 19A.
Eighteen different sequence types (ST) were identified; ST199
or SLVs of ST199 (n=150) and ST172 (n=59) accounted for
the majority of isolates. Multidrug resistant isolates were
clustered in ST199 and ST320. Conclusions: While PCV13
should significantly reduce the burden of disease due to
19A, these data highlight the need to continue to monitor
the molecular epidemiology of pneumococcal serotypes.
[email protected]
General Morbidity as Risk Factor for
Invasive Pneumococcal Disease in
Greenlanders
AUTHORS: A. Koch, M. Andersson, M. Bøerresen,
J. Navne
Background and aims: Invasive pneumococcal
disease (IPD) is frequent in native Arctic populations, but
little is known about factors accounting for this. The study
aim was to determine whether general morbidity measured
by all-cause hospitalisations prior to IPD increases the
risk of IPD in native Greenlanders (Inuits). Methods: All
microbiological testing in Greenland takes place at the
national microbiology laboratory in the capital Nuuk. All
IPD cases in the years 1994-2008 were registered from
laboratory files. The Greenland Inpatient Register contains
information of all hospitalisations in Greenlandic hospitals.
Using these nation-wide registers a cohort of all native
Greenlanders was formed and the relative risks (RR) of IPD
for hospitalisations by ICD8 and ICD10 diagnosis groups
in the period from 5 to ½ year prior to IPD were estimated
using Poisson regression analysis. Results: 121 IPD patients
were identified, hereof 100 being Inuits with information
of background factors. 53 percent of IPD patients had
been hospitalised (range 1-12 times) in the study period.
Hospitalisation for any reason was associated with increased
IPD risk (p=0.02), but mainly for those hospitalised
10+ times (RR 4.97, 95% CI 1.14–15.5, compared with
persons hospitalised 2 times). Main diagnosis groups
associated with increased IPD risk were cancers (RR 2.95),
haematological (RR 3.92), eye (RR 2.6), endocrinological
(RR 2.21), respiratory (RR 2.01), digestive (RR 1.62),
pregnancy related (RR 1.94), and infectious diseases (RR
1.46), although only significant for cancers. Conclusions:
General morbidity increases the risk of IPD but may only
explain a smaller fraction of IPD cases in Greenland.
TUESDAY ORAL
fatality rate was 6.0%, and greatest among those 65 years
and older (19.6%). Pneumonia was the most common
clinical manifestation (66%), followed by bacteremia
(30.0%), and meningitis (7.2%). Depending on the
antibiotic, susceptibility ranged from 91% to 100%. From
2007 to 2010, the most common serotypes among less than
two year olds were 19A (32% of cases) and 10A (16%),
compared to 7F (17%), 3 (13%) and 8 (13%) among adults
65 years and greater. About 42% of cases less than 2 years
of age in 2009 and 2010 had serotypes covered by PCV-13.
Conclusion: IPD continues to be a major cause of disease in
Northern Canadian populations, with particularly high rates
among infants and Aboriginals. Continued surveillance is
needed to determine the impact of the PCV-13 program.
15:30 - 17:00
[email protected]
Pneumococcal Antibodies in Dried
Blood Spot Samples as a Method for
Large-Scale Sero-Surveillance
AUTHORS: J. Navne, M. L. Børresen, B. Kantsø, H.
Slotved, A. Koch
Background: Introduction of conjugate pneumococcal
vaccines in childhood vaccination programmes has led
to increased interest in epidemiological surveillance
of serotype distribution to determine vaccine impact.
However, these studies are mainly based on determination
of nasopharyngeal pneumococcal carriage using swaps,
51
TUESDAY ORAL
15:30 - 17:00
which only reflects current carriage, besides being subject
to sampling errors. Determination of serotype specific
antibodies reflects current and past exposure, but logistic
problems associated with tapping, treatment, and shipping
of venous blood samples hamper use of such samples in
field studies. Dried blood spot samples (DBSS, finger
stick whole blood on filter paper) are easy to collect and
store, as the spot samples can be transported and stored
at room temperature. Yet, this method has not been used
in pneumococcal studies. We compared this minimally
invasive method of pneumococcal antibody detection
with antibody detection using conventional venous
blood samples. Method: Paired serum and DBS
samples where collected from 20 healthy Danish adults
and 20 children below 6 years of age chosen at random.
Antibodies to the 13 serotypes included in the PCV13 were determined in the two set of samples using the
Luminex principle and pairwise correlations between the
two were calculated. Results: Preliminary data show
very high degree of correlation (correlation coefficients
>0.95). Further testing is on going. Conclusion The DBSS
method appears an easy and reliable method to determine
antibody response to pneumococci and other pathogens,
which is particularly helpful in large-scale epidemiological
studies in remote settings with limited laboratory resources.
This may facilitate vaccine trials in developing countries.
pneumococcus. An average of 1133/1850 (61%) of village
residents participated per year. Among persons > 5 years,
antibiotic use declined by 37%, from 0.81 courses/6 months
in 1998 to 0.51 in 2010 (p <0.01); for persons < 5 years, use
declined by 22% (2.22 to 1.73 courses/6 months, p = 0.10).
Use of the pneumococcal conjugate vaccine (PCV) has been
consistently high in these villages; 76-100% of children
were age-appropriately vaccinated. A significant decreasing
number of isolates non-susceptible to tetracycline, tri/
sulfa, ceftriaxone were seen for all villages combined. An
exception was village A, where increased resistance to
all antibiotics, except ceftriaxone, was seen in 2009-10.
Serotype 19A, which is typically resistant to penicillin,
erythromycin and tri/sulfa, increased from 0.4% in 2001
to 12.5% of all isolates in 2010, and was an important
factor increasing pneumococcal antibiotic resistance.
Conclusions: This study demonstrates that despite an
overall decrease in antibiotic use, an antimicrobial-resistant
serotype, such as 19A, can cause increasing antibiotic
resistance in isolated Alaska villages. It also highlights the
importance of local surveillance of pneumococcal resistance
and serotypes after conjugate vaccine introduction.
[email protected]
moderators: B. Lefferts & I. Dagsvold
Antibiotic Prescription, Vaccine Use,
Serotype Distribution and Antimicrobial
Resistance of Nasopharyngeal
Streptococcus Pneumoniae Over 10
Years in Four Villages in Rural Alaska
Culturally and Linguistic Adjusted
Health Services for the Indigenous Sami
Population in Norway
AUTHORS: C. Hedlund1, T. Hennessy2, D. Bruden2,
A. Parkinson2, M. Bruce2, B. Evengård1
University of Tromsoe
Dept. of Public Health and Clin. Medicine, Umea University ,
Arctic Investigations Program 2
1
52
Background:
Pneumococcal
resistance
to
antimicrobials has increased over time. Changes in
antibiotic use and shifts in pneumococcal serotypes after
the 2001 introduction of pneumococcal conjugate vaccine
(PCV7) for children have affected resistance patterns. We
studied pneumococcal nasopharyngeal carriage in 4 rural
Alaskan villages annually for 10 years to evaluate factors
related to antimicrobial resistance. Methods: Every spring
season from 1998-2004 and 2008-2010, nasopharyngeal
swabs (NPS) were obtained for pneumococcal culture,
serotyping and susceptibility testing from voluntary
participants of all ages (n=1850). Information on antibiotic
use, pneumococcal vaccination status and living conditions
was collected. Comparisons were made over time using the
Cochran-Armitage trend test. Results: Over the 10 year
study period, 3908 (34.5%) of 11330 NPS were positive for
[email protected]
Health Services #3 - Medical Services
Salisbury Theatre
AUTHOR: I. Dagsvold
After a 150 year long history with assimilation policy,
the legal and political situation for the Sami people in
Norway has gradually improved. The Sami Act was
passed on in 1987, and in 1989 the first Sami parliament
opened. The Sami people obtained formal status as an
indigenous population in 1990, the same year Norway
ratified the ILO convention no.169. Chapter 25 in the
ILO convention states indigenous peoples right to receive
culturally and linguistic adapted health services. This right
is incorporated in Norwegian legislations like Patient and
user Rights Act, Health Personnel Act and others. Up to
the 1950’s the life expectancy was shorter and the infant
mortality rates was three times as high in the Sami areas
in Northern Norway than the mean rates in the rest of
the country. This called for better health services in the
northernmost region of the country. Today the state of
health for Norwegians and Samis is mainly the same.
However, the Samis are more dissatisfied with the health
services than Norwegians. One reason for this is lack of
Sami speaking health personnel and interpreters. Other
[email protected]
Frequent Use of Primary Health Care
Service in Greenland: An Opportunity
for Case-Finding
AUTHORS: A. Rolskov, M.L. Pedersen, A.R. Lynge,
J. Jacobsen
Queen Ingrid’s Centre for Primary Health Care
Objectives: To estimate the age and gender
consultation rates of primary health care service in
Greenland and to analyse contact patterns among patients
in Nuuk. Study design: Observational and cross sectional
register study using data captured from the medical record.
Methods: Age and gender specific number of patients
whom had contacted the primary health care centres within
the last year were identified using a statistic module in the
electronically medical record system. The population as it
was 1th of January 2011 was used as background population.
The age and gender specific consultation rates were
calculated. Review of most recent contact was performed in
a subsample of patients from Nuuk and information of the
type of contact and diagnoses was obtained. Results: Eightythree of the population in Greenland had been in contact
with the primary health care centre within one year. Women
were more frequent users than males. A subsample of 400
patients in Nuuk was identified. Personal contact was the
most frequent type of consultation, followed by telephone
and e-mail consultations. Musculoskeletal symptoms
accounted for the most frequent diagnoses. Conclusion:
More than eighty percent of the whole population has
been in contact with the primary health care system within
one year. This indicates that opportunistic case finding of
chronic diseases like diabetes, hypertension etc. is a possible
strategy in decreasing the number of undiagnosed cases.
[email protected]
Health & Medical Response to the 2011
Kuskokwim River Flooding in Crooked
Creek, AK
AUTHORS: B. Lefferts, L. Chikoyak, S. Freitas,
M. Scott, B. Berube, P. Hergenroether, G. McIntyre,
J. Russell, J. Dobson
Yukon-Kuskokwim Health Corporation
Seasonal flooding of the Kuskokwim River caused partial
evacuation of the Village of Crooked Creek in the early
hours of May 9th, 2011 to the nearby mining camp of
Donlin Creek. Floodwaters displaced a large percentage
of residents and created potential health concerns due
to contamination from spilled fuel and raw sewage.
Utility systems were disrupted for several days leaving
residents without power, clean water or communications.
A multidisciplinary team from the Yukon-Kuskokwim
Health
Corporation
including
Administration,
Community Health Aides, Environmental Health,
Nursing staff, Clinical Facilities, Safety, Behavioral Health;
Technology, Infection Control, and Pharmacy responded
to the health and medical needs of the affected population.
A wide variety of services were delivered including needs
assessments, health education, vaccinations, chronic
medication delivery, health care and emergency medical
service, mental health, environmental assessments, and well
and septic monitoring and disinfection were provided. The
panel will review the flood response objectives and activities
performed by the team, the evaluation to the response,
and improvements made to Emergency Operations Plan.
TUESDAY ORAL
reasons are probably lack of cultural competence, and lack
of cultural adjustment in the clinical encounter. To improve
the quality of health services to the Sami, it is necessary to
increase the cultural competence among health personnel.
Working on ones cultural competence is a process that
includes both a personal and professional investigation and
development. The presentation is based upon a model of
cultural understanding that contains of 1) reflection on ones
own cultural background, 2) knowledge about the people,
culture and area one is working in, and 3) reflection on
ones professional background and biomedical knowledge.
15:30 - 17:00
[email protected]
Application of Quality Measures
Improves Transfusion Service
Documentation in Rural Alaska
AUTHORS: C. Stager, J. Tiesinga
Maniilaq Health Center
Providing transfusion services in rural Alaska presents
significant challenges in assuring quality of care and patient
safety. These challenges, primarily related to staff turnover,
include training and competency, documentation, consent,
and others. In April 2010, Maniilaq Health Center (MHC),
a 24-bed acute care facility in Northwest Arctic Alaska,
initiated a comprehensive quality improvement project to
address these challenges. This project employed key quality
tools including brainstorming, Pareto charting, cause and
effect assessment, and task sharing to achieve dramatic
improvement over 12 months. From August 2007 to April
2010, MHC Laboratory performed quarterly blood utilization
review consisting of assessment of laboratory documents and
patient charts for all transfusions. Blood utilization averaged
53
TUESDAY ORAL
6 units packed red cells / month during this period. Prior to
April 2010, significant errors in documentation, defined as
violation of organizational procedures and / or accreditation
standards pertaining to transfusion records, involved 86%
of all transfusions. In April 2010, MHC initiated a quality
improvement project designed to significantly reduce
these errors. This project engaged multiple stakeholders
(e.g., nurses, laboratorians, and providers) to identify root
problems, clarify / simplify forms, develop interdepartmental
corrective actions, and monitor actions and forms for
effectiveness. Implementation of simplified forms and realtime supervision of documentation proved most effective
in reducing errors. This process involved alerting a Nurse
Educator prior to each transfusion, thereby allowing real-time
oversight and review of documentation and timely remedial
training. Quarterly review of blood bank records showed
dramatic reduction in the rate of documentation errors, from
initial involvement of 86% of all transfusions down to 32%
per quarter after 6 months and 20% per quarter after 12
months. In conclusion, the use of simplified forms, real-time
oversight of documentation processes, and rapid remedial
training proves highly effective in improving accuracy and
completeness of transfusion records despite high staff turnover.
[email protected]
First Nations Governance and
Management of a Regional Physician
Services Model
AUTHORS: J. Gordon1, F. Tarrant2
Sioux Lookout First Nations Health Authority 1, Dalhousie
University 2
54
The Sioux Lookout Regional Physician Services Inc.
(SLRPSI) is the organization responsible for meeting the
medical human resource needs for 28 remote First Nations
communities as well as The Meno-Ya-Win Health Centre and
the Town of Sioux Lookout and surrounding area. SLRPSI
was formed in response to the development of the Anishinabe
Health Plan (AHP) which called for a regional primary health
system and an improved Physician Services model under First
Nations governance and management. This presentation will
outline the process used to bring three different physician
practices with three different funding models together in
a regional model that is governed and managed by First
Nations. It will highlight some of the challenges of moving
forward with the implementation of the model, the strategies
used to overcome the challenges and lessons learned along
the way. The presentation will also address the capacity of
the current system and the process currently underway to
evaluate the regional physician services model, the activities
of the service delivery process, as well as determine/measure/
monitor service delivery outcomes that will help demonstrate
the program’s viability and help determine impact.
[email protected]
15:30 - 17:00
Tribal Implementation of PatientCentered Medical Home Model in Alaska
Accompanied by Decreased Emergency
Room Visits and Hospitalizations
AUTHORS: J. Johnston1, J. Smith2, V. Hiratsuka2,
D. Dillard2, Q. Szafran1, D. Driscoll1
University of Alaska Anchorage 1, Southcentral Foundation 2
Background: Between 1995 and 1998, the tribally
owned and operated Southcentral Foundation (SCF)
incrementally assumed responsibility from the Indian
Health Service for primary care services on the Alaska
Native Medical Center (ANMC) campus in Anchorage,
Alaska. In January 1999, SCF became co-owner of ANMC,
along with the Alaska Native Tribal Health Consortium.
Beginning in August 1999, SCF implemented a new
model of care with many components of the PatientCentered Medical Home (PCMH) to improve access
and continuity of care. Population Studied. Alaska Native
and American Indian people residing in urban areas of
southcentral Alaska and receiving healthcare at ANMC.
Methods: To evaluate health outcome trends before,
during, and after the PCMH implementation, aggregate
monthly counts of emergency care (EC) visits and inpatient
hospitalizations were extracted from SCF databases. EC
and hospitalization rate levels and trends were estimated
for four time periods (March 1996 – July 1999: SCF
assumed responsibility for primary care; August 1999- July
2000: PCMH implementation; August 2000 – April 2005:
early post-PCMH implementation; May 2005- December
2009: later post-PCMH implementation) using regression
analysis with correlated errors. Results. EC visits for all
patients and for diabetics increased steadily before PCMH
implementation (+0.37 per 1000 patients per month),
dropped quickly during implementation (-1.72 per 1000),
continued to decrease more slowly immediately following
implementation (-0.24 per 1000), and subsequently leveled
off (-0.06 per 1000). Inpatient hospitalizations for all
patients and for diabetics were steady before and during
PCMH implementation, declined steadily immediately
following implementation, and subsequently stabilized.
During the course of the study, reductions were also seen
in EC visits for heart failure and asthma. Additional
analyses of hospitalizations are ongoing. Conclusion.
Implementation of PCMH at SCF was accompanied by
declining EC and hospitalization rates for all patients
and for patients with serious chronic conditions.
[email protected]
Research in the North #3 Community Engagement in Research
15:30 - 17:00
McGown
moderators: T. Hoeft & S. Mollersen
Community Members as
Co-Researchers: Building Stronger
Connections in a Community-University
Partnership
University of Alaska Fairbanks 1, University of Washington2, Center
for Alaska Native Health Research 3
The Center for Alaska Native Health Research (CANHR)
is a community-based participatory research (CBPR)
center investigating risk factors for obesity and related
chronic disease in Yup’ik Eskimo people living in
Southwest Alaska. Our CBPR approach has guided the
process of developing long-term, trusting partnerships
with these rural communities. This partnership engages
and trains community members as co-researchers and
builds local research capacity. Both university researchers
and community members benefit in a bi-directional
learning process by gaining insight into each other’s culture
and knowledge. CANHR researchers have worked with
community partners to develop culturally relevant strategies
for dissemination of clinical findings. A current challenge is
learning how to discuss genetic research with our community
partners, as there are no Yup’ik words for genetics and
related terms. In collaboration with investigators from the
Center for Genomics and Healthcare Equality and the
Northwest Alaska Pharmacogenomics Network at the
University of Washington, a Community Planning Group
(CPG) of past CANHR genetic study participants was
formed to explore this issue. Additionally, a Ciuliat group
of Yup’ik professional leaders from an urban setting was
formed to facilitate communication between the CPG and
university researchers. These groups have identified Yup’ik
phrases and diagrams that can be used to communicate
genetic concepts. The conversation has also led to deeper
discussion about ways in which Western and Yup’ik
cultures develop new knowledge about the world, and how
we can help each other to gain a broader understanding
of new information produced by scientific research. This
discussion has been accompanied by active participation
of CPG members as co-facilitators of community focus
groups and participation in data analysis. An important
conclusion is that dissemination of research results is only
one component of a larger and more rewarding opportunity
for dialogue and co-management of a research process.
[email protected]
AUTHORS: A. Cunsolo Willox, S. Harper, V. Edge,
Inuit Community Government
University of Guelph
For Canada’s Northern regions, climatic and environmental
change pose significant challenges to the physical,
mental, emotional, and spiritual health and well-being of
residents. Inuit communities are particularly vulnerable to
environmental changes, as many continue to live lifestyles
closely tied to, and reliant upon, the natural environment.
Understanding the significance of the climate-health
connection, the Rigolet Inuit Community Government
in Nunatsiavut, Labrador, Canada, led a multi-year,
community-based, participatory, storytelling project, which
examined the impacts of climate change on human health
and well-being. The community of Rigolet partnered with
a transdisciplinary team of community researchers, social
scientists, epidemiologists, and health professionals to use
digital storytelling to gather stories and data about climate
change in the region, climate-health relationships, and
impacts on cultural identity and livelihoods. These ‘digital
dialogues’ formed an innovative and powerful platform for
engaging participants, and for understanding the impacts
of climate change on health in Inuit communities. Digital
storytelling also emerged as an important research method,
capable of creatively engaging individuals and communities
in the research process, and is a powerful Indigenous
narrative method. This presentation will discuss the process
of using digital storytelling as participatory research
method to preserve and promote local knowledge, discover
and share climate-health relations, and enhance adaptive
capacities.
TUESDAY ORAL
AUTHORS: S. Hopkins1, R. James2, S. Trinidad2,
T. Hoeft1, E. Orr1, H. Lupie3, R. Kinegak3,
K. Edwards2, W. Burke2, B. Boyer1
Storytelling in a Digital Age:
Digital Storytelling as an Emergent
Participatory Narrative Method for
Climate-Health Research and Promotion
Examples of the digital stories created through this
project will be screened, followed by a discussion of using
participatory digital media to conduct research about
climate-health relationships in Inuit communities and
to create culturally-relevant health media. The creation
of the ‘My Word: Storytelling and Digital Media Lab’—
the first Northern centre dedicated to using digital
media in Northern research—will also be discussed.
[email protected]
55
TUESDAY ORAL
Using Community-Based Participatory
Research Design and Indigenous
Methodology to Improve Diabetes
Treatment and Care for Aboriginal
People in Fort Smith, NWT
Everyday Life of Reindeer Herding.
Building a Research Study Regarding
Factors that May Affect Mental Health in
the Sámi Reindeer Herder Population of
Norway
AUTHORS: J. Dutton1, J. Lys2
AUTHORS: S. Møllersen1, I.M. Eira-Åhrén2,
V. Stordahl1, G. Tørres1
University of Toronto 1, Fort Smith Health and Social Services
Authority 2
Aboriginal people experience high rates of type 2 diabetes
that continue to increase. Studies of diabetes among
Aboriginal people in the North have revealed trends of
increasing sedentary lifestyles and decreasing traditional
food use. Rates of diabetes among Dene-Métis people in
NWT have tended to be the low, but these trends suggest
that diabetes rates may be on the rise, as seen in Inuit
populations. Traditional diabetes management strategies
have not been successful in Aboriginal populations.
Aboriginal people report that treatment is culturally
irrelevant, does not consider traditional values, local social
and environmental barriers and that medical advice is
not practical or hard to understand. Aboriginal people
continue to report need for better diabetes education and
treatment. Researchers have not completely understood
the needs of Aboriginal people with diabetes and new
methods are required to achieve the goal of this study:
to gain a better understanding of how Aboriginal people
respond to diabetes programming. Community members
in Fort Smith, NWT are interested in determining how
diabetes programming can incorporate Aboriginal ways
of knowing to increase cultural relevance in diabetes
programming for Dene-Métis people. The project employs
a community-based participatory research design with
indigenous methodology that emphasizes local knowledge
and traditional ways of learning about people and diseases.
Methods for gathering data about local diabetes experiences
are developed in the community by community members
to maximize local validity and usability. This presentation
will detail the process of our methods development, the
local methods defined for use in this community and the
value of these methods for Aboriginal health research
ethics. Indigenous methodology is local, collaborative and
contingent on the specific community – as such there is no
“how-to” instruction in the literature. The insights gained
from this project are useful to other researchers who may
be interested in applying these methods in their own work.
[email protected]
56
15:30 - 17:00
Sámi National Centre for Mental Health 1, The Sámi National
Reindeer Herders Association 2
According to the Sámi National Reindeer Herders
Association in Norway the level of strain in everyday life
among the reindeer herders is a threath not only to the
future existence of the nomadic reindeer herding, but also
to their overall well-being and mental health. This study
aim to highlight the perceived stessors, both societal,
envioronmental and internal factors as well as work
related stress. Then, the relationship between patterns
of stressors and quality of life and psychological distress
will be investigated. The importance of culturally relevant
and respectful research, particularly when researchers
collect and interpret data from indigenous populations, is
well known. In Norway, however, this admission is rarely
expressed in explicit research procedures of cooperation
between the indigenous community and the researchers.
During the development of our study - the aims, the
methodological approach and the instruments - the
research group and the Sámi reindeer herder community
have worked closely together. This have been organized
by a partnership agreement including indigenous
participation throughout the research process as well as
ownership of indigenous knowledge and rights to protect
use of data/results in culturally unacceptable or harmful
ways. We will here describe and discuss our experiences,
the callenges and the benefits of this planning prosess.
[email protected]
Climate Change and Impact on
Communities, Community-Based
Research Project with Elders and Youth
AUTHORS: C. Gilday, D. T’seleie
Institute for Circumpolar Health Research
It has become an indisputable fact of life that Aboriginal
peoples and northerners are being dramatically impacted
by climate change, not only in its broad implications, but
also at the individual and community level where life and
livelihood patterns are being affected. The Arctic (North
of 60) populations, peoples, lands, waters, animals and
cultures are at stake. Increasingly unpredictable weather
patterns impact the ability of people to travel safely not
only in traditional ways but also through modern means
of transportation such as airplanes. Modern mobility is
necessary to access food (community hunts) and emergency
health services like expertise in disaster management and
transportation safety. In Canada, most small health centres,
if one is nearby, have no emergency service capacity and the
closest help arrives from Ontario, over eight hours away.
[email protected]
Healthy Families #3 - Social Determinants in Maternal Health Room 301
moderators: N. Murphy & G. Osborne
Women`s Health in the Norwegian
High North
AUTHOR: G. Minde
Harstad University College
This abstract will be about Women’s Health in the
Norwegian High North. Women in this aspect will be the
ethnic Norwegians, the national minority called the Kvens
and the Sami indigenous people, also spelled The Sámi
or Saamis. My presentation will be based upon 3 studies
among women living in the Norwegian High North. The
latest study is a small regional study using a questionnaire
developed by a European network called OCIN (Older
people in Europe). The informants are 20 women living
in the Mid-Region in the Arctic. The methods are a
combination of questionnaire combined with a group
interview. The Findings indicate how strongly the Arctic
women are connected to their environment geographically,
social and culturally. They also have high expectations to
get help from the welfare state even if the Scandinavian
and Norwegian Welfare State are under constant
pressure in these days, both Samis and none-Samis. The
Findings suggest that the Arctic women are a group who
are interested in promoting Health both psychical and
mentally. They are also afraid of being a burden for their
families, even if the family ties are strong. To avoid being
a burden for their families, they participate in different
kind of activities in the local communities. This give
them a feeling of belonging and participating and prevent
loneliness, even if some of them haven`t seen a person for
several days. The Sami women don`t feel themselves lonely,
because they feel integrated in their local communities.
[email protected]
Social Determinants of Inuit
Women’s Sexual & Reproductive
Health: Community Based Research
on the Tundra
TUESDAY ORAL
In 2012, the Institute of Circumpolar Health Research and
Dene Nation were funded by Health Canada’s Climate
Change and Health Adaptation Program for Northern
Indigenous Communities to engage local groups in a
Elders and Youth project focused on the topic of emergency
management. Community-based Traditional Knowledge
methodology is being engaged, while the Walter &
Duncan Gordon Foundation is providing support through
their Arctic Fellows based in Yellowknife to mentor high
school students. The project is for the youth to to amplify
the voice of the people of the land (Elders, traditional
harvesters and youth) by producing a video for widescale
dissemination. The results of the research will contribute to
developing a national policy which is relevant to the North
and adaptation plans that have input from Northerners.
The research skills in Traditional Knowledge and western
science will go a long way in not only enhancing the
educational futures of the youth but will also be helpful
in developing research capacity for other topics related to
climate change and health of communities in the Arctic.
15:30 - 17:00
AUTHOR: J. Rand
University of Victoria
The health disparities between Aboriginal and nonAboriginal women in Canada are numerous. Inuit
women in particular face serious sexual and reproductive
health concerns. With the highest rates of Chlamydia
and Gonorrhea in Canada, high rates of teenage
and unintended pregnancies, as well as challenging
circumstances surrounding childbirth, there is a critical
need for research in this area. Inuit women experience
unique challenges to accessing sexual health care including
remote geographic location as well as cultural safety and
linguistic barriers. Narrowing our gaze to specifically focus
on Inuit women, their sexual and reproductive health, and
the unique social determinants they encounter will help
us to begin to untangle the complex web of determinants
contributing to sexual and reproductive health disparities.
A better understanding of the determinants within which
these disparities exist can also provide the needed guidance
for creating strategies, programs and policies that address
these challenges. This presentation will examine the social
determinants of Inuit women’s sexual and reproductive
health. It will describe the initial phases of a community
based research project taking place in Western Nunavut.
Included are qualitative research methods, which are most
appropriate for revealing the unique determinants that
influence Inuit women’s sexual and reproductive health.
This project endeavors to provide space for Inuit women to
contribute their unique perspective to the discourse on sexual
health promotion and STI & HIV prevention approaches.
This session will also provide information on how research
can build community capacity and provide much needed
information on program planning and development.
[email protected]
57
Learning To Mother Then and Now: A
Review of Maternal Socialization in
Arctic Villages of Northwest Alaska
Development of an Online Prenatal
Health Magazine for Expecting Parents
in Nunavut, Canada
AUTHOR: L. Schwarzburg
AUTHORS: A. Sheppard, P. Ford, A. Buchan,
G. Osborne
TUESDAY ORAL
University of Alaska-Fairbanks
Research regarding birthing practices among mostly Alaska
Native mothers of Northwest Alaska was conducted to
explore Maternal Identity Work and knowledge-seeking
behavior of mothers in this population. Alaska Native infant mortality rates have fallen over past
decades. Still, as neo-natal deaths improve, post-neonatal
death figures are on the rise. Maternal behaviors and
perceptions of care may be associated with such outcomes. The transport policy, providing air transport of expectant
mothers at 36-weeks’ gestation from outlying villages into
an urban hospital with specialized care in Anchorage—and
how it figures into the complex process of mothering—is
also included. Other studies concerning maternal decision-making
have found that these patients tend to rely more on their
own knowledge about diet, exercise, and behaviors to
adhere to while pregnant—and the opposite holds true
during hospital birth, across cultures. Women acquiesce
to biomedical staff and hospital protocol during birth,
regardless of their previous level of adherence to biomedical
advice. This study focuses on the comparative influence of
birth era, location, and transport situation among these
mostly Alaska Native mothers of the Arctic on maternal
socialization. Information gathered includes MIW among
these women as they have left their villages as pregnant
women, stayed in the Prematernal Homes until delivery,
and returned as mothers with the newest community
members. Discussion of Maternal Identity-Work (adjusted for this
population) and Social Network Analysis helps answer the
call for women-centered research based in rural, indigenous
communities. This approach to study MIW among this population of
mothers of Northwest Alaska will determine—based on
the mothers’ focal perspectives—what influences resonate
for these mothers in differing transport situations, and why. Results stand to enhance effective program design geared to
combat neonatal problems that could have ties to maternal
behavior in this Arctic community. [email protected]
58
15:30 - 17:00
The Hospital for Sick Children
There are significant child, youth, and maternal health
disparities among Canada’s Inuit populations compared to
their non-Inuit Canadian counterparts. With collaboration
from the Inuit Health Matters Advisory Board, health
priorities have been identified and a number of projects have
been designed to ameliorate these health deficiencies. With
these works, our objectives were to: promote self-esteem;
promote a sense of responsibility regarding the developing
baby; provide accurate prenatal health information in a
respectful and fun way; communicate about the negative
influences of tobacco, marijuana and alcohol use, and;
communicate about the positive impact of proper nutrition
for prenatal, child, and maternal health. One of our
projects was the creation of a printable online magazine.
The content contains: the stages of the developing fetus;
prenatal health tips, and; cultural perspectives, usually in
the form of a quote from an Inuit Elder. The work was
structured into three scenarios (using couples) to best
keep the reader’s interest, as well as to capture the unique
family structures and settings in the North. The content
was formatted into 40 weeks of information for women,
and 9 months of information for women’s partners.
Preliminary evaluations of the content will be presented
(conducted in June, 2012). Pregnancy is an enormous
responsibility that demands continuous efforts from the
expecting mother and the people around her. A mother’s
health choices and environment will directly affect the
health outcomes of the developing baby. We hope that this
resource will assist mothers through their prenatal journeys.
[email protected]
Women’s Perspective on Illness in Being
Screened for Cervical Cancer
AUTHORS: L. Hounsgaard1, S. Moeller2,
M. Augustussen2, H. Moeller3
University of Greenland 1, Institute of Nursing and Health
Sciences 2, Department of Health Sciences, Lakehead University 3
Women’s perspective on illness in being screened for
cervical cancer Background The rate of cervical cancer in
Greenland is among the highest in the world. Participation
in screening for cervical cancer in 2007 was less than
40%. Systematic screening identifies women with cellular
changes, which, left untreated, may lead to cervical cancer.
Of the 18,000 women in Greenland between 5 to 9 develop
[email protected]
Nutrition #3 - Food Security, Culture and Human
Health: Problems and Solutions 2
Schaible Auditorium
moderator: P. Loring
Food Security in Alaska: Challenges,
Opportunities, and Benefits of Local
Food Production and Distribution
AUTHORS: E. Hodges Snyder, S. Donovan
Alaska is considered the United States’ last frontier with
its vast valleys, rugged mountains, remote location, and
residents who often place a premium on independence,
resourcefulness, and self-reliance. However, this value of
self-reliance is not necessarily mirrored in Alaska’s sourcing
of food. It is estimated that Alaska’s agriculture currently
supplies no more than 5% of the state’s food needs, and the
majority of food is currently imported from the “Outside”.
The costs associated with food importation (e.g. fuel)
coupled with the inherent risks associated with “outsourced”
foods (e.g. susceptibility to food disruption events in
geographically distant locales), the unique challenges of
producing food in a remote circumpolar environment (e.g.
cold climate, short growing season, limited transportation
corridors, lack of substantial food storage facilities, climate
change, annual variations in subsistence resources, and
limited human capital), and the continued transition
away from traditional diets raises serious questions about
the sustainability, security, and healthfulness of Alaska’s
current food system. The present research project expands
the definition of food security to acknowledge the need to
understand Alaska’s food system and security now and into
the future, in the face of climate change, and with respect
to the subsistence lifestyle. Under the expanded definition
we characterize local food system activities (i.e. producing,
processing & packaging, retailing & distributing, and
consuming) and associated food security outcomes (i.e. food
availability, access to food, and food utilization). The food
security outcomes include consideration of such issues as
affordability, allocation, preference, nutritional value, social
value, and food safety. The resulting report characterizes
opportunities to develop capacity through activities such as
education and outreach and development of social capital.
TUESDAY ORAL
cervical cancer each year. Objectives To uncover the ways
that Greenlandic women understand cervical disease and
the connection between HPV and cervical cancer. Materials
and Methods The study will comprise three phases in which
2 groups of 5 women living i Nuuk will be interviewed. The
preferred language of one group is Greenlandic the other
Danish. Phase one will involve women who had a cone
operation five years ago, phase two women who had a cone
operation cero to five years ago, and phase three women
who have recently been diagnosed with cellular changes
requiring treatment. Focus group interviews are held in all
three phases starting in the spring and ending in the fall
of 2012. A semi-structured interview guide will be used to
highlight themes such as: what it means to have surgery
for cellular changes and its impact on daily living; seeking
knowledge about the risk of cellular changes, including
knowledge about HPV and vaccination; and knowledge
needed to choose screening. Data analysis will occur on
three levels: naive reading, structural analysis, and critical
interpretation using phenomenological-hermeneutictextual analysis. Results The analysis is expected to give
insight into women’s understanding of illness and to help
identify what information women should be offered to
broaden their knowledge about HPV and its connection
to cervical cancer. It is presumed that this understanding
is a prerequisite for increasing participation in screening.
15:30 - 17:00
[email protected]
An Inuit Perspective on Food Security in
the Alaska Arctic: Building a Framework
on How to Assess Change in the Arctic
AUTHORS: C. Behe, L. Ellsworth
Inuit Circumpolar Council - Alaska
The Inuit (Inupiat and Yup’ik and St. Lawrence Island
Yupik) have called Arctic Alaska home for at least the last
10,000 years. Their daily lives, culture, language, food and
overall survival have been influenced by the world around
them and in turn are an intricate part of that environment,
playing a strong and important role.
The Arctic environment is changing at unprecedented
rate, characterized by an increase in storm surges, surface
temperatures, changes to erosion rates, precipitation rates, as
well as changes in species distribution and sea ice coverage.
Climatic changes are opening new economic opportunities
in the development and expansion of tourism, oil/gas
extraction, shipping activity, and an increased potential for
commercial fishing. The multitudes of changes occurring
and increased uncertainly are posing threats to Inuit food
security.
Recent years have seen an increase effort in biodiversity
monitoring, climatologically and oceanography data
collection, and so on from the many stakeholders taking
interest in the Arctic. Yet, little is linking this research
together or to the human dimension. Meeting the
formidable challenges brought on by climate change
and increased industry activities requires an enhanced
understanding of the human dimension and its role in the
food web. The objective of this project is to investigate
59
how to evaluate food security in the Alaska Arctic from
an Inuit perspective, draw together multiple sources
of information and incorporate the human dimension
in order to increase understanding of the Arctic.
[email protected]
TUESDAY ORAL
Food Security in the Kenai Peninsula
of Alaska: What Role for Locally
Caught Seafood?
AUTHOR: P. Loring
In fall of 2011 we distributed a survey to 1500 randomly
selected homes on the Kenai Peninsula in Southcentral
Alaska to evaluate local food security with a specific focus
on access to locally caught seafood. Both Cook Inlet and
the KP watershed are well known and highly valued as
habitat for multiple valued fish species including halibut,
Pacific cod, and all five species of Pacific salmon, and many
residents both on the Peninsula and from the nearby Greater
Anchorage metro area are known to rely heavily on these
fisheries for personal use, subsistence, sport, and commercial
reasons. In this talk, we present some of the findings of
our survey, which revealed a surprisingly high prevalence
of food insecurity in the region. While participation in
local fisheries is shown as contributing to food security for
many households, others report having little or no access
to locally caught seafood. The details of these finding are
discussed as they relate to other socioeconomic and cultural
details. We conclude with a discussion of how these
findings relate to both environmental justice, and debates
over the management and sustainability of local fisheries.
[email protected]
Gathering Strength: Collaborative
Action and Evidence Based Strategies
Targeting the Issue of Food Insecurity in
Nunavut
AUTHORS: J. Wakegijig, G. Osborne
Government of Nunavut
The recent Inuit Health Survey ‘Qanuippitali’, has
confirmed. with greater statistical strength, what national
surveys have implied for years: that food insecurity rates
in Nunavut are considerably higher than in any other
Canadian jurisdiction, and that this issue affects most
people in Nunavut to a degree. Other studies continue
to corroborate these findings, including the Health
Behaviours in School-Aged Children survey. (released Feb
2012)
60
Many factors affect food insecurity in Nunavut, the most
15:30 - 17:00
significant is the rapid lifestyle change brought on by
settlement of Inuit to communities and a wage economy,
and the resulting shift in the food supply available
to Nunavummiut, from one consisting exclusively of
nutrient dense traditional foods to a diet with increasing
proportions of store-bought foods. These foods are often of
low nutritional value, of very high cost, and purchased with
very limited financial resources.
The issue of food insecurity is recognized in Nunavut
as a key determinant of health, and is a key emphasis of
government strategy documents. It is also seen as a quality
of life issue. There is currently considerable political focus
on poverty reduction in Nunavut, and food security has
emerged as a major focus of poverty reduction public
engagement.
Recent developments in this area include the establishment
by the Government of Nunavut of a Food Security
Coalition, which will include key partners such as Inuit
organizations and the private sector. In addition, new
funds have been secured for policy leadership on this issue,
for programs to support access to traditional foods, and for
community-based nutrition education programming.
Initiatives currently on the table for discussion and action
by food security partners in Nunavut include:
Initiatives currently on the table for discussion and action
by food security partners in Nunavut include:
• a focus on infants and children emphasizing infant
feeding practices, including breastfeeding, strengthening
parenting programming with an emphasis on food-related
skills, strengthening school breakfast and lunch programs
for children,
• a focus on traditional food access (including supporting
increased service of traditional foods in schools, daycares
and facilities, exploring improved support of young and
active hunters, supporting informal traditional food
networks, while working to ensure sustainability of the
traditional food supply
• a focus on community-based food security interventions,
including increased opportunities for skills development
around purchasing and preparing nutritious foods
[email protected]
Bridging Perspectives of Communities,
Research, Policy and Practice to Improve
the Food Security of Aboriginal People
in Canada
AUTHORS: M. Trifonopoulos1, T. Morrison2,
M. Guyot2, V. Smith2, B. McIntyre2, H. Cyr2
[email protected]@cdc.gov
Chronic Diseases #4 Body Weight, Metabolic Syndrome and Youth
Duckering Room 252
moderator: M. Mau
Diabetes and Metabolic Syndrome in
a Multiethnic Population in Northern
Norway
AUTHORS: A. R. Broderstad, M. Melhus
University of Tromsoe
Objectives Northern Norway consists of a multiethnic
population with Sami and non-Sami. We wanted to
evaluate the prevalence of metabolic syndrome and diabetes
type 2 in relation to gender, age and ethnicity. Material
and methods SAMINOR I that was carried through in
2003 – 2004 include 16 538 men and women aged 3679 years, a response rate of 61 %. More women than men
participated in the survey, 65.6 % versus 56.6 %. In total
15612 contributed with blood samples and gave consent to
their blood being used in medical research. Sami affiliation
was reported in 5141 people (35%). Results The study
demonstrated a high prevalence of overweight and obesity
in this population. Almost 80 % of the participants had BMI
above 24.9 kg/m2. Obesity rates were somewhat higher in
women than men, 21.5% versus 17.4% respectively. Obesity
and central obesity was most pronounced in Sami women.
The prevalence of self- reported diabetes type 2 was 4.3%
for men and 4.4% for women. Almost 19% of the women
and 12% of men had metabolic syndrome. Conclusions
The results from our analyses clearly demonstrated high
prevalence of overweight and obesity in this population.
Metabolic syndrome was pronounced especially among
women. This syndrome is a cluster of unfavourable health
factors that are all metabolically related cardiovascular risk
factors which also predict a high risk of developing diabetes.
WEDNESDAY ORAL
ISSUE Food insecurity is much higher among Aboriginal
households than non-Aboriginal households in Canada,
and is especially pronounced in northern and isolated
communities. Key contributing factors include poverty,
unemployment,
environmental
changes
affecting
traditional food practices, and the high cost and limited
availability of nutritious foods. Food insecurity has been
associated with negative health outcomes and is a marker
of compromised nutrition. In the Aboriginal context,
food security has unique considerations, including that
both traditional and market food systems must be taken
into account. Like other Social Determinants of Health;
food security is a complex issue and cannot be achieved
in isolation. COLLABORATIVE ACTION The First
Nations and Inuit Health Branch of Health Canada
continues to take action on the issue of the food security
of Aboriginal people by engaging key partners and sectors.
Examples include: • The Food Security Reference Group,
a key forum for information sharing and collective action
planning between the federal government (Health Canada,
Aboriginal Affairs and Northern Development Canada) and
National Aboriginal Organizations, with participation by
other governments, academia and sectors (e.g. agriculture).
• Federally funded community-based programming, such
as Nutrition North Canada and the Aboriginal Diabetes
Initiative, which promote nutrition and improved access
to healthy foods. • Knowledge development and exchange,
through innovative projects and ongoing research and
surveillance, to help build a stronger evidence base for
supporting decision-making and planning. • Informing
emerging policy opportunities such as the 2010 Federal,
Provincial and Territorial Framework for Action to
Promote Healthy Weights, which identifies increasing the
availability and accessibility of nutritious foods, especially
in northern, rural and remote communities, as a key
priority. VALUE AND IMPLICATIONS Collaborative
approaches help bridge perspectives of communities,
research, policy and practice. This has significant value
for informing the development of culturally appropriate
and relevant policy and programming at all levels.
10:30 - 12:00
TUESDAY ORAL
Health Canada 1, First Nations and Inuit Health Branch, Health
Canada 2
Wednesday, August 8, 2012
[email protected]
Diabetes is a Risk Factor for Tuberculosis
in the Inuit Population of Greenland
AUTHORS: S. Byberg1, B. Soborg2, M. Andersson2, P.
Bjerregaard3, M. E. Jørgensen1
Steno Diabetes Center 1, Statens Serum Institut 2, National Institute
of Public Health 3
Introduction: The association between diabetes
and tuberculosis (TB) has been known for centuries,
especially in populations where the concurrent prevalence
61
WEDNESDAY ORAL
of diabetes and latent TB is high. The prevalence of diabetes
among the Greenland Inuit is high (10%). Meanwhile the
TB prevalence remains high (175 /100,000) and studies
suggest ongoing TB transmission among the Greenland
Inuit. Objective The aim of this study was to explore
and quantify the effect of diabetes on TB development
among the Greenland Inuit. Methods: We conducted
a retrospective cohort study. Study participants were
randomly selected and comprised Greenland Inuit
from two previously conducted cross-sectional studies
(1999-2010), where diabetes status was assessed. TB is a
mandatory notifiable disease in Greenland, which enabled
the subsequent follow-up of participants in the Greenland
National TB register. Only TB cases recorded after diabetes
assessment were included in the present study. Log-linear
Poisson regression was utilized to estimate incidence rate
ratios for developing TB among participants with and
without diabetes, adjusted for sex, age and BMI. Likewise,
standard incidence ratios for the entire population of
Greenland were calculated. Results The study comprised
3012 Inuit participants, followed-up for a mean of 4.54
years. The adjusted TB incidence rate was found to be 11.9
times (95% CI 1.55;63.5, p=0.01) higher in participants
with diabetes compared to participants without diabetes.
The standard incidence rates likewise revealed a higher
risk of TB with co-existing diabetes (RR=2.17, 95% CI
0.34; 8.09), albeit lower. Conclusions: This study
suggests a marked increase in the risk of developing
TB with co-existing diabetes among the Greenland
Inuit when calculating both the incidence rate ratio and
the standard incidence rate ratio. The results suggest
appropriate diabetes control and prevention to be
potential preventive factors in TB prevention efforts.
[email protected]
Genetic Polymorphisms in Carnitine
Palmitoyltransferase 1A Gene Are
Associated with Variation in Body
Composition and Fasting Lipid Traits in
Yup’ik Eskimos
AUTHORS: D. Lemas1, H. Wiener2, D. O’Brien1, S.
Hopkins1, K. Stanhope3, P. Havel3, D. Allison2,
J. Fernandez2, H. Tiwari2, B. Boyer1
University of Alaska Fairbanks 1, University of Alabama at
Birmingham 2, University of California, Davis 3
62
Variants of carnitine palmitoyltransferase 1A (CPT1A),
a key hepatic lipid oxidation enzyme, may influence how
fatty acid oxidation contributes to obesity and metabolic
outcomes. CPT1A is regulated by diet, suggesting
interactions between gene variants and diet may influence
outcomes. The objective of this study was to test the
association of CPT1A variants with body composition and
lipids, mediated by consumption of polyunsaturated fatty
10:30 - 12:00
acids (PUFAs). Obesity phenotypes and fasting lipids were
measured in a cross-sectional sample of Yup’ik Eskimo
individuals (n=1141) from the Center of Alaska Native
Health Research (CANHR) study. Twenty-eight tagging
CPT1A SNPs were evaluated with outcomes of interest
in regression models accounting for family structure.
Several CPT1A polymorphisms were associated with
HDL-cholesterol and obesity phenotypes. The P479L
(rs80356779) variant was associated with all obesityrelated traits and fasting HDL-cholesterol. Interestingly,
the association of P479L with HDL-cholesterol was still
significant after correcting for either BMI, percent body
fat (PBF), or waist circumference (WC). Our findings
are consistent with the hypothesis that the L479 allele of
the CPT1A P479L variant confers a selective advantage
that is both cardio-protective (through increased HDLcholesterol) and associated with reduced adiposity.
[email protected]
Modifiable Risk Factors for
Non-Traumatic Lower Extremity
Amputations Among Alaska Native
People with Diabetes
AUTHORS: M. Narayanan, C. Schraer, E. Asay,
K. Koller
Alaska Native Tribal Consortium
Introduction: The incidence of lower extremity
amputations (LEA) among Alaska Native (AN) people
with diabetes (DM) are decreasing. Previous analyses
have shown that the rate of LEA is higher in those with
age <55 years and duration of DM greater than 10 years.
Because of the implications for LEA rates due to the shift
to lower age at diagnosis, we wanted to investigate the
effect of modifiable risk factors related to LEA. Methods:
The analysis was based on people in the AN Diabetes
Registry which is a clinical registry that has been in place
since 1985 and includes the date of DM diagnosis. Since
1994, as part of a national effort to provide quality care to
people with diabetes, clinical records on randomly selected
people in the registry have been reviewed. Univariate
methods and logistic regression were used to evaluate
the association of lipids, blood pressure, hemoglobin A1c
(HbA1c) and diabetes duration on LEA risk among AN
people with diabetes whose records were reviewed during
the years 1994-2009. Results: Records on 64 AN people
in the registry with LEA had been randomly selected for
review. Only HbA1c and duration were associated with
LEA. Mean HbA1c (%) was 8.7 compared to 7.4 among
AN people with and without LEA respectively. The odds
ratio for LEA was 1.40 for each one percentage increase
in HbA1c and 1.18 for each one year increase in duration
of DM. Of the 64 people with an LEA, 22 had HbA1c
before and after their first LEA. Mean HbA1c before
LEA was 9.3 and after LEA was 7.6. Conclusion: HbA1c
and duration of DM are correlated with LEA among AN
people with DM. Since the average survival after the first
LEA is about five years, a lower age at DM diagnosis
would have implications for life expectancies. These data
suggest that prevention or delay of DM and control of
HbA1c are important. Some of the possible reasons for the
reduction in HbA1c after an LEA could be the removal
of infected tissue, lifestyle changes or closer monitoring.
[email protected]
ANTHC Diabetes: A Model for Integrated
Diabetes Prevention and Care in Alaska
AUTHORS: D. Ramp, M. Narayanan,
A. Manderfeld, J. Thompson
[email protected]
Prevalence of Obesity and Associated
Metabolic Factors among Alaska Native
People: The Western Alaska Tribal
Collaboration for Health (WATCH) Study
AUTHORS: S. Hopkins1, C. Kaufmann1, J. Metzger2,
K. Koller3, A. Wolfe3, J. Umans4, E. Asay3,
B. Howard4, B. Boyer1
University of Alaska Fairbanks 1, University of Alaska
Anchorage 2, Alaska Native Tribal Health Consortium 3, MedStar
Health Research Institute 4
Background & Significance: Obesity is
associated with increased risks of cardiovascular disease, type
2 diabetes, and other chronic diseases. The risks of obesity and
obesity-related comorbidities vary among different ethnic
groups. Prevalence estimates for metabolic disorders are well
documented in European and certain ethnic populations, but
Alaska Native groups are understudied. The Western Alaska
Tribal Collaborative for Health (WATCH) Study combines
data from three western Alaska Native study cohorts. The
Center for Alaska Native Health Research, Alaska Education
and Research Towards Health, and Genetics of Coronary
Artery Disease in Alaska Natives together comprise a
cohort of more than 6000 Alaska Native people. Methods:
Analyses were based upon a sample of 3985 Yup’ik and
Inupiat participants, 2140 females and 1845 males, =18 yr
with a mean age of 39.9 yrs. Anthropometric measurements
were categorized using clinically relevant cut-points. The
prevalence of obesity and associated metabolic risk factors for
cardiovascular disease and type 2 diabetes were assessed by
gender according to NCEP/ATP III guidelines. Results: The
prevalence’s of overweight (BMI =25 to 88cm, while only
18.6% of men had a waist circumference >102cm. Discussion:
Our study population has a lower overall prevalence of
overweight and obesity as compared to 2007-2008 NHANES.
The prevalence of metabolic syndrome risk factors are lower,
indicating that this population may be relatively protected from
type 2 diabetes despite the overweight and obesity prevalence.
WEDNESDAY ORAL
The Alaska Native Tribal Health Consortium’s (ANTHC)
Diabetes Program is a clinical consultation group and one
of the twenty-four Special Diabetes Programs for Indians
(SDPI) grantees in Alaska. The purpose of this abstract is to
describe how the ANTHC Diabetes Program collaborates
with and supports our SDPI grantee partners. The three
distinct services provided by the ANTHC Diabetes
Program include clinical, epidemiological, and outreach
services. This creates a robust program for health promotion,
diabetes prevention, and expert diabetes management across
the Alaska Tribal Health System (ATHS). The diabetes
consultation group includes a medical provider, a pharmacist,
a dietitian, and a nurse case manager. The diabetes team
has several certified diabetes educators. The consultation
group serves patients at the Alaska Native Medical Center
and in field clinics throughout the year. The epidemiology
program collects data used to track patient outcomes. The
program also collaborates with ATHS diabetes programs
to evaluate diabetes quality of care indicators to improve
patient care. The outreach department is an avenue for
coordination, dissemination of ideas, and networking among
the ATHS diabetes program coordinators; offers trainings
and promotes programs related to clinical care, and diabetes
prevention; and provides community awareness of diabetes,
its prevention, and its optimal management. Examples are
a foot and nail care course, an advanced diabetes course
for health aides, and the Indian Health Services–Joslin
Vision Network (IHS-JVN) Teleophthalmology Program.
We are striving to maximize our outreach potential
using telemedicine and other technology. The diabetes
consultation group sees approximately five hundred patients
during annual field clinics with SDPI partners and another
five hundred patients on campus. The diabetes registry is
used to generate yearly prevalence and complications data.
Approximately a thousand people receive outreach services
through health fairs, presentations, and trainings yearly.
10:30 - 12:00
[email protected]
Research in the North #4 - Research Methods 1 Duckering Room 352
moderators: J. Johnston & S. Abonyi
Describing an Approach to Multi-Site,
International, Interdisciplinary and
Participatory Research: Methods Used
in Circumpolar Indigenous Pathways to
Adulthood (CIPA)
AUTHORS: J. Allen1, K. Hopper2, L. Wexler3,
M. Kral4, O. Ulturgasheva5, S. Rasmus1, K. Nystad6,
CIPA Team
63
WEDNESDAY ORAL
University of Alaska Fairbanks 1, Columbia University 2, University
of Massachusetts-Amherst 3, University of Illinois Urbana
Champaigne 4, Cambridge University 5, Sami University College 6
This IPY study funded by the National Science Foundation
in the U.S. explores stress and resilience in the lives of
circumpolar Indigenous youth. Colonial state interventions
have impacted the lives of circumpolar Indigenous peoples
over the last century, leading to many problems among youth
and their families. This presentation briefly reviews relevant
resilience theory and research, with particular attention to
arctic indigenous youth. Social determinants of health and
resilience in Indigenous circumpolar settings are described,
as are emergent Indigenous resilience frameworks. We next
describe the cross-site methodology of the Circumpolar
Indigenous Pathways to Adulthood (CIPA) study. In
addition to developmental emphasis and international
scope, the study is distinguished by a commitment to
principles of community based participatory research
(CBPR). The study is based in long-standing research
relationships in which Indigenous participants, local
institutions, and community co-researchers functioned
as collaborative partners with our interdisciplinary,
international team of university researchers. Over 100
youth were interviewed in communities in Siberia
(Eveny), Alaska (Yup’ik and Inupiat), Nunavut Canada
(Inuit), and northern Norway (Sami) using a life history
methodology to discover contemporary challenges
and the strategies youth use to overcome them. Using a
participatory approach, a local steering committee from
each community directed the study locally. Youth and adult
representatives from each of these site committees came
together for an international planning meeting at the study
inception in 2009, and are currently engaged in planning
for a cross-site interpretative conference directed toward
generating cross-site, comparative understandings. The
presentation will describe the theoretical underpinnings
and conceptual model driving the circumpolar research,
and will articulate how the project unfolded. CIPA uses a
combined modified grounded theory and narrative analysis
methodology. This presentation will describe how these
methods were applied. The other three presentations in
this symposium (Kral. Wexler, and Rasmus) will overview
key site-specific findings from CIPA on youth resilience.
[email protected]
Are You Rich?
AUTHORS: A. Dutheil1, J. Konek2, F. Tester1
University of British Columbia 1, Nanisiniq Arviat History Project 2
64
Historically, social science research has focused on Inuit
culture and cultural differences in relation to different
elements of day-to-day life. This gives rise to focusing
mainly on cultural differences. Utilizing culture as the
10:30 - 12:00
central concept to understand differences between Inuit
and Qablunaat (people from the south) risks forming an
essentialist analysis and as this paper will illustrate, ignores
the role of class differences. The relationship between the
majority of Inuit communities and Qablunaat researchers
is a class-based one. Inuit overwhelmingly occupy society’s
lower socio-economic class. In 2005 Statistics Canada
reported that the median income of Inuit populations was
approximately $9,000 less than the median income of the
general Canadian population being, $25,955.
To understand Inuit relations Mitchell employs an analysis
of class (1996). Mitchell adds that it may be possible to
employ a theoretical class perspective to all minority ethnocultural groups transitioning to the Western capitalist
economy. The comparable class experiences between Inuit
and other ethnically marginalized groups suggest that it
would be false to analyze Aboriginal and non-Aboriginal
relationships solely by ethno-cultural differences. By
examining instances of miscommunication between Inuit
participants and researchers as a result of class inequalities,
this paper aims to create a better understanding between
Inuit and Qablunaat researchers and challenges the ethnocultural analysis often applied to Aboriginal and nonAboriginal relations. The Nanisiniq Arviat History Project,
a two-year participatory action multi-media history project
initiated by Dr. Tester from the UBC School of Social work
and the Sivulinuut Elders Society from Arviat Nunavut
will be employed as the main case study to examine the
idea of class in participatory action research relationships.
[email protected]
“What Makes Life Good?”
Understanding and Developing a
Quality of Life Measure for Alaska Native
UAF Students Using a Strengths-Based &
Collaborative Approach
AUTHORS: D. K. Sharma1, E. Lopez2, D. Mekiana3,
A. Ctibor 4
Center for Alaska Native Research, UAF 1, Institute of Arctic
Biology, Center for Alaska Native Health Research 2, Rural Student
Services 3, UAF 4
Indigenous communities have experienced long-standing
health and educational disparities, and a general mistrust
towards academic research. At the University of Alaska
Fairbanks (UAF), Alaska Native (AN) college students
experience higher attrition rates than their non-native
peers due in part to the cultural and adjustment issues they
encounter while transitioning to college life. Quality of life
(QOL) is often used as an outcome measure to evaluate
health and social service programs. Yet, to our knowledge,
there are no QOL measures designed for use with AN
college students which are culturally reflective of their
[email protected]
A Collaborative Approach to
Community-Based Subsistence
Use Surveys
AUTHORS: S. Yoder, P. Anderson, J. McLaughlin
State of Alaska
Keywords: subsistence, Health Impact Assessment,
community surveys Background: Subsistence resources are
important sources of nutrition in rural Alaskan communities
and impacts to subsistence resources could have lasting
impacts on the health of a community. Health Impact
Assessment (HIA) would typically assess baseline food
consumption through detailed nutritional surveys, but this
process is complex and stressful for communities. To avoid
this problem, the Alaska Health Impact Assessment (HIA)
Program collaborated with the Alaska Department of Fish
and Game (ADF&G) to augment subsistence harvest
surveys with specific nutritional questions. Methods: Three
questions addressing the human consumption of subsistence
resources were added to the ADF&G subsistence resource
surveys. The HIA Program attended ADF&G training on
administering the subsistence surveys and accompanied
ADF&G on several scoping meetings in communities
to provide information on the HIA component of the
survey questions. ADHSS then accompanied ADF&G in
several communities to assist with administering surveys.
Outcomes: ADHSS accompanied ADF&G on survey
trips in ten communities from January to March 2012.
ADF&G provided data to the HIA program on results
that were relevant to the HIA program. Results from the
consumptions questions addressed how much subsistence
resources are consumed, if consumption of these resources
has changed in the recent past, why changes may have
occurred, and what types of food are being consumed in
replacement of traditional subsistence resources if there has
been a decrease in consumption. Information from this data
was summarized and will be integrated into several HIAs.
This state agency collaboration minimized the amount of
surveying in a community and was less time intensive and
less expensive than conducting a separate nutritional survey.
[email protected]
Are We Measuring the Right Things
in the Right Ways? Local Perspectives
on the Influence of Environment
on Community Health in Northern
Saskatchewan, Canada.
AUTHORS: S. Abonyi1, B. Anthony2, T. Lidguerre3,
S. Stylianidou, B. Jeffery4
University of Saskatchewan 1, Central European University 2, Fond
du Lac Denesuline First Nation 3, University of Regina 4
This presentation highlights a research project that is
testing and further developing indicators of community
health appropriate to northern Saskatchewan Indigenous
communities, focusing on results that elucidate local
perspectives of the environment as a determinant
of community health. Methods have included an
environmental scan of: 1) existing measures used
elsewhere, and 2) local level data availability. In addition
we conducted consultation with local stakeholders to
confirm relevancy of the environmental scan findings and
identify gaps. Finally, we conducted employed photovoice,
asking community members to capture images of and
discuss aspects of environment important to community
health. Results underscore the dominant role environment
plays in all aspects of healthy community –from culture
to infrastructure to food security. While some existing
measures are useful, local level data availability remains a
challenge. In addition, there is a need to develop measures
specific to the region, and to the unique role environment
plays across domains of healthy community. Implications
for the development of new community specific measures
of environment, as they relate to the health of northern
Saskatchewan Indigenous communities, are discussed.
WEDNESDAY ORAL
life experiences. Using a strengths-based perspective we
conducted the “What Makes Life Good?” Project with AN
UAF students and employed a mixed methods sequential
design while applying principles of Community-Based
Participatory Research. We conducted six focus groups with
AN students (N=26) to define the concepts and domains
that determine their QOL. We used a grounded theory
approach and creative strategies such as word association
exercises, and ‘stickies’ for students to write (and group into
domains) the specific things that “make their life good.”
Students, thus, became co-investigators as they guided
the qualitative analysis process from which emerged eight
QOL domains (Spirituality, Values, Culture & Traditions,
Basic Needs, Health, Learning, Relationships, Leisure). A
conceptual framework reveals how Culture & Traditions,
Values, and Spirituality form the foundation of their sense
of identity, as AN students balance their traditional ways
with western ideals for college success. These domains
and specific ‘stickie’ items informed a QOL measure that
will be pilot tested with UAF AN students during Spring
2012. The goal is that the QOL measure will be useful
when developing and evaluating support services intended
to enhance QOL and promote AN college achievement.
10:30 - 12:00
[email protected]
65
Traditional Healing #2 - Oral Abstracts
Duckering Room 347
moderatorS: T. Mala & M. Van Bibber
“I Believe in God and I Believe in Our
Own Powers and the Native Ways”:
Understanding the Significance of
Culture and Tradition to Alaska Native
Cancer Survivorship
AUTHORS: E. Lopez1, F. Williams2, D. Sharma1,
A. Ctibor1, C. DeCou1, V. Hewell1
WEDNESDAY ORAL
University of Alaska Fairbanks 1, Fairbanks Native Association 2
Alaska Native leaders, Elders, and others are voicing intense
concerns about the impact of cancer on their people. In
response, health and service providers are striving to develop
culturally responsive programs that will meet the cancer
survivorship needs of the individuals and communities they
serve. Yet we know little about how Alaska Native people
experience cancer, or the role cultural tradition plays in
cancer survivorship. The ‘Alaska Native Cancer Journey’ is
a community-academic partnership of the Fairbanks Native
Association (a non-profit organization that provides services
and research oversight to over 6000 Alaska Native residents)
and the University of Alaska Fairbanks’ Center for Alaska
Native Health Research (a NIH-funded center focused
on reducing Alaska Native health disparities). Within this
partnership, and with guidance from a community-wide
advisory group, we conducted an in-depth interview study with
Alaska Native cancer survivors to elucidate the factors that
facilitate or challenge cancer survivorship quality of life. In this
presentation we focus on thematic findings that illuminate how
interview participants discussed drawing from their Native
culture as they navigated their personal cancer journeys. From
qualitative data analysis emerged coping strategies deeply
steeped in cultural tradition that included: gaining strength
and meaning from childhood experiences; concern from and
for family and community; faith in medicine - both western
and traditional; a return to subsistence; healing with nature;
and sharing gifts with other survivors. As our population of
Alaska Native cancer survivors grows, so does the imperative
to ensure that surviving equals thriving. Understanding the
significance of culture to Alaska Native survivorship can
inform successful treatment and support programming.
[email protected]
Living Crystals of Tundra. Kamlanie
(Throat Singing) of Itelmen Shamans
AUTHORS: P. Bekkerov, V. Zinyakov,
N. Labkovskaya
66
The Union of Itelmen Families (UIF)
P.P. Bekkerov, Toyon, President of non-governmental
10:30 - 12:00
organization “The Union of Itelmen Clans.” V.M.
Zinyakov, Ph. D. (technics), system analyst on
informational technologies management “Living crystals
of tundra. Kamlanie (throat singing) of itelmen shamans”
(brief introduction) Dear ladies and gentlemen, friends and
colleagues! Today I want to present you our work under the
name “Living crystals of tundra”, devoted to the traditional
ways of men treatment, used by Itelmen people. By what
means and how the Itelmen shamans treated during the
centuries and how unique traditions and methods of
shamanism? Kamchatka tundra is reach in healing herbs,
berries and other helpful plants, which ancestors of Itelmen
and other people of the North eagerly used both as food
and for treatment purposes. But together with healing
plants everywhere in the North there was used another
practice known under the name “kamlanie”. This practice
of treatment was widely used by shamans and took the
leading position in the traditional medicine of Kamchatka
aborigines. The skill of shamans to treat people’s ailments
and diseases was with my people during centuries and
practically confirmed its efficiency in the conditions existed
at that time, namely: * remoteness from the principal
centers of culture of the other Asian and European people
and sporadic contacts with their representatives; small
number of communities (from 25 to 100 people, but
not more than 250); natural isolation from neighboring
communities caused by difficult movement in tundra in the
period of snow and frost absence; primordial ecology; good
food provision (all communities were located on the banks
of the rivers full with salmon); settled way of living in big
stationary dwellings. In those conditions the native Itelmen
people had good health and sustainable immunities to local
diseases and about those facts George Wilhelm Steller
wrote in his book “The Description of Kamchatka Land”.
Nevertheless, the vital necessity to have active way of living
in the conditions of low temperatures in winter, to hunt sea
animals in the open sea and beasts on the land on heavily
crossed territory, to fish in the icy water of mountainous
river, etc. regularly brought to catarrhal diseases, injuries and
wounds. That was why the art of shamans among Itelmens
was claimed. The art to treat people was transmitted in
shamans’ families from generation to generation, from
father to son, from mother to daughter, that is why our
people has women – shamans as well.
After loss of natural isolation of Kamchatka in the 17th
century the conditions of living and life of Itelmens
began to change fundamentally. The diseases which were
unknown before began to spread and shamans’ art was
forceless against them.
But how the shamans treated and how unique the traditions
and methods of shamanism?
The tradition of shamanism is not unique in the culture
of people of the Northen –Asian regions of Russia, it
was widely spread on the territory of the whole Siberia,
from Ural to Chukotka within not one thousand of years.
Tradition is not unique either from the point of view its
physical and physiological base.
The main means of shaman was tambourine and specific
art of throat singing - “kamlanie”. Skilled combination
of these two factors created in a sick person an acoustic
resonance on the cell level. The tambourine was tuned
by shaman on the resonance according to vibrations
of the cells of his own organs which performed in
that case as tuning –fork and standard. Kamlanie was
an additional factor for transition (extrapolation) of
standard information received from practically good cells
of shaman to the cells of the organs of a sick person.
[email protected]
AUTHORS: M. Van Bibber1, A. Haché2, D. Badry3,
A. Wight Felske4, S. Lockhart5
Arctic Institute for Community Based Research (Yukon) 1, Northern
Family Centre 2, School of Social Work, University of Calgary 3,
Mount Royal 4, Stanton Hospital 5
Abstract: Brightening Our Home Fires Project
Authors: M. Van Bibber, Dorothy Badry, Arlene Haché,
Sandra Lockhart, Amy Salmon, and Aileen Wright-Felske
Partner organizations: Centre for Northern Families,
Yellowknife, NWT University of Calgary University of
British Columbia Introduction: The project is a photo
voice study about northern women’s health and healing
in their own communities. This culturally responsive
intervention study aims to address links between trauma,
Fetal Alcohol Spectrum Disorder (FASD) prevention,
and social determinants of women’s health. Methods: This
study is employing the methodology of photo voice and
participatory research. Four Dene and Inuit communities
in urban and rural NWT are partners in this study along
with two universities. The project is based out of the
Centre for Northern Families (Yellowknife), a family
resource centre that operates an emergency shelter for
women who are struggling with addictions and trauma
related to colonization, ongoing oppression and violence.
Results: The results are two-fold in capacity building
and knowledge generation. Women will be trained in
photo voice methods, given cameras and supported in
the research process of documenting “what health and
healing looks like to me”. It is a hope that Brightening Our
Home Fires project will create a dialogue about women’s
wellness within northern communities and to “shine a
light” on the strengths and resources of northern women
and their communities. Discussion: The genesis of this
project came from discussions by members of the Canada
Northwest FASD Research Network during the 14th
Congress of Circumpolar Health in Yellowknife 2009.
Engaging northern women in a meaningful way can lay a
foundation for the development of a health and well-being
model for women that would promote healthy pregnancies.
Conclusions: This project offers a beginning place to conduct
research an opportunity for Dene and Inuit women to raise
their voices through image and textual representation.
[email protected]
Culturally Appropriate Cancer
Support - Healing Circle for Alaska
Native Cancer Survivors
AUTHORS: K. Morgan, E. Crittenden, S. Kelly
Introduction: When someone is diagnosed with
cancer, a long and difficult journey begins. Cancer is not
just the patient’s illness; it is the whole family’s illness.
Cancer support groups provide a way for cancer patients
and families to share with people who understand their
illness, people like them. Standard support group models,
however, do not consider the cultural ways and traditions
of Alaska Native people, who may not easily share their
stories and concerns with others. Method: Started in 2007,
the Cancer Healing Circle is supported by the Alaska
Native Medical Center (ANMC) Oncology Clinic. The
group is co-facilitated by a clinic social worker and a cancer
program staff member. The group is for cancer patients,
family members, and care givers. It meets once a week for
an hour and one-half in Anchorage. People who do not live
in the Anchorage area can join by telephone or through
Video Teleconferencing (VTC) arranged through their
village clinic or the hospital located in their respective
region. Results: The group dynamic changes from meeting
to meeting. Survivors range in age from 20 to 80+ years,
and include the newly diagnosed, family members, or care
givers who want to better understand their own feelings
and how best to support the person diagnosed with cancer.
Presentations are included as requested by survivors and
have included sessions on nutrition, available resources, arts
and crafts, music, wellness, spirituality and other topics as
suggested. Conclusion: While the group format may change,
there’s always an opportunity for each person attending to
share their story in the ways of their culture. The weekly
group meetings provide emotional, spiritual, and health
and wellness support. The longevity of the group is a result
of the culturally appropriate format, and commitment by
each survivor to provide mutual support to others like them.
WEDNESDAY ORAL
Brightening Our Home Fires. Photovoice
on Women’s Wellness
10:30 - 12:00
[email protected]
67
Health Services #4 - Health Policy
Duckering Room 342
moderator: G. Mulvad
WEDNESDAY ORAL
organization has had to adapt to the development of society.
The goal of health care reform is that:
The Circumpolar Health Systems Review
- Next Step
• Ensure that the health care system also in the future can
deliver a timely service
AUTHORS: K. Young1, S. Chatwood2, K. Anderson3
• Focusing on local health care service to citizens
• Improve patient access to care, regardless of residence
• Improve the quality of treatment and care
• Improve the recruitment of staff
• Utilizing the financial and personnel resources in the
best possible way
University of Toronto 1, Institute for Circumpolar Health Research 2,
Pescatore Systems International 3
The Circumpolar Health Systems Review is an Arctic
Council authorized project proposed by the Arctic Human
Health Expert Group and conducted by an international
team of health systems experts from different circumpolar
countries. The review covered profiles of the health
systems in the northern regions of Arctic States, with
special focus on financing, organization and delivery of
primary care, hospital services and public health. The
impact of geographic isolation, climatic conditions and
the proportion of indigenous people in the population is
highlighted. Several cross-cutting issues are identified.
The next step is to build on this review to study in depth
best practices and assess health system performance.
[email protected]
The Health Care Reform - The
Necessary Change
AUTHOR: A. B. Kjeldsen
Goverment of Greenland
The health care system is under pressure. The health
care system in Greenland has to serve 56,500 people in a
country with a coastline of 44,000 km with many small and
scattered settlements. The health care system has difficulty
in providing Healthcare personnel to outer areas and it
seems difficult to get resources to stretch to all services.
Meanwhile, citizens and politicians have a number of
expectations for the services that the health care system has
to provide - exctations that the health care system can not
always meet.
The health care system is required by law strive for equal
access to health care regardless of residence. This means
that citizens so far as is possible in principle should be
treated equally whether they live secluded in one of the 64
villages with a settlement consultation or in one of the 17
towns with a hospital or health care center.
68
10:30 - 12:00
Settlement Patterns, ways of living and the technological
options have changed a lot since the health care system
structure was founded in 1928 and it has therefore been
necessary to reform the health care system and the
This is done through the reorganization of the country
from 16 health districts to 5 regions, with fewer leaders
and more socalled warm hands ... that have direct patient
contact. The focus is on telecommunications technology
solutions in relation to communication, referral, diagnosis,
treatment and follow-up. Functions moving between
different personnel groups, up-qualification of staff
competencies and education is an essential element in
relation to overcoming recruitment problems and working
with common guidelines, and further a service catalog
which establishes the health care systems medical services
provided to citizens.The reform was implemented in 2010.
[email protected]
Policy Development As A Reference Tool
For Partnership Development
AUTHORS: G. Thomas1, J. Butler Walker2
Independent Consultant 1, Arctic Institute of Community-Based
Research 2
The Arctic Institute of Community-Based Research
(AICBR) conducted a review of the policy implications
for a community-based health research organization when
establishing collaborations with various institutions or
organizations. A scan of reports and existing resources
was conducted and synthesized into a Policy Framework
that brings together information, resource links, checklists
and templates that are relevant to northern communitybased organizations. Conducting community-based health
research in the North offers unique circumstances where
funds and partners from multiple sources and often across
considerable distances collaborate to address complex
issues that go beyond health specifically. Within this
context, policy development can serve as both a reference
tool for partnership development as well as a means for
clarifying common ground between community-based
health research organizations and other organizations. The
policy framework that was developed by AICBR provides
a critical analysis of the policy implications for entering
into partnership with another institution or organization.
The outcomes have been synthesized into a guide for
Northern community-based health research organizations
as they consider various partnership opportunities.
Results: - A sample policy framework to support policy
decision-making in community-based health research
organizations and strengthen partnership development.
- A critical analysis of the policy considerations
for Northern community-based health research
organizations as they assess partnership opportunities
that will support the health goals of the community.
[email protected]
Inuit Language Legislation and
Health Service Provision for
Pharmaceutical Drugs
AUTHOR: S. Romain
University of Toronto
Interviews with pharmacists and key informants examine
how pharmacies offer service to allophone Nunavummiut
patients and if the proposed enforcement of language
legislation in 2012 will result in changes in operational
practices. Strategies to encourage Inuit involvement and
education in pharmacy sciences are discussed as possible
solutions to mitigate the linguistic and cultural challenges.
[email protected]
Consultation and Remediation in
the North: Meeting International
Commitments to Safeguard Health
and Well-Being
AUTHORS: L. Banfield1, C. Jardine2
University of Oulu 1, University of Alberta 2
International and universal commitments exist for the
promotion and protection of health for all peoples and
the prevention of ill health. The principles espoused in
these documents have broad applicability to all activities
related to safeguarding health. One of the earliest global
commitments is the Declaration of Alma-Ata (1978),
which has been accepted by member countries of the World
Health Organization (WHO) as the key to achieving the
goal of “Health For All”. It provides five principles to guide
primary health care: equity, community participation,
health promotion, inter-sectoral collaboration and
appropriate technology. These principles are based on
the World Health Organization definition of health as “a
state of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity.” Toxic
and contaminated sites, such as former mining operations,
represent potential threats to all of these aspects of health
for the surrounding community and beyond. Strategies
for managing such threats usually involve an obligation to
engage the community through consultation. In reviewing
themes which emerged from a series of interviews exploring
the community consultation process for the remediation
of Giant Mine (a former gold mine in Yellowknife,
Northwest Territories, Canada) it became apparent that
the principles guiding primary health care may be directly
mapped to consultation in the North: (1) “equity” is the
capacity to fairly and meaningfully participate in the
consultation; (2) “community participation” is the right
to engage in the process through reciprocal dialogue; (3)
“health promotion” represents the need for both continued
information sharing and site monitoring; (4) “inter-sectoral
collaboration” signifies the importance of including all
stakeholders; and (5) “appropriate technology” is the need
to employ the best remediation actions relevant to the site
and the community. Within the context of remediation
for contaminated sites in the North, it is evident that
appropriate and meaningful consultation should be viewed
as a means of meeting international obligations to safeguard
health, and conducted according to these principles.
WEDNESDAY ORAL
In Nunavut, to ensure the preservation and revitalization
of Inuit languages, the Inuit Language Protection Act
and Official Languages Act were passed requiring that
all public and private sector essential services offer verbal
and written communication in Inuit languages (Inuktitut
and Inuinnaqtun) by 2012. While the legislation mandates
compliance, policy implementation for pharmaceutical
services is problematic. Not a single pharmacist or
individual with any official pharmaceutical training in
Nunavut is fluent in either of the Inuit languages. Currently,
pharmacies rely on counter staff to translate all verbal
and written instructions to patients including dosage,
side effects and contraindications. As pharmaceutical
monographs are not available in Inuit languages, patients
rely on translators to tell them what they determine is
relevant regarding their medications. Interviews with
pharmacists indicate that they are reluctant to formally
translate written documentation such as instructions,
warning labels and product monographs into Inuit
languages because they do not have the ability to verify
the authenticity of the translations and would be at risk of
liability should a misinterpreted translation result in patient
harm. The challenges of negotiating the joint requirements
of language legislation and patient liability have resulted
in pharmacies using verbal on-site translation as a tenuous
solution regardless of its many limitations.
10:30 - 12:00
[email protected]
69
“Sámi Dearvvašvuodasiida” - Bringing
Together Specialist Health Services for
Sami People Under One Roof
AUTHOR: G. K. Heatta
WEDNESDAY ORAL
Sámi National Centre for Mental Health
“Sámi dearvvašvuodasiida” – bringing together specialist
health services for Sami people under one roof Some
countries have chosen to organise health services for
indigenous people as a separate service distinct from the
ordinary health services. The Sami people are an indigenous
group residing in the Arctic part of Scandinavia. Norway
has chosen to integrate the treatment services provided
for the Sami population with the health services provided
for the population at large. The Sami National Centre for
Mental Health - SANKS and the Sami Specialist Medical
Centre, which has specialists in somatic medicine, have
been established to achieve the overall national objective
of providing equal health services to the Sami population
across geographical, linguistic and cultural boundaries.
Both institutions are part of Helse Finnmark health
trust, but are organised in two different clinics. Northern
Norway Regional Health Authority has earmarked NOK
40 million to bring together the Sami Specialist Medical
Centre and SANKS under one roof to create the “Sámi
dearvvašvuodasiida”. In january 2012, Helse Finnmark
health trust held a seminar at which relevant experts
and partners had an opportunity to discuss what services
the Sámi should offer and how it should be organised.
There was general agreement that collocating “Sami
dearvvašvuodasiida” specialist health services in one centre
will contribute to the provision of a more comprehensive
health service for the Sami population. Highly ambulant
interdisciplinary teams were emphasised as a good way of
reaching patients regardless of their geographical location.
This could also lead to better cooperation with partners in the
municipalities covered by the services. Organising services
in this way could prevent hospitalisations and contribute
to patients being discharged more quickly after hospital
stays. The hope is that the responsible regional health
authorities and health trusts will support the establishment.
[email protected]
70
10:30 - 12:00
Behavioral Health #4 - Domestic Violence
Gruening Room 206
moderators: L. Chamberlain & P. Moffitt
Intimate Partner Violence in the
Canadian Circumpolar North:
Perspectives from a Literature Review
and a Media Watch in the Northwest
Territories
AUTHORS: P. Moffitt1, H. Fikowski2, M. Mauricio2,
T. Mackenzie2
Aurora Research Institute/Aurora College 1, Aurora College 2
Although practitioners acknowledge that intimate partner
violence is a grave concern in the North, as in other
jurisdictions in Canada, there is a paucity of literature that
provides baseline data about intimate partner violence and
the local response to that violence. The purpose of this
presentation is to report on the synthesis of a Canadian
circumpolar literature review, media reports and other
government documents and policies of intimate partner
violence. This literature review provides background
and preliminary data to a 5 year SSHRC funded study
entitled “Rural and Northern Response to Intimate
Partner Violence” occurring in the Northwest Territories
and northern regions of the Prairie Provinces of Canada.
Results of the literature review and media surveillance
builds support for the necessity of the research, outlines the
public outcry for action in local media, and identifies current
published knowledge about intimate partner violence.
[email protected]
Friendships & Dating: Preventing
Interpersonal Violence for Adults with
Developmental Disabilities in Alaska
AUTHORS: J. Atkinson, K. Ward
Center for Human Development, University of Alaska Anchorage
Meaningful relationships with others are often elusive
to persons with developmental disabilities, but no less
desired for full inclusion and participation in society.
It is well documented that persons with disabilities are
victims of interpersonal violence at higher rates than
peers without disabilities. There is a paucity of empirical
research documenting the effectiveness of approaches for
teaching abuse protection skills to persons with intellectual
disabilities, and no known studies that examine teaching
the skills for healthy relationships, or combining these
skills with abuse protection. The Friendships & Dating
Program (FDP) is a primary prevention program focused
on addressing these concerns. The FDP is delivered over a
10-week period by community agency personnel in agency
and community settings. The FDP incorporates innovative
approaches that combine: 1) preventing and/or decreasing
interpersonal violence; 2) increasing social networks;
and 3) increasing social activities. The FDP has been
piloted with 126 adults with developmental disabilities
in Alaska. Qualitative feedback from participants report
FDI strategies resulted in improved social relationships.
Quantitative data was analyzed utilizing a piecewise linear
mixed model approach. The results showed an average
of 2.3 incidents of interpersonal violence at baseline,
which was significantly decreased by a mean of 1.4 (p
= .024) at the end of the intervention. Further, the data
showed an average social network size of 4.8 at baseline,
which was significantly increased by a mean of 2.5 (p =
.005) at the end of the intervention. We present findings
and offer recommendations for further development of
evidence-based interventions to prevent interpersonal
violence for individuals with developmental disabilities.
Inflicted Head Trauma Among Children
in Alaska: A Population-Based
Assessment
AUTHORS: J. Parrish1, Y. Goldsmith2, C. BaldwinJohnson3, M. Shanahan4, M. Volz3
University of North Carolina at Chapel Hill 1, Alaska Division of
Public Health 2, Alaska CARES Child Advocay Center 3, UNC-CH
Injury Prevention Research Center 4
Background: Serious physical abuse resulting
in a traumatic brain injury (TBI) has been implicated
as an underreported cause of infant mortality. Nearly
80% of all abusive head trauma (AHT) occurs among
children less than two years of age, with infants (age <1
year) experiencing an incidence nearly 8 times that of 2
year olds. The current national standard for AHT case
ascertainment is through applying a matrix algorithm to
Inpatient Hospital Discharge datasets, but this method
fails to capture less severe cases of AHT and fatal cases
that are never admitted, and also may be highly subject
to variation in hospital reporting. Methods: This study
describes the process and findings of linking multiple
sources of information and applying a standardized
definition to detect and determine the incidence of AHT
among children <3 years of age in Alaska during 2007-2008
years. Both this process and the national standard process
were compared to cases abstractions from Providence
Medical Center in Alaska. Providence likely captures
a majority of the States AHT cases, thus allowing us to
assess the validity of detection among these surveillance
activities. Results: During 2007-08, 27 cases of AHT
were identified through the multi-source linkage. Among
which, 74% (n=20) were identified by a single data source,
and 26% (n=7) by two or more. Nearly three quarters (71%,
n=20) of the cases were infants, and a majority (n=20) were
Alaska non-native. The case fatality ratio of AHT was
39%. All but one of the abstracted cases from Providence
was detected in the multi-source data linkage, which also
appeared to be much more sensitive than using hospital
discharge data alone. Conclusion: More cases were detected
using this new procedure; however for regular surveillance
activities it may be more feasible and timely to track ATH
in the Medicaid and/or Hospital Discharge datasets.
[email protected]
Maternal Screening for Domestic
Violnece in the Pediatric Setting:
Physicians’ Practices and Perspectives
AUTHOR: L. Chamberlain
State of Alaska
Objectives: Our primary objective was to examine
physicians’ maternal screening and intervention practices for
domestic violence during child health care visits. Methods/
Design: A 17-question survey about current screening and
intervention practices, training and perspectives on perceived
screening barriers was conducted by mail. Sample Studied: All
physicians practicing in Alaska who provided health care to
children, age 18 or younger. Preliminary Results: Surveys were
completed by 393 (73%) of the 540 eligible physicians, including
208 family practitioners and general practitioners; 70 pediatricians
and 48 emergency medicine physicians. Twenty-nine percent of
respondents estimated that 1 in 10 of their pediatric patients
had lived in a household with domestic violence. The majority
of physicians screened mothers often or always for domestic
violence when the mother had signs of injury (88%) or when they
suspected child abuse (95%). Routine screening was less frequent
at initial visits (16%), well-child visits (11%), urgent care visits
(31%), and when providing counseling/anticipatory guidance
to mothers of newborn infants (16%). Reported interventions
included providing information on victim services (87%)
and talking to the mother about safety concerns (81%). Most
physicians did not consider commonly perceived barriers such as
inadequate training and concerns about child witness reporting
requirements as major barriers to screening. Nearly all (98%)
respondents agreed that witnessing domestic violence in an
important health issue for children and 85% of physicians agreed
that they have a responsibility to screen mothers for domestic
violence when providing health care to children.
Conclusion: While physicians frequently screen mothers
for domestic violence when there is evidence of maternal
injury or suspected child abuse, opportunities to screen
at other child health care visits are being missed.
Commonly perceived barriers to screening may not be
predictive of physicians’maternal screening practices.
[email protected]
WEDNESDAY ORAL
[email protected]
10:30 - 12:00
71
The Healing Constellation: A Framework
for Understanding and Trauma in Alaska
Native Women
AUTHOR: W. Arundale
WEDNESDAY ORAL
The majority of Alaska Native women seeking treatment for
substance abuse or mental health issues have experienced some
form of trauma. Over the past 30 years, our understanding of
how trauma affects all aspects of a woman’s life has grown
significantly. Nevertheless, treatment for Alaska Native
women has sometimes been slow to reflect these growing
understandings. When treatment strategies tended to focus
on just a few elements, only some aspects of a woman’s distress
are considered, and treatment may be unnecessarily prolonged
or fail completely.
Broad based conceptual frameworks and approaches
to treatment are essential to avoiding these problems.
Just as constellations guided early travelers, the Healing
Constellation can provide such a conceptual framework and
guide effective treatment. The Constellation can prompt
practitioners, planners, and policy makers to examine and
recognize the wide variety of factors that may contribute to
a trauma survivor’s distress. The framework’s complexity
suggests a myriad of different relationships that may result
from the presence of these factors and invites their thoughtful
exploration. Complexity means there are a variety of entry
points for treatment, as well as places to start again if initial
efforts fail. It also offers some insurance against narrowly
focused “magic bullet” approaches.
The Healing Constellation, shaped like a double layered safety
net, has a theoretical and research-based rationale. Stars in the
constellation correspond to the major knots or nodes in the
net where many intersecting strands come together. The upper
level of the net includes nodes for treatment modalities. The
lower level of the net includes conceptual nodes that underpin
treatment through an understanding of behavior and biology.
This presentation will describe the Healing Constellation,
give examples of how it can assist us in thinking about
and treating trauma among Alaska Native women,
and suggest some implications for research and policy.
[email protected]
Healthy Native Families: Preventing
Violence at All Ages
AUTHORS: L. Avellaneda-Cruz, M. Kemberling
72
Although intimate partner violence and sexual violence
(IPV/SV) affect people of all demographic groups, there are
10:30 - 12:00
major disparities in IPV/SV among American Indian and
Alaska Native people. The 2009 Alaskan Behavioral Risk
Factor Surveillance System (BRFSS) found that 51.4% of
Alaska Native women and 29.2% of Alaska Native men
have experienced either intimate partner or sexual violence
at some time in their lives, compared to 34% of Alaskan
non-Native women and 17.4% of Alaskan non-Native men.
The 2009 BRFSS also found that 31% of Alaska Native
adults witnessed IPV when they were children, compared
to 17.2% of Alaskan non-Native adults. This presentation
brings together existing survey and service provider data on
the prevalence of IPV/SV affecting Alaska Native people
at every life stage, from the prenatal period to the elder
years, and discusses current gaps and limitations of the
data. This presentation also covers some of the potential
explanations for the disparity in violence and some of
the Alaskan-based intervention and prevention programs
that are working to curb the high rates of violence. The
presentation will cover recommendations for improving
our understanding of IPV/SV, and will provide resources
for screening and intervention in the health care setting.
[email protected]
Nutrition #4 - Changing Diets:
Nutrition and Assessment
Salisbury Theatre
moderator: G. Ferguson
Traditional Food Activity Workbook for
Alaska Native Youth
AUTHORS: K. Morgan, C. DeCourtney, S. Kelly
Introduction: A growing number of Alaska
Native youth are disproportionately overweight and
obese. Contributing factors include a high consumption
of sweetened drinks, low physical activity, high screen
time, and low fruit and vegetable consumption. The
development of a culturally- and age-appropriate
traditional food activity workbook for 3rd-4th graders will
help educate this age group about making healthy lifestyle
choices. Method: With a grant from the Prevent Cancer
Foundation, the ANTHC Cancer Program developed
an activity workbook that expanded upon the nutrition
information in the Traditional Food Guide for Alaska
Native Cancer Survivors published in 2008. The target
population was Alaska Native youth aged 8-10 years at
risk for obesity. Nutrition and physical activity information
was compiled into a 20 page workbook. Importance was
placed on the benefits of including both traditional and
store bought foods in a healthy diet. A pop quiz to test
nutrition knowledge was included at the beginning.
Each nutrition page had a problem solving game or an
interactive activity to reinforce the health topic messaging.
Resources were listed for youth to continue expanding
their nutrition knowledge, and a pledge to “live a healthy
lifestyle” card was included at the end for youth to mail in
for a healthy surprise. Results: The workbook was reviewed
by elementary school teachers, nutritionists, and wellness
providers. The workbook was finalized and printed in 2012
with distribution to schools across Alaska. Conclusion: The
development of the youth nutrition workbook provides a
culturally- and age-appropriate educational resource for
Alaska Native youth. Providing nutrition information in
an interactive and easy-to-understand format increases
the likelihood that this age group will use information
to help them make healthy food choices that incorporate
both their traditional as well as store bought foods.
[email protected]
Dietary Intake of Vitamin D in a
Northern Canadian Dene First Nation
Community
University of Manitoba, Faculty of Medicine 1, University of
Manitoba 2, Northlands Denesuline First Nation 3
Background: The wide spectrum of activity of vitamin D
has focused interest on its role in the health of Canada’s
aboriginal peoples, who bear a high burden of both
infectious and chronic disease. Cutaneous vitamin D
synthesis is limited at northern latitudes, and the transition
from nutrient-dense traditional to nutrient-poor market
foods has left many Canadian aboriginal populations
food insecure and nutritionally vulnerable. In this study
we describe the dietary vitamin D intake of a northern
Canadian aboriginal (Dene) population. Methods: Dietary
vitamin D intakes of 46 adult Dene men and women
were assessed using a food frequency questionnaire, and
compared across age, gender, season and body mass. The
adequacy of dietary vitamin D intake was assessed using
Dietary Reference Intakes. Results: Mean daily vitamin D
intake was 282.52 IU in winter and 294.20 IU in summer.
Forty percent and 47.8% of participants met the vitamin
D DRI levels in winter and summer respectively using
1997 values; this dropped to 11.1% and 13.0% in winter
and summer using 2010 DRI values. Supplements, milk
and local fish were positively associated with adequate
vitamin D intake. Milk and local fish were the major
dietary sources of vitamin D. Conclusions: Dietary intake
of vitamin D in the study population was low. Only two
food sources, fluid milk and fish, provided the majority of
dietary vitamin D. Addressing hypovitaminosis D in this
population requires action aimed at the overt and “hidden”
hunger present in northern aboriginal populations.
[email protected]
Younger Inuit Adults and Preschoolers
Have Lower Traditional Food and
Vitamin D intake which reflects in a
Lower Vitamin D Status Compared to
Older Adults
AUTHORS: J. Hayek, G. Egeland, H. Weiler
McGill University
Background: Evidence suggests that Aboriginal
people have low intakes of vitamin D and are shifting away
from the consumption of traditional foods (TF). Further
risk factors including higher body mass index, ethnicity,
and latitude status predispose Aboriginal populations to
low vitamin D status.
Objectives: (i) determine the prevalence of low
vitamin D status; (ii) identify contributors to vitamin D
intake; and (iii) identify predictors of an optimal vitamin D
status in Inuit adults and preschoolers.
Methods: Data were obtained from the 2007-2008
Inuit Health Survey (2595 adults ≥ 18 y) and from the Child
Inuit Health Survey, (388 preschoolers) who were randomly
selected. Plasma or serum 25-hydroxy vitamin D (25(OH)
D) was measured by Chemiluminesent technology. Dietary
intake was assessed through a 24-hour dietary recall and
a food frequency questionnaire. Anthropometry was
measured using standardized procedures. ANOVA, chisquare, t-tests and logistic regression were used to identify
relationships between correlates and 25(OH)D.
WEDNESDAY ORAL
AUTHORS: P. Orr1, J. Slater2, L. Larcombe2,
C. Green2, C. Slivinski2, M. Singer2,
L. Denechezhe3, C. Whaley2, P. Nickerson2
10:30 - 12:00
Results: Prevalence of 25(OH)D < 50 nmol/L at
the end of summer was 52.2% among preschoolers
and 42.2% among adults. TF contribution to vitamin D
intake was lowest among preschoolers (16%) and highest
among > 51 y adults (65-75%). Even though older adults
consumed more TF than the younger groups, more than
73% of their energy intake was derived from MF. Using
logistic regression (25(OH)D > 50 nmol/L), the strongest
predictors of an optimal vitamin D status among Inuit
adults were older age and healthy waist circumference,
while for preschoolers, they were vitamin D intake above
the adequate intake and younger age.
Conclusions: This is the first assessment of
vitamin D status of the Inuit population in Canada.
Given low consumption of milk, the high vitamin
D content of TF, and its cultural acceptability,
consumption of TF should be promoted among
Inuit to improve vitamin D intakes and status.
[email protected]
73
Greater Consumption of
Polyunsaturated Fatty Acids are Related
to Increased Lean Mass and Decreased
Visceral Adiposity in a Multi-Ethnic
Sample of Children
AUTHORS: M. Cardel, D. Lemas, J. Fernandez
WEDNESDAY ORAL
University of Alabama at Birmingham
Background: Chronic, high intakes of poly unsaturated fatty
acids (PUFAs), such as those observed in adult Alaska Natives,
have been shown to impact waist and hip circumferences
and adiposity. However, the extent to which modest intake
of PUFAs influences pediatric body composition remains
unknown. Objective: We examined the relationship of PUFA
intakes with adiposity variables and lean mass (LM) in a crosssectional cohort of children. Design: Participants included
315 peripubertal African American (n=107), Hispanic
American (n=86), and European American (n=122) children
ages 7-12. Body composition, abdominal fat distribution,
and dietary intakes were assessed by dual energy x-ray
absorptiometry (DXA), Computed Tomography (CT) scans,
and two 24-hour recalls, respectively. Multivariate linear
regression analyses were performed to examine independent
associations of total PUFA, n-3 PUFAs, n-6 PUFAs, and
the ratio of PUFA: Saturated fatty acids (SFA) dietary
consumption with child body composition. All analyses were
adjusted for total energy intake, pubertal stage, sex, and race/
ethnicity. Results: Greater total PUFA intakes were associated
with increased LM (p=0.0070) and less intra abdominal
adipose tissue (IAAT) (p=0.0365). Increased consumption
of n-3 PUFAs and n-6 PUFAs were positively associated
with LM (p=0.0061 and p=0.0286, respectively) and n-6
intake was marginally related to lower IAAT (p=0.0513). A
higher PUFA: SFA ratio was associated with increased LM
and decreased IAAT and total abdominal adipose tissue
(TAAT) (p<0.05). Dietary intakes were not related to BMI
or percent body fat. Conclusion: Dietary consumption of
PUFAs was positively associated with lean mass and inversely
associated with visceral adiposity in a multi-ethnic sample
of children. These results suggest that replacing saturated
fats intake with modest consumption of PUFAs may have
anti-obesity effects that reduce the risk of childhood obesity.
[email protected]
Quantifying Dietary Intake Among
Yup’ik Eskimos using Factor Analysis of
Food Frequency Questionnaires
AUTHORS: T. Ryman1, M. Austin1, J. Philip2,
S. Hopkins2, K. Thummel1, B. Boyer2
University of Washington 1, University of Alaska Fairbanks, CANHR 2
74
A food frequency questionnaire (FFQ) developed by
10:30 - 12:00
the Center for Alaska Native Research for studies in
the Yukon-Kuskokwim Delta region of Alaska includes
important subsistence foods such as moose, seal, waterfowl
and salmon, many of which are eaten seasonally. Based on
this questionnaire, we sought to quantify dietary intake
using factor analysis, a statistical approach that uses many
correlated dietary components to derive a smaller number
of “factors” that explain a substantial amount of the variation
in diet. Using 8 summary food frequency questions (beef
or pork; chicken or turkey; vegetables; wild bird; wild
caught land meat; fruit; wild caught ocean meat; fish),
we performed a preliminary exploratory factor analysis
of data from 373 study participants living in 11 villages.
Two factors were identified, one characterized by store
bought food (beef or pork, chicken or turkey, vegetables)
and another characterized by traditional foods (wild bird,
wild caught land and ocean meat, fruits). These two factors
provided a statistically significant fit to the food frequency
data. The analysis included participants from 7 coastal
and 4 inland villages, and the factors differed somewhat
by geographic location, with fish loading on the traditional
food factor for the coastal villages only. Ongoing analyses
will refine these factors using individual food items from
15 different food categories and incorporating seasonality
of food consumption.
Factor scores will then be related to traditional and
western lifestyle, to dietary biomarkers currently under
development, and, as part of the work of the NorthwestAlaska Pharmacogenomics Research Network, will be
evaluated for their utility in characterizing interactions
between genetic variations in drug metabolizing enzymes
and environmental factors among Yup’ik Eskimos.
[email protected]
Infectious Diseases #4 - Helicobacter pylori
McGown
moderator: K. Goodman
H. Pylori-Associated Disease Burden
in a Northern Canadian Community:
Comparing Medical Records and
Community-Based Screening
AUTHORS: H. Chang1, A. Wynne1, R. Munday2,
K. Goodman1
University of Alberta 1, Aklavik Health Centre 2
Little is known about how well health care utilization
for H.pylori-related symptoms reflects the actual disease
burden in a population. This analysis aimed to estimate the
burden of H.pylori-related disease captured by the health
care system, and compare this to frequencies observed
in population screening conducted for a communitybased H.pylori project, carried out in Aklavik, Northwest
Primary
care
centre
medical
chart
review
may provide reasonable estimates of H.pylori
prevalence in the local population, but it appears to
underestimate the frequency of epigastric symptoms.
[email protected]
Prevalence of Helicobacter Pylori and
Atrophic Gastritis in the Population of
the Industrial Center of Eastern Siberia
AUTHORS: V. Tsukanov, E. Kasparov,
O. Amelchugova, A. Vasyutin, O. Tretyakova
SRI MPN SD RAMS
Introduction. At the present time the continuing
debate about the relationship dyspepsia with Helicobacter
Pylori and gastritis, which affects on the development
of algorithms for the management of patients [1]. Aim.
To study prevalence of uninvestigated dyspepsia and
atrophic gastritis in the urban population of Siberia
over 45 years old. Methods. For the study we selected
801 persons (387 males, 414 females) aged over 45 years
old living in the Krasnoyarsk city by the method of
random sampling. To all patients were performed clinical
examination with the filling of standard questionnaire for
the study of uninvestigated dyspepsia and determination
content of pepsinogen-1, pepsinogen-2 and antibodies
to Helicobacter pylori in blood serum by immunoassay
method using test kits “GastroPanel” (producer “Biohit”,
Finland). Marker for severe atrophy of gastric body mucosa
we considered the level of pepsinogen-1 less than 25 µg/L
and the ratio pepsinogen-1/pepsinogen-2 less than 3.
Results. The prevalence of uninvestigated dyspepsia in the
surveyed population was 24.5% (males - 24.3%, females
- 24.7%). The prevalence of H. pylori infection among
surveyed persons was 90.0% (males - 89.7%, females
- 90.3%). H. pylori was determined in 95.9% people
with dyspepsia and in 88.1% persons without dyspepsia
(OR=3.01, CI 1.45-6.25) in 97.1% patients with gastritis
and in 89.4% individuals without gastritis (OR=3.93, CI
1.00-16.36). The prevalence of severe gastric body atrophic
gastritis in surveyed population was 10.9% (males - 11.9%,
females - 9.9%). Risk factor for severe atrophic gastritis
were age older than 55 years (OR=1.7, CI 1.07-2.76)
and information about gastric cancer in blood relatives
(OR=3.45, CI 1.51-7.89). Conclusion. The epidemiological
situation in the surveyed population is unfavorable: the
prevalence of uninvestigated dyspepsia, atrophic gastritis
and Helicobacter Pylori is high in the urban population
of Siberia. 1. Ford A.C., Thabane M., Collins S.M. P
[email protected]
Hygienic Behaviors and Prevalence of
Helicobacter Pylori Infection in Aklavik,
Northwest Territories, Canada
AUTHORS: K. Fagan-Garcia, H. Chang,
K. Goodman, CANHelp Working Group
WEDNESDAY ORAL
Territories. During 2008-2010, project participants were
screened for H.pylori by urea breath test and self reported
symptoms were collected via interviewer-administered
questionnaire. A clinical chart review abstracted
information about previous H.pylori tests and history of
epigastric symptoms during the 5 years preceding project
participation. Of 290 participants (age range 0-79, 54%
female, 88% aboriginal), 58% were positive for H.pylori by
the project-administered UBT. Chart review documented
56 participants having been tested for H.pylori at the
health centre, with 61% positive, 3% (95% CI: -12% to
16%) higher than by project screening. In the projectadministered clinical survey, 47 respondents reported
having been tested previously for H.pylori, with 66%
reporting a positive result, 8% (95% CI: -7% to 22%) higher
than by project-administered screening. 53% of participants
reported having epigastric symptoms, which was 28% (95%
CI: 21% to 36%) higher than the 24% of participants who
had sought health care for epigastric symptoms. Only 33%
of participants who reported any epigastric symptoms had
sought health care for these symptoms. 43% of those who
were H.pylori positive by project-administered screening
had no self-reported symptoms. The observed H.pylori
prevalence was similar by population screening, chart
review, and self report. Many H.pylori-infected individuals
are asymptomatic, and many symptomatic people with
H.pylori infection do not seek care for their symptoms.
10:30 - 12:00
University of Alberta
The Aklavik Hpylori (Hp) Project is a community-driven
research project that aims to reduce health risks from
Hp infection in Arctic Canada. This analysis describes
associations of hygienic behaviors with Hp prevalence
in project participants. During 2008-2010, participants
were tested for Hp by urea breath test or examination of
gastric biopsies. Each participant was interviewed using a
structured questionnaire to ascertain hygienic behaviors.
For household factors, a representative from each
household was interviewed. We used logistic regression
with random effects for household clustering to estimate
odds ratios (OR) and 95% confidence intervals (CI) for
associations of hygienic behaviors with individual Hp
status, adjusting for age, sex, ethnicity and household risk
factors identified in prior analysis. Among all participants,
Hp prevalence was 62% (221/355). Estimated from the
258 participants with complete data (Hp prevalence=
65%), adjusted ORs (CI) follow for behavior frequency
categories in ascending order. Bathing =few times/week,
nearly every day, and every day: 1.0, 1.5 (0.57-3.7), 1.3
(0.63-2.5); brushing teeth =few times/week, 1-2 times/
day, after every meal: 1.0, 1.0 (0.45-2.2), 0.60 (0.20-1.8);
75
using mouthwash =few times/week, =once/day: 1.0, 0.40
(0.17-0.93); sharing cups never, infrequently, every day
1.0, 0.57 (0.25-1.3), 2.2 (0.41-12); sharing dishes never,
infrequently, =a few times/month: 1.0, 0.67 (0.27-1.7), 0.93
(0.34-2.5); food not pre-chewed, was pre-chewed for you
as a baby: 1.0, 1.6 (0.63-4.2); not sharing smokes, sharing
smokes: 1.0, 1.3 (0.46-3.7). While not fully consistent,
this analysis shows an overall pattern of frequent sharing
behaviors associated with increased odds of Hp infection,
and frequent oral hygiene behaviors with decreased odds.
The dose-response did not show a clear trend, however, and
the wide confidence intervals demonstrate that additional
data is needed to more accurately estimate effects of
hygienic behaviors on Hp prevalence in Arctic populations.
[email protected]
WEDNESDAY ORAL
Adherence and Barriers to H. pylori
Treatment in Arctic Canada: Preliminary
Findings from a Randomized Trial
76
AUTHORS: M. Lefebvre, H. Chang, A. Morse, S.V.
van Zanten, K. Goodman
Helicobacter pylori infection is an emerging health concern
to some northern Canadian Aboriginal communities and
their clinicians. Clinicians in the north perceive H.pylori
infection to be a major clinical problem because they
find H.pylori infection in many patients evaluated for
common stomach complaints, leading to frequent demand
for treatment, which often fails. Moreover, public health
authorities identified the need for information to develop
locally appropriate H.pylori control strategies. We aim to
describe adherence and identify barriers to completing
treatment among H.pylori-positive participants in a
community-based project inspired by local concerns
about H.pylori infection risks. In 2008, 110 H.pyloripositive participants of the Aklavik H.pylori project
were randomized to standard-of-care or sequential
treatment. We collected adherence data by intervieweradministered questionnaire and classified adherence based
on self-report. We estimated adherence frequencies as the
proportion of participants who reported taking 100% of
doses; to compare the proportion with perfect adherence
in subgroups (age, sex, regimen) we report proportion
differences. Of the 86 participants who completed the
questionnaire, 66% reported 100% adherence. We observed
more frequent perfect adherence in males (74%) v females
(58%), participants =40 years (80%) v <40 (51%), and for
standard therapy (68%) v sequential (64%). Proportion
differences (95% confidence interval) were 16% (-3.4,
36) for male v female, 29% (10, 48) for 40+ v <40, and
4% (-16, 24) for standard v sequential therapy. Of the 29
participants who reported <100% adherence, the following
barriers to treatment were reported: forgetfulness (38%),
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nausea (17%), not wanting to take treatment (14%), alcohol
use (10%), stomach pain (10%), difficulty swallowing
pills (10%), no reason (4%), or bad taste of the pills
(3%). In this trial, adults over 40 were more adherent.
Our ongoing research in additional northern Canadian
communities will add data needed for more accurate
conclusions regarding other predictors of adherence.
[email protected]
Is There a Need for a Multicenter Arctic
Study of Helicobacter Pylori Infection
and Gastric Cancer?
AUTHORS: K. Miernyk1, J. Keck2, K. Rudolph2,
D. Bruden2, J. Morris2, L. Bulkow2, F. Sacco1,
B. McMahon1, A. Parkinson2, T. Hennessy2,
M. Bruce2
Alaska Native Tribal Health Consortium 1, Arctic Investigations
Program, Centers for Diease Control
The indigenous peoples of Alaska, Canada, Greenland, and
Sweden have high gastric cancer (GC) rates. Helicobacter
pylori (Hp) is a risk factor for GC. Most people infected
with Hp do not develop GC, so we need a marker to predict
who is at risk. Here we describe three studies that provide
preliminary GC risk factor data. A retrospective case/
control study of 94 Alaska Native (AN) persons with noncardia GC and 264 AN persons without GC showed that
Hp antibodies (odds ratio [OR] 3.92, p<0.001) and low
pepsinogen I (OR 6.04, p=0.04) were risk factors for GC.
However, the control group’s high Hp seropositivity (82%)
and the small percentage of cases with low pepsinogen I
(4.1%) gave these tests low sensitivity and specificity for
identifying GC risk. Genotyping Hp from 286 AN and nonNative persons found that 85% of isolates have the CagA
virulence protein gene and 45% have the more virulent VacA
protein (s1m1) gene. Infection with vacA s1m1 Hp was
associated with increased risk of peptic ulcer disease (PUD)
compared to Hp with all other vacA genotypes (27% vs.
12%, p=0.003). We have begun recruiting AN persons with
newly diagnosed GC and PUD. We will investigate: 1) the
presence of genes in the cag pathogenicity island and the
type of vacA gene in the Hp organisms, 2) host interleukin
genes that are related to the inflammatory response to
Hp colonization, and 3) environmental factors that might
contribute to GC or PUD. Current studies have not
identified a useful predictive marker for GC risk. Putative
bacterial virulence markers have been identified in AN
peoples. As there are few cases of GC per year in any single
circumpolar country, we propose developing a multicenter
Arctic study focusing on GC risk factors identified
in the study from which we are currently recruiting.
[email protected]
Problems with the Epidemiologic
Transition Model: Structural Inequality,
H. Pylori Bacteria, and Stomach Diseases
in Aklavik, NWT
AUTHOR: S. Carraher
CANHelp Working Group
[email protected]
Healthy Families #4 - Women’s Healthcare
Through the Continuum
Room 301
moderator: N. Murphy
Factors Influencing Red Blood Cell
Folate levels of Canadian Inuit Women
of Child Bearing Years: Results from the
2007-2008 Inuit Health Survey
AUTHORS: K. Duncan1, L. Arbour,1 G. Egeland2
UBC 1, CINE 2
Background: The benefits of folic acid
supplementation and fortification are well known for the
prevention of neural tube defects and other birth defects
and it is emerging that supplementation may play a role
in improving other birth outcomes such as prematurity
and low birth weight. For the Inuit, where dietary intake
of folate rich foods is low, understanding the effect of
fortification for women of child bearing years is necessary.
We evaluated whether red blood cell folate (RBCF) levels
of Inuit women of child bearing years are sufficient to reach
the target thought to improve birth outcomes. We also
investigated whether food security, smoking status, and
body mass index (BMI) influenced those results. Methods:
The Inuit Health Survey of 2007-2008 included 249 nonpregnant Inuit women age 19-39 years. RBCF levels were
assessed and compared across several variables, including
region of residence, cigarette use, food security, and BMI.
RBCF levels were collapsed into quartiles to compare
characteristics of those in the highest with those in the
lowest ranges. Statistical significance was assessed. Results:
Food insecurity was reported by 67% of participants and
86% were current smokers. Six percent used supplementary
vitamins (excluded for RBCF analysis). Although the
average mean RBCF levels reached target levels (>906
nmol/L), 44% had a RBCF lower than the target. Those in
the lowest quartile for RBCF were difficult to distinguish
from those in the highest quartiles, although there was a
trend toward more food insecurity, increased cigarette use,
and lower BMI and waist circumference. Conclusions:
This study offered the opportunity to understand RBCF
levels in the context of cigarette smoking, food security,
and BMI. Our results suggest that current levels of folic
acid fortification alone are insufficient to overcome effects
of food insecurity and cigarette smoking which adversely
affect RBCF levels. This information should be included in
health promotion programs to improve pregnancy outcomes.
WEDNESDAY ORAL
The Epidemiologic Transition Model (ETM), introduced
by Omran in 1971, provides an eloquent theory linking
shifting economies in societies to changing population
patterns in life expectancy and all-cause mortality.
This model has been used in public health, explicitly or
implicitly, as a theoretical platform for advocating certain
health policies in developing nations and among the
disadvantaged segments of developed nations. The ETM
has become part of the internal narrative by which many
health researchers describe increasing rates of chronic
diseases in northern Aboriginal populations as seemingly
inevitable. While some have argued that the model does
not adequately reflect the lived experiences of northern
Aboriginal populations, still no major alternate models
have been proposed. Rather, many attempt to augment the
ETM by adding new subcategories or by discussing how
northern Aboriginal populations adhere to and diverge
from the model’s predictions. This paper first presents
a critique of transition model narratives used to describe
decreasing Helicobacter pylori prevalence in wealthy
nations, and the bacterium’s high prevalence in northern
Aboriginal populations. H. pylori infection is chosen as
an example because its association with stomach cancer
challenges the tendency to view infectious and chronic
diseases as separate phenomena; and because H. pylori
is strongly associated with structural social inequities.
Problems with the ETM are highlighted by drawing from
epidemiological analysis of H. pylori bacterial infection and
ethnographic analysis of the social-economic infrastructure
in one Arctic community as a case study. Drawing from
post-colonial theory, social epidemiology, and 9 months
of field research in Aklavik, NWT, an alternate model
is presented for understanding the structural inequities
which promote high prevalence of H. pylori infection.
10:30 - 12:00
[email protected]
77
Prenatal Alcohol Exposure among
Alaska Native / American Indian Infants
AUTHORS: B. Khan, R. Robinson, J. Smith,
D. Dillard
WEDNESDAY ORAL
Southcentral Foundation
BACKGROUND: Alcohol use among Alaska Native /
American Indian (AN/AI) pregnant women is a major
public health concern for the AN/AI community. Though
previous rates of Fetal Alcohol Syndrome among AN/AI
infants have been among the highest in the state and nation,
more recent reports have shown a decline in these rates.
Nevertheless, AN/AI infants are still disproportionately
impacted by the effects of Prenatal Alcohol Exposure.
METHODS: AN/AI pregnant women in their 3rd
trimester completed a questionnaire on demographic
data and the amount and frequency of their alcohol
consumption prior to conception and during pregnancy.
Differences across demographics and trimesters were tested
with the chi-square, Fisher’s exact, or McNemar’s test as
appropriate. RESULTS: Of the 125 participants, 43%
reported drinking alcoholic beverages during pregnancy
(1st, 2nd, and/or 3rd trimester), with most (35%) reporting
alcohol use in the 1st trimester only. Average daily absolute
alcohol consumption decreased over the duration of
reporting period from 0.371 fl. oz. during the month prior
to pregnancy to 0.055, 0.004, and 0.001 fl. oz. for the 1st,
2nd, and 3rd trimesters, respectively. Twenty percent (n=25)
of participants reported at least one occurrence of binge
drinking during the 1st or 2nd trimester, with an additional
18 percent (n=29) reporting binge drinking in the month
prior to pregnancy. Women who reported binge drinking
during the month before pregnancy were significantly more
likely to report binge drinking during their 1st trimester
(p<.0001) and 2nd trimester (p<.0001). During pregnancy,
a higher percentage of women in the youngest age category
reporting binge drinking compared to the older categories,
although this difference was not significant (p=0.0544).
CONCLUSION: In this study we found more than 1/3
of women reported pre-conception binge drinking, and we
found rates of pre-conception binge drinking to be strongly
associated with binge drinking during the first trimester.
[email protected]
78
10:30 - 12:00
pregnancy is related to an increased risk of diabetes and
congenital abnormalities. Given the trend of increasing
overweight or obesity, the Institute of Medicine (IOM)
issued new guidelines for weight gain during pregnancy
in 2009. These new guidelines include a recommendation
specific to obese women. Methods: We used 2009-2010
data from the Pregnancy Risk Assessment Monitoring
System (PRAMS), a population-based survey of mothers
of newborns linked to birth certificate data, to look at
risk and preventive factors associated with overweight or
obesity. Appropriate prenatal weight gain was also reviewed.
Overweight or obese was defined as a Body Mass Index
(BMI) of 25.0 or higher. IOM guidelines for appropriate
prenatal weight gain were applied where the recommended
amount of weight gain is dependent on the woman’s prepregnancy BMI and whether she had a multiple birth.
Results: During 2009-2010, 47% of Alaska women
delivering a live-born infant were overweight or obese prepregnancy; 21% were obese. During the same timeframe,
26% of women reported dieting or changing their eating
habits to lose weight, and 50% of women reported exercising
three or more days per week during the 12 months before
becoming pregnant. White women (30%) were more likely
than Alaska Native (15%) or women of other races (25%)
to have dieted (p < 0.01). Obese women were least likely
to exercise (42%), compared with overweight (51%) and
not overweight/obese women (54%) (p < 0.01). Only 34%
overall gained an appropriate amount of weight during
pregnancy. Obese women were least likely to have gained
an appropriate amount of weight (21%), compared with
overweight (30%) and not overweight/obese women
(41%) (p <0.01). 80% of women indicated that a health
care worker talked with them about how much weight they
should gain during pregnancy; obese women were the least
likely to report this (75%, p = 0.01).
Conclusions: Health care workers should
talk to their clientele about a personalized plan of
appropriate prenatal weight gain and should improve
their monitoring of weight gain during pregnancy.
[email protected]
Dietary Intakes of Energy and
Macronutrients by Lactating Women of
Different Ethnic Groups Living in Yakutia
Maternal Overweight or Obesity and
Prenatal Weight Gain in Alaska, 20092010
AUTHORS: T. Burtseva1, M. Savvina1, I. Solodkova2,
G. Dranayeva1, S. Avrusin2, M. Sinelnikova2,
V. Chasnyk2
AUTHORS: K. Perham-Hester, B. Szymoniak,
A. Camerlin
Research Center of the Academy of Medical Sciences 1, State Pediatric
Medical Academy 2
State of Alaska
Introduction: It is well known that during
lactation there should be a substantial increase in the
intake of dietary energy, protein and other nutrients by a
Background: Obesity among women prior to
[email protected]
Incidence of Postpartum Depressions in
Nuuk; Greenland
AUTHORS: I. Motzfeldt, S. Andreassen
Health Care Health Care
Introduction: The incidence of postpartum
depression in countries worldwide is approximately
10% although great variation between populations has
been described. The incidence of postnatal depression in
Greenland is however unknown. The Edinburg Depression
Scale is used in many different countries and cultures as a
screening tool for of detecting postnatal depression. It is
possible that Edinburg Depression Scale can be used in
Greenland too. Aim: The aims of this study was to estimate
the prevalence of postnatal depression in Nuuk and to
evaluate the Edinburg Depression Scale as a screening tool
in Nuuk, Greenland. Method: In 2011, the home health
care system started a project in Nuuk where all new born
mothers were screening for depression using the Edinburg
Depression Scale. All mothers resident in Nuuk, whom
had given birth in the period 1.1.2011 to 31.12.2011 were
included in the cohort. The screening were performed
approximately 3 months after birth by health care visitors.
The score ranged from 0-30 points. Mothers, whom scored
12 points or above were defined as having a postnatal
depression. These mothers were then referred to a doctor.
Clinical depression was defined when the doctor diagnosed
a depression. Medical records were reviewed one year after
birth for all mothers in order to find all mothers that had
developed a clinical depression within the first year after
birth. Results: The prevalence of women with postpartum
depression after birth will be estimated. The Edinburg
Depression Scale applicability as a screening tool will
be assessed by sensitivity and specificities calculations
with clinical depression within a year by default as
golden standard. Conclusion: The preliminary results
will be presented to the ICC-H15 in Fairbanks, Alaska.
[email protected]
Reproductive Health Factors Among
Alaska Native Women: The Alaska
Education and Research Towards Health
(EARTH) Study
AUTHORS: N. Murphy, D. G. Redwood,
J.M. Johnston, M.A. Murtaugh, A.P. Lanier
Background: The purpose of this study was to
examine self-reported reproductive health factors among
Alaska Native women (AN) who enrolled in the Alaska
Education and Research Towards Health (EARTH)
Study, 2004-2006.
WEDNESDAY ORAL
woman, though these special increments can be different
in different ethnic groups because the breastfed babies
of different ethnic groups living in the same area have
different weight and length. Objectives: To compare
dietary intakes of energy, protein, carbohydrate and fat
by lactating women of different ethnic groups living in
different settlements of Yakutia. Methods: Averaged
food intake recorded during 3 successive days of the year
2011 for 185 Sakha, Russian and indigenous women aged
20 – 36 living in 7 settlements situated in different areas
of Yakutia was analyzed using t-test, multiple regression
and multivariate exploratory techniques. Results: Daily
intakes of energy, protein, fat and carbohydrates being in
average correspondingly 1953 kkal (range 334 – 3714),
75 g (range 24 – 270), 68 g (range 7 – 166), 276 (range
45 – 476) differ greatly depending on the settlement, not
on ethnicity. The largest daily protein intake was revealed
in women living in Yakutsk (104 g) being 20-35% higher
than in small settlements, the largest energy intake – in
women of Anabarn, which was the only region where the
requirements in energy intake were fulfilled (2100 – 2900
kkal/day). Conclusion: The dietary intakes of energy and
macronutrients depend on the place where a woman lives
rather than on her ethnicity. The intakes differ considerably
from community to community in Yakutia. For protein
and energy they are at the levels, which are lower being
compared with the declared requirements for Europeans.
10:30 - 12:00
Methods: A total of 2,315 AN women ≥18 years
completed reproductive health questions as part of
a comprehensive health history questionnaire. The
reproductive health section included menstrual status
(age at menarche and menopause), pregnancy and live
birth history, use of hormonal contraception, hormone
replacement therapy, and history of hysterectomy and/or
oophorectomy.
Results: A total of 453 (20%) of women experienced
menarche before age 12 with a decline in mean age at
menarche by age cohort. Over 86% had been pregnant
(mean pregnancies=3.8, mean live births=2.9). Two-thirds
of women (65%) had their first live birth ages 18 to 24.
Almost 28% of the participants had completed menopause
of whom 24% completed menopause after age 52. Less
than half (43%) reported ever using hormone replacement
therapy. Almost two-thirds (62%) reported ever using
oral contraceptives, while fewer reported ever using birth
control shots (30%) or implants (10%).
Conclusions: This study is unique in reporting
reproductive health factors among a large group of
AN women. These data show that AN women have
selective protective factors for reproductive cancers,
79
including low nulliparity rates, low use of menopausal
estrogens, and common use of contraceptive hormones.
However, analysis by age cohorts indicates decreasing
age at menarche which might increase the risk for
reproductive cancers among AN women in the future.
[email protected]
Healthy Communities #4 - Climate Change Effects Schaible Auditorium
moderators: M. Brubaker &. B. Evengård
Tundra Warming and Access to Primary
Care Services by the Native Reindeer
Herders in the Russian Arctic
AUTHORS: P. Amstislavski1, L. Zubov2
WEDNESDAY ORAL
State University of New York Downstate 1, Northern State Medical
University 2
Arctic ecosystems are highly susceptible to human impacts
such as gas and hydrocarbon development and to the
warming of the surface temperatures. In tundra, these
impacts are amplified due the fragility of the local socioecological relationships. The native circumpolar peoples
are tightly integrated within the tundra ecosystems and
therefore may be directly and adversely affected by such
impacts. The migratory Nenets herders in Western Siberia
experience decline of the traditional sources of livelihood
from the reindeer due to recent fall in the reindeer
populations. Simultaneously, they face new obstacles in
access to primary health care. We study the change in access
to primary health care services by the reindeer herders in
the Nenets Autonomous Okrug of Arkhangelsk Oblast.
The herders annually travel long distances across the tundra
from the summer camps near the reindeer pastures on the
Barents Sea coast to the villages in the interior, where they
winter. Due to the hydrologic conditions in the region, for
the reindeer and the herders such a journey is only possible
when a firm snow cover is present. One consequence of
the recent warming is a later annual arrival of the snows
in the fall, followed by an earlier spring thaws. This shift
causes the herders to prolong their stay in the tundra camps
and to leave from the villages to the camps earlier, before
the spring thaw arrives. As a result, the migrant herder
families spend less time in the villages, where they can
access the primary care at the clinics. Utilizing longitudinal
data for the 15-year period, we report on findings of the
relationship between the shift in surface temperatures
in the region, access and utilization of stationary village
clinics by the migratory herders for primary care as well as
frequency of emergency medical care at the tundra camps.
[email protected]
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10:30 - 12:00
Morbidity and Mortality Associated
with Unintentional Falls Through the
Ice in Alaska
AUTHORS: N. Fleischer1, P. Melstrom1, E. Yard2,
M. Brubaker2, M. Tcheripanoff 2, T. Thomas2
Centers for Disease Control and Prevention 1, Alaska Native Tribal
Health Consortium 2
Background: Climate change has contributed to
increasing temperatures, earlier snowmelts, and thinning
ice packs in the Arctic region. During wintertime, crossing
frozen bodies of water is essential to transportation and
subsistence living. Anecdotal reports indicate that Alaskans
are falling through the ice at higher rates in recent years
and are altering their modes of travel due to the perception
of unsafe ice. The purpose of our study was to describe the
morbidity and mortality associated with unintentional falls
through the ice in Alaska from 1990–2010.
Methods: An event was defined as someone breaking
through or falling through ice on a body of water, including
breaking or falling through in a vehicle. The main
data source was newspaper reports from the following
sources: Nexis, online archives for Alaskan newspapers,
and microfiche for small, weekly publications. We also
used data from the Alaska Trauma Registry, the National
Institute of Occupational Safety and Health, the Alaska
State Troopers, and vital statistics.
Results: During the 21-year period, we identified more
than 250 events. The number of people falling through the
ice per event ranged from one to six. Events ranged from
less serious incidents, resulting in no morbidity, to fatalities
of up to five people during one event. Ice fall events often
occurred while people were traveling by snow machine.
Data collection is ongoing; trends over time cannot yet be
assessed.
Conclusions: These data represent the first systematic
characterization of falls through the ice in Alaska. Falls
through the ice may represent an important marker of adverse
health outcomes related to changes in climatic features in
the Arctic. In Alaska, an increase in falls over time could
discourage travel, disproportionately impacting Alaska
Native people, many of whom live in remote communities
and rely on traditional hunting and fishing for food.
[email protected]
Examining the Climatic and
Environmental Determinants of Mental
Health: A Case Study from Nunatsiavut,
Labrador, Canada
Rigolet Inuit Community
[email protected]
Facing the Limit of Resilience:
Perceptions of Climate Change Among
Reindeer Herding Sami in Sweden
AUTHORS: M. Furberg1, B. Evengård2, M. Nilsson3
Umeå Univeristy, Sweden 1, Clinic of Infectious Diseases,
Umeå University Hospital 2, Umeå Centre for Global Health
Research, theme Climate Change 3
Background: The Arctic area is a part of the globe
where the increase in global temperature has had the
earliest noticeable effect and indigenous peoples, including
the Swedish reindeer herding Sami, are amongst the first
to be affected by these changes. Objective: To explore the
experiences and perceptions of climate change among
Swedish reindeer herding Sami. Study design: In-depth
interviews with 14 Swedish reindeer herding Sami were
performed, with purposive sampling. The interviews
focused on their experiences of climate change, observed
consequences and thoughts about this. The interviews
were analysed using content analysis. Results: One core
theme emerged from the interviews: facing the limit
of resilience. Swedish reindeer-herding Sami perceive
climate change as yet another stressor in their daily
struggle. They have experienced severe and more rapidly
shifting, unstable weather with associated changes in
vegetation and alterations in the freeze-thaw cycle, all of
which affect reindeer herding. The forecasts about climate
change from authorities and scientists have contributed to
stress and anxiety. Other societal developments have lead
to decreased flexibility that obstructs adaptation. Some
adaptive strategies are discordant with the traditional life
of reindeer herding, and there is a fear among the Sami
of being the last generation practising traditional reindeer
herding. Conclusions: The study illustrates the vulnerable
situation of the reindeer herders and that climate change
impact may have serious consequences for the trade and
their overall way of life. Decision makers on all levels, both
in Sweden and internationally, need improved insights
into these complex issues to be able to make adequate
decisions about adaptive climate change strategies. Full
text free article at: http://www.globalhealthaction.net
WEDNESDAY ORAL
Canadian Inuit have been experiencing some of the most
rapid climatic and environmental changes on the planet:
increased seasonal temperatures; decreased snow and ice
quality, stability, and extent; melting permafrost; decreased
water levels in ponds and brooks; increased frequency and
intensity of severe storms; later ice formation and earlier
ice break-up; and alterations to wildlife migration and
plant growth patterns. These changes are decreasing the
ability of Inuit to hunt, trap, forage, or travel on the land,
which directly disrupts the socio-cultural fabric of the
communities and individual livelihoods. These changes
also impact on the health of individuals and communities.
While there is a burgeoning field of research examining
climate-health relations, most studies rarely consider the
implications for mental health and well-being. Yet, from
data gathered as part of a multi-year, community-driven,
participatory project in Nunatsiavut, Canada, it is clear
that the emotional and mental consequences of climatic
and environmental change are of increasing concern and
importance to Northern residents. Drawing from 85
in-depth interviews and 112 questionnaires conducted
in Rigolet from 2009 to 2010, community members
reported experiencing climate-related mental health
impacts through eight interrelated pathways: increased
reports of family stress; increased reports of drug and
alcohol usage; increased reports of suicide ideation;
the amplification of other traumas or mental health
stressors; decreased place-based mental solace; a sense
of identity loss; and grief for a changing environment.
This work represents the first research to examine the
mental and emotional health impacts of environmental
change within a Canadian Inuit context, and one of the
first such studies globally. These findings indicate the
urgent need for more research on environmental-changerelated mental health impacts and emotio-mental adaptive
processes in Canada and internationally, and for more
mental health programming to enhance resilience to and
assist with the mental health impacts of climate change.
10:30 - 12:00
[email protected]
Comparing Perceptions of Climate
Change to Observational Data from the
Sami Region of Northern Sweden
AUTHORS: D. Hondula1, M. Furberg2, M. Saha1,
J. Rocklöv2, M. Nilsson2, R. Davis1
University of Virginia 1, Umeå University 2
The indigenous peoples of the Arctic are amongst the
populations expected to be most impacted by changes to
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WEDNESDAY ORAL
Earth’s climate. An increase in average air temperatures in
the Arctic region is one of the most widely documented
changes from the past century and is expected to continue
or accelerate in the future. The indigenous Sami in
northern Sweden, however, perceive that their daily lives
have been instead impacted by significant changes in
climate variability and extremes. Interviews with reindeer
herding Sami indicated more drastic daily changes in
temperature and precipitation and a tendency toward
longer wet and dry spells in the cold season. We sought to
develop quantitative measurements of climate variability in
northern Sweden over the past four decades to compare to
respondents’ perceptions. Daily climate data were obtained
from several meteorological stations in the Sami region
with continuous observations over the period 1970–2010.
We then calculated various metrics associated with climate
variability and extremes. Emphasis was placed on how
the most recent decade compares with those prior, as
interview subjects indicated that changes were especially
pronounced during the last ten years. Preliminary
results indicate that many of the extreme percentiles of
temperature and precipitation and daily change variables
have significantly changed while simpler measures such as
variance indicate no trend. The major findings of the study
are (1) inhabitants of the Arctic observe and emphasize
a broader set of aspects of climate change than those
typically included assessment reports, and (2) standard
metrics used to evaluate variability are incomplete for
assessing long-term changes in daily weather fluctuations.
Future work estimating climate change and its impacts in
the Arctic could place more emphasis on variability and
consider a broader scope of quantitative and qualitative
metrics to understand what has happened in the past.
[email protected]
15:30 - 17:00
Chronic Diseases #5 Cardio-pulmonary Disease 1 Duckering Room 252
moderators: L. Duffy & M. Voevoda
Major Depression Predicts 16-years Risk
of Myocardial Infarction Incidence in
Russian Female Population
AUTHORS: V. Gafarov, D. Panov, E. Gromova,
I. Gagulin
Coll. lab. of CVD Epidemiology; Inst. of Int.Med. SB RAMS
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The aim: To explore the influence of major depression
(D) on relative risk of myocardial infarction (MI) in
female population of 25-64 years in Russia. Material and
methods: Within the WHO “MONICA-psychosocial”
program random representative sample of women aged
25-64 years (n=870), who were residents of one district
in Novosibirsk, were surveyed in 1994. Levels of D were
measured by questionnaire “MOPSY” at the baseline
examination. From 1995 to 2010 women were followed for
16 years for the incidence of MI on the base of Myocardial
Infarction Registry data. Cox proportional regression
model was used for an estimation of relative risk (HR)
MI. Women having heart disease at the baseline were
not included in the analysis. Results: In this longitudinal
study data on MI were collected for 79% (687 persons)
surveyed. MI was developed in 15 (2.2%) women during
16-years of follow up. The prevalence of major D in female
cohort was 12%. Major D in women with developed MI
was revealed in 25% of women. HR of MI in women
with major D during 16 years of study was higher in
2.5 time, compared women who had no D (HR=2.53;
95.0%CI:1.26-24.34; p<0.05). There were no differences
in marital status, education and occupational status for
the incidence risk of MI between women with or no D.
The conclusion: Our findings indicate high prevalence
of major D in female cohort of 25-64 years which is
increased in those who developed MI. Major D predicts
higher risk of MI in women during 16-years follow-up.
[email protected]
Evolution and Clinical Characteristics of
Coronary Atherosclerosis in Natives of
North Asia
AUTHORS: M. Voevoda1, N. Makharova2,
T. Romanova2, A. Romanova2, T. Tomskaya2,
M. Tomskii2, J. Ragino2
Institute of Internal Medicine SB RAMS 1, Yakut Scientific Centre
of RAMS SB 2
Dramatic changes in traditional life style of native
populations of North Asia have resulted in significant
increase of prevalence, severity and age of onset of coronary
artery diseases (CAD) in these ethnic groups. At present,
CAD is one of the leading cause of mortality in all native
populations with previously low level of atherosclerotic
lesions in all majors arterial basins. At the same time
the information about clinical peculiarities of coronary
atherosclerosis in natives of North Asia is still very limited.
To fill this gap we have conducted comparative analyses
between CAD and clinical, instrumental, laboratory,
genetic and angiographic characteristics in native and nonindigenous patients of Yakutia in cross-sectional and cohort
surveys. Comparative analyses of risk factors prevalence was
also conducted in native and non-indigenous populations
of Yakutia. Results: In general, the severity of coronary
atherosclerosis was less prominent in native patients with
CAD. In native patients CAD is clinically manifested at
lower level of coronary arteries stenosis. At the same time
native patients had higher frequency of arterial hypertension,
left ventricle hypertrophy, carotid artery intima-media
thickness and left atrium conduction abnormalities.
Native people had lower total cholesterol level both in
CAD patients and in population, which was comparible
to non-indigenous CAD patients and population. Both
ethnic group had high frequency of metabolic syndrome
presumably playing important role in the development
of coronary atherosclerosis. Native patients had a higher
rate of coronary atherosclerosis progression comparative to
non-indigenous patients. Native patients also had higher
rate of left ventricle progression. Conclusion. Our data
suggest that coronary atherosclerosis in natives of North
Asia is characterized by some peculiarities in risk factors
profile, clinical manifestations and disease progression.
[email protected]
AUTHORS: N. Makharova1, M. Voevoda2, F. Lutova2
Yakut Scientific Center SB RAMS 1, Institute of Internal Medicine
SB RAMS 2
Objectives: To compare the clinical and instrumental
parameters of patients with coronary atherosclerosis
indigenous and non-indigenous inhabitants of Yakutia
Study design: The study of Register selective coronary
angiography (SCAG) patients of Republican Hospital for
the years 2004 to 2007 (n = 1233) has been conducted.
We studied patients with verified coronary atherosclerosis
568 (46.1%) after exclusion of patients with heart defects,
abnormalities of the coronary arteries, intact coronary
arteries, as well as heart defect combined with coronary
atherosclerosis (53.9%). Methods: We analyzed the clinic,
BMI, lipid fractions, parameters of SCAG, the calcium index
(by MSCT), electrocardiography (ECG) (Sokolov-Lyon,
Gubnera Ungerleydera, Cornell voltazhny, Cornell product,
R aVL> 11 mm, RV5 (V6) = 27 mm), echocardiography
(LVMI for RB Devereux, types of geometry). Results:
The single vascular lesions were found more often among
Indigenous population, three vascular and more lesions among non-indigenous. The average number of affected
arteries was 2.1 + 0,1 vs 2.4+0.1; p=0.001 respectively.
The average level of calcium index below for indigenous
than non-indigenous. Among non-indigenous were more
frequent obesity, high triglycerides. Among the Indigenous
- often hypertension, left ventricular hypertrophy (LVH)
in all ECG criteria and LVMI. Conclusion: Thus, the
Indigenous inhabitants of Yakutia have less atherosclerosis
of coronary artery, obesity, low values of triglycerides, but
more often have the hypertension and the eccentric LVH.
[email protected]
Cold-Related Cardiorespiratory
Symptoms Among Subjects With and
Without Hypertension: The National
Finrisk Study 2002
AUTHORS: T. Ikäheimo1, T. Lehtinen2,
R. Antikainen2, J. Jokelainen2, S. Näyhä1, J. Hassi3, S.
Keinänen-Kiukaanniemi2, T. Laatikainen4,
P. Jousilahti4, J. Jaakkola3
University of Oulu 1, University of Oulu, Institute of Health
Sciences 2, University of Oulu , Center for Environmental and
Respiratory 3, National Institute for Health and Welfare 4
Background: Exposure to cold increases blood
pressure (BP) and may aggravate the symptoms and
influence the prognosis of subjects with hypertension
(HTN). The prevalence of cold-related symptoms among
hypertensive subjects is not known. This information
is relevant for proper treatment and could serve as an
indicator for predicting wintertime morbidity and mortality.
Methods: The authors compared the occurrence of coldrelated cardiorespiratory symptoms between subjects with a
history of HTN (n=2163), measured elevated BP without
history of HTN (n=1060) and a reference group with normal
BP (n=2743) selected from the population based FINRISK
2002 Study. A self-administered questionnaire inquiring
cold-related symptoms and perceptions was sent out to
6,951 men and women aged 25-74 yrs. Results: Men with
diagnosed HTN reported more often cold-related dyspnoea
[OR 1.58(1.16-2.16)], cough [OR [1.55 (1.1-2.2)] and
arrhythmias [OR 5.15 (1.11-23.9)] than the reference group.
Women with diagnosed HTN experienced more cold relateddyspnoea [OR 1.42(1.14-1.77)] and cough [OR 1.39 (1.071.81)] compared to the reference group. The prevalence of
symptoms was higher in the oldest (>55 yrs.) age group and
especially among those with diagnosed HTN. The history
of myocardial infarction and HTN combined increased the
prevalence of cold-related dyspnoea [OR 2.49 (1.28-4.85)],
wheezing [OR 2.18 (1.00-4.75)], chest pain (OR 3.82 (1.2012.2)] and arrhythmias [OR 3.35 (1.06-10.7)]. A history of
stroke or presence of diabetes did not affect the prevalence
of cold-related symptoms in hypertensive subjects. Smoking
and alcohol use were not consistent determinants of
symptoms among hypertensive subjects. Conclusions: Coldrelated cardiorespiratory symptoms are more common in
persons with diagnosed hypertension than in persons with
no hypertension. A history of myocardial infarction and
HTN combined further increases the prevalence of these
symptoms. As the symptoms may predict adverse health
events, hypertensive patients need customized care and cold
risk management practices.
Keywords: cold, hypertension, symptoms, population
[email protected]
WEDNESDAY ORAL
Clinical and Instrumental Parameters
Patients with Coronary Atherosclerosis
Indigenous and Non-Indigenous
Inhabitants of Yakutia (The NorthEastern Part of Siberia)
15:30 - 17:00
83
Coronary Heart Disease and
Hyperlipidemia Were Associated
with NAFLD in Siberia. Results of
Open Multicenter Prospective Study
DIREG_L_01903
WEDNESDAY ORAL
AUTHORS: V. Tsukanov, J. Tonkikh, E. Kupershtein,
E. Kasparov, O. Amelchugova, A. Vasyutin
Healthy Communities #5 Residential Environmental Health
Duckering Room 352
moderators: T. Ritter & T. Kovesi
Indoor Air Quality in Rural Alaskan
Homes
AUTHOR: L. Albertson
SRI MPN SD RAMS
Introduction. There is a view that non-alcoholic
fatty liver disease (NAFLD) is associated with cardiovascular
diseases (1). But in Russia, especially in different regions,
this data has not yet been confirmed. Aim. To study
prevalence of NAFLD and its association with coronary
heart disease and with parameters of blood lipids in
population of Siberia. Methods. We examined 5116 persons
(2412 male and 2673 female), average age – 46,4 years in
7 cities of Siberia. Diagnostic algorithm of NAFLD was
substantially based on Dionysus study diagnostic criterion
(2). NAFLD was established on the basis of careful physical
examination, serum biochemistry (ALT, AST, GGT, lipid
spectrum, glucose), alcohol consumption, viral hepatitis
markers and abdominal ultrasonic scanning. ?oronary heart
disease was diagnosed according to recommendations of the
Russian Scientific Society of Cardiology (2008). Results.
The overall prevalence of NAFLD in Siberia was 31,6%
(steatosis – 24,9%, NASH – 5,9%, cirrhosis – 0,8%). In
our study NAFLD prevalence increased up to age 50 years,
reached the peak in 50-59 age-group, then went to plateau.
Dependence of liver steatosis and NASH prevalence
on age submitted to similar laws. Prevalence of coronary
heart disease was higher in patients with NAFLD than
in patients without NAFLD (27,1% and 13,%; p<0,001).
NAFLD was associated with hypercholesterolemia,
hypertriglyceridemia and metabolic syndrome (34,9% and
5,2%; p<0,001). Conclusion. We found strong association
of NAFLD with coronary heart disease and hyperlipidemia
in Siberia. 1. Targher G., Bertolini L., Padovani R. et
al. Prevalence of non-alcoholic fatty liver disease and its
association with cardiovascular disease among Type 2
diabetic patients // Diabetes Care. 2007; 30: 1212-1218.
2. Bedogni G, Miglioli L, Masutti F, et al. Incidense
and natural course of fatty liver in general population:
The Dionysus Study. Hepatology 2007;46:1387-1391.
Residential indoor air quality is a pillar of environmental
health. With exceptionally high rates of respiratory disease,
a critical housing shortage and exceptionally demanding
heating needs, Alaskan households face major indoor air
challenges. In this session we will examine how the unique
aspects of climate, geography, building construction and
culture influence air quality in rural and remote Alaskan
homes. Many agencies offer outreach material and bestpractice recommendations regarding indoor air quality.
Unfortunately, Alaskan environmental health workers are
finding much of this material is poorly suited to the unique
and challenging conditions of our state. A careful review of
housing issues and respiratory disease rates details a web of
weighty, and often unique, air quality factors that gravely
impact health. By making use of available research, as well
as field experience, we will explore and prioritize the air
quality concerns which have the greatest impact on rural
residents. Looking towards the future, we will discuss how
increased concern over heating efficiency and the progressive
“tightening” of Alaskan homes will create new challenges for
the residential environmental health professional. We will
describe a systematic, evidence-based review of available
health and housing information and how these data can
be used to set priorities and a address housing as a complex
health topic. While this session will focus specifically on
the residential indoor air quality issues of remote and rural
Alaska, it will be well suited to anyone trying to develop
or adapt healthy housing guidelines for northern latitudes.
[email protected]
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15:30 - 17:00
[email protected]
Bedbugs in the Last Frontier: Strategies,
Challenges, and Opportunities for
Collaboration
AUTHORS: M. Rasy, L. Albertson
University of Fairbanks-Cooperative Extension Service
While the re-appearance of bedbugs has been making
headlines across the country for years, local agencies
are just beginning to identify the unique challenges to
combating these pests in Alaskan communities. Many
national organizations have research-based guidelines
for addressing bedbug infestations however, they may
not be appropriate for Alaskan communities and homes.
[email protected]
Sustaining Access to Safe Drinking
Water and Sanitation for Promoting
Local Well-Being in Alaska Native
Villages
AUTHOR: F. Ochante
The task of ensuring that all Alaska Native villages have access
to potable water and proper sanitation is still not complete
despite many decades of federal and state efforts. Barriers to
the continued operation and maintenance of water and sewer
systems are various and increasing, placing public health and
capital investment at risk. There is an emphasis on looking
for financial and technological solutions disregarding the
fact that both are mainly provided by actors outside these
remote villages. Research initiatives that focus on fostering
local capacity to enhance the sustainability of these systems
at the village level are minimal. This study aims to explore
how the current system for providing water utilities relates to
native notions of healthy water and well-being considering
that place-based policy design could render more successful
results. This study will also open up the discussion on how
the current system for provisioning water and sanitation
impacts rural villages and self-reliance. To achieve these aims,
qualitative interviews will be conducted with representatives
of villages in the Interior region of Alaska, public officials
and water experts. Responses to questions will be analyzed
using a grounded theory approach. Findings will potentially
elucidate limitations and opportunities for policymakers,
resource managers, scientists, community and tribal leaders.
[email protected]
Exploring Alternatives to Regulating
Small Drinking Water Systems
AUTHOR: S. Struck
British Columbia Centre for Disease Control
It is widely recognised that private small drinking water
systems (SDWS) in rural and remote areas tend to be the
most vulnerable, due to a lack of capacity in terms of financial
resources and operating capability. Although data on the
association of disease with micro potable water systems
is limited, of the waterborne disease outbreaks caused by
microorganisms in the US from 1999-2000, 64% were
associated with private wells. A recent look at water advisories
in the interior of British Columbia also highlights the plight
of small systems, with small private water systems being at
greater risk of boil water advisories and for longer periods of
time. This brings into question the effectiveness of the existing
regulatory environment for these systems. Currently, British
Columbia regulates drinking water systems that have two or
more connections for residential systems. These systems are
required to meet the same standards as those serving larger
populations. A recently introduced draft proposal provides a
new definition of SDWS which would provide an alternative
to regulating very small residential systems. Alternatives to
regulating these systems such as a health promotion approach
are being explored. The design of policies and programs to
prevent waterborne disease is also hampered, in part, by the lack
of systematically collected information on the characteristics
and causes of waterborne disease events (WBE). The
National Collaborating Centre for Environmental Health
(NCCEH) has reviewed recent studies and published
work on WBE to identify sources, health impacts and
other contributing factors to waterborne infections, an
important cause of preventable enteric disease in Canada.
These two studies will be discussed to continue a dialogue
on challenges faced by SDWS in rural and remote areas.
WEDNESDAY ORAL
Differences in climate, geography, sanitation and pestcontrol infrastructure mean that Alaskan’s often need to find
alternate strategies to deal with this problem. This has left
many individuals, businesses and organizations around the
state struggling to identify and communicate appropriate
science-based strategies while discouraging dangerous
activities such as the off-label use of toxic pesticides. In this
presentation we describe some of the fascinating biology
of Cimex lectularius, discuss national trends in bedbug
control and use the available scientific evidence to identify
best-practice for Alaskan communities. We will also
discuss the role of government agencies in addressing this
problem and describe existing inter-agency collaborations
which have been working to provide useful guidelines to
help communities and individuals throughout the state. In
addition, in Alaska and other areas of the north, their is
limited availability to research based resources that will be
the most effective for proper bedbug treatment programs.
Northern habits of spending much time indoors during
the winter months can cause many disorders and problems,
including a perfect opportunity for bedbug invasion and
potentially dangerous conditions if not treated appropriately.
How agencies work together across vast distances and
communities, to best address this bedbug resurgence will
determine efficacy and healthy communities in the future.
15:30 - 17:00
[email protected]
Washeteria Closures, Infectious Disease,
and Community Health in Rural Alaska A
Review of Clinical Data in Kivalina, Alaska
AUTHORS: T. Thomas1, J. Bell1, M. Brubaker1,
D. Bruden2, M. Hawley3
Alaska Native Tribal Health Consortium 1, Centers for Disease
Control and Prevention 2, Maniilaq Association 3
Background: Kivalina is a northwest Alaska barrier
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WEDNESDAY ORAL
island village of 400 people vulnerable to storm surges
exacerbated recently by delayed winter sea and shore ice
formation. The village has no in-home piped water or
sewage; the “Washeteria” is the only structure providing
public showers, laundry facilities and flush toilets. In
October 2004, a storm damaged the washeteria septic
system resulting in prolonged facility closures. We assessed
rates of gastrointestinal, respiratory and skin infections
potentially impacted by prolonged washeteria closures.
Methods: We obtained washeteria closure dates from
2003-July 2009 and defined >7 day closure as prolonged.
We received de-identified data on all Kivalina clinic visits
from 2003 - 2009 and selected visits with ICD-9 diagnosis
codes for respiratory, skin, or gastrointestinal infection;
subsequent same patient/same illness category visits within
14 days were excluded. We compared annual visit rates, for
all ages combined, before (2003-2004) and after (20052009) the ‘2004’ storm.
Results: The washeteria had prolonged closures
for 34 days (4.7%) in the 2 years 2003-04 and 864 days
(51.7%) between January 2005 to July 2009. Closures
ranged from 8-248 days, primarily between February and
May. Respiratory infection rates declined significantly
from 1.32 visits/person/year in the 2003-04 period to
0.99 visits/person/year in the 2005-2009 period. There
was a significant increase in skin infection rates after
2004, peaking at 0.28 visits/person/year in 2007 and
then declining significantly to 0.15 visits/person/year in
2009. Gastrointestinal infection rates remained stable
and low throughout (average; 0.05 visits/person/year). No
association was observed between the rates of respiratory,
gastrointestinal or skin infections and prolonged washeteria
closures. Conclusion: The Kivalina washeteria was closed
frequently and for extended periods between 20052009. Initial closures may have resulted in increased skin
infection rates. No increase in respiratory or gastrointestinal
infections was noted. Evaluation of other factors including
community adaptive strategies would be valuable.
[email protected]
The State of Health Hardware in Housing
for Aboriginal Australians - Just More
Houses is Not Enough
AUTHORS: P. Torzillo, P. Pholeros, S. Rainow,
Healthabitat
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For three-quarters of a century commentators have linked
Indigenous poor health to living environments – but there
were no substantive attempts to detail the elements of
the living environment likely to contribute to what kinds
of health problems, and how they might be corrected. In
1985 we set out to address these questions by undertaking
a detailed study of the living environment of Aboriginal
15:30 - 17:00
people (Anangu) in central Australia. We determined ten
healthy living practices (HLPs) that would be necessary for
anyone to live there: 1. Electrical safety 2. Washing people,
especially children 3’ Washing clothes and bedding 4
Removing waste safely 5. Improving nutrition 6. Reducing
the impact of crowding 7. Reducing the impact of animals,
particularly dogs as vectors of disease 8. Reducing the
impact of dust 9. Improved temperature control 10.
Reducing trauma We then examined the housing stock
to see whether there was functioning “health hardware”
necessary to carry out these HLPs and defined targets for
each them -- for example, mothers should be able to wash
their children daily. Our report proscribed a range of design
and implementation recommendations for the provision
of health hardware. Subsequently, from 1999 to 2011,
we developed a detailed process of surveying and fixing
health hardware, undertaking projects in 184 communities
with 7,348 houses and assessing 250 items in each house
focusing on testing health hardware performance. Only 10%
of houses had basic electrical safety; in 35% a functioning
shower existed and waste was adequately removed in
58%. During this period tradesmen repaired 186,000
items. Only 9% of these were due to misuse/overuse.
Our projects produced improvement in all categories of
health hardware performance. Despite massive federal
government investment, recently constructed housing for
Aborigines performs no better than that built a decade
in terms of health hardware performance. This work has
major implications for other indigenous populations
advocating for
government investment in housing.
[email protected]
Health Services #5 - Mental Health Services
Duckering Room 342
moderator: J. Miller & L. O’Neill
Culturally Appropriate Mental Health
Services in Canada’s North
AUTHOR: A. Drossos
For many of the indigenous people in Canada’s North
the notion of mental illness was unheard of prior to
colonization, and even today many do not relate well to
the concept especially as a separate diagnostic entity. The
holistic view of health - including the spiritual, physical,
emotional and mental - is more inline with indigenous
ways of knowing. Furthermore, healthcare service delivery
in Canada’s North is an ongoing challenge. In most
communities the only healthcare facility is a nursing
station staffed by highly qualified nursing professionals,
with only infrequent fly-in visits by physicians. Access to
specialist physicians, including psychiatrists, is even more
[email protected]
The Ethical Toolkit: Medical Morality and
the Local Worlds of Indigenous FrontLine Health Care
AUTHOR: C. Tait
University of Saskatchewan
Drawing upon research from First Nations and Métis
communities, this paper examines the challenges in
applying ethical principles of justice and beneficence to
local health care settings where historical distribution
of power, entitlements, and resources have perpetuated
health disparities that are distributed along racial and
socioeconomic lines. Emerging and evolving fields of
neuro-, bio- and public health ethics largely configure
questions of medical morality within the context of highpriced, high-tech, high-drama biomedical settings however,
for the majority of First Nations and Métis peoples living
in the North, illness episodes are experienced, interpreted,
and responded to in the context of the family or community
and are shaped by factors such as cultural values, Indigenous
identity, gender roles and socioeconomic status. How
ethicists choose to respond and apply medical morality
within these local worlds is slowly emerging. This paper
calls for the consideration of an “ethical toolkit” in which
local Indigenous worldviews, including ideas of moral
responsibility are given equal consideration to that of Western
ethical principles. This work involves the reconciliation of
scientifically based knowledge that defines much of the
Western world with Indigenous epistemologies based
on participatory consciousness and personal experiences
with human, natural, and supernatural relationships. The
new enterprise of the ethical toolkit therefore, requires
cooperation between Indigenous peoples and Western
medical institutions. The work of the ethical toolkit has the
potential to create new currents of knowledge that flow in
several directions and overrun entrenched ways of thinking
towards more inclusive, valid, and useful understandings.
[email protected]
Ayaangwaamiziwin: A First Step
Toward Making First Nations
Communities Healthier
AUTHORS: J. Gordon1, F. Tarrant2
Sioux Lookout First Nations Health Authority 1, Dalhousie
University 2
The purpose of this study was to conduct a Public Health
Services inventory and comparison analysis in 10 selected
First Nations communities in the Sioux Lookout, Ontario
region with the data informing the development of a plan
for providing culturally appropriate Public Health services
in remote First Nations communities. The research tools
for the proposed review and comparison analysis were
based on Ontario’s Public Health Standards and best
practices identified from the literature. This format allowed
for the comparison of the collected data against current
best practice and the Public Health services mandated
by the Ontario Health Protection and Promotion Act
(HPPA) and delivered by the local Public Health units.
Both qualitative and quantitative data were collected and
analyzed. Data analysis as well as the literature review was
used to support the identification of service gaps for this
population in comparison to mainstream provincial services.
Interview data from key community informants provided
support for the development of an implementation plan
for moving forward. The report highlighted the level of
systemic neglect displayed by both federal and provincial
governments regarding Public Health services for remote
First Nation communities. Communities as well as
First Nation’s leadership recognize this issue as having a
tremendous impact on their health and well being and are
ready to take action to address these issues. This report has
been the catalyst for that action in that it provided bestpractice evidence to substantiate long-term claims of service
inequities and root causes for deteriorating health status.
WEDNESDAY ORAL
rare. Local mental health services are almost non-existent,
not to mention ones that are culturally appropriate and
designed with Inuit Qaujimajatuqangit in mind. Currently,
Inuit who need specialized mental health services generally
travel South to access them, or otherwise go without them
altogether. For Inuit from Nunavut, most of the Inuitspecific mental health services are in the nation’s capital,
Ottawa. Not only is Ottawa a great distance from home
for most Inuit, but culture shock, a lack of family and
community supports and many other differences are major
barriers to healing. Many have recognized that the gap in
mental health services in the North needs to be addressed.
Using a combination of personal experience through travel
and clinical work in Nunavut, a literature review of both
mental health issues and mental health services design and
provision in other Indigenous areas around the world, and
informal input from Inuit around the country a description
of possibilities for innovative, comprehensive and culturally
appropriate mental health services for Inuit, by Inuit and
in Inuit communities is described. These include acute,
chronic, rehabilitative as well as community-based services
for the entire lifespan that use a collaborative approach.
15:30 - 17:00
[email protected]
87
Academic-Community Partnerships
in Rural and Frontier Communities:
Improving Services for Children with
Autism and Other Developmental
Disabilities in Alaska
AUTHORS: J. Miller1, K. Ward2
WEDNESDAY ORAL
UAA Department of Health Sciences 1, UAA Center for Human
Development 2
Access to health services for children and youth with
autism and other developmental disabilities in Alaska is
seriously challenged by shortages across the professional
workforce. Alaska shares this problem with other rural
and frontier states, but the challenges are magnified by the
diversity of populations and their wide dispersion across
the vast landmass. The Alaska LEND Without Walls
(Leadership Education in Neurodevelopmental and related
Disabilities) aims to improve the health of children who
have or are risk for developing disabilities and their families
by preparing trainees from nine professional disciplines to
assume interdisciplinary leadership roles. With funding
from HRSA’s Maternal and Child Health Bureau, the
University of Alaska Anchorage, Center for Human
Development has pioneered partnerships with community
organizations, family members, the Alaska Title V Agency
and multiple community and university stakeholders.
The goal is to develop a uniquely Alaskan model with
interdisciplinary, community-based, family-centered
teams to coordinate leadership training and culturally
competent service delivery. The faculty disciplines include:
occupational therapy; nursing; social work; psychology;
special education; speech-language; psychology; family
and public health. We present our experience in the
development of community-academic partnerships that
promote the Growing Our Own approach. Key elements to
reducing health disparities in Alaska entail using telehealth
for service delivery, building on existing community
services, employing distance delivered education strategies
and developing capacity to bring services, personnel, and
community and continuing education to local communities.
[email protected]
Informal and Formal Mental Health
and Wellness Support in the North:
Qualitative Phase
AUTHORS: L. O’Neill1, S. George2, C. Koehn2,
B. Shepard3
University of Northern British Columbia 1, UNBC 2, University of
Lethbridge 3
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Informal and Formal Mental Health Support in the
North Significance: This research presentation focuses
15:30 - 17:00
on the qualitative phase of a three year research study
involving formal and informal mental health and wellness
support in communities in northern BC, Yukon and
NWT. Understanding the complexities of northern mental
health and wellness not only potentially benefits northern
community members, but also counsellors, psychologists
and other helping professionals preparing to work in isolated
northern communities. Information from formal mental
health and wellness practitioners, both those originating
in the community where they work, and those who make
the transition into northern communities, adds to our
understanding of isolated mental wellness practice and how
to improve services. The information and experience shared
by the participants adds important pieces to a conceptual
model of isolated mental health practice. Informal mental
health supporters were also included in this study. Mental
health services along with other social services have been
cut-back in many northern communities, resulting in more
responsibility and stress on the few remaining mental health
and wellness practitioners and on informal helping support
such as lay counsellors, elders, and other community helpers.
Method: Twenty participants working in communities
in northern BC, Yukon and NWT provided in-depth
descriptions of their experience in providing mental health
and wellness support in the north. Participants included
counsellors and psychologists, and informal mental health
practitioners and helpers such as youth care workers, family
support workers, and health care practitioners. The research
team used Consensual Qualitative Research (CQR) analysis,
with all seven members doing individual analysis and then
working towards a consensus regarding the categories and
themes. Categories, subcategories, and themes contained
rich descriptions of the challenges of northern mental health
and wellness practice and what that entails, a discussion of
North/South dichotomies, the phenomenon of insider/
outsider helpers, the importance of the cultural context,
how to best sustain northern practice, and visions for
improved mental health and wellness delivery in the North.
[email protected]
Informal and Formal Mental Health
Support in the North: Survey Phase
AUTHORS: L. O’Neill, S. Seebok, W. Hobson,
N. Robinson
UNBC
Informal and Formal Mental Health Support in the North:
Survey Phase Significance: This research presentation
focuses on the quantitative phase of a three year research
study involving formal and informal mental health and
wellness support in communities in northern BC, Yukon and
NWT, Canada. Based on descriptive in-depth interviews
with 20 practitioners working in northern communities in
northern BC, Yukon and NWT, a comprehensive on-line
[email protected]
Healthy Families #5 - Preventing Infant Mortality Gruening Room 206
moderatorS: L. Arbour, M. L. Børresen
Dying to Be Counted: Challenging
Indigenous Infant and Child Mortality
AUTHORS: J. Freemantle1, B. Heffernan1,
D. McAullay2
University of Melbourne 1, Aboriginal Health Council of WA 2
Of all human rights, the most basic is the “right to survive”.
Infant survival is increased when the social, economic
and cultural environments are optimal for all families
in a society. It is for this reason and because it reflects
social and economic conditions that infant mortality is
widely recognised as one measure of a Nation’s overall
social prosperity. High infant and child mortality rates in
marginalised groups within Australia reflect the stresses and
challenges faced by them, not only from birth and in the first
year of life, but throughout the entire life cycle. Disparities
in infant and child mortality rates between Aboriginal and
Torres Strait Islander and non-Aboriginal groups provide
an important indicator of the health of Aboriginal and
Torres Strait Islander communities and the long term
impact that racism, discrimination and dispossession have
had and continue to have on them. Researchers in Western
Australia have developed a unique database that includes
over a quarter of a century of total population birth and
death data, with a validated Indigenous status. This paper
will present the powerful evidence-derived analysis of these
data and demonstrate how these data are being translated
into meaningful policy and practice. The paper will also
discuss Australian Indigenous health (and mortality) in
the context of data describing other colonized Indigenous
infant and child populations. It will highlight the
importance of early influences on the whole of life, not only
intergenerational influences, but periconceptional and in
the early years. Our aim is to contribute to knowledge that
will facilitate all children reaching their full potential and
becoming young people who result in the next generation
of parents who are socially and emotionally competent and
can raise children in an environment to which they can
reach their full potential.
“Children are our future. Our hopes and aspirations as people
of this world rest on their shoulders and they will carry us
with them as they grow and develop, as they walk the path
we have created for them, and in turn they will prepare a
place for us on which to rest in our later years” (Milroy 2005).
[email protected]
Postneonatal Mortality Among Alaska
Native Infants -- Alaska, 1989-2010
WEDNESDAY ORAL
survey was developed to access the career/professional and
personal situation of practitioners who support community
members in northern communities. Practitioners were
asked to list the challenges and strengths of doing the
work they do and to access how to improve mental health
services in the North. Information from formal mental
health and wellness practitioners, both those originating
in the community where they work, and those who make
the transition into northern communities, adds to our
understanding of isolated mental wellness practice. The
information and experience shared by the participants adds
important pieces to a conceptual model of isolated mental
health practice. Method: Twenty participants working in
communities in northern BC, Yukon and NWT provided
in-depth descriptions of their experience in providing
mental health and wellness support in the north. The initial
themes from the qualitative analysis were used to develop
an on-line survey reflecting the conditions, supports, and
logistics of mental health support in northern communities.
Due to the high profile of northern practitioners, a survey
was believed to be the best approach to address concerns over
anonymity in small communities. The response to the survey
versus the qualitative phase of this research project suggests
that this was an appropriate strategy to better understand
northern mental health and wellness support.The survey is
in the process of analysis and the findings will be presented
for the first time at the ICCH conference if accepted.
15:30 - 17:00
AUTHORS: M. Young, B. Gessner, Y. Goldsmith,
J. Parrish
Alaska Division of Public Health
Alaska’s postneonatal mortality rate of 3.4 deaths per 1,000
live births during 2006–2008 was 48% higher than the 2007
U.S. rate of 2.3 per 1,000. Among American Indian/Alaska
Native (AN) infants, the Alaska rate of 8.0 per 1,000 was
70% higher than the U.S. rate of 4.7. The Alaska Bureau
of Vital Statistics provided an electronic file with linked
records for all recorded live births and postneonatal deaths
among infants aged 28–364 days born to Alaska residents
that occurred during 1989–2010. Potential risk factors for
infant mortality that might be determined from information
included on birth certificates were identified through prior
research and literature review. Race was categorized as AN,
which included all indigenous groups, or non-AN, based on
mother’s race. For the analysis, logistic regression modeling
was conducted, as was joinpoint testing for significance
of trends and to detect significant points of change in the
slope of linear trends. Cause of death was obtained from
the Alaska Maternal Infant Mortality Review (MIMR), a
committee coordinated by the Alaska Division of Public
Health consisting of private physicians, nurses, and other
child health experts. Overall and non-Alaska Native rates
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declined during 1989-2009, but no significant trends in
AN-specific mortality were apparent. Infant mortality
review committee findings indicated a decline during 1992–
2007 among all postneonatal deaths attributed to sudden
infant death syndrome (SIDS) or sudden unexplained
infant death (SUID), but not for other causes. Overall rates
in 2010 were half the rates of previous years and the lowest
ever recorded for Alaska. Further analysis of the 2010
rate is needed. Current initiatives to reduce preventable
causes of postneonatal mortality need to be evaluated so
that successful models can be more widely implemented.
Rates in subsequent years should be monitored to
determine if the 2010 decline has been sustained.
[email protected]
WEDNESDAY ORAL
Understanding the Causes of Infant
Mortality in Nunavut
90
AUTHORS: S. Collins1, P. Surmala2, G. Osborne2,
L. Arbour1
University of British Columbia 1, Government of Nunavut 2
Objective: Nunavut is home to the largest Inuit population
in Canada. The infant mortality rate in Nunavut is
consistently 3 times higher than the Canadian average. We
report results from a Nunavut-wide systematic review of
causes of infant death and associated risk factors for infant
mortality from 1999 to 2011. Methods: All available cases
of live birth with death before the first birthday between July
1, 1999 and June 30, 2011 (n=115) were reviewed for cause
of death and associated risk factors. Causes of death were
categorized and, when available, gestational age at birth,
sleep position, bed-sharing, breast feeding and parental
smoking were also documented. Cases were reviewed
from the Chief Medical Officer of Health (coroner’s
reports) and through Nunavut Vital Statistics. Rates and
associated factors were compared to information reported
by Statistics Canada and the 2008 Canadian Perinatal
Report. Results: Over-all, the leading causes of death were
Sudden Infant Death Syndrome and Sudden Unexpected
Death in Infancy (SIDS/SUDI; 48%), respiratory infection
(14%) and infections other than respiratory (7%). Of cases
reporting gestational age (n=73), 38% were born premature,
representing at least 24% of the total cases. Of SIDS/SUDI
cases with information on sleep position (n=38) and bedsharing (n=43), 74% were sleeping in a non-supine position
and 72% were bed-sharing. Of those cases bed-sharing
at time of death (n=31), 24 had one or more additional
risk factors present, usually non-supine sleep position.
Conclusion: SIDS and SUDI are the leading causes of
infant death in Nunavut, followed by deaths caused by
respiratory infection and non-respiratory infection.
Further exploration as to the underlying contributors
in each category is underway (information on CPT1A
15:30 - 17:00
P479L status will be reported elsewhere). Our goal is
to understand the contributors to infant mortality in
Nunavut and to develop culturally relevant prevention
and management strategies with local partners.
[email protected]
The Healthy Native Babies Project
AUTHOR: M. Pierce-Bulger
National Institute of Child Health and Human Development
Purpose: American Indian and Alaska Native (AI/AN)
infants are two to four times more likely to die of SIDS
as white infants making it the leading cause of postneonatal deaths for Native babies. Objective: The Healthy
Native Babies Project provides Sudden Infant Death
Syndrome (SIDS) risk-reduction messages to American
Indians and Alaska Natives via culturally and regionally
appropriate training and outreach materials. The Eunice
Kennedy Shriver National Institute of Child Health and
Human Development (NICHD), working with AI/AN
stakeholders, developed this project with these deliverables:
Workbook, Resource CD, and a Toolkit program for
developing community-tailored materials; and training
sessions. The materials and training encourage further
development of community-specific cultural competence.
Each outreach coordinator, health educator, and community
partner can choose the most appropriate outreach approach
for his or her specific audience. Methods: The Eunice
Kennedy Shriver National Institute of Child Health and
Human Development assembled a work group of experts
and guided the efforts, which included conducting focus
groups to determine what SIDS risk-reduction messages
resonated with young parents and what approaches were
most effective for communicating the messages. Results: It
is important to target the entire community and parents/
grandparents are important opinion leaders in regards to
infant care. Also, media and materials should be tailored
for the Tribal and/or regional setting with colors, graphics,
photographs, and Native languages. Conclusions: The
Healthy Native Babies Project blended values and beliefs
and drew on existing strengths and traditional practices
for the conception of project materials. The project
represents an effort to add AI/AN-specific cultural
competence to recognized SIDS risk-reduction practices.
[email protected]
Carnitine Palmitoyltransferase 1A
p.P479L Variant and Unexpected Infant
Death in Nunavut, NWT and Yukon
AUTHORS: S. Collins1, G. Sinclair1, G. Osborne2,
F. Bamforth3, R. Thompson4, C. Greenberg5,
H. Vallance5, L. Arbour6
University of British Columbia 1, Health and Social Services,
Government of Nunavut 2, University of Alberta 3, Cadham
Provincial Laboratory, University of Manitoba 4, University of
British Columbia 5, Dept of Medical Genetics, University of British
Columbia 6
Although the p.P479L variant was associated with UID in
Nunavut as a whole,population stratification as an underlying
determinant of the association needs further assessment,
as does the association of other potentially interactive risk
factors. More comprehensive study is planned for Nunavut.
Evidence for an Association Between
Infant Mortality and Homozygosity for
a Carnitine Palmitoyltransferase 1A
Genetic Variant
AUTHORS: B. Gessner1, D. Koeller1, M. Johnson1,
C. Richards1, D. Sesser2, T. Wood3
Oregon Health Sciences University 1, NW Regional Newborn
Screening Program 2, Alaska Division of Public Health 3
Background: Alaska Native infants, particularly
those residing in Western and Northern Alaska, historically
have had a high infant mortality rate; this same population
recently has been found to have a high gene frequency for
a variant of carnitine palmitoyltransferase 1A (CPT1A)
(c.1436C?T; p.P479L) deficiency, one of a group of disorders
of fatty acid oxidation that has been associated with sudden
infant death. Methods: We performed an unmatched casecontrol study to determine if homozygosity for the variant
is a risk factor for infant death. Using available newborn
screening cards, cases were 110 Alaska Native infant deaths
that occurred from 2006 through 2010; controls were
395 Alaska Native births from the same time period. We
conducted two analyses to increase the likelihood of having
both cases and controls come from the Yupik/Inupiat
populations, in whom the CPT1A variant is concentrated.
The first used all genotypes but was limited to the Western/
Northern regions, which contain primarily Yupik/Inupiat
people. The second included all regions but was limited
to infants homozygous or heterozygous for the variant.
Genotyping was by an allelic discrimination assay. Results:
Among Western/Northern residents, 66% of cases and 51%
of controls were homozygous for the variant (crude odds
ratio [OR] 1.8; 95% CI: 1.0-3.3). In a multivariate model
adjusting for maternal education, prenatal substance use, and
a composite variable of marital status and the presence of a
father’s name on the birth certificate, infant mortality and
homozygosity remained associated (OR, 2.5; 95% CI, 1.35.0). Results for the all-Alaska analysis were similar. Cause
of death analysis is ongoing. Discussion: Homozygosity for
the c.1436C?T sequence variant of CPT1A is associated
with an increased risk of infant mortality. The associated
risk accounts for the majority of the increased risk of infant
mortality observed in Western and Northern Alaska.
WEDNESDAY ORAL
Carnitine palmitoyltransferase 1A (CPT1A) is a hepatic
enzyme required to use long chain fats for energy during
fasting. Classic CPT1A deficiency confers risk for nonketotic hypoglycaemia, seizures and sudden death. We
previously established that the p.P479L (c.1436C>T)
genetic variant of CPT1A is highly prevalent in Northern
and Coastal populations, in particular in Nunavut and the
Inuvialuit region of NWT. Although association with the
variant and infant mortality in BC and Alaska has been
reported, it remains controversial whether the p.P479L
variant is a risk factor itself or a marker of other risk factors
in high prevalence areas. To determine if the CPT1A
p.P479L variant is associated with infant mortality
in Nunavut, we compared the frequency of p.P479L
homozygosity in unexpected infant death (UID) cases
(SIDS/SUDI and infectious disease) to the population
homozygosity for each territory. Risk factors associated
with Nunavut cases were also reviewed (n=33). Ethics
approval was obtained from university REBs and local
research institutes, and with consultation with territorial
Aboriginal groups. Of the 99 UID cases we identified in
the three territories, 44 had genotype results. p.P479L
homozygosity was associated with increased risk for UID
in Nunavut as a whole (OR 3.21, 95%CI:1.20-10.75;
p=0.0143), but not in the Kitikmeot and Kivalliq regions
where population p.P479L homozygosity is significantly
higher, suggesting possible population stratification. All
p.P479L homozygous SIDS/SUDI cases in Nunavut were
sleeping in a non-supine position and/or were bed-sharing
at time of death. Due to small numbers, association was not
established in NWT or the Yukon.
15:30 - 17:00
[email protected]
[email protected]
91
Nutrition #5 - Changing Diets: Measurements and Risks Salisbury Theatre
The Changing Face of Subsistence in
Polar Communities: Methodologies for
Assessing Health Related Effects
AUTHORS: K. Lyncoln1, K. Boucha1, P. Anderson2
WEDNESDAY ORAL
NewFields, LLC 1, Alaska DHS HIA Program 2
The stakeholder engagement process frequently documents
community concern over potential project-related impacts
to subsistence activities. Potential impacts included changes
on quantity, quality (actual and perceived) and access to
subsistence resources. The environmental impact process
typically develops detailed subsistence resource maps that
focus on geography (resource footprint versus the project
footprint) and density (quantity of the resources within a
defined footprint).Community harvesting practices are often
assessed. Social assessment work, including “traditional and
local knowledge” surveys is an equally important tool that
contributes to the critical role of subsistence activities in
local communities. However, while both the environmental
and the social surveys are useful for the health impact
assessment, we have found that these data are potentially
insufficient for fully analyzing and categorizing potential
human health impacts from large extractive industry
projects. We describe our ongoing Alaska experience in
characterizing and profiling potential community and
household level health impacts from extractive industry
projects. The cost-benefits of community level nutritional
surveys will be presented. Trends in community level
nutritional status and behaviors will be discussed. Novel
use of store surveys and shopping practices are illustrated.
Health focused survey questions that can be readily added
to existing environmental/social surveys will be described.
[email protected]
Stable isotope Biomarkers of Traditional
and Market Food Intake in the Yup’ik
Eskimo Population: The CANHR Stable
Isotope Study
AUTHORS: D. O’Brien1, S. Nash2, A. Bersamin2,
B. Luick3, B. Boyer2
Professor 1, Center for Alaska Native Health Research, UAF 2, UAF
Cooperative Extension Services 3
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The Yup’ik population of Southwest Alaska is experiencing
a nutrition transition: intake of traditional (marine) foods is
decreasing, and intake of non-traditional foods, including
high-sugar foods, is increasing. Understanding the impact
of these dietary changes on health is crucial, especially given
15:30 - 17:00
the recent increases in obesity and obesity related chronic
diseases. However, linking dietary intake to health benefits
or risk factors is challenging because commonly used selfreported measures suffer error and bias, which can obscure
relationships. Biomarkers of dietary intake may be helpful
in dietary assessment, as they do not suffer the same error
and biases as self-report measures. We are developing
biomarkers based on naturally occurring stable isotope
ratios for the Yup’ik Eskimo population of Southwest
Alaska. In particular, the carbon isotope ratio is elevated
in foods that contain corn or cane sugar, and the nitrogen
isotope ratio is high in animal protein and fish. In this
study, we investigate the relationship between red blood cell
carbon and nitrogen isotope ratios, and intake of traditional
and marine foods in 1003 Yup’ik Eskimos participating in
the Center for Alaska Native Health Research study. We
find that nitrogen isotope ratios are strongly and positively
associated with intake of marine foods, as measured by both
self-report and marine fatty acids eicosapentaenoic (EPA)
and docosahexaenoic acid (DHA). Red blood cell carbon
isotope ratios are positively associated with total market
intake, specifically with intake of foods that contain corn
or sugar cane. We conclude that stable isotope markers
have great potential in the Yup’ik Eskimo population
as easy to measure, reliable indicators of dietary intake.
[email protected]
Alanine Stable Carbon Isotope Ratios in
Human RBC: a Powerful New Biomarker
of Sugar-Sweetened Beverage (SSB)
Intake
AUTHORS: K. Choy, S. Nash, D. O’Brien
Over the past decades, the prevalence of obesity and
type 2 diabetes has increased dramatically among Alaska
Natives. Recent epidemiological studies have suggested
that increased consumption of Sugar-Sweetened Beverages
(SSB) is associated with obesity, type 2 diabetes, and dental
caries, although these data are controversial. Thus, there is
a need for the valid and objective methods for measuring
SSB intake, to better resolve these associations. Recent
studies have suggested that the naturally-occurring carbon
isotope ratio of human serum and RBC could be potential
biomarkers of SSB intake, based on the elevated carbon
isotope ratio of corn syrup and sugar cane. However, this
association is complicated by intake of other corn products
and meat from animals that are corn fed. These concurrent
associations limit our ability to detect dietary carbon
specific to SSBs. To identify new objective biomarkers of
SSB intake, we investigated the carbon isotope ratio of
individual amino acids in human RBC, from 68 Yup’ik
Eskimo participants in the CANHR study. Amino acids
can be classified into two groups; essential amino acids
(EAAs), which must come from dietary protein and nonessential amino acids (NEAAs), which can be synthesized
from other parts of the diet. Here we present the first study
to examine associations between NEAA carbon isotope
ratios in human RBC and SSB intake. Among 7 NEAAs,
alanine carbon isotope ratios were strongly correlated with
SSB intake (r = 0.62, p<0.0001). Importantly, alanine
carbon isotope ratios were not associated with other
corn products or market meats. Thus, we propose that
alanine carbon isotope ratio of RBC might provide a
powerful, specific biomarker of SSB intake for the Yup’ik
population, and that this tool could facilitate more accurate
evaluation of the effect of SSB intake on health issues.
[email protected]
AUTHORS: L. Larcombe1, N. Mookherjee2, J. Slater2,
C. Slivinski3, M. Singer3, C. Whaley3,
L. Denechezhe4, S. Matyas3, E. Turner-Brannen3,
P. Nickerson3, P. Orr3
University of Manitoba, Faculty of Medicine 1, University of
Manitoba, Department of Medicine 2, University of Manitoba 3,
Northlands Denesuline First Nation 4
The wide spectrum of vitamin D activity has focused
attention on its potential role in the elevated burden of disease
among Canadian First Nations. Vitamin D deficiency and
gene polymorphisms in the vitamin D receptor (VDR) and
vitamin D binding protein (VDBP) have been implicated
in susceptibility to infectious and chronic diseases. We
report on vitamin D intake, circulating serum levels of
vitamin D and vitamin D binding protein, and VDR and
VDBP polymorphisms. Vitamin D intake was analyzed by
food frequency questionnaire. Venous blood was collected
from Dene and Caucasians, in summer and winter, over a
one-year period and was analyzed for 25 hydroxy-vitamin
D (25(OH)D) and VDBP concentrations. Polymorphisms
in the VDR and VDBP genes were evaluated. Compared
to Caucasians, the Dene had significantly lower median
concentrations of 25(OH)D in the winter (p<0.05) as
well as significantly lower VDBP concentrations in the
summer (p=0.005). Compared to Caucasians, the Dene
demonstrated a higher frequency of VDBP genotypes
that have high (Gc1f (p=0.005)) or intermediate (Gc1s
(p=0.005)) affinity for 25(OH)D. The Dene had a high
frequency of VDR polymorphisms associated with
infectious disease susceptibility (Fok1“f ”(p=0.003);
Bsm1“b”(p=0.003); Taq?1“T/T”(p=004)). Low winter
serum levels of 25(OH)D among the Dene are likely related
to dietary deficiency and limited exposure to sunlight. In
this context, low summer VDBP serum concentrations,
and VDBP and VDR genotypes associated with high
25(OH)D affinity, may adversely affect the diverse
functions of this vitamin and may in part, contribute to
infectious and chronic disease patterns in this population.
[email protected]
Dermal Vitamin D Production Suggested
in Man at 70oN
AUTHORS: S. Andersen, A. Jakobsen, P. Laurberg
Aalborg University Hospital
Background: Vitamin D status as measured by serum
25-hydroxy vitamin D (25OHD) is important to human
health. Dermal 25OHD production depends on ultraviolet
B light but is influenced by latitude, season, length of
exposure and skin pigmentation. Objective: To identify
factors important to s-25OHD in Arctic people. Design:
Ilulissat town and Saqqaq settlement in North Greenland
(70oN) were surveyed at four seasons. Participants were
enrolled with balanced representation of non-Inuit and
Inuit in town and Inuit in settlement, men and women,
participants aged 30-39 years and 40-49 years. Supplement
use, hours spent outdoors, and other life style factors were
determined by questionnaires. Inuit food scores were
computed from a food frequency questionnaire at inclusion.
Intake of local foods the latest week prior to data collections
was recorded. Serum 25OHD was measured. Results:
Participants were 64 Inuit and 33 non-Inuit. Traditional
Inuit diet associated with serum 25OHD (p=0.003).
Serum 25OHD was lower in non-Inuit than in Inuit
(spring/summer/autumn/winter/average: 31.4 vs 44.6/45.6
vs 49.7/44.7 vs 53.2/34.9 vs 50.9/39.0 vs 49.6 nmol/l, p=
0.002/0.62/0.19/<0.001/0.011). A marked rise in serum
25OHD was seen during spring (Inuit, p<0.001; non-Inuit,
p<0.001). It also differed with diet (Inuit, p<0.001; nonInuit, p<0.001) and hours spent outdoors (Inuit, p<0.001;
non-Inuit, p=0.012). Serum 25OHD was determined
by diet (p=0.001), season (p=0.001), gender (p=0.006)
and vitamin intake (p=0.034) in the adjusted analysis.
Conclusions: Season influenced vitamin D status in Arctic
populations beyond diet and vitamin intake and suggested
dermal 25OHD production at high latitude of 70o N.
WEDNESDAY ORAL
Vitamin D Concentrations and
Functional Polymorphisms in the
Vitamin D Binding Protein (VDBP)
and the Vitamin D Receptor (VDR) in a
Northern Canadian Dene Population
15:30 - 17:00
[email protected]
93
Infectious Diseases #5 - Sexually Transmitted Infections
15:30 - 17:00
McGown
moderator: E. Dunne & G. Wurtak
Sexually Transmitted Infection
Screening Practices among Physicians
and Community Nurses in Yukon,
Canada
AUTHORS: K. Machalek1, B. Hanley2, J. Kajiwara3,
P. Pasquali3, C. Stannard3
WEDNESDAY ORAL
Public Health Agency of Canada; Site: Government of Yukon 1,
Government of Yukon 2, Department of Health & Social Services,
Government of Yukon 3
94
Background: Yukon, a territory in northern Canada,
has one of the highest reported Chlamydia infection rates
in the country. We examined screening practices among
physicians and community nurses to elucidate factors
that may be contributing to the high rates. Methods: A
survey was distributed to all physicians in Yukon and all
community nurses in Yukon’s communities. We surveyed
sexual health assessment frequency, Chlamydia testing
frequency, and barriers to screening. Comparison of
physician testing practices was performed to another
Canadian jurisdiction which previously undertook a
similar survey. Survey results were compared to available
laboratory data in Yukon. Results: 79% and 77% of eligible
physicians and nurses, respectively, participated in the
survey. Physicians tested young females more frequently
than young males for Chlamydia. Physicians who asked
sexual health assessment questions were more likely to test
for Chlamydia in both females and males. More physicians
screened females based on risk factors compared to males.
Family physicians in Yukon were more likely to test females
for Chlamydia than family physicians in Toronto, Canada.
Community nurses had different testing patterns than
physicians, with a lower overall frequency of testing, equal
frequency of testing males and females, and in applying risk
factor-based screening to both males and females. Barriers
to screening included: testing causing patient discomfort,
patients reluctant to discuss screening, health provider
uncomfortable conducting STI tests and sexual health
assessments, amongst others. Laboratory data in Yukon
appear to confirm provider screening patterns.
Conclusions: This survey provides valuable information
on health provider screening patterns. We have some
evidence to support the hypothesis that Yukon’s testing
rates are higher than other jurisdictions. However, more
consistent application of optimal screening methods
with support to “start the conversation” around sexual
health may assist in overcoming barriers to screening
and in addressing Yukon’s high rate of Chlamydia.
[email protected]
Different Boats for Different Folks: HPV
Related Disease Prevention Equity for
Indigenous Peoples Globally
AUTHORS: G. Wurtak1, B. Lawton2, F. Cram3,
M. Heffernan4, Y. Jayasinghe5, E. Kliewer6, P. Lhaki7
International Centre for Infectious Diseases 1, University of Otago 2,
Katoa Ltd 3, RMIT University 4, Royal Women’s Hospital (Melbourne)
5
, Cancer Care Manitoba 6, Nepal Fertility Care Centre 7
Indigenous peoples in circumpolar countries have much in
common with their counterparts in other parts of the world,
including an increased risk from infectious diseases. The
Human Papillomavirus (HPV) is one of the most commonly
sexually transmitted infections, and is the main cause of
cervical cancer and genital warts. HPV is also associated
with cancers of the anus, oropharynx, penis, vagina and vulva.
Cervical cancer rates continue to be significantly higher in
Indigenous peoples than in the general populations of certain
regions and countries. A group of individuals, now known
as the International Indigenous HPV Working Group, has
collaborated since 2008 in an effort to reduce the burden of
HPV related diseases experienced by Indigenous peoples. This
working group, lead by volunteer chairs based in Canada and
New Zealand, includes members in 18 countries around the
globe. The group recently held an international symposium in
Berlin, Germany (September 2011) entitled “Prioritizing HPV
immunization of Indigenous populations”. Outcomes from this
symposium will be discussed in this presentation, with topics
including: 1) Equity tools used to address systemic disparities
in health 2) the value of inclusive, transparent, and accountable
processes; 3) rates of HPV, cervical cancer, genital warts, and
HPV vaccination among Indigenous populations; and 4)
methods used by the Maori Equity Advisory Group to assist
in achieving and exceeding HPV immunization targets among
Indigenous Peoples of New Zealand. These models, which
lead to the optimization of HPV vaccination and reduction
of the burden of HPV related diseases, may be generalizable
to similar populations in circumpolar and other countries.
Issues raised and discussed at a recent workshop focusing on
equity and prioritizing HPV immunization of Indigenous
populations will also be described in this presentation, including
considerations and methodologies leading to improvement in
HPV vaccination rates in indigenous populations globally.
[email protected]
The HPV Vaccine: Knowledge, Attitudes,
and Perceptions of Alaska Native
Parents and Daughters
AUTHOR: M. Kemberling
From 2006-2009, the Alaska Native Epidemiology Center
[email protected]
A Pilot Study of Ciprofloxacin
Resistant Neisseria Gonorrhoeae in the
Population of Nuuk, Greenland
AUTHORS: P. Clausen-Dichow, M.L. Pedersen
Queen Ingrid Health Care Centre
Introduction: For decades infections caused
by Neisseria Gonorrhoeae (NG) have been frequent in
Greenland. Formerly, penicillin was the drug of choice until
resistant NG strains developed. Single dose ciprofloxacin
is now the standard treatment. Worldwide ciprofloxacin
resistance is a growing problem affecting 65% of all NG
strains. Diagnostics has been changed from cultivation
to the utilization of a polymerase chain reaction (PCR)
test. Resistance monitoring is no longer routine, and
thus undiscovered resistant NG strains in Greenland is a
possibility. Aim: To examine the existence of ciprofloxacin
resistant NG strains among patients in Nuuk with NG
positive urine test. Methods: Follow-up study on patients
testing NG positive on a urine sample using PCR
technique (Viper®, Becton, Dickinson and Company)
administered at Queen Ingrid Health Care Centre, Nuuk,
during a 35 day period in Autumn 2011 were included.
All patients were offered a cultivation and ciprofloxacin
resistance test in addition to standard. Cultivation of GN
was performed on chocolate agar. Identification of GN
strains was performed on gram-negative, oxidase-positive,
diplococci using Minibact-N® (SSI, Denmark). Minimal
inhibitory concentration (MIC) of ciprofloxacin less than
0.032 mg/l was used as the threshold for sensitivity whereas
MIC above 0.064 mg/l was used to determine resistance.
Results: Seventy-four patients (ranging from 15-52 years
old: 36 males, mean age 28, and 38 women, mean age 23)
where tested positive for NG on urine. Seventy percent
(49/74) accepted the offer. NG was isolated in 65%
(32/49) of those tested. Of those, none where ciprofloxacin
resistant indicating a ciprofloxacin resistance of less than
3% (1/32) in Nuuk, Greenland; 95% CI: 0-9. Conclusion:
This pilot study indicates a very low prevalence of resistant
NG stains in Greenland. However, resistance may develop
in Greenland as seen world-wide, and thus a strategy for
monitoring NG ciprofloxacin sensitivity is recommended.
[email protected]
‘I Want the Kit’ - Free At-Home STD
Testing in Urban and Rural Alaska
WEDNESDAY ORAL
in collaboration with the Centers for Disease Control Arctic
Investigations Program conducted a two-phase qualitative
study on knowledge, attitudes, and perceptions regarding
cervical cancer, HPV, and the HPV vaccine among Alaska
Native parents and female adolescents. In the first phase,
eleven focus groups (n-80) were held with parents of
Alaska Native daughters and in the second phase, seventynine in-depth interviews were conducted with adolescent
females. While many parents had heard about HPV, most
were unaware of its link with cervical cancer. The majority
of parents wanted to vaccinate their daughters because
they had health and safety concerns; believed that vaccines
work; had personal experiences with cancer; or believed
that their daughters were susceptible to HPV. Reasons for
refusal included general concerns about vaccines; a need
for more information; a fear of side effects; wanting more
vaccine research; and a fear of being in an experimental
trial. The interviews with adolescent girls revealed that
many didn’t know the purpose of a vaccine and were not
familiar with basic knowledge about HPV, genital warts,
and cervical cancer. Most teens said they were interested
being vaccinated. The data findings from this project
were used to design a poster and brochure to encourage
Alaska Native families to vaccinate their daughters. The
vaccination program in Alaska appears to be working. For
the quarter ending September 30th, 2011 the Alaska Native
Tribal Health Consortium (ANTHC) Immunization
Program reported that 80% of Alaska Native 13-17 year
old girls statewide had received their first dose of the
vaccine, 67% had received their second dose, and 52% had
finished the vaccine regimen.. This presentation will review
study findings and discuss how they are being used to
promote vaccination among Alaska Native young women.
15:30 - 17:00
AUTHORS: B. Simons1, C. Jessen1, L. Rea1,
M. Barnes2, P. Barnes2, C. Gaydos2
Alaska Native Tribal Health Consortium 1, Johns Hopkins
University 2
In 2010 Alaska had the highest rate of Chlamydia and third
highest rate of gonorrhea in the United States. Alaskan
women, youth (15-24 years) and Alaska Native people
are disproportionately affected. Alaska Native health
organizations have jurisdictions over large geographic areas,
containing small isolated communities where a perceived
lack of confidentiality and privacy is an identified barrier
to accessing health care. The Alaska Native Tribal Health
Consortium (ANTHC) has partnered with the “I Want the
Kit” program (IWTK) at Johns Hopkins University ( JHU)
to provide a discrete and reliable sexually transmitted
disease (STD) testing alternative to all Alaskans. ANTHC
is the first tribal health entity to partner with IWTK at
JHU. A no-cost testing kit can be requested online at www.
iwantthekit.org. Self-administered penile, vaginal and/or
rectal swabs are sent back to JHU in a pre-paid envelope for
chlamydia, gonorrhea and trichomonas testing. Test results
for Alaskan residents are reported to ANTHC which is
responsible for patient notification and referral services.
Implementation of this public health initiative requires
95
coordination between tribal, state, federal and private
health groups. IWTK Alaska was launched in August 2011.
During the first 6 months, IWTK received 536 genital and
rectal kit requests from all regions of Alaska. To date, 127
(24%) kits were returned for testing. Rectal kit return rates
were lower (10% males, 9% females) than genital kits (29%
overall; females 35%, males 21%). Among returned kits, 7
(6.2%) tested positive; 2 (1.5%) chlamydia and 5 (4.7%)
trichomonas. Program staff has followed up with every test
result and referred participants for treatment at location of
participant choice.
Regardless of testing result, several persons selfidentified as high risk and would not have gone
in for testing otherwise. Adaptation of IWTK in
Alaska may provide a model for targeting at-risk and
less-accessible populations in remote communities.
WEDNESDAY ORAL
[email protected]
“If I Had a Hammer...”: Tools for HIV/
Sexually Transmitted and Blood Borne
Infection (STBBI) Outreach Program
Planners
AUTHORS: A. Poetz, K. Bunzeluk
National Collaborating Centre for Infectious Diseases
In response to feedback from participants at two Knowledge
Translation Forums in 2008, the National Collaborating
Centre for Infectious Diseases (NCCID) initiated an
outreach project to address both the need for evidence-based
guidance for planning and the need for knowledge translation
at the program level. The Outreach Planning Guide was the
first tool developed to assist those in public health planning
and management to develop outreach programs for the
prevention of HIV and sexually transmitted and bloodborne
Infections, and to share knowledge of current promising
practices in Canada. Since the release of the Guide, NCCID
conducted 6 regional workshops in 2010 representing 96
diverse participants from 73 organizations across Canada.
Northern regions of Canada were represented by participants
from organizations located in Nunavut, the Yukon and
Northwest Territories. In response to this feedback,
additional tools identified by outreach practitioners have
been prioritized and are under development. These tools
include a checklist based on the content within the Guide,
and a data collection tool based on program indicators. With
regard to the development of these tools, this presentation
will: a) highlight the process, b) outline the various types
of knowledge utilized. This session will share information
on the outreach planning tools which have been developed
with practitioners in northern and remote regions in mind.
[email protected]
96
15:30 - 17:00
Room 301
moderator: G. Conway
Work-Related Fatalities in Alaska: Two
Decades. 1990-1999, and 2000-2009
AUTHORS: J. Lincoln1, M. O’Connor2,
P. Somervell2, D. Hull-Jilly3, D. Lucas1
CDC/NIOSH 1, CDC/NIOSH/APRO 2, State of Alaska,
Department of Public Health 3
Background: In 1991, NIOSH established the
Alaska Field Station in collaboration with the Alaska
Department of Health and Social Services, to prevent
work-related deaths. Working through partnerships and
by applying the public health model, Alaska experienced
a 49% decline in work-related deaths from 1990-1999.
Many of the hazards faced by Alaskan workers were
exacerbated by the remoteness and cold environment.
Additional prevention efforts have continued. Methods:
The Alaska Occupational Injury Surveillance System was
used to identify all fatal work-related traumatic injuries
that occurred since 1999. Data are available on age, gender,
occupation/industry, weather and circumstances of death.
Results: During 2000-2009 there were 379 occupational
fatalities in Alaska. This is a decrease of 41.5% from the
previous decade. The occupations accounting for the
highest number of fatalities continued to be commercial
fishermen (111, 29%) and pilots (47, 12%). The most
common events or exposures leading to fatalities also
remained the same. They were related to vessels such as
sinkings or falls overboard (128, 34%), aircraft crashes
(87, 23%), contact with objects (46, 12%), vehicle crashes
(35, 9%) and assaults (29, 8%). Conclusions: Although
the occupations with the most fatalities and the events/
exposures leading to traumatic deaths have not changed
from the decade of the 1990s to the 2000-2009 decade,
there continues to be a substantial decline in the number
of work related fatalities in Alaska. NIOSH has reported
that fatality rates among crab fishermen have declined by
60% since 1999. Additionally, the aviation crash rate has
declined by 34% since 2000. Interventions that have been
developed in Alaska since 2000 include stability checks
for the Bering Sea crab fleet, and the Capstone Program
to improve aviation safety. Progress has been made, but
there remains a need for continued safety interventions
to combat the unique work hazards found in Alaska.
[email protected]
Nomadic Herder Children’s Injuries in
Mongolia
AUTHORS: N. Myagmarjav1, G. Conway2
MDI 1, NIOSH/CDC 2
[email protected]
Mechanisms of Regulation and
Interaction of Pituitary-Adrenal and
Pituitary-Thyroidal Systems in Healthy
Men and Men with Vibration Disease
AUTHORS: R. Fedina1, Y. Poteryaeva1, V. Khasnulin2,
S. Filippova3
Novosibirsk State Medical University 1, Research Center of
Experimental Medicine 2, Municipal Teachers Training University3
Background. The problem of vibration disease
keeps its medical and social importance due to high disease
incidence and a caused economic damage. Early detection
of alteration in mechanisms of regulation and interaction
of the pituitary-thyroidal-adrenal system in apparently
healthy men under the effect of the vibration production
factor will contribute to the prediction of a pathologic state.
The purpose of this study was to investigate the mechanisms
of regulation and interaction of pituitary-thyroidal-adrenal
system under the effect of vibration stress in apparently
healthy men and men with vibration disease.
Materials and methods. Our study included
995 apparently healthy men of ages 25-54 years (average
age 44.6 years) and 155 men with vibration disease of
ages 26-55 years (average age 45.2 years). The study
participants lived in 3 districts in the city of Novosibirsk
under similar conditions with relative ecological
wellbeing. A radioimmunoassay was used to determine
adrenocorticotropic hormone, somatotropine, cortisol,
triiodothyronine, tiroxine, and thyrotropic hormone in the
blood.
WEDNESDAY ORAL
Objective: This research was designed to identify the
incidence and risk factors for child labor-related injuries
and prevent further potential consequences. In Mongolia,
small children under 7 years are reported to be used as
jockeys in horse races over distances of more than 15
kilometers across the steppes. Nomadic herder children
perform multiple chores daily and may experience multiple
types of injury as a result. Methods: This study synthesized
results from a nationwide injury surveillance database, a
national child labor survey report, and a survey that had
been conducted in a rural district. The compiled data were
analyzed by Pearson’s correlation coefficient for bivariate
correlation of multiple variables using SPSS. Results:
Children’s outpatient unintentional injury morbidity rates
were 366.1-387.2 per 10,000 population aged 5-19 years in
2007-2009 in Mongolia. 91.7% of working children have
worked in agricultural sectors such as animal husbandry.
Annually, one tenth of nomadic herder children surveyed
were injured while working. Particularly, herder children
were at increased risk of serious injury including head
trauma and fractured long bones while performing animal
husbandry chores, particularly those entailing horse riding
and care of large animals. The principal animal husbandry
chores-related risk factor is riding horses, for multiple
chores and/or in races. 58.6% of nomadic children have
worked longer than 9 hours a day. The longer hours may
result in overwork-related fatigue, tending toward injuries.
Older working children were at greater risk of workplace
injury. Surveyed children and families rarely if ever wear
helmets or other protective gear. Conclusion: Nomadic
herder children and jockeys are susceptible to injuries
characteristic of their work. The older such children may
accrue more risk due to greater exposure. Policy measures
appear warranted to encourage: age-appropriate tasks;
reduce children, especially the very young, in racing and
the more dangerous herding activities; and to provide
proper training, equipment, and supervision for the older
children still involved. Thus, to improve rural families’
lifestyle environment and change their behavior is a
potentially important approach to reduce nomadic herder
children’s health challenges such as injury in Mongolia.
15:30 - 17:00
Results and discussion. The concentration of
hormones in the men with vibration disease as compared
with the healthy men is detected: adrenocorticotropic
hormone (p<0.004) by 1.5 times, somatotropine (p<0.003)
by 1.3 times, and cortisol (p<0.001) by 2 times, which
indicates hypercortisolism. T3 (p<0.02) is reduced by
2.3 times, T4 (p<0.001) is decreased by 2.1 times, and
thyrotropic hormone (p<0.001) is increased by 1.8 times
as compared with the control group. The functional
thyrotropic hormone-T3 and thyrotropic hormone-T4
interdependence is not observed in the men with vibration
disease. The T4/T3 coefficient in the control group is less
than in the men with vibration disease, 61.5 and 72.4,
respectively, which demonstrates weakening of tissue
conversion of the first hormone to the second one. Under
the effect of vibration stress, dysregulation in the system of
neuroendocrine relations caused the thyroid dysfunction.
Conclusion. Dysfunction of pituitary-thyroidaladrenal system in the men with vibration disease indicates
the alteration of mechanisms of regulation and interaction
of the pituitary-thyroidal-adrenal system. The obtained
97
data of hormone concentrations in the blood serum of
the men-donors can be used to predict, diagnose and treat
diseases, as well as to detect people having risk factors.
Research in the North #5 Research Ethics and Registries
[email protected]
moderators: A. Parkinson & J. Bull
Occupational Safety and Health of Arctic
Disaster and Oil Spill Response Workers
Doing the Right Thing! A Model for
Building a Successful Hospital Based
Ethics Committee in Nunavut
AUTHORS: G. Conway1, W. Parker2, J. Burton3
CDC/NIOSH , Parker Assoc Inc. , CDC/NIOSH Alaska Pacific
Regional Office 3
1
WEDNESDAY ORAL
15:30 - 17:00
2
There is currently very little in the scientific literature on
the topic of worker safety and health in oil spill response
in the Arctic, other ice-covered waters, and in very
cold surface environments. Instead, issues of detection,
mechanical recovery, and the in-situ burning of oil products
are the main areas of emphasis in Arctic oil spill response
research. Therefore, the purpose of this project, approved
by EPPR in Oslo, October 21, 2011, is to conduct research,
develop guidelines, and recommend effective measures
to prevent morbidity and mortality among oil spill
response workers in the Arctic environment. This project
will conduct research on oil spill response operations to
identify the hazards that oil spill response workers may
encounter, suggest strategies to either control or eliminate
those hazards, and provide information to public health
responders deployed to protect oil spill response workers.
This international, collaborative project is intended to
improve regional operational capabilities to protect Arctic
oil spill response workers by providing information to
enhance safety and health practices during an oil spill
response. The information developed during this project
will include preparedness tools that will assist governments
and agencies in identifying and controlling hazards that
may be encountered by workers responding to an oil spill in
the Arctic. The primary output, intended as a supplement
to the Arctic Council’s “Field Guide for Oil Spill Response
in Arctic Waters”, and other EPPR preparedness and
response products, will represent a significant contribution
to the understanding and control of the unique hazards
that exist to workers responding to an oil spill in the Arctic.
The information will serve to guide operational planning
and response by the indigenous peoples of the Arctic
and the eight member nations of the Arctic Council.
[email protected]
AUTHORS: M. Cole1, G. Healey2
Qikiqtani General Hospital 1, Qaujigiartiit Health Research Centre 2
There exists a need throughout the North to increase
capacity to address issues of health ethics and for community
members to better understand and share their perspectives
on this topic. Northern regions must collaborate to share
capacity, successes and experiences in order to meet the
unique needs of northern health care institutions and move
forward on this issue. To fill a critical need and to meet
accreditation standards, the Qikiqtani General Hospital
(QGH) in Iqaluit, Nunavut, Canada is in the process of
building an Ethics Committee. Capitalizing on partnerships
with other bodies both in northern and southern Canada
has proved an efficient and effective way to develop local
solutions to challenges that have been experienced both
at Qikiqtani General Hospital and in other jurisdictions.
The Ottawa Hospital Ethics Office and the active Ethics
Committee of Stanton General Hospital in Yellowknife,
NT both shared their expertise and experience, helping
provide some direction to the QGH Ethics Committee as
we move forward. At the local level, based on our shared
commitment to health care ethics, the Qaujigiartiit Health
Research Centre is an invaluable partner whose parallel
efforts to develop a northern Health Research Ethics Board
(REB) gives great synergy to the QGH Ethics Committee.
Passion and commitment, as well as administrative support
and endorsement from health care leaders, are the aspects
of successful initiatives that we have identified to date.
Using the information from both the experiences of other
partners, as well as information gathered at a retreat held
in Iqaluit in September 2011, we have developed a model
for the QGH ethics committee that incorporates multilevel perspectives, from that of community to that of
front-line worker. Ideally, the scope of the QGH Ethics
Committee will grow over time to include ethics education,
facilitation of clinical ethical consults, ethical review
of policy, advice on governance issues and involvement
and support of an external northern Health REB.
[email protected]
98
Schailble Auditorium
Sami Health Research in Norway:
Is There a Need for Indigenous
Sensitive Guidelines?
AUTHORS: V. Stordahl1, G. Toerres1, S. Moellersen1,
I.M. Eira-Åhrén2
Sami National Center for Mental Health (SANKS) 1, Norwegian
Reindeerherding Association (NRL) 2
[email protected]
Register Resources in Greenland –
Unique Nationwide Tools for
Health Research
AUTHORS: A. Koch1, M. Andersson1, N. Nielsen1,
M.L. Børresen1, B. Søborg1, J. Navne1, M. Olesen2,
K. Ladefoged2, M. Melbye1
Statens Serum Institut 1, Queen Ingrids Hospital 2
In contrast to other Arctic areas Greenland offers unique
possibilities for register-based research. Like in Denmark
every citizen is at birth assigned a unique person identifiable
number (Central Person Register number, CPR) that
follows the person from cradle to grave and identifies the
person in official registers. Unlike in Denmark, however,
where much cutting-edge register-based research has
been carried out, nation-wide registers have only to a very
limited extent been used for health research. Two registers
central to health research are the CPR register and the
Greenlandic Inpatient Register (GIR). The CPR register
comprises information of any given person’s time and place
of birth, place of living, and identity of parents. Through
database management information in the CPR register
can be extended to include among others family size
and familiar links. Thus, a database of family structure in
Greenland can be constructed offering unique possibilities
to study familial aggregation of disease. The GIR
comprises information of all hospitalizations in hospitals
in Greenland since 1987 numbering approximately
350,000, and represents an invaluable resource for health
research. The register has, however, never been used for
research. The Department of Epidemiology Research at
Statens Serum Institut, Copenhagen, Denmark, was by the
Greenland Department of Health given the task to validate
the register. The validation carried out in 2011 showed
that the register has a high degree of both specificity and
completeness, and is highly suitable for scientific studies.
Other person identifiable health registers with information
from Greenland comprise among others the Birth Register,
Cause of Death Register, Cancer Register, Reportable
Disease Register, and Pathology Register. In the
presentation an overview of health registers in Greenland
will be given, inclusive of a description of the validity of
the GIR, examples of current register-based research in
Greenland, and possible perspectives for use of the registers.
[email protected]
WEDNESDAY ORAL
Even though the Sami Parliament in1997 stated that it was
necessary with guidelines for ethical conduct in research
involving the Sami people, no such guidelines have been
developed. Contrary to countries like Canada and Australia
there are literary no debate, be it in the Sami Parliament,
the Sami society more generally or in the Academic
community as to the necessity of such guidelines, be it for
health research or research as such. Scholars in Norway
are required to submit their research protocols for review
to ethics committees. In Norway there are four national
committees for research ethics: for science and technology
(NENT), for social sciences and the humanities (NESH),
for Human Remains and for medical and health research
(NEM). NEM is an advisory body for seven regional
committees for medical research. Of the national research
ethic committees it is only the committee for Human
remains where it is mandatory that one of the members
are to have experience from research in Sami culture and
society. For a period the NEM had a Sami medical doctor
as a consultant. Drawing on the discussion in countries like
Canada and Australia as to research ethics for indigenous
people and the experiences one of us has as being a member
of the regional committee for medical research for eight
years, we will discuss why the discourse on research ethics
involving the Sami people in Norway are almost non-existing.
15:30 - 17:00
Access to Genetic Resources and Benefit
Sharing: Implications for Research in
Canada’s North
AUTHORS: J. Geary, T. Bubela
Research in northern Canada focused on Aboriginal
Peoples has historically benefited academia with little
consideration for the people being researched or their
traditional knowledge. Aboriginal groups in this region
have successfully advocated for greater control over
what research is allowed in their communities, what
happens with the data that is collected, and for equal
respect of traditional/local knowledge systems alongside
Western science. Control has been facilitated through
the settlement of Land Claims and the establishment of
Northern research institutes, such as the Aurora Research
Institute. Whether this new research framework leads
to meaningful collaborations, however, remains an open
question. Research collaborations involve multiple and
diverse stakeholders, and require legal frameworks that
facilitate trust, appropriately acknowledge contributions,
fairly distribute benefits and liabilities, and address conflict
resolution. Partnerships between academic and Aboriginal
99
WEDNESDAY ORAL
communities add a layer of complexity, as they work within
different legal and cultural systems. These complexities
result in a need to understand the legal and partnering
frameworks and communications challenges to anticipate
impediments to forming research relationships, to facilitate
trust building, and to streamline the negotiation between
academic and Aboriginal knowledge production.
A significant stumbling block towards building trust
in research is Access to Genetic Resources and Benefit
Sharing (ABS). While there are requirements that scientists
working in Canada’s north consult with Aboriginal
communities, there is no requirement for benefits sharing.
Ensuring equitable ABS could be accomplished with more
explicit guidelines for including ABS provisions in research
agreements. Such research agreements are complicated to
draft for long-term research partnerships which often change
over time. However, legal tools are available to facilitate the
development of research agreements. This talk will focus
on the Canadian environment for ABS and how we can use
existing legal tools to improve ABS which may facilitate
building trust in research relationships in Canada’s north.
[email protected]
The Alaska Area Specimen Bank: A
Tribal-Federal Partnership to Maintain
and Manage a Resource for
Health Research
AUTHORS: A. Parkinson1, S. Smith2
Centers for Disease Control & Prevention 1, Bristol Bay Area Health
Coproration 2
100
Access to banks of human biological specimens is
becoming important for research that improves human
health. Numerous health surveys have been conducted
in indigenous communities in the circumpolar countries
and many specimen collections remain that could be used
to improve the health of these populations. However,
access to these specimens is often complicated by issues
of ownership and historical unethical and undesirable
research practices. This paper describes the formation
of an Alaska Native tribal and US Federal partnership
to develop policies and procedures that would allow the
secondary use of banked specimens collected from a largely
Alaska Native population for the purposes of improving
the health of that population. The Alaska Area Specimen
Bank (AASB) currently contains 266,353 residual biologic
specimens (serum, plasma, whole blood, tissue, bacterial
cultures) from 83,841 persons who participated in research
studies, public health investigations and clinical testing
conducted in Alaska since 1961. The majority (95.7%)
are serum specimens, 77% were collected between 1981
and 1994, and 85% were collected from Alaska Native
people. Oversight of the specimen bank is provided by a
15:30 - 17:00
Working Group with representation from Tribal, State
and Federal health organizations. The specimen bank
is governed by policies and procedures developed by
the Working Group, and managed by a Specimen Bank
committee. The Tribal-Federal partnership fits well with
the Alaska Native Tribal Health system and is consistent
with tribal sovereignty and self-determination in areas of
human health research. The management structure created
includes both the cultural expertise of Tribal leaders with
the scientific and public health expertise of State and
Federal partners. This benefits not only the management
of the AASB, but also provides a forum for discussion of
proposed research involving Alaska Native communities,
and ensures ongoing review and refinement of policies and
procedures governing the operation of the specimen bank.
[email protected]
Human Biobanks in Research: Recent
Studies of Health Effects of Metals, and
Plans for Persistent Organic Pollutants.
Experiences and Plans in Northern
Sweden
AUTHORS: I. Bergdahl, G. Hallmans
Umea University
The Northern Sweden Health and Disease Study (NSHDS)
is a combination of three population-based studies that
continuously collect human blood samples in Sweden’s
two northernmost counties and store them in biobanks for
future research. These two counties belong to the Arctic
region but are culturally quite similar to Western Europe.
Sampling started 1985 and over 100,000 individuals have
been sampled at almost 200,000 occasions. These samples
form a valuable resource in studies of those environmental
pollutants that can be biomonitored through blood samples,
such as certain metals and persistent organic pollutants.
For studies of environmental health the most important
designs are the nested case-control study with prospectively
collected samples and studies of exposure time-trends.
Within the recently finished PHIME project (Public
health impact of long-term, low-level mixed element
exposure in susceptible population strata; www.phime.org),
several studies of health effects of metals have been made
within NSHDS. Case-control studies have been performed
on fractures (cadmium), uremia (cadmium, lead, mercury),
diabetes (cadmium), stroke (mercury) and acute myocardial
infarction (mercury). In addition, time-trends have been
monitored and risk-benefits analyzed for acute myocardial
infarction (methylmercury and n-3 fatty acids from fish).
In the future these biobank samples may be utilized in e.g.
studies of persistent organic pollutants (pop:s) in relation
to diabetes. For epidemiological purposes, an asset has been
the possibility to use prospectively collected samples in
environmental health studies. For the future, an increasing
number of individuals have left samples more than once,
giving further possibilities. This increases the potential
in studies were associations are evident, but with unclear
cause-effect relationship. Here, diabetes and pop:s is an
issue that needs such studies, being of great concern both
in the circumpolar regions and in the rest of the world.
[email protected]
the females in age groups 14-18, 18-39, 40-64, and >64
years respectively. We also determined overall movement
(counts/day), time spent sedentary, and bouts of activity
and inactivity. Objective measurement of physical activity
is important in assessing what elements of physical
activity are most beneficial in maintaining good health.
[email protected]
AUTHORS: G. Ferguson, D. Bergeron
Chronic Diseases #6 - Lifestyle and Interventions Duckering Room 252
moderator: M. Mau
The Alaska Native Tribal Health Consortium (ANTHC)
recently concluded a five year research grant funded
by the USDA. The community-based research project
entitled Helping Ourselves to Health (HOH): Addressing
Factors that Contribute to Obesity Amongst Alaska
Natives evaluated the dietary patterns of six Southwestern
Alaskan communities and implemented a comprehensive
multimedia intervention. The project was funded to study
the effects of the introduction of the Food Distribution
Program on Indian Reservations (FDPIR) in rural Alaska
in 2007. The FDPIR program (commodity foods) was
introduced to other American Indian reservations in 1970
but with no research component to study the effect on
health and diet the foods may have. HOH program staff
worked closely with participating communities to develop
and implement an intervention designed to prevent obesity
by promoting the increased intake of fruits and vegetables
and traditional food consumption. During the course of the
grant nutrition and health factors were evaluated in three
groups, matched by geography, size and type of traditional
foods available. One set (2) of villages was introduced
to FDPIR foods and participated in a comprehensive
intervention, one set was introduced to FDPIR foods and
received delayed intervention (after study completion), and
one set did not receive FDPIR foods and received delayed
intervention. Total diet was measured in each of the villages
pre and post intervention using a culturally validated food
frequency questionnaire developed by Sangita Sharma
PhD, director of Aboriginal Health at the University
of Alberta. Weight, height, socioeconomic factors, and
readiness to change were also evaluated pre and post
intervention. Throughout the grant cycle many unexpected
variables impacted the program such as low FDPIR
participation and HOH staff changeover. The intervention
phase of the project included the filming of Traditional
Foods Contemporary Chef/Store Outside Your Door.
Objective Measurement of Physical
Activity in Yup’ik Eskimos Using a
Combined Heart-Rate Movement
Monitor
AUTHORS: M. Bray1, J. Pomeroy2, W. Knowler2,
S. Hopkins3, B. Boyer3
University of Alaska Fairbanks 1, National Institute of Diabetes
& Digestive & Kidney Disease 2, Center for Alaska Native Health
Research, UAF 3
Regular physical activity is closely related to good health
and quality of life. Maintaining a consistently active
lifestyle helps to reduce the risk of diseases such as type 2
diabetes, cardiovascular disease, and cancer. Physical activity
comes in many forms and includes all activities with body
movement. These include activities such as hunting, fishing,
physical work, household chores, active transportation,
playing, and planned exercise. This analysis involved a
cross-sectional study of Yup’ik Eskimos in Southwestern
Alaska, many of whom still lead a traditional subsistence
lifestyle. The World Health Organization (WHO) and
Center for Disease Control (CDC) recommend that adults
get at least 150 minutes of moderate-to- vigorous physical
activity (MVPA) per week. One study suggested that total
movement in a day (counts/day) was more important
for maintaining health and reducing disease risk than
minutes of MVPA. We used the Actiheart, a combined
heart rate and movement monitor, to objectively measure
the current activity level in this study population. The
Actiheart monitor, a small chest worn device, quantifies
physical activity and its subcomponents in terms of heart
rate and body movement (counts/day) over many days in a
free-living environment. The percentage of the population
who met the minimum recommendations of 150 min/
week (21 min/day) of MVPA was 100%, 96%, 90%,
and 70% of the males and 100%, 94%, 75%, and 68% of
THURSDAY ORAL
10:30 - 12:00
WEDNESDAY ORAL
Thursday, August 9, 2012
Helping Ourselves to Health: Addressing
Factors that Contribute to Obesity
Among Alaska Native People
[email protected]
101
Overweight in Greenland - a 45 years
Follow-Up
AUTHORS: S. Andersen1, K.F. Rex2, P. Noahsen1,
H.C.F. Sørensen3, G. Mulvad4, P. Laurberg1
THURSDAY ORAL
Aalborg University Hospital 1, Queen Ingrids Hospital 2, Ammassalik
Hospital 3, Primary Healthcare Clinic 4
Background: Overweight and obesity associates
with increased morbidity and premature death in most
populations including Inuit. Obesity rates increase
worldwide and the WHO recommends monitoring. A
steep increase detected in Greenland from 1963 to 1998
warranted follow-up. Aim: To follow-up on body mass
index (BMI) and rates of overweight and obesity among
Inuit in Greenland. Methods: BMI was calculated from
height and weight measured on Inuit aged 50 years or
above surveyed in 1963, 1998 and 2008 in Ammassalik
district in East Greenland and in 1998 and 2008 in the
capital Nuuk in West Greenland. Results: Participants
were 117 (53 men/64 women) in 1963, 434 (229/205) in
1998 and 505 (258/247) in 2008. BMI was 25 kg/m2 or
above in Ammassalik men in 20.0/44.3/50.9% (p=0.001)
in 1963/1998/2008 respectively, and in 29.7/35.2/54.9%
of Ammassalik women (p<0.001). BMI was 30 kg/m2 or
above in 2.0/10.8/17.5% of men (trend, p=0.003) and in
8.3%/23.0/24.5% of women (trend, p=0.02) in Ammassalik
in 1963/1998/2008. BMI increased over the latest decade
(p=0.004). Also, BMI increased with urbanisation in men
(p=0.001; in 1998, settlements/town/city: 23.9/24.9/25.5
kg/m2; in 2008, 25.0/25.6/26.8 kg/m2) while not in
women (p=0.18; 1998, 24.0/22.7/23.9 kg/m2 ; in 2008,
26.6/25.7/26.6 kg/m2). Conclusions: Overweight and
obesity rates continue to rise over time and rise in men
with changes of societies in Greenland while not in women.
[email protected]
Improving Disparities in Diabetes
Care in Rural Native Communities:
Experiences from Alaska and Hawai’i
AUTHORS: M. Mau1, T. Mala2, M. Cotten3
University of Hawaii 1, SCF 2, ANTHC 3
102
Alaska Natives (ANs) and Native Hawaiians (NHs) comprise
a greater proportion of people living in rural areas in the US.
Despite advances in health information technology, providing
high quality health care services to remote villages and/
or communities remains a challenge. As the prevalence of
Chronic Diseases; such as diabetes, continues to grow globally,
the challenges of providing quality health care access to rural
areas with a high proportion of Native people widens the health
disparity gap. The purpose of this abstract is to explore the
challenges of providing quality diabetes care to NHs and ANs
10:30 - 12:00
in rural and remote communities and villages. The prevalence
of diabetes mellitus (DM) is increasing worldwide and native
populations are known to have an excess burden. In the US, native
populations include American Indians, Alaska Natives and
Native Hawaiians. Though numerically small compared to the
general US population, Native populations are geographically
overrepresented in rural areas in the US, including Alaska
and Hawai’i. Consequently, a substantial number of Native
individuals with DM are currently living in rural areas with
limited access to health care and specialty services for complex
chronic diseases such as diabetes. We propose a conceptual
model of diabetes care in rural and remote Native communities
and villages based on existing literature and recent studies
among Alaska Native and Native Hawaiian populations.
Though well-established clinical evidence on therapeutic goals
for DM prevention and treatment exist, challenges on how
best to implement these clinical practice guidelines in remote
Native communities remain a persistent problem. The use of
tele-health technology and training of community-based health
workers in partnership with culturally competent health care
providers and specialists that strengthen the patient-provider
relationship holds promise for improving health care access
and quality of care for diabetes and other chronic diseases.
[email protected]
Stable Isotope Markers of Sweetened
Beverage Consumption: Their
Relationships with Biomarkers of
Chronic Disease Risk in a Yup’ik Eskimo
Study Population
AUTHORS: S. Nash1, A. Bersamin2, A. Kristal3,
B. Boyer2, D. O’Brien2
Center for Alaska Native Health Research 1, Center for Alaska
Native Health Research, UAF 2, Fred Hutchinson Cancer Research
Center 3
Consumption of sugars and sweetened beverages has been
linked to increased rates of obesity and chronic diseases
throughout the US and globally. The Yup’ik population of
Southwest Alaska is experiencing a nutrition transition that
includes increased consumption of sweetened beverages
and other sugary foods, especially in youth. Here, we show
that carbon stable isotope ratios may provide markers of
sugar consumption in the Yup’ik population, however
their utility is diminished by a concurrent association
with intake of both traditional and commercial sources of
animal protein. Thus, we investigate whether correcting
carbon isotope markers using the nitrogen isotope ratio, a
known marker of marine food intake in this population,
strengthens the relationship with sugars intake in a Center
for Alaska Native Health Research study population (n =
68). We find that adjustment using the nitrogen isotope
ratio does improve the linear relationship between carbon
isotope ratios and reported intake of sugars. We then use
these markers to investigate the relationship between
sugars intake and biomarkers of chronic disease risk in
a larger study population (n = 1003). After adjustment
for age, sex, BMI and traditional food intake, carbon
stable isotope ratios were positively associated with
markers including fat mass, waist circumference, Apo-A2,
triglycerides, leptin, insulin, HOMA_IR and VLDL.
They were negatively associated with ghrelin and Hba1c.
Stable isotope markers of sugar intake suggest that
increased intake of sugar-sweetened beverages and other
sugar products impact blood sugars, and other risk factors
for TIIDM in this Yup’ik Eskimo study population.
[email protected]
Depression and Type 2 Diabetes Mellitus
Among Alaska Native and American
Indian People in Primary Care
AUTHORS: D. Dillard1, R. Robinson1, J. Smith1,
B. Khan1, E. Dubois1, M. Mau2
Southcentral Foundation 1, University of Hawaii at Manoa 2
[email protected]
Research in the North #6 - Research Methods 2 Duckering Room 352
moderators: J. Johnson & P. Bjerregaard
The Greenland Health Research
Community
AUTHOR: P. Bjerregaard
University of Southern Denmark
It is a general impression in Denmark that the Greenland
health research community is made up of a tiny group of
dedicated and somewhat geeky individuals. In order to
quantify the size of the worldwide research community
doing health research in Greenland and to map the topics
for their research, a literature survey was conducted through
Pub Med. A total of 361 publications were identified
using the search criteria ‘Greenland’ [in title and abstract],
‘human’ and ‘last ten years’. A manual purge left 265
relevant publications for further analysis. The study base
was further restricted to 198 papers in English language
published in peer-reviewed journals. A total of 169
individuals were first or last authors of these publications
with the number of authorships ranging from 1 to 23.
Only five researchers had more than ten authorships while
117 had only one. The three most prevalent topics were
environmental health, infectious diseases, and metabolic
diseases. It is concluded that the Greenland health
research community contrary to expectations is quite large
but most are temporary visitors; only 22 researchers had
more than 3 authorships and these were responsible for
half of all publications. A quantitative pilot study showed
that the topics of health research in Greenland were less
specialized than those of other research fields. Similar
studies are recommended in other circumpolar countries
as well as studies of other medical fields for comparison.
[email protected]
Validation of Household Illness Diaries
as Tools to Assess Impact of HealthRelated Intervention
THURSDAY ORAL
Objectives: To assess whether type 2 diabetes mellitus
(DM) and type 2 DM complications are associated with the
presence and severity of depression among Alaska Native and
American Indian people (AN/AIs). Design: Retrospective,
cross-sectional analysis of medical record information.
Setting: The Southcentral Foundation Primary Care
Center (SCF-PCC) in Anchorage, Alaska. Participants: A
total of 23,543 AN/AI adults. Main Outcome Measures:
Patient Health Questionnaire (PHQ) scores (0 - 9 negative,
10 - 14 mild, 15 -19 moderate, 20+ severe) and DSM-IV
depression diagnosis. Results: A depression diagnosis was
present in 5% (n=1,177) and 12% were positive on the
PHQ (4% mild, 4% moderate, 4% severe). Type 2 DM
prevalence was 7% (n = 1,526). Of those with type 2 DM,
20% (n = 294) had one or more DM complication and
34% (n = 517) had an average HbA1c greater than 7%.
In multivariate logistic regression models, type 2 DM was
not associated with PHQ severity (p = 0.887) or depression
diagnosis (p = 0.056). Increased odds of depression and
higher depression severity was associated with female
gender, younger age, being unmarried, substance abuse/
dependence, and increased ambulatory visits. Depression
was associated with number of other chronic conditions
amongst AN/AIs with type 2 DM but not associated with
number of type 2 DM complications. Conclusions: The
presence and severity of depression among AN/AI primary
care patients was not significantly associated with type 2
DM nor type 2 DM complications but was associated with
other demographic, clinical, and service utilization factors.
10:30 - 12:00
AUTHORS: T. Thomas1, T. Ritter1, M. Bruce2,
D. Bruden2, S. Bentley2, K. Hickel1, T. Hennessy2
Alaska Native Tribal Health Consortium 1, Centers for Disease
Control and Prevention 2
Background: Recent Alaskan studies demonstrated
significantly higher rates of respiratory and skin infections
in un-served (i.e. without in-home piped water and
sewage) versus served villages, suggesting the importance
of adequate water quantity to prevent ‘water-washed’
infections. We are studying the health impact of inhome piped water installed in four rural villages between
103
THURSDAY ORAL
2008 and 2011. Assessment includes review of electronic
medical records (EMR) before and after piped water
installation and collection of household illness diaries. We
report on an illness diary validation exercise. Methods:
We enrolled 1100 adults and children residents of 397
households in four villages. Household members recorded
the age group and number of individuals with symptoms of
sinus congestion, cough, skin infection and diarrhea each
week. Diaries were collected each month for period of 3
years; households were compensated per completed diary.
We searched the EMR of village health clinics for visits
between 01Jan09 – 31Dec09 with ICD-9 diagnosis codes
for sinus, respiratory, skin and gastrointestinal infections.
We linked individuals with clinic visits to their household
of residence and calculated the proportion of clinic visits
with an age-appropriate matched report of individual(s)
with related symptoms.
Results: During 2009 there were 2823 sinus congestion,
1907 cough, 742 skin infection and 376 diarrhea household
diary entries. There were 465, 286, 174 and 19 clinic visits
for sinus, respiratory, skin and gastrointestinal infections
respectively among individual study participants. Overall
23% of the clinic visits matched to a corresponding
household diary report of symptoms in a person of the
same age group. Conclusion: The concordance between
clinic visits and symptom reporting on the illness
diaries was low. Household fatigue with weekly diary
completion over an extended period may account for
this. Different strategies should be considered for more
accurate reporting when using home illness diaries.
[email protected]
Comparison Between the International
Physical Activity Questionnaire (IPAQlong) and Combined Accelerometry and
Heart Rate Monitoring in Greenland
AUTHORS: I. K. Dahl-Petersen1, P. Bjerregaard1,
M. E. Jørgensen2, S. Brage3
National Institute of Public Health, SDU 1, Steno Diabetes Center 2,
MRC Epidemiology Unit, Institute of Metabolic Science 3,
104
Background: Information about physical activity
(PA) in Greenland is limited, partly due to a lack of
validated instruments in countries with non-western living
conditions. We modified the long form of the International
Physical Activity Questionnaire (IPAQ-L) to arctic living
conditions. Objective: To compare IPAQ-L-estimates
with combined accelerometry and heart rate monitoring
(ACC+HR) in a population-based study of adult Inuit
in Greenland. Methods: Cross-sectional data collected by
face-to-face interview and ACC+HR monitoring among
Inuit (18+years) in Greenland during 2005–2010 (n=1510).
Physical activity energy expenditure (PAEE) and time spent
10:30 - 12:00
sedentary (SED) and at moderate and vigorous intensity
(MVPA) were derived from IPAQ-L and ACC+HR.
Estimates were compared using Bland-Altman agreement
analysis and Spearman correlation coefficient stratified by
sex, place of residence (capital, towns, and villages) and
age groups. Results: PAEE measured by IPAQ-L was
moderately correlated with objectively measured PAEE
(r=0.20–0.36, P<0.01). Time spent at MVPA and SED
were weakly correlated (r=0.11–0.27). The Bland-Altman
plots showed relatively small mean differences for all
measures of PA; however, the limits of agreement were
wide. Conclusion: The IPAQ-L adapted to arctic living
conditions in Greenland had a moderate level of agreement
with combined accelerometry and heart rate monitoring for
PAEE at population level but a high individual variability.
[email protected]
Household Movement Patterns in Rural
Alaska: Considerations for Study Design
AUTHORS: D. Bruden1, M. Bruce1, T. Hennessy1,
D. Hurlburt1, J. Wenger2, L. Bulkow1
CDC 1, Gates Foundation 2
Introduction: Recent epidemiologic research
studies in rural Alaska examined risk factors for infectious
diseases collected at the household level. Examples include
the health effects of inhome piped water and household
air quality. Because the exposure is measured at the
household level, it is necessary to determine if participants
remained in the same house throughout the course of
follow-up. Methods: We used data from a pneumococcal
carriage study in 8 villages (3 regions, average size 642 [182,
723] persons) of Alaska to quantify changes in household
structure and individual movements (2008-2010). Because
the same households participated in carriage surveys over
several years, we could determine changes on an annual
basis. We calculated the percentage of households with
a = 1 person change in household size from year to year.
Additionally, we present the percentage of individuals that
changed households during consecutive years. Results: In
three regions of Alaska, the average household size was
5 persons. Between 2008 and 2009, 46% (227/497) of
households had a change in their structure (= 1 person
moved in or out). 48% of households experienced some
movement between 2009 and 2010. Nineteen and 9% of
households had a change of = 2 and = 3 persons, respectively.
The percentage of households with movement was similar
between the three rural regions and varied from 39% to 63%
between villages. At the individual level, an average of 11%
of persons moved houses between years. The group with the
most movement was persons 18-29 years of age (19%) and
least movement was in 5-10 and 50-64 years (6%). There
was no difference in movement by gender. Conclusions: In
rural Alaska, 46% of households experienced movement of
individuals between years and 11% of individuals change
households. These are important demographic figures to
consider when planning and designing studies that measure
an epidemiological exposure at the household level.
10:30 - 12:00
Health Services #6 - Oral Health
Duckering Room 342
moderators: J. Butler & A. Corriveau
[email protected]
Alaska’s Dental Health Aide Program
Logical Framework Analysis: The Case
for Geographic Information Systems in
Northern Risk Communication
AUTHOR: S. Shoffstall
AUTHOR: J. McGetrick
In 1999, an Oral Health Survey of American Indian and
Alaska Native Dental Patients found that 79% of twoto five-year-olds had a history of tooth decay. Alaska’s
American Indian/Alaska Native (AI/AN) population
experience ongoing oral health disparities. The Alaska
Native Tribal Health Consortium in collaboration with
Alaska Tribal Health Organizations (THO) developed
and implemented a unique solution to address AI/AN
dental health disparities which includes a new and diverse
dental workforce model. This workforce development
has been through the introduction of the Dental Health
Aide (DHA) Initiative under the federally sanctioned
Community Health Aide Program. The DHA Initiative
introduces new dental workers who will be part of a team of
providers, with a dentist as the team leader. These new dental
team members work with the THO dentists and hygienists
to provide prevention and basic restorative services. Over
the last 10 years, Alaska’s THO have added Dental Health
Aide Therapists, Dental Health Aide Hygienist, Expanded
Function Dental Health Aides and Primary Dental Health
Aides to their dental team. These new providers, working
in tandem with their supervising dentists and hygienists,
are the framework to institute effective dental disease
prevention in our rural villages as never before possible.
School of Public Health, University of Alberta
For a comparative case study, my research is currently
centred on two communities, the Akaitcho Treaty 8 First
Nations around Blachford Lake, Northwest Territories,
and the Kluane First Nations around Burwash Landing,
Yukon. Blachford Lake is in consultations with Avalon
Rare Earth Elements Limited, and Burwash Landing
is in consultations with Yukon Hydro. In addition to
providing information about my thesis work with GIS
in risk communication, I feel that this presentation
or poster would contribute valuable insight regarding
the potential to employ Logical Framework Analysis
for sustainable development in Canadian arctic.
[email protected]
[email protected]
Prevalence and Risk Factors of ParentalReported Early Childhood Caries Among
Manitoba First Nations Children: Results
from the RHS Phase 2 (2007/08)
THURSDAY ORAL
Both the duty and the capacity to consult with First Nations
communities, regarding natural resource development
projects, has been a continual source of controversy in
Canada. With the rate of development in northern regions
poised to accelerate, it is critical that risk communication
practices, as part of environmental impact assessment
procedures, validate and enrich northern perspectives,
regarding the impacts and benefits involved. My key research
question is whether geographic information systems (GIS)
can be used to better facilitate risk communication, as
part of consultations and negotiations for environmental
impact assessments. My submission would demonstrate
the feasibility of adapting a GIS to the problem of risk
communication in the north, by presenting the deliverable
components of a Logical Framework Analysis. Logical
Framework Analysis is commonly employed by donor
agencies and development organizations involved in
planning positive projects, interventions, and programming
in marginalized communities. It consists of an iterative
process of objective-oriented research, linking the variables
for these initiatives to a set of identified outcomes and
evaluation procedures. My substantive result of this
preliminary research consists of a four by four project
table matrix, with Activities, Outputs, Purpose, and Goal
on the vertical axis, and Narrative, Objectively Verifiable
Indicators, Means of Verification, and Assumptions on the
horizontal axis.
AUTHORS: S. Halchuk1, K. Avery-Kinew2, R.
Schroth3
University of Manitoba 1, Assembly of Manitoba Chiefs 2, University
of Manitoba & Manitoba Institute of Child Health 3
Background: The First Nations Regional
Longitudinal Health Survey (RHS) is a First Nations
controlled and managed national health survey in Canada.
This longitudinal study collects information based on
both Western and traditional understandings of health
and well-being, including oral health of children and
adults. Methods: The purpose of this study is to determine
the prevalence and risk factors of parental-reported
Severe Early Childhood Caries (S-ECC), which is often
105
more frequently referred to as Baby Bottle Tooth Decay
(BBTD) by community members. A total of 29 Manitoba
First Nations participated in the RHS Phase 2 (2007/08).
A parent or primary caregiver completed an interview
administered questionnaire for each First Nations child < 6
years of age participating in the RHS. Preliminary Results:
Overall, parents of 410 preschool children responded.
According to parent reports, the majority of children
(75.1%) had S-ECC. Further, 65.0% responded that their
child had already undergone treatment to deal with their
child’s caries. While 57.2% indicated that their child had
already visited the dentist, less than half (47.4%) saw a
dental professional within the last year. Unfortunately, only
47.3% stated that their child had no current dental needs at
the time of the RHS study. Further analyses will explore the
associations between S-ECC and dietary habits and lifestyle
practices, family characteristics (e.g. parental education,
income, and history of residential school experience), and
access and availability of health services in the community
to identify risk factors for BBTD in Manitoba First Nations
preschool children. Conclusions: This evaluation will
provide evidence of the prevalence of S-ECC and its risk
factors in young First Nations children in Manitoba. This
will help inform prevention activities in these communities.
[email protected]
A Collaborative Effort in Oral Health in a
Remote Northern Health Region
THURSDAY ORAL
AUTHORS: J. Smith, C. Lennie, R. Munday
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BDHSSA
When a child has dental caries and/or gum disease there
are significant health implications. Pain resulting from
poor oral health makes eating healthy foods difficult and
comfort foods are sought, usually with minimal nutritional
value. Harmful effects include: poor nutrition; obesity
and other health related issues; trouble sleeping; and lack
of concentration in school. In the Beaufort Delta Health
and Social Services Authority (BDHSSA) of the NWT,
approximately 120 children require teeth extraction under
general Anesthesia each year. As traditional approaches in
addressing this issue have not been successful, the Beaufort
Delta Region recognized that a united approach in the
attainment of oral health was needed to change existing
cultural behavior, while at the same time maximizing
minimal resources to remote, isolated communities in the
North. Funded by the Aboriginal Health Transition Fund,
an alternative five year, comprehensive oral health program
for children aged 0 to 6 years was developed. Participants
included: physicians, dentists, home care nurses, dietitians,
speech language pathologist, an early childhood education
representative, and members of the Inuvialuit Regional
Corporation and Gwich’in Tribal Council. The purpose of
this presentation is to present the outcomes of this innovative
10:30 - 12:00
project. At the end of the presentation, participants will be
aware of strategies to use in addressing oral health care in
areas with minimal dental resources. To date, this plan has
been enthusiastically received by professionals, community
representatives, and parents. Implications for practice
include better overall health and quality of life for children.
[email protected]
A Comprehensive Multi-Level Strategy
to Reduce Oral Health Disparities
Among Alaska Native Children
AUTHOR: D. Chi
University of Washington
Introduction. Dental caries (also known as tooth decay) is
the most common disease among U.S. children. Over 75%
of Alaska Native children have a history of tooth decay,
which is nearly three times the national average. When left
untreated, tooth decay can lead to pain, infection, systemic
health problems, hospitalizations, and in rare cases death.
Furthermore, poor oral health during childhood is one of
the strongest predictors of dental disease in adulthood. The
aims of this presentation are to review the literature on
the oral health of Alaska Native children and to outline
a multi-level strategy aimed at reducing oral health
disparities in Alaska Native children. Methods. A review
of the literature was conducted via PUBMED using the
search terms “Alaska Native”, “children”, “oral health”, and/
or “disparities”. A sociocultural oral health disparities model
was used to organize identified oral health determinants
into interrelated domains, which formed the basis for a
multi-level strategy to reduce oral health disparities among
Alaska Native children. Results. Alaska Native infants,
children, and adolescents are among the most vulnerable
individuals in terms of risk for oral diseases. Systems-level
approaches such as the Dental Health Aide Therapist
(DHAT) program and high Medicaid reimbursement
rates have increased access to dental care for many
Alaska Native children. However, there is a dearth of
individual-, family-, and community-level approaches,
which overlooks the behavioral and social determinants
of children’s oral health disparities. Conclusion. To date,
strategies to improve the oral health of Alaska Native
children have focused almost entirely on systems-level
approaches. Culturally-sensitive strategies that target the
behavioral as well as social determinants of oral health
are needed to further reduce and eventually eliminate
oral health disparities among Alaska Native children.
[email protected]
Infectious Diseases #6 - Hepatitis
10:30 - 12:00
Gruening Room 206
moderators: B. McMahon & A. Koch
Inactivated Hepatitis A Vaccine
Immunogenicity: 17 Year Follow-up of
an Alaska Native Prospective Cohort
AUTHORS: G. Raczniak1, L. Bulkow1, M. Bruce1,
C. Zanis1, R. Baum1, M. Snowball2, K. Byrd3,
U. Sharapov3, T. Hennessy1, B. McMahon2
Arctic Investigations Program, Centers for Disease Control 1, Alaska
Native Tribal Health Consortium 2, Center for Disease Control and
Prevention 3
[email protected]
AUTHORS: S. Livingston, L. Townshend-Bulson,
J. Gove, C. Homan, B. McMahon
Standard treatment for hepatitis C virus (HCV) infection
prior to the 2011 approval of protease inhibitors for
genotype 1 consisted of a 24-week course of pegylated
interferon/ribavirin for genotypes 2, 3 and 48 weeks for
genotype 1. Sustained virologic response (SVR) in treatment
naïve patients (undetectable HCV RNA six months after
treatment end) has been 70-80% for genotypes 2, 3 and
40-45% for genotype 1, with reported discontinuation rates
due to side effects of = 15% in clinical trials. There have
been few published reports of HCV treatment results in
indigenous populations. We report our treatment results
in Alaska Native and American Indian persons living in
Alaska. Between 2001 and 2011, we initiated treatment
with pegylated interferon/ribavirin in 100 patients.
Treatment was conducted according to clinical practice
guidelines of the American Association for the Study of
Liver Diseases. The over-all intention to treat SVR rate was
46% (46/100), with results by genotype as follows: genotype
1, 23% (10/43); genotype 2, 70% (26/37), and genotype 3,
50% (10/20). Treatment discontinuation rate due to side
effects was 34% (34/100) over-all, including 47% (20/43)
for genotype 1; 19% (7/37) for genotype 2, and 35% (7/20)
for genotype 3. Of those who completed treatment or were
discontinued due to treatment failure (failure to achieve
2 log drop of HCV RNA at week 12 of treatment), overall SVR rate was 68% (46/66), including 43% (10/23) for
genotype 1; 81% (26/30) for genotype 2, and 77% (10/13) for
genotype 3. In conclusion, treatment response to pegylated
interferon/ribavirin in Alaska Native and American Indian
persons was limited by dropout secondary to side effects but
was similar to published reports in those who completed
treatment or were discontinued due to treatment failure.
THURSDAY ORAL
Background: CDC recommends hepatitis A
vaccination for all children at age 1 year and for high risk
adults. The vaccine is highly effective; however, duration
of protection is unknown. Methods: We recruited a
prospective cohort of Alaska Native children (n = 144)
3–6 years old who were hepatitis A virus antibody (antiHAV) seronegative. Patients were randomized to receive
HAVRIX™ (320 EU) on one of three schedules: “A”(0, 1,
2 months, n = 51), “B”(0, 1, 6 months, n = 46), or “C”(0,
1, 12 months, n = 47). Sera were obtained every 2–3 years
to determine the proportion having protective immunity
(anti-HAV =20mIU/mL). Anti-HAV geometric mean
concentrations (GMC) were compared by schedule at 10,
12, 14 and 17 years using ANOVA. Results: Twenty (87%)
of 23 schedule A participants had anti-HAV titers =20mIU/
mL at 17 years, which are similar to results at 12 (81%)
and 14 (86%) years. Likewise, 17 (100%) of 17 schedule B
and 18 (95%) of 19 schedule C participants had protective
antibody levels after 17 years. Schedule A participants had
significantly lower (P = 0.028) anti-HAV GMC (129mIU/
mL) than schedules B (235mIU/mL) and C (391mIU/mL).
Between 10–17 years, anti-HAV GMC for each schedule
demonstrated no significant decrease (P = 0.563). After
adjusting for peak anti-HAV levels, the antibody levels did
not differ for the three schedules over 17 year follow-up (P
= 0.916). Conclusion: These data demonstrate protective
anti-HAV levels persist 17 years after vaccination,
indicating booster doses are not needed at this time. Stable
anti-HAV GMC levels over the past 7 years indicate that
interval reassessments are needed to determine how long
protective antibody levels persist. Keywords: hepatitis
A, inactivated hepatitis A vaccine, RNA virus infections,
enterovirus infections, immunogenicity, infectious hepatitis
Treatment of Hepatitis C in Alaska
Native and American Indian Persons
[email protected]
Exploring the Role of Immune-Mediated
Destruction During Chronic Hepatitis B
Infection
AUTHORS: B. Simons1, M. Apodaca2,
T. Choromanski1, D. Pratt1, C. Morishima2, C. Knall3,
B. McMahon1
Alaska Native Tribal Health Consortium 1, University of
Washington 2, University of Alaska, Anchorage 3
The Hepatitis B Virus (HBV) activates strong immunemediated liver damage resulting in complications of
chronic HBV. Chronic HBV manifests in many ways,
107
THURSDAY ORAL
some chronic carriers experience active disease with high
levels of HBV DNA and liver inflammation while others
experience inactive disease with low HBV DNA and no
liver inflammation. Approximately 20% of chronic carriers
will continue to fluctuate between an inactive and active
phase of disease. Thus, HBV prognosis is difficult and often
requires invasive methods such as liver biopsy, a method
unavailable to remote communities. Host factors, such
as immunity, that predict chronic HBV progression are
unknown. Regulatory T cells (Tregs) are an important part
of the balance between immune-mediated viral clearance
and immune-mediated damage. Whether in this case Tregs
are detrimental or beneficial is not yet determined. We
designed this study to compare the presence and function
of Tregs in inactive and active chronic carriers. Peripheral
Blood Mononuclear Cells (PBMC) were assessed by
flow cytometry for the frequency and phenotype of Tregs
amongst the chronic HBV carriers. Direct ex vivo cultures
were also established to assess the function of Tregs in
HBV-specific immune responses and compare Treg
function between inactive and active HBV carriers. Our
findings indicate significantly higher frequencies of Liverspecific Tregs in the inactive carrier group.
Analysis of overall immune function and specific Treg
function in chronic HBV disease was conducted. Data
revealed a direct role in HBV-specific Treg activity
in both active and inactive HBV carriers reflected in
an increasing trend in HBV-specific responses in the
absence of Tregs. Overall HBV-specific inflammatory
immune responses in active HBV carriers were increased
as compared to the inactive HBV carrier group.
Understanding what characteristics of immunity coincide
with control of chronic HBV provides the potential for
new, less invasive, diagnostic tools in chronic HBV care.
[email protected]
Clinical Burden of Chronic Hepatitis B
Carriage in Greenland. A PopulationBased Longitudinal Study
AUTHORS: M. L. Børresen1, K. Ladefoged2,
M. Melbye1, I. Kleist2, A. Koch1
SSI 1, Dronning Ingrids Hospital 2
108
Hepatitis B virus infection (HBV) is endemic in
Greenland with 7% of the population being chronically
infected (HBsAg-positive). However, the incidences of
acute viral hepatitis, liver cirrhosis, and liver cancer are
less frequent than expected in the same population. In a
prospective cohort study we determined the clinical burden
of chronic HBV-infection in Greenland. Methods In total,
8976 Greenlanders (16% of the Greenlandic population)
participated in two population-based surveys in 1987 and
1998. Stored serum from these surveys were tested for
10:30 - 12:00
HBV-markers. In 2009, we conducted a follow-up study
of all originally HBsAg-positive persons alive by January
2009 age and sex matched 1:1½ to HBV-immune and 1:1½
to HBV-negative individuals. In 2009/2010, consenting
participants were re-tested for HBV-markers and tested
for liver enzymes, besides filling in a questionnaire. Odds
ratio were estimated by linear regression. Results in total,
1870 persons were invited. Participation rate was 64%. Less
than 4% (10/252) of chronic infected were aware of their
HBV-status, and only 4% of participants knew of having
been HBV tested at any time. The adjusted geometric
mean (GM) of Alanine Amino Transferase (ALT) of
chronically infected was significantly higher (42.9, 95%CI
40.5-45.5) than those of immune (36.6 95% CI 35.1, 38.2)
and HBV-negative persons (36.8 95% CI 35.4, 38.4).
However, none of the chronic carriers reported icterus or
cirrhosis. Chronically infected had significantly higher
intake of alcohol and cigarettes, but self-reported health
was not significantly different from that of controls .
However, none of the chronic carriers reported icterus or
cirrhosis. Chronically infected had significantly higher
intake of alcohol and cigarettes, but self-reported health was
not significantly different from that of controls. Discussion
Despite being a high-endemic country our survey showed
very little awareness of HBV in Greenland. Chronic carriers
had significantly higher ALT levels than controls, but did
not seem to have clinical manifestation of chronic HBVinfection. This supports the common notion that HBVinfection appears less severe in Greenland that elsewhere.
[email protected]
Long-Term Follow-up of Chronic
Hepatitis B Virus Carriers in the
Canadian North
AUTHORS: G. Minuk1, S. MacRury1, N. Coleman1,
K. Cummings1, C. Osiowy2, J. Uhanova1
University of Manitoba 1, National Microbiology Laboratory 2
Background: Previous clinical experience and
limited, single-community studies have suggested that
chronic hepatitis B virus (HBV) infections in the Canadian
North are not associated with significantly increased
morbidity or mortality. Objective: The principal objective
of this study was to document morbidity and mortality rates
in chronic hepatitis B surface antigen (HBsAg) positive
carriers and compare the findings to age/gender matched
HBsAg negative controls residing in 12 communities on
Baffin Island, Nunavut, Canada. Methods: In 1983-85,
168/3,267 (5.1%) residents of Baffin Island tested positive
for HBsAg during a sero-epidemiologic survey of HBV
in Canada’s North. Of these, hospital and/or vital statistics
records were available for review in 114 (68%) cases. The
mean age at diagnosis of the HBsAg+ carriers was 38 ± 17
years and 69 (61%) were males. Median follow-up was 23
years (range: 2-28 years). Controls (N=114) were matched
for age (± 5 years) and gender from the same communities.
Median follow-up in the control cohort was also 23 years
(range: 12-28 years). Of the 114 HBsAg+ carriers 12 (11%)
were HBeAg and 90 (79%) anti-HBe positive. In the 70
individuals in whom viral quantitation could be performed,
the median viral load was 4.3 log 10 IU/ml (range: 2.3-8.8
log 10 IU/ml) and all were genotype B (subgenotype B6).
At last follow-up visit, 12/66 (18%) HBsAg+ carriers had
elevated ALT levels versus 7/52 (14%) controls (p=0.49).
Bilirubin levels were increased in 3/66 (4.5%) HBsAg+ and
0/50 (0%) controls (p=0.13). Hospitalizations for hepatic
disorders were also similar in the two groups (HBsAg+:
4/114 (3.5%) versus controls 1/114 (0.9%), p=0.39). A total
of 44/114 (39%) HBsAg+ carriers died during the 23 years
of follow-up compared to 45/114 (40%) controls (p=0.89).
Mean ages at death were 68 ± 12 years (range: 4389 years) versus 66 ± 16 years (range: 27-88 years)
respectively (p=0.88). Liver related deaths were 0/44
(0%) and 2/45 (4.4%) respectively. Although viral loads
and the presence of pre-core mutations correlated with
death in the HBsAg+ carriers, neither variable remained
statistically significant following multivariate analysis.
Conclusions: The results of this study indicate that
chronic HBV infections in the Canadian North are
not associated with significantly increased morbidity or
mortality rates in genotype B, subgenotype B6 carriers.
[email protected]
AUTHORS: B. McMahon1, S. Negus2, M. Snowball2,
C. Homan2, L. Bulkow3, M. Bruce3,
B. Simons2, S. Livingston2
Alaska Native Tribal Health Consortium and AIP/CDC 1, Liver
Disease and Hepatitis Program, ANTHC 2, Arctic Investigations
Program, NCEZID,CDC 3
Alaska Native (AN) People have high rates of chronic
hepatitis B virus (HBV) and hepatocellular carcinoma
(HCC). Over 80% of those infected live in rural
communities. Person with chronic HBV infection have a
15-25% lifetime risk dying prematurely of HCC or cirrhosis
without proper management. During a population-based
screening program in the 1980’s, 1360 persons with chronic
HBV were identified and a Registry was established by
the Liver Disease and Hepatitis Program (LDHP) of
the Alaska Native Tribal Health Consortium (ANTHC).
Since 1982 persons with chronic HBV have been tested
for alpha-fetoprotein every 6 months to attempt to detect
hepatocellular carcinoma at an early and treatable stage.
After 2001, when oral antiviral therapy became available,
aminotransferase levels (ALT and AST) were added.
Quantitative HBV DNA testing of persons with elevated
ALT/AST levels is performed at the Alaska Native
Medical Center (ANMC) Molecular Biology Laboratory.
Patients receive treatment following the evidenced-based
Practice Guideline for Hepatitis B of the American
Association for the Study of Liver Diseases. In the ensuing
27 years, 53 Alaska Native Persons were found to have
HBV associated HCC; 47 (88.7%) HCC at a potentially
removable stage, 34 of whom underwent surgical resection
and the other 13 were treated with either alcohol injection
of the tumor or radiofrequency ablation. Of the six where
it was not possible to potentially remove the entire tumor,
four received transarterial chemoembolization and two
with large tumors received only palliative treatment.
Ninety patients have received antiviral therapy for
chronic hepatitis with moderate to severe fibrosis, all
but four received oral nucleos(t)ide analogues. Since the
advent of treatment, only two patients have developed
decompensated cirrhosis, both also had a history of
heavy alcohol use in addition to HBV. This program
demonstrates that management of chronic HBV care can
be provided to persons living in rural Arctic Communities.
[email protected]
Healthy Communities #7 - Environmental
Contaminant and Toxin Threats
Salibury Theatre
moderators: J. Berner & A. Ratio
Human Health vs. Lifestyle and
Environment in Greenland: Genetics,
Biomarkers and Effects – an Overview
AUTHOR: E.C. Bonefeld-Jorgensen
Centre for Arctic Medicine, Aarhus University
An overview will be presented that summarizes data from
Greenland on human biomarkers of persistent organic
pollutants (POP) exposure and health effects. The focus
will be on the hormone disruptive potentials, health risk
and genetic sensitivity biomarkers. Biomonitoring in
Greenland showed a general geographical and gender
differences of serum POP levels, which were primarily
related to diet and lifestyle. High intake of traditional
Greenlandic diet and smoking caused higher concentration
of POPs in the blood. The highest POP values were found
on the East coast of Greenland. A general inverse relation
between high serum POP concentration and estrogen
receptor and aryl hydrocarbon-receptor transactivity but
a trend towards increased androgen- receptor activity
THURSDAY ORAL
Clinical Management of Chronic
Hepatitis B Infection in Alaska Native
People: Outcome and Effectiveness
of Surveillance for Early Detection of
Hepatocellular Carcinoma and Antiviral
Therapy to Prevent Cirrhosis
10:30 - 12:00
109
was found. In conclusion, the actual mixtures of serum
POPs in Greenlandic Inuit have an endocrine disrupting
potential. A survey of perfluorinated compounds (PFCs)
in Greenlandic Inuit showed a trend to higher PFCs in
the Nuuk compared to non-Nuuk Inuit. In general male
had higher serum levels of PFCs. A recent study on breast
cancer risk in Greenlandic Inuit showed that the cases
had significantly higher level of legacy POPs and PFC
compared to their controls. Also the frequency of certain
gene polymorphisms differed between the cases and
controls. Whether epigenetic changes upon exposure to
POPs might be involved in the risk of breast cancer will
be discussed.
have the estimated “safety” limits or cut-off-points to be
used in every day-life, e.g. for the most sensitive groups
of exposed populations, pregnant women and children.
New methods for risk estimation and characterization
are needed for giving e.g. dietary recommendations.
The studies were carried out with financial support from
the Danish Ministry of the Environment (DANCEA),
the Health Science Research Council, Aarhus
University Research Fund, The national Institute of
Health (NIH, United States), and the European Union
University of Alaska Fairbanks 1, Nestle Purina 2
[email protected]
Health Risks of Populations Living in
the Arctic
AUTHORS: A. Rautio1, A. Huusko1, K. Abass1,
P. Nieminen1, H. Lehtiniemi1, K. Vähäkangas2
THURSDAY ORAL
University of Oulu 1, University of Eastern Finland 2
110
10:30 - 12:00
The effects of global and climate change affect Arctic
regions and populations living there even more than other
global areas. The changes have been already noticed in
the environment, livelihoods, diets and living conditions,
which all include also new diseases and risks for human
health and well-being to be taken into account with the old
killers, smoking and substance abuse. In the on-going EUfunded research project ArcRisk (Arctic health risks) we
have focused on contaminant exposure – health outcome
relationships based on published epidemiological and
other articles, reports and reviews. By using meta-analyses
and other statistical methods our aim is to estimate
exposure levels (cut-off-points of exposure) beyond which
adverse health effects are more likely to occur in exposed
populations. We didn’t find any correlation in the review
of PCBs and sex-ratio. Classical meta-analysis has been
shown to be impossible due the difficulties to harmonize
published studies according to statistical standards (e.g.
unhomogeniety of populations, statistical methods used
or poor documentations of results). Same difficulties are
also found in the cases to study the possible correlations
between contaminant exposure and birth weight or child
development. As conclusions, in the case of exposure
to environmental contaminants there is a need for
harmonization of study designs as much as possible
before the risks for human health can be scientifically
evidence-based way to estimate. However, we need to
[email protected]
Sled Dogs as Indicators of Climate
Change and Resultant Contaminant Fate
and Transport Along the Yukon River
AUTHORS: L. Duffy1, K. Dunlap1, A. Reynolds2,
C. Gerlach1
Mechanisms involving oxidative stress and inflammation
have been proposed to explain associations of pollution from
a changing environment with cardiovascular morbidity. Rural
circumpolar people have exhibited a low incidence of obesity,
diabetes, and cardiovascular disease. These health benefits
are attributable to a subsistence diet that is rich in omega-3
fatty acids and antioxidants that reduce oxidative stress and
inflammation. Pollution, both global and local, is a new threat
to subsistence diets through the introduction of contaminants
in a variety of ways into the food system. For example,
Northern indigenous people and their sled dogs are exposed
to both air and water contaminants, including mercury, that
accumulate in the fish and game. Since sled dogs in Alaskan
villages are maintained on the same subsistence foods as their
human counterparts and are exposed to the same air and water
pollution, biomarkers such as antioxidant status, cytokine
levels and metals were measured in village sled dogs along the
Yukon River. A reference kennel, maintained on a nutritionally
balanced commercial diet was also measured for comparison.
Hair samples taken from rural and kenneled sled dogs indicate
that higher mercury levels (though still below EPA levels of
concern) were correlated with decreased total antioxidant
power in the blood. Inflammatory biomarkers did not show a
trend in relation to mercury in this study. Funded by: USDA
grant 2005-34495-16519 and NIH grant U54 NS41069
[email protected]
Tissue Type and Food Processing
Considerations for Hg Exposure via
Marine Subsistence Foods in Alaska
AUTHORS: T. O’Hara1, J.M. Castellini1, C. Lieske1,
S. Moses2
University of Alaska Fairbanks 1, Great Lakes Indian Fish &
Wildlife Commission 2
We determined inorganic and organic nutrient and
contaminant concentrations in subsistence foods consumed
by Alaska Natives in two rural communities (not on road
system) poised along the western coast of Alaska. This
assessment focuses on fish, but does include a seal species
(spotted seal). We assessed concentration changes related
to common preparation methods and by tissue type for a
variety of vertebrates used as food, but will focus on marine
species for this effort. We compare these concentrations to
various fish consumption guidelines (e.g., World Health
Organization, U.S. EPA, and State of Alaska) and other
measures of exposure such as Tolerable Daily Intake Limits
(TDIL). We highlight the differences in tissue type and
that cooking altered mercury (Hg) concentrations in most
of the food studied. For example, the TDIL was exceeded
in a 100 g serving of seal for THg in raw and fried liver
and boiled kidney; and MeHg in dried muscle and raw and
fried liver. However, toxicity potential is likely reduced by
the element form (i.e, inorganic Hg) and the presence of
protective nutrients such as Se and polyunsaturated fatty
acids (PUFAs). We conclude preparation methods alter
wildlife tissues from their raw state, significantly affecting
Hg concentrations in a manner deserving of further scrutiny.
Thus we provide evidence that direct evaluation of actual
food items is warranted to determine risk-benefit ratios of
traditional diets. Traditional foods provide many essential
nutrients with a very limited risk from contaminants. We
encourage continued consumption of traditional foods,
and urge public health agencies to develop applicable
models for providing consumption advice, incorporating
food processing considerations to allow for more public
confidence in the quality of their subsistence resources.
10:30 - 12:00
at the military site and also examined Yupik traditional
foods for contaminants to inform community decisions
and interventions. They conducted sampling to assess
contamination from the military site. Results show elevated
levels of contaminants in the watershed at Northeast Cape,
an important traditional subsistence use area and village
site prior to the military occupation. In order to assess
dietary exposures, community researchers collected several
hundred samples of the diverse species that are important
in the traditional diet. Rendered oil samples contained the
highest PCB concentrations, ranging from 200-450 ppb in
seal species. For unlimited fish consumption, EPA’s riskbased consumption limit for PCBs in fish is 1.5 ppb to avoid
excess risk of cancer. Since the Yupik people sustain cultural
ways of life that rely on traditional foods, dietary exposure
is likely a significant source of the PCBs, particularly
rendered oils and blubber. Researchers are working with
community leadership on SLI to develop collaborative
interventions that will eliminate and reduce exposures.
This presentation will include discussion of the research
results, collaborative interventions and policy engagement
[email protected]
Healthy Families #6 - Birth Defects and Genetics
McGown
moderator: L. Arbour
Community-Based Research and Policy
Engagement to Protect Environmental
Health on St. Lawrence Island, Alaska
AUTHORS: J. Schoellhorn, J. Sharpe, J. Bisson,
S. Longacre, A. Camerlin
AUTHORS: P. Miller1, V. Waghiyi2, G. WelfingerSmith3, D. Carpenter3
Alaska Community Action on Toxics 1, Alaska Community Action on
Toxics/Native Village of Savoonga 2, University at Albany School of
Public Health 3
Community-based participatory research demonstrates
that the Yupik people of St. Lawrence Island (SLI) in
the Bering Sea region of Alaska, receive disproportionate
exposures from contaminants through long-range transport
and military sources. Community concerns prompted a
study which demonstrated that blood serum of the Yupik
people contained PCB levels significantly above those of
the general U.S. population. This research suggests that
atmospheric transport of PCBs contributes to levels in the
Yupik people, and that the abandoned military site at the
Northeast Cape on SLI also contributes to the human body
burden in those individuals who have either spent substantial
time or consumed food from there. The collaborative
research team conducted investigations of contamination
State of Alaska
Introduction: The Alaska Birth Defects Registry
(ABDR), the state’s source for measuring the prevalence
of congenital anomalies in Alaska populations, employs
multi-source, passive surveillance methodology. Prevalence
estimates are generally based on cases reported under
qualifying ICD-9 codes and not routinely verified through
medical record reviews. Evaluations of the Registry have
demonstrated that while sensitivity is high, the positive
predictive value of reports to ABDR may vary substantially
by condition. In 2010, the registry enhanced surveillance
to include case verification for ten sentinel conditions.
The purpose of this report is to present verified prevalence
estimates for these conditions, to assess trends and to
examine Alaska Native/ non-Native disparities.
Methods: For children born in 1996 and forward,
every report to the ABDR of a sentinel condition was
systematically verified through on-site medical record
review using established case definition criteria. Verification
THURSDAY ORAL
[email protected]
Estimating Birth Defects Prevalence in
Alaska: Enhanced Passive Surveillance
and Revised Estimates for Sentinel
Conditions
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reviews were conducted at all sources until reported
diagnoses were either confirmed or ruled out. For each
condition, we calculated positive predictive value, statewide
and population-specific prevalence and associated trends.
Results: The positive predictive value of a report
to the ABDR ranged from 21% for omphalocele to
84% for cleft lip with or without cleft palate. After
confirmation, cumulative statewide prevalence estimates
were significantly higher than national estimates for 5 of 8
conditions (cleft lip, cleft palate, gastroschisus, fetal alcohol
syndrome and Hirschsprung’s disease). Alaska Native
children had higher rates than non-Native children for all
sentinel conditions except spina bifida aperta. Within the
birth cohorts studied, significant declines were seen for the
Alaska Native population for neural tube defects and fetal
alcohol syndrome.
Conclusions: Alaska Native children are at
higher risk of being born with the birth defects
we studied, but when preventive interventions are
available and implemented, excess risk is diminished.
[email protected]
10 Year Review of Congenital Anomalies
in Yukon
AUTHORS: S. Ryan1, A. Ionescu1, L. Arbour2,
B. Hanley1
THURSDAY ORAL
Yukon Health & Social Services 1, University of British Columbia 2
112
Background:
The
Congenital
Anomalies
Surveillance Yukon project was developed to create a
surveillance registry for reportable congenital anomalies
(CAs) in children born to Yukon residents from the prenatal
period to 1 year of age. Objective: This study creates a
baseline of CAs in Yukon by reviewing the incidence of
CAs at Whitehorse General Hospital (WGH) over a
period of 10 years. Methods: The chart review consisted
of births registered at WGH between January 2001 and
December 2010. Births with major CAs identified by one
year of age were registered in the EUROCAT database.
The surveillance cohort consisted of all births previously
Q-coded (and some E-coded) using ICD-10. Additionally,
medical records of healthy newborns were reviewed where
indicators in the WGH Meditech database suggested
a risk for CAs. Finally, we performed an internal audit
by reviewing the medical charts of a randomized cohort
of healthy newborns to determine if any cases had been
missed.
Discussion: This study is an important step in
the development of a CAs registry that will assure full
ascertainment and analysis of rates, trends and validation
of CAs within Yukon. Cases were ascertained from WGH
10:30 - 12:00
births which account for approximately 85-90% of Yukon
births which average around 350 a year. However, each
year approximately 25-35 women give birth under the
care of a midwife or in BC or Alberta due to the lack of
tertiary health care facilities in Yukon. Accessing these
medical records can be difficult and thus we may not
have captured all significant data. As a consequence our
current dataset may not reflect our population accurately.
Conclusion: This study will provide Yukon with a baseline
incidence of CAs and will inform CAs surveillance
moving forward. Work is in progress to obtain data on
those births to Yukon women occurring outside WGH.
[email protected]
Genetic History of Ethnic-specific
Diseases in Siberian Yakut Population
AUTHORS: V. Stepanov1, N. Maximova2, V.
Kharkov1, K. Kurtanov2, A. Marusin1
Institute for Medical Genetics, SB RAMS 1, Yakut Scientific Cenrtre,
RAMS 2
The phenomenon of accumulation of rare genetic diseases
in isolated populations with founder effect is well known.
French Canadians, Ashkenazi Jews, Finns, Afrikaners
are among the examples. In Arctic Russia the Yakut
population is characterized by the accumulation of several
monogenic disorders with the prevalence in Yakuts more
than ten times higher that anywhere in the World. Such
diseases as spinocerebellar ataxia 1, myotonic dystrophy,
inherited methemoglobinemia, oculopharyngeal muscular
dystrophy (OPMD), Yakut short stature syndrome (3M
syndrome) and recently described SCOP syndrome belong
to the list of “Yakut” diseases. The Yakuts are Mongoloid
Turkic-speaking population isolated in the northeastern
part of Siberia who emigrated from southern to northern
Siberia in the 13th or 14th century. The population
showed a bottleneck effect at some point, suggesting that
they are a genetic isolate. We have investigated the genetic
variability in Yakuts using Y-chromosomal, mtDNA,
X-chromosomal markers and genome-wide single
nucleotide polymorphisms, and found reduced genetic
diversity associated with the bottleneck effect. This effect,
according to phylogeny of specific Yakut Y-chromosomal
lineages, is dated back to 11th – 12th centuries. Haplotype
analysis of CUL7 gene in 3M syndrome, NAG gene in
SCOP syndrome and PABPN1 gene in OPMD suggested
that the accumulation of the disorders in Yakuts was driven
by two major events: (1) a bottleneck about 1000 years ago,
associated with the initial migration of ancestors of modern
Yakuts from south to north; and (2) population expansion
approximately 350 years ago when Yakuts extended from the
central part into the territory of their modern settlement.
Population screening and DNA diagnostics algorithms
of Yakut-specific disease is currently under development.
10:30 - 12:00
We suggest that research of Mendelian and common
diseases in isolated Siberian populations may provide a
new source of understanding of disease genetics, as well as
improving the quality of health care to indigenous peoples.
[email protected]
Evidence for an Association Between
Clinical Outcomes and a Carnitine
Palmitoyltransferase 1A Genetic Variant
AUTHORS: B. Gessner1, M. Gillingham1, T. Wood2,
D. Koeller1
OHSU 1, Alaska Division of Public Health 2
[email protected]
Social Determinants of Health - Social Determinants
of Circumpolar Health
Room 301
moderators: D. Driscoll & K. Young
Health and Other Characteristics of
Aboriginal Children Who Have Ever Been
Removed From Their Homes
AUTHOR: X. Cui
Alberta Center for Child Family and Community Research
The number of children who are involved with child
Aboriginal children who were reported by parents/
guardians to have ever been removed from their homes
face multiple challenges. They tend be less healthy in
general and more specifically they have a higher rate of
Fetal Alcohol Spectrum Disorder, asthma, and other
chronic health conditions. They also tend to have more
behavioral and developmental issues such as attention
deficit disorders and speech and language delays.
[email protected]
Self-Rated Health Among Indigenous
Adolescents: Similarites and Differences
in Associated Risk and Protective
Correlates Among Greenlandic Inuit and
Norwegian Sami
THURSDAY ORAL
OBJECTIVE: Alaska Native and other circumpolar
indigenous populations have a high frequency of the
c.1436C?T sequence variant of carnitine palmitoyltransferase
type 1A (CPT1A).This variant results in a decreased capacity
for ketogenesis but only a partial loss of enzymatic activity.
Nevertheless, we hypothesized that this CPT1A variant was
associated with outcomes identified in Alaska Division of
Public Health databases. PATIENTS AND METHODS:
As part of a quality control exercise at the Alaska Newborn
Metabolic Screening Program, we conducted genotyping
for 2499 consecutively born Alaskan infants and included
in the current analysis all 616 Alaska Native infants with
birth certificate data available. For 435 children, we linked
data to Alaska Medicaid billing claims when the children
were age 2-2.5 years. RESULTS: Among 152 homozygous
variant, 219 heterozygous, and 245 homozygous wildtype
infants, we found an association between homozygosity for
the variant and lower mean birth weight. We also found
that homozygous variant infants had an increased risk of
otitis media, lower respiratory tract infection, respiratory
syncytial virus infection, and hospitalization for LRTI
(adjusted odds ratios, 2.0 to 2.5). CONCLUSION: The
c.1436C?T sequence variant of CPT1A is associated with
various adverse clinical outcomes, providing support for
definitive identification of newborns and development
of evidence-based clinical management guidelines.
welfare system is increasing and Aboriginal children
are over represented in Canadian child welfare system.
Data and information is lacking for Aboriginal children
especially young children who are off reserve and
experiencing maltreatment. A good understanding of the
health and characteristics of these children, the social and
living conditions, and the family environment they live in
is important for the improvement of child intervention
services and to ensure the healthy development of these
children in a safe and enriched environment. Early
childhood is a critical time period for brain development,
child maltreatment whether it is in the form of abuse or
neglect is a toxic stressor and has strong negative impact
on a child’s life and has long-term effects on child’s
mental and physical health. The Aboriginal Children’s
Survey conducted by Statistics Canada in 2006 surveyed
Aboriginal children under 6 years of age who were living
off reserve in Canada. This is an extensive survey that was
designed to provide information of the development of
Aboriginal children and the social and living environment
in which they are growing in. Current study based on the
survey data provides a description of the social demographic
characteristics, the family environment, and the health, and
the developmental issues of children who had contacts with
the child welfare system and those who are in foster care.
AUTHORS: A. Spein1, C.P. Pedersen2, A.C. Silviken1,
M. Melhus1, S.E. Kvernmo3, P. Bjerregaard2
Center for Sami Health Research 1, Public Health in Greenland,
National Institute of Public Health 2, Department of Child and
Adolescent Psychiatry 3
Abstract Objectives: Self-rated health (SRH)
and associated risk and protective correlates were
investigated among Greenlandic Inuit and Norwegian
Sami youth. Study design. Within the cross-sectional”Wellbeing among Youth in Greenland” (WBYG) and ”The
Norwegian Arctic Adolescent Health Study” (NAAHS),
conducted during 2003-05, 15-to-16-year old pupils
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(10th and 11th graders), 378 Inuit and 359 Sami, were
included. Methods: SRH was tapped by one single item,
and dichotomized into “very good” (WBYG) and “very
good/good” (NAAHS) as the reference category in the
logistic regressions. Analyses were performed separately for
Sami and Inuit to explore the influence of risk (drinking,
smoking, violence, and suicidal behavior) and protective
(physical activity, well-being in school, adolescent-parent
relationship) correlates of SRH, when simultaneously
controlling for socio-demographics (gender, parental marital
status, parental education or financial status). Results:
The majority of Inuit and Sami youth (>60%) reported
“good” or “very good” SRH. However, Inuit reported a
threefold higher rate of “poor” SRH than Sami (38% vs.
11% p=. 001). Significantly more Inuit females than males
reported ”poor” SRH (44% vs. 29%, p =.001), while nonsignificant gender differences occured among Sami (12%
vs. 9%). Suicidal behaviour (”risk”) and physical activity
(”protective”) were shared correlates of SRH among Sami
and Inuits. Conclusions: The influence of suicidal behavior
and physical activity on youth SRH among indigenous
need to be target in future intervention programs. The
Inuit-Sami differences in SRH could partly be due to
general higher ”risk” and lower ”protective” approach
in Greenland than in Norway, as found in this study.
depression was higher among women living in households
with more than seven people (OR: 1.79; 95%CI 1.15-2.78)
and in households with more than two persons per room
(OR: 1.50; 95%CI: 1.08-2.08). Measures of household social
structure were not significantly associated with depression
among men and with anxiety among women or men. In
the total and sex-stratified samples, lower odds of problem
behaviours were generally associated with more people
in the house and higher household crowding. However,
compared to households with children, the risk of smoking,
heavy drinking and addiction was significantly higher in
‘adult-only’ households. The number of people in the house
and household crowding seem to depict larger number of
children in the house, which may be protective for some
problem behaviours, but associated with psychological
symptoms, especially among women. Considering these
measures may not accurately reflect the social structure
of the house and its potential effect on Inuit health.
Associations Between Household
Social Structure and Self-Reported
Psychological Symptoms and Problem
Behaviours Among Inuit: Evidence from
Greenland
Institute for Circumpolar Health Studies
THURSDAY ORAL
[email protected]
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10:30 - 12:00
AUTHORS: M. Riva1, C. V. L. Larsen2,
P. Bjerregaard2
Centre de Recherche du CHUQ, Université Laval 1, National
Institute of Public Health, Univ Southern Denmark 2
Housing is a basic human right and an important social
determinant of health. Across the circumpolar north, Inuit
experience high level of inadequate, overcrowded housing.
This study examines whether household social structure
is associated with psychological symptoms and problem
behaviours among Inuit in Greenland. Data on 3107
Inuit aged 18 years and older are from the Inuit Health
in Transition Survey. Dependent variables considered
were: feelings of depression and of anxiety; heavy alcohol
consumption; addiction to alcohol and drugs. Household
social structure was measured using: number of people
in the house; household crowding (number of people per
room); and ‘adult-only’ households vs. households with
children younger than 18 years of age. Data were analysed
using logistic regression models adjusted for respondents’
age, sex, occupational status and household wealth. Models
were also stratified by sex. In sex-stratified analyses, risk of
[email protected]
Seeing the Forest for the Trees:
Assessing the Social and Physical
Determinants of Circumpolar
Population Health
AUTHORS: D. Driscoll, B. Dotterrer, R. Brown
Systematic reviews of the current body of population health
research highlight key social and physical determinants
of health disparities, and provide metrics for process
and outcome evaluation of programs to mitigate those
disparities. Previous meta-analyses of the population
health literature have identified several proximate social
and physical determinants of population health in the
Circumpolar North. Proximate health determinants
are those that are most amenable to early detection and
modification or mitigation through disease prevention or
health promotion interventions. These include addiction,
environmental exposures, diet/nutrition, global climate
change, access to clean water, access to quality health care,
and social connectedness. There is a need for research to
replicate these findings based on the latest science. This
presentation describes a study applying Dahlgren and
Whitehead’s (1991) socioecological model of health
determinants to identify the proximate social and physical
determinants of population health in the Circumpolar
North. The study consisted of a systematic review of
recent studies that link social determinants of health
with the leading causes of mortality and morbidity in
Alaska. Our search strategy consisted of a keyword search
using the Circumpolar Health Bibliographic Database
(CHBD) and four databases associated with the Web
of Knowledge (WoK) data gateway. Keywords included
various terms for the arctic and all relevant nations and
territories within the region. Health outcomes were also
included as either a categorical limiter (CHBD) or as a
secondary search within results (WoK). Inclusion criteria
included original research within a circumpolar population,
published in English during 2011, and rigorously
demonstrating a link between a social determinant and
one or more of the selected health outcomes. Study
conclusions will include the list of determinants identified,
the outcomes with which they are associated, and the
study designs implemented to assess that association.
[email protected]
Acculturation and Self-Reported Health
Among the Iñupiat, Kalaallit, and Sami
of Norway. The SLiCA Study.
AUTHORS: B. Eliassen1, T. Braaten2, M. Melhus3,
K. L. Hansen3, A.R. Broderstad3
University of Tromsø 1, Department of Community Medicine,
University of Tromsø 2, Centre for Sami Health Research, University
of Tromsø 3
[email protected]
Climate Change Assessment and
Adaptation Planning for the Health
Sector: Bridging the Gap Between
Federal and Local Approaches
AUTHOR: G. Luber
Centers for Disease Control and Prevention
Accumulating evidence and understanding of the health
consequences of climate change has generated an increased
interest in the public health community to develop
plans to anticipate and respond to these impacts. These
adaptation plans are formal, written plans that articulate
how a jurisdiction detects and responds to changing
weather patterns and shifting disease ecologies that have
the potential to affect the health of the community. This
presentation will describe and contrast two approaches
to climate change adaptation planning for the health
sector: the federal approach, characterized by the analysis
of large spatial and temporal scales and wide availability
of climate impact and health outcome data, and the
local, or community-based approach, which focuses on
smaller spatial scales and a shorter time horizon and
leverages local observations of climate impacts towards
a more nuanced understanding of social vulnerabilities
and pathways of exposure. The goals of this discussion
are to identify points of convergence between these
two approaches and highlight how community-based
approaches can help inform our understanding of the
social and cultural context of vulnerability to climate
change impacts, and how the federal approach can facilitate
engagement with longer time scales and the collection
and dissemination of best practices and evaluation
criteria to support evidence-based decision making.
[email protected]
Behavioral Health #5 - Suicide Risk Factors
Schaible Auditorium
moderators: A. Bult-Ito & A. Silviken
THURSDAY ORAL
OBJECTIVES. The main objective of this study is to explore
the relationship between acculturation and self-reported
health among the Iñupiat, Kalaallit, and the Sami of Norway.
STUDY DESIGN. Population-based cross-sectional survey.
METHODS. This study conceptualizes acculturation as
certain traditional subsistence activities being of lesser
importance to people’s ethnic identity, and poorer indigenous
language skills. Indigenous individuals aged 16 years and over
living in traditional settlement areas in Greenland, Alaska,
and Norway were invited to participate. Very high overall
participation rates of 83% were obtained in Greenland and
Alaska, whilst a more conventional rate of 57% was achieved
in Norway. Exploratory factor analysis was done to assess
the relationship between 12 subsistence variables. A score
constituted of these variables was used in an ordinal logistic
regression to assess the relationship between self-reported
health and acculturation. RESULTS. The factor analysis
showed that all variables were explained well by the factor
in all three regions/countries; the factor loadings were strong
and the unique variance systematically low. In Greenland and
Alaska, a significant association between poorer self-reported
health and acculturation was observed after controlling for
relevant confounders. No significant results were observed
among the Sami. CONCLUSION. It is plausible that the
variation in the observed variables is explained by latent
acculturation, and that acculturation positively predicts
poorer self-reported health. However, by examining the factor
loadings it is also plausible that the latent effect measured
is at least partly related to socio-economic status within a
mixed cash/harvest economic adaptation. Future studies shall
explore factors that may mediate the relationship between
self-reported health and acculturation in these populations.
10:30 - 12:00
Suicide in Alaska: Exploring Inter- and
Intra-Regional Differences
AUTHORS: J. Craig1, D. Chromanski Hull-Jilly2
Alaska Native Tribal Health Consortium 1, Alaska Department of
Health and Social Services 2
BACKGROUND: Alaska has consistently had one of the
highest suicide rates in the United States (U.S.). Alaska
Native people have consistently had suicide rates higher
than any other racial/ethnic group in the U.S. Inter- and
intra-regional variation has not previously been explored.
METHODS: Descriptive analyses were conducted using
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Alaska Violent Death Reporting System data for 2003
through 2008. Suicides among Alaska Native and Alaska
non-Native people by region were examined. Communities
within a region were divided into hub or non-hub. Hub
communities were defined as the city or cities where
the majority of the region’s population resides and/or
where major health, tribal government, educational, and
commercial resources are located. RESULTS: The rate of
suicide among Alaska Native people was highest in the
Northwest Arctic and lowest in the Southeast tribal health
region (93.1 versus 20.2 per 100,000 persons). The rate of
suicide was highest for Alaska non-Natives in the YukonKuskokwim and lowest in the Southeast tribal health region
(27.1 versus 15.4 per 100,000 persons). Examining the
regional hub versus non-hub communities separately, the
rate of suicide for both Alaska Native and Alaska non-Native
people was significantly higher in the non-hub communities
than in the hub communities (p<0.01). CONCLUSIONS:
Alaskan non-hub communities had higher rates of suicide
than hub communities. Previous studies have linked low
population-density areas with isolation, reduced access to
resources such as behavioral health counselors, decreased
likelihood of intervention if a person was experiencing
suicidal ideation and higher suicide rates. Further
research is needed to explore innovative ways to provide
behavioral health resources in non-hub communities
in order to improve future suicide prevention efforts.
THURSDAY ORAL
[email protected]
116
Community Perspectives on Protective
and Contributing Factors in Alaska
Native/American Indian Suicide
AUTHORS: J. Shaw, D. Dillard
The suicide rate among Alaska Native/American Indian
(AN/AI) people is more than twice the rate of non-native
people in the state. Suicide is a significant problem in all
Alaska Native communities, but everyone is not equally
affected. There are regional disparities in AN/AI suicide
rates across Alaska, with rates ranging from 80 suicides
per 100,000 people in the Northern region to less than
30 in Southern regions. This variability suggests potential
differences in underlying risk and protective factors
for AN/AI suicide between regions. Despite abundant
epidemiological data on suicide risk and protective
factors, we know little about meaningful differences in
these factors across regions and their implications for
understanding regional variation. This study investigated
the perspectives of AN/AI people on factors affecting
suicide in their communities. We used focus groups in
three communities to ask AN/AI adults about local risk
and protective factors and how they affect regional suicide
rates. We also interviewed community members who
10:30 - 12:00
work in education, healthcare, law enforcement, clergy,
and tribal leadership to gain professional perspectives on
risk and protective factors. Preliminary findings suggest
that comprehensive, community-based, and ecological
approaches to suicide prevention, intervention and
“postvention” are needed to foster “groundedness” and
connectivity among individuals at risk, build protective
communities, and reduce suicide in all AN/AI communities.
[email protected]
High Prevalence of Medicine Induced
Attempted Suicides Among Females in
Nuuk, Greenland
AUTHORS: L.H. Bloch1, G. Hansen Drachmann1,
M. Lynge Petersen2
Dronning Ingrids Hospital 1, Primary Health Care in Nuuk 2
High prevalence of medicine induced attempted suicides
among females in Nuuk, Greenland Introduction: The
suicide rate in Greenland, especially among men, is among
the highest in the world. Attempted suicide rates may
be high too. However, the rates of attempted suicides are
unknown. Objective: We aimed to estimate the age- and
gender-specific incidence of attempted suicides using
medicine in Nuuk 2008-2009. Study design: Observational
retrospective study of consecutive medical records on
patients admitted to Dronning Ingrids Hospital in
Nuuk in 2008-2009 with possible medicine intoxication.
Methods: Patients with possible attempted suicides using
medicine were identified as those whom had at least one
measurement of serum-paracetamol taken in 2008 or
2009. Only residents in Nuuk were included. Information
about age, gender, residence, intake of medicine including
paracetamol, alcohol intoxication, intension of suicide was
obtained from the medical records for all cases. Results:
Seventy-four (sixty females and fourteen men) cases of
attempted suicide using medicine were included. Of those,
forty-three used paracetamol alone or in combination
with other medicine. The incidence of attempted suicide
using medicine was higher among females than males
(P<0.001). The highest incidence (1.31 per 100 inhabitants
per year) was demonstrated among females aged 1519 years old. Conclusion: The incidence of attempted
suicides using medicine was high in Nuuk Greenland,
especially among females. This may reflect psychosocial
vulnerability among young people in Greenland. Initiatives
to improve living conditions for children and adolescents
are highly recommended to be initiated immediately.
[email protected]
Development of Suicidality Among Sami
Reindeer Herders as a Result of WorkRelated Stress
AUTHOR: A. Silviken
Sami National Center for Mental Health/Sami Health Research
[email protected]
Suicide Among Young Alaska Native
Men: Community Risk Factors and
Alcohol Control
AUTHOR: M. Berman
Universitiy of Alaska Anchorage
Objectives: We examined community risk factors
that explained variation in suicde rates among young
rural Alaska Native men, evaluating the effectiveness of
local alcohol control as a public health policy for reducing
the historically high vulnerability of this population.
Methods: We compiled suicide data, alcohol control
status, and community-level social, cultural, and economic
characteristics for 178 small rural Alaska communities
over a 28-year period. Poisson regression equations,
taking into account the endogenous community selection
of alcohol control, explained variation in suicide rates for
Alaska Native males age 15-34 as a function of alcohol
control and community characteristics. Results: Young
male suicide rates were higher in communities prohibiting
alcohol importation under state law, but the effect was
not significant after controlling for other community
characteristics. More remote communities, those with
fewer non-Natives, and those with evidence of cultural
divides had higher suicide risks. Communities with higher
incomes, more married couples, and traditional elders
had lower risks. Conclusion: Alcohol control appears
ineffective as a prevention measure. However, communities
have limited means to pursue economic and cultural
development strategies that appear more promising.
[email protected]
An Exploration of Suicide Risk Factors
in Alaska 2003 – 2006: Combining the
Alaska Trauma Registry and Alaska
Injury Prevention Center Data
AUTHORS: T. Sunbury1, N. Luvsandagva2
Institute for Circumpolar Health Studies 1, University of Alaska
Anchorage 2
Objectives. Suicide rates in Alaska are approximately
twice as high as in the general US population and about
four times higher for 20-29 year olds. Even though
variations exist in the rate of suicide across geographical
location, gender, and mechanism of injury much of the
past research findings have focused on univariate and
bivariate statistics ignoring the complicated multifactorial
relationships between and among these risk factors.
Multivariate research is needed to assess the importance
of differentiating subgroups within populations, and the
distinction between populations and communities in
understanding causes of disparities in suicide rates. The
purpose of this study was to provide further examination
of smaller-scale (local) analysis of spatial characteristics
and identify spatial-temporal trends in suicidal behaviorrelated hospitalizations. Methods. The Alaska Trauma
Registry (ATR) was searched for hospitalizations with
injury cause listed as suicidal. Information concerning each
inpatient included: gender, age, ethnicity, occupational,
type of injury, injury mechanism, home of record, principle
diagnosis, and trauma code. Rates were age-adjusted and
calculated using the 2000 and/or 2010 U.S. Census data
and mapped to the local level using ArcGIS v.10 software.
Additional data on completed suicides were obtained
from the Alaska Injury Prevention Center (AIPC) for
2003 – 2006 and included information on: gender, age,
THURSDAY ORAL
Aim: To discuss the development of suicidality as a result
of work-related stress in reindeer herding management in
view of Mark Williams’ model “Cry of Pain”. Background:
The Sami people is an indigenous group with their own
culture and native language residing in the arctic part of
Scandinavia. Traditional Sami reindeer herding is small
business on a national scale, but it is an important symbol
and bearer of Sami culture. There are several aspects
of reindeer herding that can cause work-related stress.
Reindeer herding management is characterized by hard
work of physical and mental character, and they work
under challenging climatic conditions. In recent times we
see additional strains due to internal and external conflicts,
such as access to grazing land, poor grazing conditions,
mixing of herds, development of grazing lands, and
predator problems. The suicide rates in the general Sami
population in Northern Norway can be considered as
moderate (19/100 000, 1970-1998). However, it is wellknown that in some Sami communities there has been a
high prevalence of suicide during the last three decades,
and that several villages have experienced suicide clusters.
Previous research has indicated that the reindeer herding
Sami have been protected against suicide, while recent
studies show an increased incidence of suicidal thoughts
and plans among Swedish reindeer herding Sami. Method:
In the presentation, the development of suicidality
as a result of work-related stress in reindeer herding
management, will be understood in view of Mark Williams’
model “Cry of Pain”. Conclusion: Work-related stress due
to internal and external conflicts may cause an experience
of entrapment among vulnerable Sami reindeer herders,
and thus increase the risk of development of suicidality.
10:30 - 12:00
117
employment, injury mechanism, toxicity, and blood
alcohol concentration. Results. From 2003–2006, the ATR
reported 2,583 patients that were hospitalized for suicidal
injury intent, whereas AIPC reported 426 completed
suicides during the 36 month study period. More women
were represented in the ATR dataset, while the ratio
of men-to-women was 4:1 in the AIPC data. Spatialtemporal trends were consistent between the two data sets.
The ATR suggested that patients engaged in an incident of
interpersonal argument/violence before attempting suicide.
Conclusions. Geographic location is a substantial suicide
risk factor, even controlling for month (seasonality). Suicide
prevention, gun safety, and treatment enhancements
should specifically address high-risk locations. Further
study into the circumstances prior to suicide attempt is
needed to fully understand the geographical disparities
and to adapt and implement prevention programs.
[email protected]
Friday, August 10, 2012
Duckering Room 252
FRIDAY ORAL
THURSDAY ORAL
moderators: L. Duffy & M. Voevoda
118
[email protected]
Personal Anxiety and 16-years Risk
of Myocardial Infarction in Female
Population in Russia
I. Gagulin,
10:30 - 12:00
Chronic Diseases #7 Cardio-pulmonary Disease 2
DHA. Methods Consumption of dietary FAs and their
concentrations in plasma and red blood cell membranes
were compared with CVD risk factors in a sample of 819
Eskimos > age 34 years. Multiple linear regression analyses
were used to analyze the associations of specific FAs with
CVD risk factors, after adjustment for relevant covariates.
Results EPA and DHA were associated with lower heart
rate, blood pressure, carotid intimal medial thickness, and
triglycerides. In contrast, palmitic and myristic acids were
positively associated with carotid plaque, glucose intolerance,
higher blood pressure and triglycerides. Conclusions
Multiple CVD risk factors are positively associated with
the same FAs previously shown to predict cardiovascular
mortality. These findings suggest that the CVD risk
factors mediate the effects of FAs and CVD mortality.
Saturated Fatty Acids are Associated
with CVD Risk Factors: The GOCADAN
Study
AUTHORS: S. Ebbesson1, P. Higgins2, S. Voruganti3,
R. Devereux4, P. Okin4, L. Ebbesson5, R. Fabsitz6,
B. Howard7, J. Umans7, A. Comuzzie3
University of Alaska Fairbanks 1, University of Alabama at
Birmingham 2, Texas Biomedical Research Institute 3, Weill Cornell
Physicians 4, Lund University 5, National Institutes of Health 6, Med
Star Health Research Instiute 7
Background Alaskan Eskimos are undergoing
acculturation involving a dietary shift from unsaturated to
saturated fatty acids (FAs). Although average consumption
of eicosapentaenoic acid (EPA) and docosahexaenoic acid
(DHA) is high (nearly 3g/d), cardiovascular disease (CVD)
incidence is increasing rapidly in GOCADAN. Although
dietary intake of EPA and DHA were not associated with
presence or amount of carotid plaque, some saturated
FAs were cross-sectionally associated with plaque burden.
Hypothesis We tested the hypothesis both dietary FAs as
well as their measured concentrations in plasma and red
blood cell (RBC) membranes would be associated with
CVD risk factors, demonstrating positive associations
for saturated FAs and negative associations for EPA and
The aim: To explore the effect of personal anxiety
on relative risk of myocardial infarction (MI) in female
population of 25-64 years in Russia. Material and
methods: Within the WHO “MONICA-psychosocial”
25-64 years (n=870), who were residents of one district
in Novosibirsk, were surveyed in 1994. Levels of personal
anxiety were measured at the baseline examination by
means of Spilberger’s test. From 1995 to 2010 women
were followed for 16 years for the incidence of MI on
the base of Myocardial Infarction Registry data. Cox
proportional regression model was used for an estimation
of relative risk MI. Women having heart diseases at the
baseline were not included in the analysis. Results: In this
longitudinal study data on MI were collected for 79% (688
persons) surveyed. MI was developed in 15 (2.2%) women
during follow-up period. High level of anxiety (HLA) in
studied cohort revealed in 58.3% of women. Risk of MI
development in women with HLA during 16 years of study
was higher in 4.2 time, compared women with low and
average levels of anxiety (95.0% CI:1.946-18.583; p=0.05).
There was a tendency of high MI risk in all age groups of
women with HLA. MI incidence rates were significantly
higher in married women with HLA compared divorced
ones with lower level of anxiety (?2=5.66 n=1 p<0.05).
The conclusion: These findings show high prevalence
of HLA in female cohort of 25-64 years that predicts
high MI risk, especially in group of married ones.
[email protected]
10:30 - 12:00
The Arterial Hypertension at Sick of
the Ischemic Heart Disease at the Age
of 60 Years Also is More Senior, Living
in Yakutia
importance of AH as a risk factor of IHD development
in the senior age groups, communicating BP with the
years, revealed in group of patients of non- nationality.
AUTHOR: P. Ozhegov
The Influence of Low Social Support on
16-Years Risk of Myocardial Infarction in
Russian Female Population
Medical institute of Northeast Federal University
I. Gagulin
The aim: To explore the influence of social support
(SS) on relative risk of myocardial infarction (MI) in
female population of 25-64 years in Russia. Material and
methods: Within the WHO MONICA-psychosocial
25-64 years (n=870), who were residents of one district in
Novosibirsk, were surveyed in 1994. Brekman-Sym test
was used to measure indices of close contacts (ICC) and
social network (SNI). From 1995 to 2010 women were
followed for 16 years for the incidence of MI with using
of Myocardial Infarction Registry data. Cox regression
model was used for an estimation of hazard ratio (HR)
MI. Women having heart diseases at the baseline were
not included in the analysis. Results: In this longitudinal
study data on MI were collected for 79% (688 persons)
surveyed. MI developed in 15 (2.2%) women. Low levels
of ICC and SNI in women with MI was revealed in
54.5% and 63.6% of women, respectively. HR of MI in
women with low ICC during 16 years of study was higher
in 4.9-time, compared women with higher levels of ICC
(95.0%CI:1.108-21.762; p<0.05). Women with low SNI
had 2.9-fold risk of MI compared those with higher
levels SNI (HR=2.93; 95.0%CI:1.040-8.208; p<0.05).
Depending on age women 55-64 years had highest risk
of MI for low compared higher levels of SNI (HR=5.9;
95.0%CI:1.534-22.947; p=0.01). The conclusion: There is
high prevalence of low SS in Russian women aged 25-64
years which predicts high MI risk, particularly in older ones.
[email protected]
The Therapy of Patients with Chronic
Heart Failure, Efficacy and Safety
AUTHORS: Y. Ekimova1, M. Voevoda1,
O. Tsygankova2, Z. Bondareva2, E. Fedorova2
Institute of Internal Medicine of Siberian Branch of Russian 1,
Novosibirsk State Medical University 2
Echocardiography has been used to study the initial
parameters of heart morphometry in patients with chronic
heart failure (CHF). The influence of therapy with the
FRIDAY ORAL
Research objective: Studying features of current arterial
hypertension (AH) in patients of ischemic heart disease
(IHD) of the older age cohorts living in Yakutia,
independent of nationality, age, and sex. Research methods:
354 IHD patients (60 years of age and older) were surveyed.
Patients were divided into groups – non- nationality
(n=149) and Yakuts (n=205); advanced age (60-74 years;
n=154), senile age (75-89 years; n=149) and long-livers (90
years or more , n=51); men (n=187) and women (n=167).
For AH I degrees level systolic blood pressure (SBP) or
diastolic BP(DBP) 140-150/90-99 mm Hg was accepted;
AH II degrees the SBP or DBP 160-179/100-109 mm
Hg; AH III degrees the SBP or DBP 180/110 mm Hg
and more. Results: From 354 patients, the SBP level of
140 mm Hg and higher for non-national person was not
detected in any of the 149 patients. In Yakuts, taking into
account six sick individuals (2,9 %) had normally high
SBP, SBP levels above 140 mm Hg were observed in 199
individuals (97,1 %) from 205 persons (p=0,091). Patients
of non-nationality had higher SBP levels than Yakuts
(166,3±1,5; 162,0±1,4 mm Hg, respectively) (p=0,039).
For those communicating SBP (p=0,037) that it was not
observed in similar group of Yakuts (r=0,06 is revealed with
the years; p> 0,10). SBP levels had authentic distinctions
between comparison groups of elderly (160,5±1,4 mm
Hg), senile age (166,9±1,5 mm Hg) and long-livers
(165,2±3,3 mm Hg) (p=0,007); groups of elderly and senile
age (t=3,10; p=0,002). Statistical differences were revealed
between comparisons of average DBP levels of patients of
non- nationality and Yakuts (84,7±0,8 mm Hg; 82,0±0,6
mm Hg, respectively) (p=0,010). There were no statistical
differences found between comparison of age groups of
authentic distinctions in size DBP (82,9±0,7; 83,2±0,8
and 83,7±1,7 mm Hg, respectively) (p> 0,10). There were
no statistical differences found between DBP levels in
men versus women (p> 0,10). Statistically significant
increases in the SBPlevels between groups of patients of
non- nationality and Yakuts was not detected. There is
a small tendency for AH to be more expressed in nonnational persons (p=0,067). The share of patients with
DBP 90 mm Hg and above, prevails in group of patients
of non-nationality (p=0,018). In 70 % of the surveyed
patients, the isolated systolic arterial hypertensia is revealed.
Conclusion: BP level increases with increasing age with
the greatest frequency of revealing isolated systolic arterial
hypertension in both ethnic groups. The fact testifies to the
[email protected]
119
inhibitor of angiotensin converting enzyme (iACE),
renitec, sartan (losartan), direct inhibitor of renin (DIR),
rasilezom, and combination therapy with DIR + antagonists
of angiotensin receptors II (ARA and BRA) on indexes of
systolic and diastolic heart function have been estimated.
The efficacy and safety of the therapy for patients with
circulatory decompensation have been evaluated and the
kidney’s functional ability in the dynamics has been judged.
Synchronous and unidirectional changes of the early
diastolic period of the right and left ventricles in patients
using triple neurohumoral blockade (iACE or ARA,
aldosterone and ß-blockers antagonists) have been revealed.
That contributed to the optimization of systolic and
diastolic heart function in the process of chronic heart failure
and significantly reduced the incidence of exacerbation of
CHF symptoms and rehospitalization for heart failure
decompensation during the year. Direct renin inhibitors,
rasilez both in monotherapy and in combination with
losartan, provides a hypotensive action and corrects cardiac
dysfunction in patients with refractory hypertension and
chronic heart failure. Additionally, it has few adverse events.
[email protected]
Infectious Diseases #7 - Haemophilus Influenzae Duckering Room 252
FRIDAY ORAL
The model was able to accurately reproduce observed
Hib incidence in Alaska Natives between 1980 and 2008.
This includes the increase in Hib incidence in 1996-97
associated with the switch from PRP-OMP vaccine (which
induces high antibodies after the first dose at 2 months
of age) to HbOC vaccine (which does not induce high
antibodies until the third dose at 6 months of age). The
estimated transmission dynamics suggest that 5-9 year olds
are the primary source of Hib transmission among Alaska
Natives. During the Hib vaccine shortage, PRP-OMP
vaccines from the national vaccine stockpile were used
for Alaska Native infants. Had the shortage continued,
it would have become necessary to switch to PRP-T
vaccines, which have similar immunogenic properties as
HbOC. Our model predicts this switch would have caused
a 2.25-fold increase in Hib incidence, to 42 cases per
100,000 children <5 years of age. Discussion: Availability
of PRP-OMP Hib vaccines is critical for ongoing
control of invasive Hib disease in Alaska Native children.
[email protected]
No Evidence of Increasing Haemophilus
Influenzae Non-B Infection in Australian
Aboriginal Children
moderators: R. Tsang & M. Ulanova
AUTHORS: R. Menzies1, P. McIntyre1, V. Krause2,
P. Markey2, J. Hanna3
Modeling Insights into Haemophilus
Influenzae Type B Vaccination Programs
in Alaska Natives
National Centre for Immunisation Research and Surveillance 1,
Northern Territory Centre for Disease Control 2, Tropical Public
Health Unit 3
AUTHORS: M. Jackson1, C. Rose2, A. Cohn2, T.
Clark2, J. Wenger2, L. Bulkow2, M. Bruce2,
N. Messonnier2, T. Hennessy2
Background There are many similarities between
the health status of indigenous people in Australia and
the arctic. These include very high burdens of respiratory
infections such as Haemophilis influenzae (Hi) and
Streptococcus pneumoniae, earlier onset of disease and
broader serotype distributions compared to their nonindigenous counterparts. Conjugate Hib vaccines were
introduced in Australia and north America in the early
1990s with great success. Given recent reports of increases
in non-b Hi infections in north American indigenous
populations, the aim of this study was to examine whether
similar trends have been observed in Australia. Method
The Northern Territory in Australia is notable for its
remoteness and high indigenous population, compared to
the rest of the country. Pre-vaccination rates of Hi invasive
isolates by serotype in Aboriginal children aged <5 years
were obtained from a study conducted in 1985 to 1988, in
which laboratory records were searched in all five hospitals
in the territory, and isolates from sterile sites recorded.
Post-vaccination rates were obtained from notifications
of invasive Hi infections to the Northern Territory Centre
for Disease Control from 2008 to 2010. Results In the
pre-vaccine period there were 80 Hi isolates identified in
indigenous children aged <5 years. The annual disease rates
Group Health Reseach Institute 1, Centers for Disease Control and
Prevention
120
10:30 - 12:00
Background: Haemophilus influenzae type b (Hib)
vaccines have reduced Hib incidence in Alaska Native
children 40-fold. However, Hib continues to circulate in
Alaska Native populations, and control of invasive Hib
requires maintaining Hib vaccine coverage. In response
to the 2007-2009 United States shortage of PRP-OMP
Hib vaccines, we developed a simulation model of Hib
transmission, colonization, and disease to help manage
the shortage. We applied the model to Alaska Native
populations to gain insights about Hib transmission
dynamics and possible effects of the Hib vaccine shortage.
Methods: The mathematical model divides a population
into categories defined by age, by colonization/disease
status, and by antibody levels. Movement across categories
is defined by differential equations. We modeled Hib
transmission dynamics and the impact of the Hib vaccine
shortage on Hib incidence among Alaska Natives. Results:
were 429/100,000 for all Hi, 370 for Hib, 36.5 for Hia and
22.0 for non-typable Hi. In the post-vaccination period,
there were a total of 14 notifications of Hi (60/100,000
per year), with rates of 18.9/100,000 for Hib, 14.1 for
Hia and 23.6 for non-typable Hi. Conclusion There is
no evidence to support an increase in non-b Hi infection
in this population of Australian aboriginal children.
[email protected]
Invasive Disease Due to Haemophilus
Influenzae Srotype a (Hia) in the
Canadian North, 2000 to 2010
AUTHORS: J. Lourenco1, S. Desai2, R. Tsang2
Public Health Agency of Canada 1, National Microbiology
Laboratory 2
[email protected]
Haemophilus Influenzae Serotype
A: Characterization of a Significant
Bacterial Pathogen in The North
AUTHORS: R. Tsang, M. Shuel, D. Law
National Microbiology Laboratory
Background With the introduction of conjugate
vaccines for protection against serotype b Haemophilus
influenzae (Hib), most invasive H. influenzae disease in The
North is now due to non-Hib strains and serotype a (Hia) has
emerged as an important cause of disease. This presentation
summarises the current knowledge of this pathogen. Methods
In this study, we analysed 161 Hia isolates recovered from
patients in Canada by biotype, multi-locus sequence typing
(MLST), and antibiotic susceptibility testing. The presence
of the sodC gene and the bexA-IS1016 partial deletion was
also examined in some of the isolates. Results Based on
detection of the sodC gene by PCR, the majority of clinical
Hia isolates were found to be negative for this gene while 2
clinical isolates and an ATCC reference strain were positive.
Fifty of the 51 sodC-negative Hia isolates were typed by
MLST to belong to the ST-23 clonal complex, and only 1
was found to belong to a different clonal group, ST-4. The 2
sodC-positive clinical isolates were typed as ST-62, while the
ATCC reference strain was identified as ST-372. The single
ST-4 isolate was found to have the bexA-IS1016 partial
deletion while representative isolates of the ST-23 clonal
complex, and the sodC-positive Hia isolates were negative
for this characteristic. One hundred and forty-nine of the 151
Hia isolates tested were found to be susceptible to commonly
prescribed antibiotics, while only 2 were found to be resistant
to ampicillin due to ß-lactamase production. Conclusion
This presentation summarises our current knowledge
on Canadian Hia isolates. including the identification
of 2 clonal populations that have been described in the
literature with different propensity to cause serious diseases.
[email protected]
Research in the North #7 Cold Climate Physiology
Duckering Room 342
moderator: T. Schnurr
To the Evaluation of the Polar Electrojets
Influence on Physiological Parameters of
a Man at Phonic Conditions While Using
Unmedical Heliomagnitoprotective
Remedies
FRIDAY ORAL
Background: The International Circumpolar Surveillance
(ICS) project is a population-based surveillance network.
Since 2000 Canada has participated in the ICS Invasive
Bacterial Disease Working Group’s surveillance of invasive
Haemophilus influenzae disease (Hi). The Hi serotype b
(Hib) vaccine was introduced into Canadian childhood
immunization programs in 1988. Methods: A standardized
case report form containing demographic and clinical
information was completed for all reported Hi cases in the
study regions. Isolates were sent to a reference laboratory
for confirmation, serotyping, and antimicrobial resistance
testing. The Northern Canadian population was estimated
using Statistics Canada information. Aboriginal peoples
comprised about 58% of the study population. Results: Of
the 142 Hi cases reported from 2000 to 2010, 72 (56% of
cases with serotype information) were due to Hia, followed
by non-typeable (22%) and Hib (15%). Serotypes c, d,
e, and f made up only 7% of the cases collectively. The
average Hia incidence over the 11 years was 4.6 cases per
100,000 population. The number of Hia cases reported
each year ranged from a low of two in 2008 to a high of
13 in 2010. Each year, the majority of Hia occurred in
infants less than two years of age (73%). This age group
had an average incidence was 87.5 cases per 100,000
population. The average incidence among Aboriginals
was 6.9 cases per 100,000 population and no cases were
reported among Non-Aboriginals. The most common
clinical presentation was meningitis (reported in 32.9%
of cases), followed by bacteremia (30.3%) and pneumonia
(23.4%). Over 90% of cases were hospitalized and there
were four deaths, resulting in a case fatality rate of 5.6%.
Conclusion: Hia is an important cause of morbidity and
mortality in the Canadian Circumpolar North. Serotype
distribution information from the rest of Canada is
needed. Further work on a vaccine should be encouraged.
10:30 - 12:00
AUTHORS: A. Trofimov, M. Hirch
Int.Sci-Res.Institute of Cosmic Anthropoecology
Biotrop influence of ionosphere electric currents (electrojets)
121
and of electromagnetic disturbance in the zone of auroral
oval on electric homeostas of healthy people were under
research. These researches were done with the people
from the middle parts of Russia at the end of the first
year working at the Far North (Dikson settlement of
Krasnoyarsk region, 73 degree, 30 minutes of the Northern
latitude).The research was done under conditions of
unmedicinal helio-magnitoprotective remedies aprobation.
During the Polar night period, when 120 men volunteers
of 19-20 years took part in the research experiment, electrocardiographic parameters (R,PQ,QT) and electroconductance on acupuncture points of heart meridian
were registered on PEP-1 apparatus. Frequency of systole
and arterial pressure on automatic measuring instruments
at different manifestation of electrojet(on the riometric
data) and electromagnetic environmental disturbance
(according to Ak index) were registered. The regime of the
research was: before and after drinking 50,0ml. of heliomagnitoprotective water, prepared according to ISRICA
technology.
After statistical calculation it was shown that all the
registered physiological parameters of the people
under experiment with (P < 0,05) were changing at the
periods of increase of cosmophysical factors intensity.
The test introduction of heliomagnitoprotective in the
volunteers drinking water considerably lessens(P< 0,05)
functional dependence of human organism on solar
corpuscular and electromagnetic currents and disturbances
in magnetic ionosphere. We see as a good perspective to
use heliomagnitoprotective drink water for prophylactic
measures against helio-depending diseases, crisis state
and their hemodynamic life dangerous consequences
for the people living near the world polar regions.
FRIDAY ORAL
[email protected]
122
10:30 - 12:00
to the different environment, a resistance to new stress
is increased. In cold exposed adult humans, significant
decreases in body temperature are delayed by reducing
rates of heat loss via peripheral vasoconstriction and by
increasing rates of heat production via shivering and nonshivering thermogenesis. Shivering is elicited by exposure
to cold air and this can increase the resting metabolic rate.
Fuel selection mechanisms are responsible for sustaining
shivering thermogenesis. It has been reported that over a
3-month trip to Antarctica, subjects lost more than 25%
of body weight despite an average energy intake (Stroud
et al. 1997). However, the adaptation process to cold and
Antarctic environments in the human biological system is
not well understood. Life in cold environments has many
different effects on the body. One interesting and important
effect is the pronounced metabolic changes in people in a
cold environment. Therefore, we are investigating whether
and how to adapt to human physiology in cold environment.
Especially, we are interested to know whether and how
to adapt to human physiology in cold environment. We
address the current study how acute cold stress affects on
human metabolism, carried out in a -15 cold room. This
study was supported partly by the Grant for The Polar
Research Phase VIII Project in National Institute of Polar
Research and Joint Research Program of the Institute
of Low Temperature Science, Hokkaido University.
[email protected]
Health Services #7 - Telemedicine
Salibury Theatre
moderators: R. Johnson & C. Sarin
Enhancing Technology Uptake in Health
Practitioners on First Nations Reserves
in Alberta Canada
Acute Human Metabolic Response in
Cold Environment
AUTHORS: C. Sarin1, K. Zakariasen2, M. Hoeber1,
J. Hermsen
AUTHORS: J. Yamauchi1, S. Kawada2, R. Kinugasa3,
N. Morita4, K. Takizawa5, T. Yamaguchi6, S. Takada5,
S. Imura7
Health Canada 1, University of Alberta 2
TMU 1, The University of Tokyo 2, Kanagawa University 3,
Hokkaido University of Education 4, Hokkaido University 5, Rakuno
Gakuen University 6, National Institute of Polar Research 7
Our ancestors survived in an unforgiving environment
dominated by ice ages. Also, because global warming is the
largest threat to humanity in the future, how to survive the
next ice age is an important topic for humans. Humans, in
order to survive, have acquired the function of sustaining
constant temperature in any circumstance over the years.
To survive in extreme environment, the body adapts
physiologically. When the body is repeatedly exposed
Through the Virtual Communities of Practice project,
First Nations and Inuit Health Branch (FNIHB), Alberta
is working with the University of Alberta to increase the
uptake of health technology on reserve. FNIHB funds
and/or provides health services on 45 First Nations in
Alberta. Despite initiatives in areas including Electronic
Medical Records and Telehealth, eHealth uptake is lower
than expected. This presentation summarizes the outcomes
of an engagement process intended to accelerate the
uptake of health technologies amongst health providers
to First Nations living on reserve in Alberta Canada. An
Appreciative Inquiry (AI) process was used to engage
specific health provider groups. AI is a whole systems
approach to change that involves all stakeholders in
an organization to uncover the possibilities for change
already inherent in the organization. The 23 interview
participants were asked to envision how technology could
support their work in First Nations communities and
to identify their health technology needs. A follow up
group session was held to review the results and inspire
collaboration and creativity amongst the program areas.
The presentation will summarize participant responses
by theme. Overall, participants provided positive feedback
about the AI process and wanted to use it in an ongoing
manner to guide future strategic directions of FNIHB
programming. Participants felt that any particular
technological solution should not be imposed. Each of
the program areas identified specific opportunities for
collaboration and those areas are being actively explored
today using available technologies. These opportunities
include developing communities of practice for self
learning and professional development, and expanding
the FNIHB role in clinical telehealth service provision.
AI was an effective engagement tool and provided useful
information to guide future health technology initiatives.
[email protected]
Perspectives on Telemedicine Chronic
Disease in Alaska Native and Native
Hawaiian Populations
AUTHORS: V. Hiratsuka1, B. Khan1, R. Delafield2,
R. Robinson1, M. Mau2
Southcentral Foundation 1, Department of Native Hawaiian Health,
University of Hawai`i 2
improving patient care in remote AI/AN/NH populations
and may supplement patient-provider relationships.
[email protected]
Telemedicine in Nenets Autonomous
Okrug: Contemporary Reality and
Future
AUTHORS: O. V. Bartashova1, A. Karpunov2,
V. Ilin2, L. Zubov3
Administration of the Nenets autonomous area 1, Nenets Area
Hospital 2, Northern State Medical University 3
Practical application of telemedicine in the Nenets
autonomous okrug (NAO) began in 2000. From 2003
the telemedicine was singled out as structural unit of the
Nenets Area hospital. During 11 years, 1819 consultations
have been carried out (1139 adults, 680 children), the
biggest number was of consulting has been given to
adult patients – in cytology, roentgenology, orthopedicstraumatology, neurology, thoracic surgery, and to children
– in cardiology, orthopedics-traumatology, urology,
roentgenology, functional diagnosis, pulmonology. In
2011, as part of the departmental regional target program,
7 district hospitals and 8 ambulatories were equipped
videoconference communication and telemedicine. The
main purpose of this program is to create a telemedicine
network NAO. Our priorities are: active work with
medical staff for giving information about possibilities of
teleconsultations, introduction in standards of treatment
with use of telemedicine, recognition of telemedical
consultations by insurance companies, regulation with
orders of sending planned patients to the regional
medical institutions with preliminary consulting in
telemedicine; carrying out of expertise of medical care
quality taking into consideration telemedical resources;
material and moral stimulation of all participants
of the telemedical process. Further development of
telemedicine requires joint efforts of authorities, healthcare
organizers, specialists in telemedicine and doctors.
[email protected]
Updates on the Utility of Tele-Health in
Labrador
AUTHOR: M. Jong
Memorial University
Introduction. Telehealth in Labrador was
introduced 20 years ago as a store and forward system using
the plain old telephone line. For the past 16 years we have
been using real time video and for the past 3 years we have
been using robotic telemedicine. Results. The advance in
tele-health has: • improved access to physicians; • improved
FRIDAY ORAL
The use of telemedicine in remote populations has the
potential for improving access to health care to patients
with chronic diseases. Among American Indian, Alaska
Native, and Native Hawaiian (AI/AN/NH) populations
at increased risk for chronic diseases such as diabetes,
telemedicine may also improve delays in health care
services and thus may reduce adverse health outcomes. Yet
few studies are available on how best to use technology to
reduce health care disparities. In this study, we conducted an
organizational scan and examined perspectives of patients
and providers in two indigenous populations in Alaska
and Hawai’i about the use of telemedicine in primary
care chronic disease management. Results from six focus
groups found three broad themes common to both sites:
(1) benefits and barriers of using telemedicine; (2) building
patient-provider relationships; and (3) elements of an
acceptable telemedicine primary care encounter. Thematic
analysis led to the emergence of two key elements endorsed
by both patients and providers on an effective telemedicine
encounter: (1) the initial patient-provider interaction should
be face-to-face; and (2) patients must see the same provider
on follow-up visits. In summary, the use of telemedicine
in chronic disease management has potential for
10:30 - 12:00
123
management of urgent and emergent care; • improved
mental health assessments; • improved personal interactions
between nurse, patient/family and physician; • improved
collaboration amongst health care team; • improved job
satisfaction and decreased job stress amongst physicians
and nurses; and • decreased costs of medical transportation.
Conclusion. Tele-health is now an essential service in
our Circumpolar region. It has improved access to care,
reduced cost of transportation and provided professional
support for health providers in our remote communities.
[email protected]
“It Can’t Be Done”...Overcoming Barriers
to Deliver Digital Xray to TB Clients in
Nain, Nunatsiavut
AUTHOR: G. Turner
FRIDAY ORAL
Nunatsiavut Government
The rate of TB among Inuit Nunangat is 185 times that
of non Aboriginal Canadians (PHAC, 2009). In Nain,
Nunatsiavut, TB remains endemic. Applying a Social
Determinants lens reveals access to health care, xray in
particular perpetuates the challenge to follow Canadian
Tuberculosis Standards. In the jurisdictional quagmire
that is Public Health in Labrador, TB control is under the
province of Newfoundland and Labrador(NL),Primary
Care and Communicable Disease Control is with Labrador
Grenfell Health and Public Health at the community level
is with Nunatsiavut Department of Health and Social
Development (DHSD). The current system of flying to
Goose Bay from Nain for xray requires the client to be away
for a minimum of 3 days (weather). This affects compliance
and the success of TB elimination goals. The solution is to
bring the xray to Nain. When first approached, Labrador
Grenfell Health said “it can’t be done”.. not willing to
accept that, the lobby group persisted with looking at every
aspectof the delivery challenge, monies were secured, a
new champion in Diagnostic Imaging was found, and the
planning began. Months later, in true collaborative spirit,
industry, health authority, provincial and Nunatsiavut
governments, came together and the first ever digital xray
clinic was held in Nain, followed by a second months later.
The project was a huge success on many fronts.The presenter
takes you through the process with words and pictures and
outlines both the direct and indirect success outcomes.
[email protected]
Evaluation of Pipaluk
AUTHORS: A. B. Kjeldsen1, L. Ragus1
Goverment of Greenland 1, Ministry of Health 2
124
The Greenlandic population of 56,700 live along a costal
10:30 - 12:00
line of 44,000 km in 17 towns and 64 settlements. The
framework conditions to ensure equal access for citizens
to health care are difficult. Geography, settlement patterns
and nature are a challenge in regards to using scarce
resources effectively and meeting citizens’ desire to receive
competent treatment for disease locally.
Pipaluk is a telemedicine tool. There is a computer with
a number of tools for diagnostics, which provide decision
support to the health service staff in relation to being able
to provide rapid diagnostic screening and treatment. The
project was conducted from February 2008 - July 2010.
Pipaluk is now established in all towns and settlements
with more than 50 inhabitants. There are in total 68 units
in towns and settlements on the coast.
The primary purpose of Pipaluk is twofold, firstly to ensure
better utilization of resources (eg better screening, fewer
examinations by health staff, faster diagnosis and treatment,
shorter waiting time for patients, fewer patient transports)
and secondly to ensure an increase in the quality of services
of the health care system - particularly through a more
equitable access to health care for all citizens. The project
thus aims both to optimization of the health care system’s
resource utilization, and at the societal level’s demand
for efficiency in the public sector in terms of increased
accessibility to health services and ultimately ensure the
citizens most health for money.
Evaluation aims to answer two main questions:
• to what extent has Pipaluk helped to ensure a better use
of resources and improving the quality of health services?
• what learning can be extracted from the previous
implementation of Pipaluk to make the system better?
The learning perspective is central in the evaluation.
The assessment of Pipaluk is based on the following
six evaluation criteria: Achievement of objectives,
organizational implementation, technical implementation,
Process, Efficiency, Quality.
The evaluation includes a number of methods such
as literature review, stakeholder analysis, interviews,
questionnaires, data-/healtheconomic analysis and expert
review. Overall, the evaluation will uncover if the project
– the implementation of Pipaluk - have helped to ensure
a better use of resources and improving the quality of
health care systems’ services and also what learning can be
extracted in order to make the telemedicine system better.
[email protected]
Nutrition #6 - Changing Diets: Health Communication
10:30 - 12:00
McGown
Rural Nutrition Services:
Building Community Capacity in
Health Promotion
AUTHORS: S. McConnell, F. Deacon, M. Attla
Troth Yeddha’ Nutrition Project’s (TYNP) Rural Nutrition
Services (RNS) academic program, designed by Alaska
Natives, rural Alaskans, Registered Dietitians and behavioral
health providers, provides culturally relevant education
and outreach to promote health including nutrition and
physical activity for healthy weight, diabetes prevention
and support. Interior – Aleutians Campus of the University
of Alaska Fairbanks, provides RNS coursework integrating
nutrition science, Behavioral Health; Alaska Native
knowledge and outreach skills, preparing a workforce to
serve rural Alaskans on site in their home communities as
they face nutrition-related health risks. TYNP is a project
sponsored by the USDA NIFA NRI. Three years of student
success in development and delivery of community based
practicum outreach projects will be described, along with
sustainable impacts of the student projects. Participants of
this session will learn about the education and outreach
activities of the project; learn about highlights of innovative
health promotion and treatment support applications
by rural Alaskan/Alaska Native students; and learn how
to access the education and outreach services of RNS.
[email protected]
Communicating About Healthy
Eating in the Context of Today’s
Arctic Food Supply
AUTHORS: J. Wakegijig, G. Osborne
Government of Nunavut
Nunavut’s Department of Health and Social Services
has invested considerably in initiatives to address these
issues, emphasizing community-based nutrition education
programming, and development of clear nutrition
The training and support of community-based workers
who provide nutrition education programming is the
most important investment to help ensure improved and
sustainable knowledge and skills in communities. Effective
training and clear, useful tools are essential for their success,
as is regular contact with professional support.
Development of nutrition education tools that are well
understood by community workers and community
members, and that feature key essential messages, is also an
important investment.
In October of 2011, a new Nunavut Food Guide was
released, based on a 2 year process including input and
focus testing by health professionals, community workers,
and community members across Nunavut.
This fall, workers will receive a new community workers
toolkit, with practical guidance for key nutrition education
activities. As a complementary initiative, a set of core
recipes and cooking videos translated to Nunavut’s 4 official
languages is set to be released this fall, in partnership with
the two major retail chains in Nunavut.
These materials and initiatives build on past
evaluations, and respond to expressed needs of
community workers and community members, and their
effectiveness will be evaluate d in the coming years.
[email protected]
The Antioxidant Level of Alaska’s
Wildberries: High, Higher, and Highest
AUTHORS: R. Rodgers Dinstel1, S. Koukel2,
J. Cascio1 , P. Holloway3
Alaska Cooperative Extension 1, NM Cooperative Extension 2, School
of Natural Resources and Agricultural Sciences 3
In the last few years, antioxidants have become the stars of
the nutritional world. Antioxidants are important in terms
of their ability to protect against oxidative cell damage
that can lead to conditions like Alzheimer’s disease, cancer
and heart disease - conditions also linked with chronic
inflammation. The antioxidant and anti-inflammatory
effects of wildberries may have the potential to help prevent
these diseases. Alaska wild berries have extraordinarily
high antioxidant levels. This research centered on both
the raw berries and products made from the berries. The
first year a variety of wild berries were tested to discover
their Oxygen Radical Absorption Capacity (ORAC) in the
raw berries. ORAC measures the number of antioxidants
FRIDAY ORAL
Several recent surveys in Nunavut show high rates
of a number of nutritional health issues, including
micronutrient deficiencies among pregnant women and
infants, obesity, and related chronic diseases. In many
cases, these conditions are 100% preventable, and the high
rates can be linked to a shift in dietary habits from a diet
consisting exclusively of nutrient rich country foods to a
diet with increasing proportions of market foods, often of
low nutritional value.
education materials. In addition, a recent environmental
scan helped to identify key initiatives that would support
improved effectiveness of community based nutrition
education programming.
125
present in the berries. The berries ranged from three
to five times higher than their cultivated cousins. For
instance, cultivated blueberries have an ORAC scale of
30, Alaska wild Blueberries measure 93. All of Alaska’s
berries have a level of antioxidants considered nutritionally
valuable, ranging from 29 for watermelon berries to 206
for lingonberries on the ORAC scale. The second level
of the research project created a series of 11 products
from blueberries, lingonberries, salmonberries, highbush
cranberries, currants and crowberries. These products were
tested for both ORAC as well as specific antioxidants.
One of the unexpected outcomes of the research was that
the berries continued to have high levels of antioxidants
despite the effects of commonly used heat processing
techniques. The high antioxidant levels of Alaska
wildberries can provide an opportunity to develop new
businesses based on production of value-added products.
[email protected]
“Norton Sound is Our Refrigerator”:
Linkages Between Ocean Health and
Human Health, as Described by Marine
Mammal Hunters of the Bering Strait
Region
AUTHOR: L. Ray
FRIDAY ORAL
Kawerak, Inc.
Marine mammals are an important food source for residents
of Alaska’s Bering Strait region, with a regional average
annual harvest of 2,688.5 pounds per household. Many
residents consider access to marine mammals an essential
part of community and individual health. Kawerak, Inc.
is currently conducting a participatory, communitybased research project on ice seal and walrus hunting.
During participatory research design, hunters, community
members, and tribal governments indicated that ocean
health was a major concern to them because of its influence
on food safety, food security, and hunter access to game. This
presentation will explain 1) the role of ice seals and walruses
in local food security, 2) community concerns about access
to marine mammals, and 3) community concerns about
marine mammal food safety and traditional methods for
determining the safety of marine mammal foods. These
points will be supported by hunter and elder observations
of factors influencing the health and availability of marine
mammals and their prey, including the effects of climate
change, pollution, and disturbance. The presentation
will conclude with community policy suggestions for
maintaining marine mammal food safety and security.
[email protected]
126
10:30 - 12:00
Store Outside Your Door Intiative
The Store Outside Your Door Initiative (SOYD) is a
concept from the Alaska Native Tribal Health Consortium’s
Wellness and Prevention Department. This program seeks
to highlight hunting, gathering, and growing foods within
the unique regions of Alaska. Where many who come to
Alaska consider our communities to be a “food desert”,
this program reframes our communities as rich sources of
food that can be harvested from the store outside your door.
This project promotes the concept of eating the nutrientdense foods that can be found within a 100 mile radius
of where an individual lives. Local farmers markets and
accessible food systems are a nation-wide movement. The
SOYD mirrors those concepts and adapts them so that
they may work in Alaska. SOYD staff are working with the
Northwest Indian College in Washington state to develop
a traditional foods infant feeding guide, giving our children
a taste for traditional foods from the start. The SOYD also
seeks to fund the concept of an Alaskan Statewide Native
Foods Sharing System, which will support our traditional
hunting activities for traditional and customary foods.
Using the positive deviance model, the SOYD program
seeks to highlight those hunters and gatherers who have
successfully worked with the Department of Environmental
Conservation (DEC) and State of Alaska (SOA) to share
their products with the community. The initial project
of the SOYD program is entitled Traditional Foods
Contemporary Chef (TFCC). TFCC is a web-based video
series, released via social media, which highlights Alaska
Native foods available in the diverse regions of our state. The
mission of this innovative project is to promote the health
benefits, awareness, and accessibility of Alaska Native foods.
[email protected]
Room 301
moderator: G. Conway
Culturally-Appropriate Boating Safety in
Arctic Alaska: Use of White Float Coats in
Whaling Communities
AUTHOR: H. Strayer
INTRODUCTION AND BACKGROUND: Alaska
Native people have drowning rates twenty times the
national rate, over half occurring during boating activities.
Alaska Native whale hunters historically have not
worn flotation gear; they generally wear white as arctic
10:30 - 12:00
camouflage while hunting, and white flotation gear has not
been available. Alaska has 13 northern communities that
are members of the Alaska Eskimo Whaling Commission
(AEWC), allowing them to participate in whale hunting.
Each community has from 50 to 200 residents participating
in whale hunting. METHODS: To determine whether
whale hunters would accept and use flotation gear if
it were available in white, we asked whaling crews in all
AEWC communities if they would participate in pilot
testing the flotation gear. Captains provided crewmember
size information. We obtained white flotation coats from
Mustang Survival, who made them as a special order, and
distributed them to each crew. We surveyed crews before
and after use of the white gear to determine perception of
risk, opinions of comfort of flotation gear, and frequency
flotation gear use. RESULTS AND DISCUSSION: The
pilot test was two-stage: in 2010 eight crews participated
from Wales, Wainwright, and Barrow, and in 2011 two
crews from each of the remaining AEWC communities
participated. Final surveys will be collected from crews this
spring. Preliminary findings indicate the white floatcoats
worked well during whaling hunts: ice did not adhere as
it does to traditional cotton parkas, and the coat’s belt
provided easy access to knives needed for safety. Some
hunters requested improvements: the exterior material was
noisy at colder temperatures, and the hood was too shallow
for sufficient face protection.
following vessel disasters (e.g. sinking, capsizing) in which
the crew was forced to abandon ship. Another 31% (41)
of fatalities were the result of falls overboard. In addition
there were 25 fatalities resulting from other causes (e.g.
struck by gear, fall from height, diving). Fatalities occurred
most frequently while fishing for salmon (39, 29%).
Falls overboard caused the most deaths among salmon
fishermen followed by drownings after skiff capsizings.
However, the Bering Sea Aleutian Island Freezer Trawl
fleet had the highest fishery specific fatality rate of
340/100,000 FTE/year. Conclusions: Tailored prevention
programs for specific high risk fisheries in Alaska such
as Bering Sea crab have resulted in safety improvements
since the 1990s. In addition to these prevention
programs, safety training for fishermen is available and
very affordable in Alaska. Progress has been made, but
there remains a need for continued safety interventions
to combat the unique work hazards found in Alaska
particularly in salmon fishing operations utilizing skiffs
and in the freezer trawl fleet operating in the Bering Sea.
CONCLUSION: If white floatcoats are available
to the community, whaling crews will wear them
during hunts. We will work with other agencies to get
white float coats readily available to Arctic hunters.
Bristol Bay Area Health Corporation
[email protected]
Commercial Fishing in Alaska,
2000-2009
AUTHORS: D. Lucas, J. Lincoln, R. Mohelski
CDC/NIOSH/APRO
Injury Rates in Southwest Alaska: The
Impact of Variations in Income from
Commercial Fishing
AUTHOR: B. Reed
Studies from several countries have demonstrated
increased rates of serious injury during harsh economic
times. Non-occupational injuries are the leading cause
of premature death for residents of Bristol Bay Alaska.
In this region, commercial salmon fishing occurs during
two summer months and accounts for a large proportion
of many households’ annual income. I hypothesized that
wide variations in income from commercial fishing would
dramatically alter overall injury rates in Bristol Bay. I
obtained injury data from the Bristol Bay Area Health
Corporation’s Severe Injury Surveillance System for
the years 1996 – 2009; and economic data from Alaska’s
Commercial Fisheries Entry Commission. I calculated
total income associated with commercial salmon fishing
by identifying the number and gross earnings of fishing
permit holders. Total annual per capita income data was
obtained from the Alaska Department of Labor and the
US Bureau of Economic Analysis.
Over the 14-year period, the overall injury rate declined
34%, from 418 in 1996 to 266 per 10,000 in 2009. This
decline was associated with an increase in median per
capita income, from $22,572 in 1996 to $36,694 in 2009.
There was no association between overall injury rates and
annual income from salmon fishing, which ranged from
$8,836 (2002) to $45,930 (2009). This surprising finding
FRIDAY ORAL
Background: The National Institute for Occupational
Safety and Health recently completed a study of commercial
fishing fatalities in the United States. The purpose of the
study was to identify the most hazardous fisheries around
the country and to describe the unique safety issues in each
region. The cold water and remote fishing grounds found
in Alaska make it a dangerous place to work. However,
significant improvements in safety have been realized
due to focused prevention efforts on high risk fisheries.
Methods: The Commercial Fishing Incident Database
was used to identify all fatal occupational traumatic
injuries that occurred in Alaska during 2000-2009. Data
are available on person, vessel and environment. Results:
During 2000-2009, 133 commercial fishermen died in
Alaska. Half (67) of the deaths were caused by drowning
[email protected]
127
may have resulted from supplementary sources of income
that maintained stable levels of total personal income in
the face of wide variations in income from commercial
fishing. Our next step is to identify these supplementary
sources; and explore how specific types of injury (such as
suicide attempts and domestic violence) might vary during
lucrative and disappointing summers of commercial fishing.
[email protected]
Maritime Disasters and Occupational
Fatalities in Alaskan Arctic Waters,
1986-2011
AUTHORS: J. Burton, G. Conway
FRIDAY ORAL
CDC/NIOSH
128
Objectives. To identify fatal maritime disasters in Alaskan
Arctic waters between 1986 and 2011. Study Design. As
regional reconnaissance for an EPPR/Arctic Council
project intended to promote worker safety and health
during disaster response, events were identified using public
and proprietary information sources for maritime disasters,
defined here as a shipwrecks, fires, and vessel casualties, in
Alaskan Arctic waters, defined here as being north of 60
degrees latitude plus the Bering Sea and Aleutian Islands.
Events were limited to occupational incidents, within
the defined geographic area and date range. Events were
then broken down by vessel type and within vessel type by
fatality occurrence. Concerted public/private efforts have
been made since 1990 to prevent deaths in such events,
and this study attempts to measure whether any progress
has been made on that front. Results. Preliminary data
show between 1986 and 2011 there were 166 maritime
disasters in Alaskan Arctic waters. 38 (23%) of these were
fatal incidents, with 128 total fatalities. The majority of
these (31 incidents and 110 fatalities) were in commercial
fishing. Almost all of the commercial fishing related deaths
happened along or near the Aleutian Islands. 3 fatalities
occurred during the response to an earlier maritime disaster.
The frequency of such events decreased from 7.4/year in
1986-1990 to 3.8/year in 2007-2011. Conclusion. Arctic
waters in Alaska provide a unique challenge to workers, in
particular, commercial fishermen. This challenge extends
to workers responding to maritime disasters as well. The
marked progress made in reducing such events during the
last quarter century gives hope and may provide useful
examples for such efforts in other cold waters worldwide.
[email protected]
10:30 - 12:00
Work-Related Aviation Fatalities
in Alaska: 2000-2010
AUTHORS: M. O’Connor, J. Lincoln, D. Lucas
CDC/NIOSH/APRO
Background: Aviation is a vital industry in a remote
region like Alaska. During the 1990s, a total of 108 fatal
aviation crashes resulted in 155 work-related fatalities. In
the early 2000s, several interventions were developed and
implemented by the aviation industry, government agencies
and nongovernmental organizations through a multifaceted
public health approach to improve aviation safety. Aircraft
crashes remain the second leading cause of work-related
deaths in Alaska; efforts continue to be needed to address
this high risk means of transportation. Methods: Data
from the National Transportation Safety Board (NTSB)
and the Alaska Occupational Injury Surveillance System
(AOISS) were used to identify risk factors for work-related
fatalities due to aircraft crashes. NTSB reports include
information on aircraft, crash circumstances, pilots and
crew, and a narrative outlining contributing factors. AOISS
contains information on all fatal occupational traumatic
injuries that occur in Alaska. Results: During 2000-2010,
a total of 54 crashes resulted in 90 work-related fatalities,
an average of five fatal aircraft crashes and eight fatalities
per year. Among those crashes, 21 (39%) were associated
with intended takeoffs or landings at remote landing sites
not registered with the Federal Aviation Administration
(FAA). Fifteen crashes (28%) were associated with
weather, including poor visibility, wind, and turbulence.
In addition, 11 crashes (20%) resulted from pilots’ loss of
aircraft control; nine (17%) from pilots’ failure to maintain
clearance from terrain, water, or objects; and seven (13%)
from engine, structure, or component failure. Conclusions:
Although aviation safety has improved greatly from the
1990s, efforts are needed to further reduce work-related
fatalities resulting from aircraft crashes in Alaska. Future
safety interventions should focus on providing weather
and other flight information to increase pilots’ situational
awareness, maintaining pilot proficiency and decisionmaking abilities including avoiding fatigue, and expanding
the infrastructure used by pilots to fly by instruments.
[email protected]
Behavioral Health #6 - Suicide Prevention 10:30 - 12:00
Schaible Auditorium
moderators: A. Bult-Ito & S. Scullion
The Village Wellness Project: Building
Community Resilience and Preventing
Suicide in Rural Alaska
AUTHORS: P. de Schweinitz1, C. Nation1,
C. DeCou2, T. Stewart2, J. Allen2
Tanana Chiefs Conference 1, University of Alaska 2
The Village Wellness Project of Tanana Chiefs Conference
(TCC, Alaska) has three primary purposes: 1) to empower
villages to build unique programs for resiliency and
suicide prevention; 2) to allow individual villages to shape
the larger system of care at TCC; and 3) to develop an
(indigenous) Athabaskan theory of community wellness
and suicide prevention. In this presentation we discuss our
process of wellness team building (and lessons learned),
the gun safe program, the collection of focus group data,
the analysis by means of modified grounded theory, and
our preliminary research findings. While our findings vary
by village, preliminary data suggest that rural Alaskans
living in Native predominant communities 1) are willing
to discuss and prioritize issues of mental well-being and
want to take strong measures to reduce suicide; 2) wish to
focus on increasing community safety; 3) are concerned
about cultural loss; 4) wish to increase local professional
counseling services; and 5) want to increase local
economic opportunities for recent high school graduates.
[email protected]
Cultural Intervention for Suicide
Prevention: The Qunagsvik Projects with
Indigenous Youth in Alaska
AUTHORS: J. Allen1, W. Charles2, S. Rasmus2
University of Alaska Fairbanks 1, Center for Alaska Native Health
Research 2
Please include in symposium on “Community Directed
Suicide Prevention in the Circumpolar North”
[email protected]
Intervention Among Alaska Native
People: An Evaluation of ASIST
AUTHOR: H. Strayer
Introduction and Background: Alaska
Native people have suicide rates nearly four times the
national average. The Applied Suicide Intervention Skills
Training (ASIST) is an evidence-based program training
community members to recognize and help people at
risk of suicide. Starting in 2008, trainers associated with
the Alaska tribal health system began ASIST trainings.
To date, 1,306 people have received this training from 50
trainers in the Alaska Tribal Health System. Methods: To
evaluate the effectiveness of these trainings, we surveyed
ASIST participants by phone at least nine months after
their training. The questionnaire asked about their
experience using ASIST to intervene, changes in comfort
levels talking about suicide, how appropriate ASIST was
for their community, and what type of support they needed.
Those contacted were a convenience sample of participants
from rural and urban communities.
Results and Discussion: The questionnaire
included 30 questions and averaged 20 minutes to complete.
We completed questionnaires with over 100 participants:
data analysis is pending. Final data will include percentage
of participants who are Alaska Native people; that live in
rural communities; that work in a profession associated
with suicide prevention; that had suicide intervention
experience prior to taking ASIST. We will report the
number of suicide interventions ASIST participants
were involved in, and what proportions took place in
rural communities and at work. We will determine the
proportions of participants who felt ASIST improved their
FRIDAY ORAL
Indigenous understandings of youth development and
the change process serve as point of departure in cultural
intervention rooted in indigenous theory. Elluam Tungiinun
(toward wellness) is a cultural program for the prevention
of youth suicide and alcohol abuse for rural Yup’ik youth
in Alaska ages 12-18 and their families. The intervention
developed out of a long-term CBPR collaboration between
members of an Alaska Native community and university
researchers. One aim of Elluam Tungiinun was to ground
the intervention in local Indigenous theory to create
contexts to experience Ellangneq (awareness) through its
activities. This presentation provides an example of two
activites, Murilkelluku Cikuq (watch the ice), which teaches
river ice safety, and the Qasgiq (men’s house), which teaches
a model of community organizing and decision making.
We describe how this indigenous process became the
basis for intervention development and a flexible adaptive
process for intervention in other communities, which our
co-researchers named Qungasvik (toolbox). Effective
intervention for indigenous communities is adaptive to
local cultural context, and based on the function of the
activity as event in system, not specific components or form
of intervention activity. The basis of intervention is the
protective factors embedded in the cultural values with the
activity. Selected outcomes are described and intervention
is understood as a community development process.
129
MONDAY POSTER
ability to talk about suicide and recommended that other
community members should take ASIST. Preliminary data
show the most frequent support requested was refresher
training. We will provide data on difficulties perceived
with ASIST, such as how many participants felt the twoday training was too long. Conclusion: These results
support using ASIST as a suicide intervention tool in
Alaska. We will explore refresher training for participants.
[email protected]
The Role of Community Consultations in
Suicide Prevention Research in Labrador
AUTHORS: N. Pollock1, M. Jong2, S. Mulay3,
K. Chaulk4, J. Wight4, A. Al-Krenawi5
FRIDAY ORAL
Memorial University of Newfoundland 1, Labrador-Grenfell Health
& MUN 2, Faculty of Medicine, MUN 3, Labrador Institute,
MUN 4, School of Social Work, MUN 5
130
Background: In Canada, many Aboriginal
communities struggle with a disproportionate burden
from suicide. Despite substantial mobilization to prevent
suicide, it persists as an urgent health problem in many
northern areas, including Labrador. Two provincial studies
have found that compared to Newfoundland, Labrador had
higher rates of suicide mortality [superscript “1” for end
note) and hospitalization for attempts.[superscript “2” for
end note] Another study reported that the suicide rate in
Nunatsiavut communities is twice as high as other Inuit
settlement areas.[superscript “3” for end note] In response
to local concerns, stakeholders in Labrador have requested
research to help identify at-risk groups, develop effective
prevention programs, and improve access to mental health
services. Methodology: To address this need, Aboriginal
governments, the regional health authority, and university
researchers have initiated a suicide prevention research
program. The primary objectives are to understand local
risk and protective factors for suicidality and translate this
into enhancing programs and services. The partners are
undertaking a community consultation as the first step in
the research process to learn about local experiences and
priorities, build relationships, and design future studies.
This consultation involves multiple activities including
workshops with elders and youth, and key informant and
focus group interviews with community leaders and health
professionals. Results: The consultations are taking place
during the winter and spring of 2012, therefore the specific
priorities and themes are still emerging. The consultation
will inform a multi-year research plan. Conclusion: This
presentation will provide a overview of the community
consultation process and identify the themes and priorities
that emerge from it. We will also present our research plan
and lessons learned about community consultations. This is
meant to foster discussion and seek
10:30 - 12:00
Works Cited: 1 Edwards N, Alaghehbandan R,
MacDonald D, Sikdar K, Collins K, Avis S. Suicide
in Newfoundland and Labrador: A linkage study
using medical examiner and vital statistics data. Can J
Psychiatry. 2008;53:252-259. 2 Alaghehbandan R, Gates
KD, MacDonald D. Suicide attempts and associated
factors in Newfoundland and Labrador, 1998-2000. Can
J Psychiatry. 2005;50:762-768. 3 Hicks J. Toward more
effective, evidence-based suicide prevention in Nunavut.
In: Abele F, Courchene TJ, F., Seidle L, and St-Hilaire F,
eds. The Art of the State IV Northern Exposure: Peoples,
Powers and Prospects in Canada’s North. Montreal:
The Institute for Research on Public Policy; 2009:467.
[email protected]
The Huslia Wellness Team Documentary:
Suicide Prevention Through Community
Empowerment
AUTHORS: P. de Schweinitz1, C. Nation1, C. Sam2
Tanana Chiefs Conference 1, Huslia Tribal Administration 2
The Huslia Village Wellness Team seeks to empower
villages through a community-based participatory
research process. Near the end of our first year in the
village of Huslia, we asked the leader of the Wellness
Team what more could be done. She suggested that we
create a film as a means of disseminating knowledge
about wellness team development. The film, shot in two
days and edited over several weeks by a professional
filmmaker working pro bono, has become a method of
opening conversations in other villages about suicide,
mental health, and wellness team development. In this
presentation we will introduce our methods of community
work, show the 40 minute film, and answer questions.
[email protected]
Behavioral Health
POSTER NUMBER: M1
Academic Performance and Alcohol Use
among Urban and Rural Alaskan College
Students
AUTHORS: R. Burket, M. Skewes
Youth in Alaska’s circumpolar north often migrate from
rural villages to urban centers to pursue post-secondary
education. Rural student retention rates lag behind those of
their urban counterparts despite support services that aim to
facilitate rural students’ adjustment to college life in an urban
environment. Stressors related to behavioral health and
alcohol misuse may contribute to the high rates of attrition
in this population. This research examined the associations
between rurality, alcohol use, and academic performance
among students at a university in the circumpolar north.
A sample of 298 students answered a questionnaire that
assessed rurality, academic performance, substance use,
and other behavioral health variables. Analysis of variance
was used to compare responses between rural Alaskan,
urban Alaskan, and non-Alaskan students in order to
evaluate associations between rural status and academic
performance, alcohol consumption, and overall behavioral
health. Urban students reported significantly higher GPAs
than rural students, F(1, 275) = 31.30, p < .001, η2 = .10, and
missed significantly fewer days of class than rural students,
F(1, 276) = 8.29, p < .01, η2 = .03, regardless of ethnicity.
The analyses found no significant difference between rural
and urban students in age of first alcoholic drink. However,
rural students from Alaska scored significantly higher on
measures that assessed alcohol dependence, F(1, 262) =
7.27, p < .01, η2 = .03, and alcohol related consequences,
F(1, 256) = 4.36, p = .04, η2 = .02. The results suggest
that rural Alaskan students’ use of alcohol may put them
at increased risk for alcohol dependence and may play a
role in class attendance. Implications for interventions to
increase rural student retention rates will be discussed.
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Municipal Teachers Training University2,Research Center of
Experimental Medicine, Siberian Branch3
Background: The problem of the young people’s
health becomes more urgent today, which is governed
by their high incidence of disease and the reduction in
the number of healthy students. The investigation into
this problem is caused by an insufficient study of the
effect of negative factors of unhealthy lifestyle, such as
social-harmful addictions (tobacco smoking and alcohol
use), on hormonal-metabolic characteristics of young
men. The purpose of this study was to determine the
effect of tobacco smoking and alcohol use on hormonalmetabolic characteristics among students attending higher
education institutions in Novosibirsk. and to determine
the mechanisms of regulation and interaction that are
connected with alteration of a human organism that results
from tobacco smoking and alcohol consumption.
Material and methods: Our study included
193 apparently healthy young people of ages 18-19 years.
The study participants lived in three districts in the city
of Novosibirsk under similar conditions with relative
ecological wellbeing. Participants’ blood was screened for
lipid peroxidation, cortisol, insulin, adrenocorticotropic
hormone, triiodothyronine, tiroxine, and thyrotropic
hormone.
Results: The hyperproduction of cortisol and
hyperinsulinemia was detected and indicate relative
insufficiency of adaptive processes and probably the state
of psychoemotional tension. The increase in cortisol can
demonstrate a syndrome of tension, which is caused by
smoking. The simultaneous increase in cortisol and insulin
in 75% of the young men is typical of the first phase of
stress. Differences in the concentrations of T3 and T4
(p<0.001) were dependent on tobacco smoking and
alcohol use. The thyrotropic hormone differed (p<0.01)
in 25% of young men who smoke and drink alcohol and
10% of them showed noncompliance of the principle
of “direct” and “inverse” connection in the thyrotropic
hormone- thyroid gland system. The processes of lipid
peroxidation intensifies in smokers and alcohol drinkers.
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[email protected]
POSTER NUMBER: M3
POSTER NUMBER: M2
Perceptions of Needs Regarding FASD
Across the Province of British Columbia,
Canada
The Effect of Factors of Unhealthy
Lifestyle (Tobacco Smoking and Alcohol
Use) on Hormonal and Metabolic
Characteristics of Young Men
AUTHORS: R. Fedina1, S. Filippova2,
V. Khasnulin3
Novosibirsk State Medical University State Budgetary Education1,
MONDAY POSTER
AUTHORS: A. George, C. Hardy
University of British Columbia
Background Considerable activity exists to address
FASD across the province of British Columbia, Canada.
This includes a provincial government public awareness
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MONDAY POSTER
campaign launched in Fall 2011, provincial-wide diagnostic
services, a provincial program providing support for families
who are going through the assessment processes, a teacher
education program, parent peer support programs and
research. In 2006, the provincial government established
the FASD Action Fund, with $7 million supporting
demonstration projects conducted by organizations across
BC. Methods We analyzed the 110 proposals submitted
to the FASD Action Fund for funding, according to the
submitting agency’s community size, previous experience
in the area of FASD and the project focus. Two researchers
independently coded the proposals along the 3 dimensions
and any disagreements were resolved by consensus. Each
proposal could have multiple codes for topic. Results
110 proposals were submitted: 32 (29.1%) from rural or
small town communities, 26 (23.6%) from small cities,
38 (34.5%) from metropolitan areas and 14 (12.7%) from
agencies working with networks of communities of various
sizes. The most common types of needs expressed were for
direct services for people with FASD. Skill development
for people affected by FASD was also a common theme,
as was awareness raising education. Development of
resources such as cultural camps, libraries or curriculum
development was frequently proposed. Compared to
proposals from larger communities or networks of
communities, proposals from rural communities were
more likely to focus on awareness raising education.
Discussion The robust response from communities across
the province to the call for proposals indicates widespread
interest in FASD. The emphasis on services, supports, skill
development, and awareness raising education reveals
perceptions needs in the area of FASD in BC communities.
[email protected]
POSTER NUMBER: M4
Coordinating Fetal Alcohol Syndrome
Interventions in Alaska
AUTHORS: G. Hartley, K. Broom, C. Hardy,W.
Getchell, J. Olson
University of North Carolina, Chapel Hill
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Background: Fetal Alcohol Syndrome (FAS) is
a leading cause of mental disability yet is completely
preventable. Alaska continues to have the highest incidence
of FAS in the US with rates higher among natives than
non-natives. Remarkably, Alaska reduced the incidence of
FAS by about 50% from 1996 - 2002. Still, annual FAS
costs for Alaska are projected to be more than $6.3 million.
Objectives: To review current Alaska FAS policies and
interventions and identify successful FAS interventions
in the Circumpolar region for implementation in Alaska.
Methods:We conducted a Pubmed and web search of
FAS interventions in Alaska and the Circumpolar region.
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Results: We identified many ongoing interventions
including: community –based grants for prevention,
training services, diagnostic teams, public education
campaigns, and a partnership with the State Department
of Education. Discussion: Across the circumpolar region,
major concerns for FAS treatment are coordination of care
and funding constraints. Three findings are of particular
interest: the State of Alaska manages the majority of its
FAS services through external organizations with almost
90% of the Governor’s 2012 FAS budget dedicated to
grants; CanFASD, a comprehensive FAS research network
in Canada, has been identified as a potential model for
Alaska; AFCHAN is a proven cost-effective telehealth
delivery program in Alaska but lacks an FAS component.
Conclusions: We recommend that Alaska emphasize FAS
telehealth through the AFCHAN project to improve
access and coordinate care. All funds required to support
this should be moved to the services side of the FAS budget
from the grants allocation. The state should dedicate 5%
of the FAS grant budget towards the development of an
online network, modeled after CanFASD, to coordinate
interventions. Alaska should also require that all state
grant recipients participate in this network. These
recommendations would eliminate service redundancy to
improve FAS programs while remaining budget neutral.
[email protected]
POSTER NUMBER: M6
Trends in Fetal Alcohol Syndrome
Prevalence in Alaska: Setting
Surveillance Standards to more
Accurately Assess Trends and Evaluate
Preventive Strategies
AUTHORS: J. Schoellhorn, A. Camerlin
State of Alaska
Background: Population-based estimates of fetal
alcohol syndrome (FAS) birth prevalence are higher for
Alaska than in other states using consistent surveillance
methodology. Past analyses of surveillance data document
a 19 fold disparity in FAS prevalence for Alaska Native
versus non-Native children. Problem Statement:
Evaluation of the statewide effectiveness of multiple FAS
prevention programs is problematic because of diagnostic
and surveillance factors that may affect case ascertainment
and temporal comparability. Objective: The objective of
this study was to determine whether there was a decline in
FAS prevalence coincident with statewide implementation
of FAS prevention, diagnostic and treatment programs.
Design: A retrospective cohort study using linked public
health surveillance data and information from complete
medical record review to examine trends in FAS birth
prevalence allowing for diagnostic evaluation through the
fifth year of life. Data was standardized to account for
surveillance bias that could affect temporal comparability.
Results: We identified a 28% overall decline in standardized
FAS birth prevalence in Alaska during 1996-2002
(p=0.5). Population-specific analysis demonstrated a 59%
decline (p<.0003) among Alaska Native children. Six
non-Native children met all FAS criteria during 19962000, compared to ten in 2001-2002. The cumulative
FAS risk for Alaska Native children born during 19962002 was13 times higher than for non-Native children
[relative prevalence (RP)=13.2; 95% confidence interval
(CI): 7.7,22.5]. For children born in 2001 and 2002, the
Alaska Native / non-Native disparity was substantially
reduced (RP=3.5; 95% CI: 1.7, 6.9). Conclusions: FAS
prevention activities likely contributed to a substantial
reduction in FAS risk for the Alaska Native population
during 1996-2002 but had no measurable effect on
reducing the prevalence of FAS among non-Native infants.
[email protected]
POSTER NUMBER: M7
Measuring Attitudes Toward Alchohol
Misuse Interventions in Alaskan College
Students
AUTHORS: M. Skewes1, V. Gonzalez2
University of Alaska Fairbanks1, University of Alaska Anchorage2
with positive attitudes toward HR (r = -.17, p = .009) and
positively associated with favorable attitudes toward AO (r
= .17, p = .007), providing evidence for convergent validity.
These findings provide initial evidence of the reliability
and validity of this newly created measure, which can be
used to examine differential attitudes toward HR and
abstinence-only among potential treatment recipients and
factors affecting those preferences in different populations.
[email protected]
POSTER NUMBER: M8
Association Between Daylight,
Temperature, and Alcohol Consumption
Among Alaska College Drinkers
AUTHORS: T. Stewart, V. Gonzalez, L. Blackwell
College students, compared with their non-college
attending peers, are particularly likely to evidence alcohol
abuse and to engage in binge drinking. Research has
found significant seasonal variations in alcohol use among
students and non-students, with peak alcohol consumption
during the winter and summer seasons. However, little to
no research has been published exploring the influence of
environmental factors that could be contributing to the
seasonal variations that have been correlated with alcohol
consumption. Furthermore, this lack of research holds
true even in areas of the world, such as the circumpolar
region, which experience dramatic environmental changes
throughout each season. This study attempts to gain a
better understanding of the seasonal variations in alcohol
consumption by examining the influence of average daylight
and temperature on alcohol consumption. Participants were
binge drinking (i.e., 4 or more—women, or 5 or more—
men, standard drinks on one occasion or sitting) emerging
adult (18- to 25-year-old) college students (N = 182) drawn
from two studies of college drinkers conducted over a oneyear period. Participants’ alcohol consumption was gathered
using the 30 day Timeline Follow Back, a retrospective, selfreport measure of daily alcohol intake. Average sunlight and
temperature data was gathered for the corresponding time
period. A statistical analysis of this data will be conducted
to reveal any significant associations that may exist between
average amount of sunlight and temperature with the
participants’ alcohol consumption. Additionally, this study
will attempt to control for extraneous variables that could
also be contributing to seasonal variations, such as holidays,
special events, and final exams. Understanding whether
environmental variables, such as sunlight and temperature,
effect alcohol consumption can be of use in the field of
substance abuse epidemiology, prevention, and treatment.
[email protected]
FRIDAY ORAL
Binge drinking among college students in Alaska remains
a public health concern. Current best practices for treating
college student alcohol misuse involve harm reduction
(HR) strategies. Harm reduction is a public health
approach to addiction that aims to reduce the negative
consequences associated with drinking without requiring
abstinence. However, no research has been conducted to
examine attitudes toward HR versus abstinence-only (AO)
approaches to alcohol treatment among potential treatment
recipients,largely due to a lack of valid and reliable assessment
instruments. This research aimed to fill this gap in the
literature. A 46-item measure was generated to assess the
perceived effectiveness of different treatment approaches.
A sample of 256 college students completed the attitudes
measure, rating on a Likert scale the perceived effectiveness
of each technique. Participants also completed measures of
alcohol dependence symptoms, alcohol consumption, and
attitudes about alcoholism. An exploratory factor analysis
using maximum likelihood extraction and promax rotation
resulted in a two factor solution with factors representing
HR and AO. Factor loadings ranged from .45 to .80
on the HR subscale and .40 to .89 on the AO subscale,
and no items loaded on both factors. These factors were
moderately correlated (r = .43) and had high internal
consistency (alpha = .92 for each subscale). Belief in a
disease model of alcoholism was negatively associated
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MONDAY POSTER
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POSTER NUMBER: M9
POSTER NUMBER: M10
Epidemiological Portrait of Behavior
Problems among Inuit Children:
Preliminary Results
Examining Tlingit Conceptions of
Gendered Geography in Alaskan
Circumpolar Communities
AUTHORS: G. Bégin1, S.W. Jacobson2, N. ForgetDubois1, J. Gagnon3, E. Dewailly3, P. Ayotte3, J.L.
Jacobson2, G. Muckle1
AUTHORS: K. Dexter, T. Lower, L. McKnight
Laval University1, Wayne State University2, Centre de recherche du
CHUQ3,
This study utilizes indigenous Tlingit psychological theory
of gendered geography or “wet” and “dry” as a means of
examining whether a correlation exists between election
outcome and Tlingit conceptualizations of surrounding
environmental conditions in the state of Alaska. Data for
the study comes from the 40 separate voting districts as
determined by the State of Alaska Division of Elections.
Each voting district was defined as being either a “wet”
or “dry” area as it pertains to the Tlingit understanding
of gendered geography. Election outcome was designated
by the elected officials as being either Republican or
Democratic based on the State of Alaska Division of
Elections. Archival data stemming from the past three
State of Alaska election cycles at both the national and
state level races have been analyzed with a chi-square test
of independence. Results suggest the Tlingit psychological
theory of gendered geography could have implications
for future studies examining indigenous ontological
systems as it impacts the circumpolar communities.
Recommendations for future research are discussed.
High rates of poverty, substance abuse, psychological
distress and domestic violence are reported in aboriginal
communities, including the Inuit from circumpolar
countries. Many studies have shown a link between those
psychosocial risk factors and the presence of behavior
problem in children, but this association has not been
demonstrated for the Inuit. The aim of this study was to
examine the association between multiple psychosocial risk
factors and behavior problems among school aged Inuit
children. Population and methods: Associations between
risk factors and child behaviors were analyzed in a sample
of 11-year-old children from Nunavik (Northern Quebec,
Canada; N = 294). Externalizing and internalizing behavior
problems were assessed with the Teacher Report Form of
the Child Behavior Checklist and the Disruptive Behavior
Disorders Rating Scale. The child’s teacher completed
both instruments. Four dichotomous variables were used
as psychosocial risk indicators: 1) maternal psychological
distress, defined as the presence of depressive symptoms
or suicidal thoughts or attempts; 2) domestic violence: the
presence of physical violence perpetrated by the partner
or by the mother (Conflict Tactic Scales); 3) economic
precariousness: receiving welfare or being single parent; 4)
substance use: alcohol or drug use during the previous year.
Additional variables included parity, residential crowding and
maternal education, assessed in a maternal interview. Results:
From latent class analysis on behavioral variables emerged
four profiles of children: little risk of behavioral difficulties
(60%), high risk of internalizing problems (15%), high risk
of externalizing problems (17.5%) high risk of externalizing
and internalizing problems (7.5%). Conclusions: These
findings indicate that a large proportion of the children in this
population manifest behavioral problems in school. Further
analyses will examine the degree to which the psychosocial
risk factors documented are associated with the probability
of belonging to one of the four behavior problem profiles.
[email protected]
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[email protected]
POSTER NUMBER: M11
Addictive Disorders in female with
borderline personality organization in
Siberian North
AUTHORS: T. Korolenko1, T. Korolenko2, T. Shpiks1
Novosibirsk State Medical University1, Institute of Physiology, SB
RAMS2
Authors present the data of the study of 40 female, aged
18-48, inhabitants of towns, villages, and monasteries of
North regions of Siberia. The clients revealed the signs of
O.Kernberg’s (1967) borderline personality organization.
They were expressed in diffuse non-cohesive identity, in
the use of primitive psychological defenses in form of the
denial, the projection, projective identification and the
splitting. The general estimation of themselves and the
environment was preserved. In nine cases the diagnosis
of borderline personality disorder, according to criteria of
DSM-IV-TR (2000), was established. Observed clients
revealed the symptoms of chemical addictive behavior
and/or process addictions that included addictive use
of alcohol, pathological use of Internet, overeating,
starvation, workaholism with burnout syndrome The
clients had been experienced the child abuse, parents’
emotional rejection, the Strange Situation, according to M.
Ainsworth (1969). Addictive realizations were intensified
in the situation of conflicts, the experience of the jealousy
and the boredom. 11 clients displayed the signs of sexual
fluidity when their basic, heterosexual or lesbian, gender
identification was preserved. The periods of temporary
change of their sexual orientation was accompanied with
the increase of addictive realizations served as the tool
for the mitigation of developed psychological tension.
The analysis of the role of the presence in several clients
the traits of temporal lobe personality (singled out by
the authors and discussed at Seattle Annual Meeting
Integrating Medicine and Psychiatry in June 2011) as
the factors of a resistance to the development of addictive
way of the escape from the reality is provided. The role of
the interplay of specific environmental, psychological and
genetic factors in the risk of the development of addictions
and their prevention in condition of North is emphasized.
[email protected]
POSTER NUMBER: M12
Yellowknife Street Outreach Community
Consultation
AUTHORS: J. Russell1, B. Denning2, L. Mantla2, S.
Chatwood2
Yellowknife Health and Social Services Authority1, Institute of
Circumpolar Health Research2
the sex trade in Yellowknife can be effectively addressed;
How can communication, coordination and collaboration be
increased between service providers and service agencies in
Yellowknife, and; Defining the appropriate outreach measures
to reach Yellowknife’s marginalized street population.
[email protected]
POSTER NUMBER: M13
The Prevalence of Emotional and
Conduct Disorders in Native Children of
the North
AUTHORS: N. Semenova, V. Tsukanov
State Scientific Research Institute for Northern Problems
AIM OF THE RESEARCH: To study the prevalence
of emotional and conduct disorders in native children of
the North. MATERIALS: We examined 888 children by
native populations (the Yakuts, the Evenks, the Evens)
in ages from 7 to 16 years. METHODS: M. Rutter
questionnaire – B2 scale for teachers, psychiatric interview.
RESULTS: In primary school the prevalence of emotional
and behavior disturbances amount 14.2%. The share of
emotional disorders was 1.6%, behavior disorders 11.9%,
combined disorders 0.7%. In adolescents the growth of
the prevalence of psychic disturbances took place (21.4%)
due to the growth of both emotional disorders (3.1%) and
behavior disorders (16.5%) and also combined disorders
(1.8%). In boys psychic disorders were marked 2.8 – 3.6
times more frequent than in girls. In terms of frequency
behavior disorders (F91) ranked first, hyperkinetic
(F90) ranked second and anxiety (F93.8) ranked third.
Among psychic disorders the number of children with a
comorbid diagnoses makes 59.3%. The most prevalent
type of comorbidity was a combination of hyperkinetic
(F90) and behavior (F91) disorders (26.6%). Children
with emotional and behavior disorders showed adaptation
disturbances to children organized group, which were
reflected in poor school performance, regular absence from
school, no respect from classmates. CONCLUSIONS:
So, the prevalence of emotional and behavior disorders in
native children of the North early school ages approached
14.2%, in adolescence 21.4%. As preventive measures
against the complex of disadaptive states and difficulties
in further socialization it is necessary to timely diagnosis
neural psychic disorders and provide medical and
psychological assistance to the said kind of schoolchildren.
[email protected]
FRIDAY ORAL
The purpose of this study was to describe the health and
addictions assets in the downtown core of Yellowknife, NWT,
in order to better address the high hepatitis C (HCV) and
sexually transmitted infection (STI) rates in Yellowknife,
especially infection transmitted through illicit drug use. Data
was collected over the summer of 2011 through focus groups
with 19 street people; a Photovoice workshop with 8 street
people; and 7 one-on-one interviews with service providers
in the downtown core. A number of themes emerged
through the consultation process, including: - Needle
Exchange; Non-Beverage Alcohol Use; Mixed Messages
to Youth; Sex Trade; Interagency Coordination, and; Need
for Outreach Services. The community consultation results
indicate that the high HCV and STI rates are likely not
related to illicit drug use, such as transmission by crack
cocaine pipes. However, links may be found through further
investigation into the following areas: The development
of harm reduction mechanisms that address the needs
of the street population; How non-beverage alcohol use
impacts the HCV and/or STI rates in Yellowknife; How
to effectively perform social marketing to youth that uses
messaging consistent with local laws and/or policy; How
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MONDAY POSTER
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POSTER NUMBER: M15
POSTER NUMBER: M16
Lifetime Problem Gambling among
Greenland Inuit – Do Childhood
Conditions and Sociodemographic
Factors Contribute to the Problem?
Traditional Living and Subsistence as
Protective Factors Against Suicide:
Perceptions of Alaska Native University
Students from Rural Alaska
AUTHORS: C. VL Larsen, P. Bjerregaard
AUTHORS: C. DeCou, M. Skewes, E. Lopez
NIPH, University of Southern Denmark
Introduction: During recent years problem gambling has
become a much debated subject in Greenland. For the
majority gambling is harmless, but for some the gambling
activities develop into a problem with negative impact on
their social life, health and economic status. The objective
of this study is to investigate the prevalence of lifetime
problem gambling among Inuit in Greenland and its
association with sociodemographic characteristics and
alcohol related problems during childhood.
Methods and Materials: Data were derived from the Inuit
Health in Transition – Greenland Survey 2006-2010 – a
population based general health study among adults in
Greenland. Data were collected by structured interviews
and self-administered questionnaires. The self-administered
questionnaire contained the questions about gambling and
was filled out by 2195 of the 2458 participants. Problem
gambling was measured using the lie/bet questionnaire - a
two question short version of the 10 DSM-IV-TR criteria
for screening pathological gambling.
Results:The prevalence of lifetime problem gambling
was 16% among men and 10% among women with
significant differences between age groups. Regarding
sociodemographic variables, lifetime problem gambling was
associated with age, education, place of living and alcohol
problems in childhood, but associations were different for
men and women. Occupational status and region were not
significantly associated with lifetime problem gambling.
Discussion: Our most significant finding is the association
of reported alcohol problems in childhood home, which
rendered an increase in the odds ratio of lifetime problem
gambling for those who often experienced alcohol
problems in their childhood home. Although the measure
of alcohol problems is a rather unspecific question and
does not hold any explanations to the kind of problems
or the persons involved, it clearly works as an indicator
for social problems in childhood, and more research
is needed to understand the influence of childhood
conditions on adult health among Greenland Inuit.
Alaska Native people in Alaska suffer one of the highest
rates of suicide in the world. This represents a significant
health disparity for indigenous populations living in
Alaska. This research was part of a larger study that explored
qualitatively the perceptions of Alaska Native university
students from rural communities regarding suicide. This
analysis explored the resilience that arose from participants’
experiences of traditional ways, including subsistence
activities. Previous research has indicated the importance
of traditional ways in preventing suicide and strengthening
communities. Semi-structured interviews were conducted
with 25 university students who had migrated to
Fairbanks, Alaska from rural Alaskan communities. An
interview protocol was developed in collaboration with
cultural and community partners. Interviews were audiorecorded and transcribed. Participants were asked specific
questions concerning the strengthening of traditional
practices towards the prevention of suicide. Transcripts
were analyzed using the techniques of grounded theory.
Participants identified several resilience factors against
suicide, including traditional practices and subsistence
activities; meaningful community involvement; and an
active lifestyle. Traditional practices and subsistence
activities were perceived to facilitate healthy relationships,
transmit important cultural values, and promote an active
lifestyle. Participants considered the strengthening of these
traditional ways as important to suicide prevention efforts.
However, subsistence and traditional practices were viewed
as compromised due to the complex constellation of factors
affecting rural Alaska. Many college students from rural
Alaskan villages have been affected by suicide, but have
important strengths that allowed them to cope with such
tragic events. Subsistence living and traditional practices
were perceived as important social and cultural processes
with meaningful lifelong benefits for participants. Future
research should continue to explore the ways in which
traditional practices can contribute to suicide prevention, as
well as the far-reaching implications of subsistence living.
[email protected]
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[email protected]
POSTER NUMBER: M17
Embrace Life: A Celebration of Inuit Life
and Culture on Parliament Hill
AUTHORS: E. Ford, K. Merritt
Canadian Inuit have a suicide rate which is eleven times
that of other Canadians. The majority of completed
suicides throughout Inuit Nunangat (the Inuit homelands)
are primarily among young men between the ages of 14-27,
with an estimated rate of over 40 times that of their cohort
in the rest of Canada. Given that the Inuit population is
among the fastest growing and most youthful segments of
Canadian society, Inuit are losing their future leaders and
role models at an untenable rate.
The National Inuit Youth Council brings national attention
to the unacceptable suicide statistics of Inuit youth by
leading a celebration of Inuit life and culture on Parliament
Hill in Ottawa (the capital of Canada) every September
9th (World Suicide Prevention Day) for the past five years.
This “Inuit Embrace Life” event is a collaborative effort
between various organizations: the National Inuit Youth
Council, Inuit Tapiriit Kanatami, Inuit Tuttarvingat of the
National Aboriginal Health Foundation, Pauktuutit Inuit
Women of Canada, Honouring Life, and Inuit Circumpolar
Council Canada.
This presentation will provide an overview of the history
and context of suicide among Inuit, outline the “Embrace
Life” concept of Inuit suicide prevention, and discuss
the creation of the 2004 National Inuit Youth Suicide
Prevention Strategy. The evolution of the “Inuit Embrace
life” event, as well as the steps some Inuit communities
have taken to promote suicide prevention awareness will
be highlighted.
[email protected]
POSTER NUMBER: M18
AUTHORS: C. Carry1, K. Tagoona, D. Rideout, A.
Kronstal2, S. Chess
National Aboriginal Health Organization1, Nunavut Health and
Social Services2
In 2010, Inuit Tuttarvingat of the National Aboriginal
Health Organization (NAHO), with funding from
Health Canada, wanted to enhance its Inuit Tobaccofree Network (ITN) project by engaging Inuit youth in
collecting video footage of quit smoking stories from their
families, friends and communities. The project’s Inuk youth
coordinator provided six youth with basic guidelines and
an instructional video on how to best use the Flip video
camera they each received to film their subjects. The youths’
video footage was edited into seven 3-5 minute stories,
produced in the Inuit language and English. These were
posted on the ITN website (www.InuitTobaccofree.ca)
and YouTube along with an introductory clip and a public
service announcement about smoking. Wanting to share
these quitting stories with more youth, the team looked
at adapting a tobacco awareness program, called Smoke
Screening, that ran school contests for a number of years
in the three Canadian territories using international antismoking ads. After reviewing evaluation findings of that
program, we partnered with the Nunavut Department of
Health and Social Services to run an adapted version of the
contest in Nunavut Grade 7-12 classrooms in 2011. For
the contest, we asked teachers to play the quitting videos in
class, hold discussions with their students about tobacco use
issues and then have their classes vote on which one of our
video stories was powerful enough to be aired on northern
TV. We offered classes and schools various prizes for their
participation. Evaluation results based on 38 viewings by
hundreds of students demonstrated that this activity helped
to engage youth on the topic of tobacco use reduction.
Highlights from the results will be shared in this presentation
along with a two-minute excerpt of the winning video
“Quitting”, which aired on CBC North TV in March 2011.
[email protected]
POSTER NUMBER: M19
The Effect of Iqmik Derived Metals on
ROS Generation and Cytokine Response
in Human Gingival Epithelial Cells
AUTHOR: G. Dwyer
University of Alaska, Anchorage
Iqmik is a form of smokeless tobacco commonly used by
Alaska Natives especially on the Yukon-Kuskokwin Delta.
The elders from villages in this region estimated that 50% to
80% of the population use iqmik. Iqmik is a combination of
tobacco leaves mixed with Phellinus igniarius (punk fungus)
or Salix alaxensis (willow) if the punk fungus is unavailable.
Tobacco has a large number of carcinogens including toxic
metals which cause inflammation, oxidative stress and
apoptosis in cells. The ash component of iqmik has higher
levels of cadmium, cobalt, and nickel than tobacco alone.
Cadmium, cobalt and nickel are known carcinogens and have
adverse effects on cells causing oxidative stress, inflammation
and apoptosis. Reactive oxygen species (ROS) are produced
in response to cadmium, cobalt and nickel causing oxidative
stress in the cell. Interleukin-6 (IL-6) and interleukin-8
FRIDAY ORAL
Engaging Inuit Youth in Tobacco Use
Reduction Using Video Stories on
Quitting
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MONDAY POSTER
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MONDAY POSTER
(IL-8) are two cytokines that are activated in an oxidative
stress environment. IL-6 and IL-8 have been identified
as two biomarkers for oral squamous cell carcinoma and
are involved in chronic inflammation, and the growth
and metastasis of tumors. The specific aims of the project
are to first quantify the uptake into oral epithelial cells of
three toxic metals, cadmium, cobalt and nickel in artificial
saliva extracts of iqmik. The second aim is to determine the
level of ROS and proinflammatory cytokines produced by
oral epithelial cells in response to cadmium, cobalt, nickel
and iqmik exposure. Metals, ROS and interleukins will
be analyzed by ICP-MS, ROS sensitive fluorescence dye,
and ELISA, respectively. It is expected that the exposure
of oral epithelial cells to artificial saliva extracts of iqmik
will lead to absorption of cadmium, cobalt and nickel
and will cause elevated ROS, IL-6 and IL-8 response.
[email protected]
POSTER NUMBER: M20
Chronic Diseases and Alaska Native
Tobacco Use: An ANTHC Initiative to
Improve Services
AUTHORS: S. Kelley, K. Doster, B. Wooley, C.
DeCourtney
ANTHC
138
The Alaska Native Tribal Health Consortium (ANTHC)
provides healthcare services to Alaska Natives statewide.
Alaska Natives have the highest rate of tobacco use in Alaska.
The prevalence of cigarette smoking is 39% for Alaska
Natives compared to 19% for all Alaskans (BRFSS 2009).
The ANTHC Cancer program recognized the need for
increased collaboration to address the tobacco use disparity
among Alaska Natives. While there have been many tobacco
policy and clinical cessation successes within the Alaska
Tribal Health System (ATHS), the disproportionally high
tobacco use rate among Alaska Native people indicates
the need for innovative and collaborative partnerships to
substantially impact tobacco use. The goal of the Chronic
Disease and Tobacco Use Initiative was to create a
collaborative workgroup involving healthcare professionals
from pulmonary, cardiology, diabetes, cancer and tobacco
specialty clinics at the Alaska Native Medical Center. The
workgroup would lead to increased collaboration while
strengthening the tobacco clinical protocol. The workgroup
focused on a) identifying patients who use tobacco, b)
provider training to address US Public Health Service
Guidelines c) referral to the ANTHC Tobacco Treatment
Program, d) access to pharmacotherapy, including nicotine
replacement therapy, and e) follow up treatment including
behavioral counseling. Workgroup outcomes resulted in
increased communication between specialty clinics and a
streamlined clinical protocol for high risk patents seeking
14:30 -15:30
cessation services. The need for additional health education
materials was identified as well as the overall need for better
coordination of tobacco education and treatment services.
The ANTHC Chronic Disease initiative demonstrates the
value of identifying specific health care professionals to assist
with process improvement projects across chronic disease
programs. As the need for comprehensive communication
and coordinated referrals to the tobacco program was
identified, it became evident that a comprehensive system
wide evaluation of the tobacco program and clinical
tobacco cessation protocol needed to be addressed.
[email protected]
POSTER NUMBER: M21
Tobacco Use Prevalence – Disentangling
Associations between Alaska Native,
Socio-Economic and Rural Disparities
AUTHORS: E. Peterson1, J. Dilley2, M. Bobo3,
K. Pickle2
State of Alaska Department of Health & Social Services1, Program
Design & Eval Svcs, Multnomah Cty/OR Hlth Authority2, State of
Alaska DHSS, Tobacco Prevention & Control3
Alaska Native communities and people with lower socioeconomic status (low SES) are high priority population
groups for Alaska’s tobacco control efforts, due to high
tobacco use prevalence. Tobacco use is also higher outside
the relatively few densely populated areas in the state, such
as Anchorage, Fairbanks and Juneau. These three factors
(Alaska Native race, low SES status and rural location)
are frequently correlated. For the purpose of better
informing tobacco control interventions, we conducted a
descriptive study to isolate and also examine interactions
among these characteristics. We used combined data from
Alaska’s 2006-2009 Behavioral Risk Factor Surveillance
System (BRFSS) for analysis. This statewide, randomdigit dialed telephone survey of adults in the state collects
information about an individual’s residence (zipcode),
race, SES (based on years of formal education completed)
and current tobacco use. We used stratified analysis and
multiple logistic and factorial models to describe current
use of cigarettes, smokeless tobacco (including prevalence
specifically of Iq’mik, a unique Alaska Native smokeless
tobacco product) and “dual use” (both products). We
also included gender, age and having children in the
home as covariates. All three factors we examined were
independently predictive of tobacco use prevalence in most
models. The magnitude of association varied for different
outcomes. In some cases, there were interactions between
factors which suggest that special consideration be given
to populations with multiple risk factors. Having children
in the home was independently predictive of smokeless
tobacco use, which may be useful for tailoring tobacco
control messages. While Alaska Native race, low SES
status and rural residence can each be considered alone,
and tobacco control interventions targeted appropriately,
our study showed that there is high correlation among
them and that thinking of population “segments” (such
as urban Alaska Native people) may be helpful for
better tailoring effective tobacco control interventions.
[email protected]
POSTER NUMBER: M22
Are More Smokers Using Smokeless
Tobacco Products? Evidence of “dual
use” in Alaska
AUTHORS: E. Peterson1, J. Maher2, M. Bobo3, C.
Bushore2, K. Rohde2, C. Dent2
State of Alaska Department of Health & Social Services1, Program
Design & Eval Svcs, Multnomah Cty/OR Hlth Authority2,S tate of
Alaska DHSS, Tobacco Prevention & Control3
[email protected]
POSTER NUMBER: M23
A Study of Tobacco Use or Exposure and
Cotinine Measurement among Alaska
Native Women During Pregnancy and
Infants During the First Year of Life
AUTHORS: J. Smith1, R. Robinson1, B. Khan1, C.
Sosnoff2, D. Dillard1
Southcentral Foundation1, Centers for Disease Control1
Introduction: Saliva cotinine measurement has been utilized
to estimate tobacco use and second-hand smoke (SHS)
exposure for epidemiological studies, tobacco cessation
studies, indoor smoking studies, and tobacco cessation
programs. Given few cotinine studies of Alaska Native
(AN) women and their infants, we estimated a cotinine
cutoff to distinguish smoking from non-smoking pregnant
AN women and estimated associations between infant
and maternal cotinine in the first year of life. Methods:
Pregnant AN women eligible for care at Southcentral
Foundation Anchorage Primary Care Center could enroll
in the study. At all pre- and post-natal visits, women
provided a saliva sample and reported use of and exposure
to tobacco. In the post-natal visits, a saliva sample was also
collected from the infant. Using prenatal data, we estimated
an optimal saliva cotinine cutoff for indication of active
cigarette use during pregnancy with receiver operating
characteristic (ROC) curve analysis. Using postnatal data,
we estimated associations between maternal and infant
cotinine with linear regression. Results: Using self-reported
past-week cigarette use as indication of active smoking
during pregnancy, the area under the ROC curve was
0.968 (95%CI: 0.943 – 0.993). The point closest to 100%
specificity and sensitivity occurred with the cotinine value
of approximately 0.897 ng/mL with sensitivity of 94% and
specificity of 93%. In post-natal analysis, there was positive
correlation between maternal and infant cotinine (p<0.01).
Conclusions: We recommend using a saliva cotinine cutoff
of 1 ng/mL to distinguish active smoking in pregnant AN
women. This cutoff is lower than used in other studies with
pregnant women, most likely due to high incidence of light
or intermittent smoking. Further, in the year following
birth, there is a strong correlation between increased
maternal cigarette use or SHS exposure and infant exposure.
[email protected]
FRIDAY ORAL
Introduction: Recent examination of tobacco industry
documents detail a strategy to promote the use of smokeless
tobacco (SLT) to smokers. This session will focus on a study
in Alaska that examined the potential impact of industry
efforts. Methods: Trends in the use of SLT among current,
former and never smokers were examined using data on
adult (aged 18+ years) males (n = 16,590) from the 19962008 Alaska Behavioral Risk Factor Surveillance System
(BRFSS). We also examined trends from 2004-2008 in
cigarette consumption among smokers who also use SLT
(dual users), and compared characteristics of dual users
to those of other smokers. Results: From 1996-2008, the
prevalence of SLT use among current smokers significantly
increased (p = .004), but remained unchanged among
former and never smokers. Cigarette consumption among
dual users significantly decreased between 2004 and 2008 (p
< .001), but consumption remained steady among smokers
only. Compared to other smokers, dual users in 2004-2008
were younger (p < .001), more likely to live in rural areas (p
= .006), and more likely to be heavy drinkers of alcohol (p
= .037); they were also somewhat -- but not significantly -more likely to have lower incomes and more likely to report
a smoking ban at home. Conclusions: We found evidence
that male smokers in Alaska might be substituting some
cigarettes with SLT, but not quitting smoking. Other state
tobacco control programs should examine their data to
confirm our findings, and should continue educational
campaigns encouraging cessation of all tobacco products.
14:30 -15:30
MONDAY POSTER
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MONDAY POSTER
POSTER NUMBER: M25
Health Services
Two Partnership Efforts for Village
Based Teaching on Health and Domestic
Violence
POSTER NUMBER: M26
AUTHOR: P. Ciniero
Itinerant Public Health Nurse
This poster session shows how two partner groups provide
teaching in villages and communities throughout the State
of Alaska. The two to three day trainings include lecture,
discussion and breakout sessions.
A Public Health Nurse is one of the training members on
both teams
One training team, led by the Alaska Native Womens
Coalition, is funded by tribes. This team travels to villages
on an invitation only basis. The invitation is extended by
the tribes.
The other team, led by the Alaska Native Tribal Health
Consortium (ANTHC) is funded by a Domestic Violence
Initiative Grant. This grant is awarded by the Indian
Health Service administered through ANTHC. This grant
program has been well received in many communities,
therefore a request to extend another year of this three year
grant is under way.
Examples of topics that are similar in both groups are:
Historical trauma, Sexual Assault and Village Based
Response, Domestic Violence Effects on Children and
Introduction to Domestic Violence and Sexual Assault.
Additionally, with tribally funded trainings, the tribe may
identify other topics they may wish to be included in the
training. For example, the training team may go to the
school to teach students on safe/unsafe touch, bullying and
teen dating violence. These sessions are done concurrently
with the conference.
Villages that have requested the Alaska Native Womens
Coalition training team may request second trainings
(which one has so far); the topics become more in depth,
building on previous trainings.
What we have observed, is that the target audience is
different in the tribally funded and the IHS funded
trainings. The IHS funded trainings are attended by
behavioral and medical professionals and the tribal ones by
more community members.
[email protected]
140
14:30 -15:30
Management of Chronic Obstructive
Lung Disease in the Primary Health
Care System in Greenland. A Feasible
Indicator for Primary Health Care
AUTHORS: S. Olsen1, K. Abildskov1, D.E. Jarbøl2,
M.L. Pedersen1
Queen Ingrid Health Care Centre1, Research Unit of General
Practice, Institute of Public Health, University of Southern
Denmark2
Background:Population survey has documented very high
prevalence of smoking in Greenland.
Although a decline has been observed during the last
two decades around two thirds of the adult population is
smokers. Use of tobacco is a well established risk factor
for chronic obstructive lung disease (COPD). Measuring
forced expiratory volume in one second (FEV1) is crucial
to diagnose, graduation and choice of treatment in COPD.
It is recommended to monitor FEV1 annually for patients
diagnosed with COPD. However, the management of
COPD and use of FEV1 measurements in Greenland is
unknown.
Objective:The aim of this study was to estimate the
prevalence of use of drugs for obstructive airway diseases
among persons at 50 or above years old in Greenland and
to estimate the use of FEV1 measurements.
Study design: Observational cross sectional study based on
reviewing electronically medical records.
Methods: The study was performed in the six largest
primary health clinics in Greenland representing 65 % of
the population in Greenland. Adults at 50 or more years
old, whom had at least one drug prescribed electronically
for obstructive airway diseases was identified using
a statistic module incorporated in the electronically
medical record system used in all primary health clinics in
Greenland. Drugs for obstructive lung disease was defined
as therapeutic subgroup R03 in the Anatomical Therapeutic
Chemical Classification System. The medical records
were reviewed four years back in time in order to obtain
information about diagnosis of COPD and performance
of FEV1 measurements.
Results:We found a prevalence of 6.1 % of adult aged 50
0r above receiving treatment for obstructive lung disease.
Of those, around a third (2.1 %) had the diagnosis COPD
mentioned in their medical record. Among all patients only
16.3% percent had their FEV1 measured within four years
and only 12.9 % within two years. Among those with the
CODP diagnosis only 25.1 % and 31.6 % had their FEV1
measured within two and four years respectively.
Conclusion: The use of drugs for obstructive airway diseases
in Greenland among adults aged 50 years old or above is
common. However, the use or FEV1 measurement is very
low and increased aware or COPD seems to be is needed.
It is suggested to use the percentage of patients treated
with drugs for obstructive airway diseases, whom had
their FEV1 and smoking status measured and registered
as an indictor tool to monitor and improve quality of
care for among patients with obstructive lung disease.
[email protected]
POSTER NUMBER: M27
Electronic Access to Inuktitut Medical
Terms for English Speaking Clinicians
AUTHOR: A. Drossos
[email protected]
POSTER NUMBER: M29
Presentation of National Centre for
Mental Health
AUTHORS: R. Persen, F. Nystad Nilsen, E. Johnsen,
L. Somby Iversen
Sami National Centre for Mental Health
Sami National Centre for Mental Health (SANKS) Main
goal SANKS has been assigned national responsibility
for the development of mental health services for the
Sami people in Norway that are on par with the services
available to the rest of the population. Objectives: To
develop clinical services, research and development,
teaching and counselling, education of specialists and
training of students. Organisation: SANKS, which is
located in Karasjok and Lakselv, has approximately 120
employees, and is an integrated part of the specialist
health services of the Finnmark Hospital Trust. SANKS
has three departments: 1)Department of mental health
services for adults, 2) Department of mental health services
for children and adolescents, and 3) Department of
research and development. The following clinical services
are provided: out-patient clinics, in-patient treatment
and rehabilitation, family treatment and acute services.
[email protected]
POSTER NUMBER: M31
Frontier Extended Stay Clinics: A New
Provider Model
AUTHORS: R. Frazier, S. Doucatte
Background: Frontier Extended Stay Clinics (FESCs) are
located at least 75 miles from facilities offering the next
level of care, placing them in geographic isolation serving
small populations. Transporting patients from remote
locations to higher levels of care is not always possible
which means that FESC’s are required to expand beyond
primary care to provide urgent/emergent care and extended
stay services. Purpose: In 2004 five remote clinics—four
in Alaska and one in Washington—were funded to test
the operational viability and financial sustainability of a
clinic model equipped and staffed to provide emergency
and extended stay encounters in addition to primary care.
Methodology: The five remote clinics in the demonstration
collected outcome data for each extended encounter from
September 15, 2005, through September 14, 2010 totaling
2,226 encounters. Patient encounters of four hours or
longer are considered extended stay encounters. FESC
sites recorded each extended-stay patient encounter via
an On-line Clinical Outcome Log. Results: Our principal
findings show that FESC’s provide access to primary,
emergent, and extended-stay services in remote areas
without a hospital. Flexibility in staffing is essential to the
success of the FESC provider model. Additional funding
is critical for FESC’s to maintain this staffing as well as
to maintain a suitable physical plant and appropriate
equipment in order to provide quality health care during
extended-stay encounters as assured by the Alaska state
licensure and CMS certification processes. Conclusions:
FRIDAY ORAL
An elective rotation for medical school in Iqaluit, Nunavut,
Canada led to a personal goal to learn some Inuktitut, even at a
basic level. While working in the hospital and local public health
facilities access to an easy to use English-Inuktitut “medical
dictionary” to assist with patient encounters was always desired,
but never achieved. Since returning South from Nunavut, I have
worked on this goal slowly, but surely, as part of my graduate
studies in University, as an extra “pet” project. The first step
involved learning some beginner level Inuktitut. The second
step included contacting and collaborating with individuals who
were experienced translators and also familiar with health and
medical vocabulary, both in Nunavut and in Canada’s South.
The third step was figuring out what this dictionary should look
like to make it most effective and to encourage its widespread
use. At this point, it became clear to me that this was going to be
a long-term project, and I realized that the medical dictionary I
was creating should be a living dictionary, one that is accessible
by all and to which anyone could contribute. This naturally
led to posting the terminology in the dictionary to an online
website in a searchable format, also allowing for easy updates
and additions. The website incorporates functionality for user
feedback, corrections and new submissions. The most recent
phase of the project is comprised of creating an iOS app for use
on iPhones, iPod Touches and iPads. The working name of this
“app-in-progress” is MedInuktitut and it is modeled after the
many available medical language apps through the iTunes store.
14:30 -15:30
MONDAY POSTER
141
MONDAY POSTER
Distances and sparse population in remote and frontier
areas make access to health care difficult. While many of
these areas can support a clinic, doctor’s office, or similar
facility for primary care, there is an ongoing need for these
facilities to also provide emergent and extended-stay care.
The FESC model provides for these necessary services.
POSTER NUMBER: M33
Emergency Care and Transportation of
the Seriously ill in Greenland
[email protected]
AUTHORS: N. Kieler Jensen1, A. Bredsdorff2,
H.Berg2
POSTER NUMBER: M32
Queen Ingrids Hospital1, Dept. of Anaesthesia2
Standardization and Update of
Anesthetic Equipment in Coastal
Greenland
In Greenland, caretaking of the seriously ill is a major
challenge. In the towns outside the capitol Nuuk, every
Health Care Centre has emergency room and surgical
facilities, but the therapeutically possibilities are limited.
Therefore it is necessary to have a system for patienttransport to the central hospital in Nuuk. Transport is a
challenge, due to size of the country, climate and airportfacilities. We do not have dedicated aircrafts at disposal.
We collaborate with the national airline, Air Greenland,
using commercial aircrafts, helicopters (Bell 212, Sikorsky
S61), Beech King Air 200, Dash – 7 and -8, which are
configured at each case. The different types of aircrafts
are necessary, as the airports are very different in size. The
medical staff consists of a specialized anaesthetic nurse
and an anaesthesiologist. Aside the basic set-up for any
emergency transport i.e. monitor, ventilator, medication,
it is necessary to have different set-ups according to type
of aircraft. Our equipment is organized in a setup for
children and one for adults. Furthermore two settings,
one for Beech King Air, and one for other aircrafts. Beech
King Air uses its own stretcher, is furnished with a “medibase” with oxygen, air, suction and power-supply, as well
as rails for attachment, which make use of standard ICUequipment possible, and which limits the need for extra
battery- and oxygen-capacity. The other aircrafts use a
different stretcher, have no built-in supplies and everything
must be brought. It is therefore important, to know travel
time, know battery capacity, calculate consumption of
oxygen and bring extra, to be sure that everything last
during transport and considering risk of delay. Average
number of transports with the full setting is one a week.
Aside these there are a vast number of transports with
less ill patients, where we compose staff according to case.
AUTHOR: N. Kieler Jensen
Queen Ingrids Hospital
In Greenland, Anesthesia, Intensive and Emergency
Care (AIE) of seriously ill patients is a challenge, due to
the size of the country and the widespread settlements
of citizens. Outside the capitol, Nuuk, with the central
hospital, Queen Ingrids Hospital, there are 15 towns along
the coastline. Each has a health care center (HCC) with
surgical facilities. The equipment for AIE at the HCC’s
has been very heterogeneous. In 2009, the responsibility for
AIE was placed under the Department of Anesthesia and
Intensive Care at Queen Ingrids Hospital. Due to the status
of HCC-equipment, we decided to make a “Greenlandstandard” at all HCC´s. We applied for a donation from
a foundation, awarded late in 2010. Implementation of
new equipment is a challenge, especially in the arctic.
Technical conditions and the educational level of staff may
vary, the back-up in case of technical breakdown may be
far away. The aim was therefore to construct “Anesthesia
Care Stations” (ACS) as flexible and reliable as possible
and which could be used also by non- specialized staff. We
chose to construct an ACS, which could be used either as
a unit or in parts according to knowledge at the user level.
We acquired 14 ACS’s consisting of an anesthetic machine
with a circle system, a ventilator, a monitor, an infusion
pump and a flow meter for oxygen. The parts were delivered
in January 2011, and the assembly and configuration of the
“standard-ACS” was begun. After assembly, every ACS
was tested for 2 weeks at our unit, and shipped to their
destinations. Installation and education of local staff was
timed with the presence of anesthesia-persons from Nuuk.
The first ACS was delivered in February, and by August
2011, all have reached their destination. By November
2011, twelve of 14 ACS’s have been in clinical use.
[email protected]
142
14:30 -15:30
[email protected]
14:30 -15:30
POSTER NUMBER: M34
POSTER NUMBER: M35
Creating an Integrated Chronic Disease
Management Strategy: Lessons from
Canada’s Northwest Territories
Delivering Quality Palliative Care North
of the Arctic Circle
AUTHORS: C. Kirvan1, E. Leith1, K. Lewis2, S.
Robertson3
Canadian Health Services Research Foundation (CHSRF)1, Stanton
Territorial Health Authority, Northwest Territory2, Department of
Health and Social Services, Northwest Territory3
[email protected]
Beaufort-Delta Health and Social Services Authority
For the past eight years, two of us, one a physician and
one a community health nurse, have delivered palliative
care at home in our community of 3500 people 120 miles
north of the Arctic Circle in the Northwest Territories of
Canada. There is no designated budget for what we do and
no specific time allotted in advance. However, with the
support of our superiors, we are able to use the resources
we have and create the time we need on a case by case
basis to do the work. We support several families per year
through the process of dying at home. In our presentation,
we will outline the course which some of these cases have
followed. Our hospital and health authority is a designated
teaching institution, affiliated with the University of British
Columbia. One of the authors is a Clinical Instructor for
UBC. So, in addition to having our caring roles, we also
have roles as teachers of Family Practice Residents, and
occasionally, nursing students. As for our professional
backgrounds, one of us is a full-service primary care physician
and the other is a public health and home care nurse. We
have both taken the week-long course offered by Victoria
(B.C.) Hospice for providers of palliative care. One key to
our being able to deliver a high level of care in a remote
centre with few dedicated resources, is our involvement in
our community. We both have a long history of living in
the “Delta”. Another key piece is the flexibility and support
which we have been afforded in order to do the work. A
third key to our delivering a high standard of care is the
availability of 24-hour information and collegial support
from the team in a distant large urban centre (Vancouver).
We wish to present our work in order to share with other
circumpolar colleagues the way in which quality community
palliative care can be delivered with very few resources but
much willingness at various levels of the system to ensure
the service is offered and that it continually improves.
[email protected]
POSTER NUMBER: M37
Demonstration of Robotic Telemedicine
AUTHOR: M. Jong
FRIDAY ORAL
CHSRF works collaboratively with jurisdictions and
healthcare leaders to assess, design, implement and
evaluate health system improvements, while acting on
opportunities for spread within and across jurisdictions.
This presentation highlights CHSRF’s health system
transformation approach, with lessons from the adaptation
of the approach within the NWT context. In 2010 the
NWT Department of Health and Social Services (DHSS)
and the Canadian Health Services Research Foundation
(CHSRF) partnered to design and build capacity for an
integrated chronic disease management strategy for the
territory. Interdisciplinary cross-regional teams were guided
though a series of workshops designed to build capacity
for participants to unpack and understand complex health
system problems, identify solutions and articulate reasoned
improvement plans. These were based on shared experience,
regional evidence and data, and grounded by national and
international evidence and best practice. With strategies
in hand, teams have produced evidence-informed pilot
improvement plans aimed at improving delivery of mental
health, renal and diabetes care within the territory. The
DHSS has begun piloting implementation of the concepts
to further enhance new models for service delivery and
chronic disease management. Lessons learned from these
pilots will provide essential insight and evaluative evidence
to support further spread and scaling up of the NWT
chronic disease management strategy. Implementation
of pilots include: Mental Health • Develop standardized
processes for sharing client information between providers
• Establish standardized minimum competencies and
service levels for programs and providers Diabetes •
Integrate self-management approach as component for
programs and services Renal Disease • Establish process
for a consistent single entry point to the renal care system
• Develop territorial database to determine baseline data
• Develop algorithm for decifor decision support of early
stage renal disease detection and management
System Level
• Develop chronic disease prevention and management
framework as foundation to create chronic care program
standards
AUTHORS: L. Seaman, T. Wilson
MONDAY POSTER
Memorial University
Introduction. Access to health care is a major challenge
in the Circumpolar region. Robotic telemedicine in the
remote community of Nain has allowed for greater access
143
MONDAY POSTER
and enhanced the delivery of health care. Method. This
presentation will allow the audience to see how this can
work from Fairbanks to Nain and to a training center in
California. It will permit one or two individuals from the
audience to practice using the robot. The audience will
be able to appreciate how easy it is to use the technology.
The uses of robotic telemedicine will be described.
[email protected]
POSTER NUMBER: M38
Portable Remote Presence Device for
Point-of-Care Health Care Delivery
AUTHORS: I. Mendez, M.Van den Hof
Dalhousie University
Timely access to effective medical care is a significant
challenge in the Circumpolar Region. Barriers of distance,
lack of adequate health care infrastructure and medical
expertise have a negative impact on the provision of health
care to vulnerable populations in underserviced remote
communities of the North. However, the rapid expansion
in telecommunication technology has opened the door for
the development of solutions that may help address these
challenges. Cellular phone networks have grown exponentially
in the world, it is estimated that at present over 90% of the
world’s population is covered by mobile cellular signal As part
of the Remote Presence Medicine Program at our institution,
we have begun pilot projects of a novel portable device capable
of providing remote presence connectivity using existing cell
phone network transmissions. The device allows connection
of peripherals such as vital signs monitor, portable ultrasound,
digital stethoscope and other digital scopes. The device can
provide telestration and is able to store video and still images
of the remote presence sessions and to archive peripheral
devices data for further analysis. Connectivity is provided
by a standard 802.11 Wi-Fi internet link and 3G cell phone
signals with a minimum bandwidth of 300 Kbps. We have
tested the device in two different settings and for two distinct
potential clinical applications in Canada and the Bolivian
Andes. In the first setting we focused on the use of the device
for point-of-care assessment in emergency situations. The
second setting was prenatal assessments of pregnant women
in remote, resource-poor settings in the Bolivian Andes. We
have found this device to be highly effective for transmitting
diagnostic quality information without signal disruption from
the remote locations.
144
We can envision the use of portable remote presence devices
in a wide range of clinical scenarios in remote communities
of the Circumpolar Region from emergency situations to
primary and mental healthcare where access to medical
expertise in real time could be just a phone call away.
[email protected]
14:30 -15:30
POSTER NUMBER: M40
The Development of an International
Academic Network in Indigenous Health
AUTHORS: C. Cook1, D. Carpenter2, M. Anderson
DeCoteau1, L. Diffey, G. Dine’Chicon3, N. Hayman4,
M. Kamaka 2, B. Lavallee1, T. Parker3, S. Pitama5, P.
Reid6, C. Shannon7
University of Manitoba1, University of Hawaii2, University of New
Mexico3, Inala Indigenous Health Service4, University of Otaga5,
University of Auckland6, University of Queensland7
The concept of academic networks as a means for promoting
knowledge creation and exchange in the field of Indigenous
health has emerged over the last decade, although the
efficacy of such networks has not been explicitly described
in the literature. Building on the work of others who
have attempted to establish international collaborations
in research, curriculum development and graduate degree
programs, the University of Manitoba’s Faculty of Medicine
is leading a project that seeks to develop an international
academic network in Indigenous Health that will stimulate
knowledge creation and mobilization across three domains:
medical education, health research and health service
delivery. Through partnership with faculties of medicine in
four other international locations (New Zealand, Australia,
Hawaii and New Mexico), the network will facilitate
academic exchanges that are intended to influence change
within these domains. Using an intervention research
approach, the impact of participation in this network
on advancing Indigenous health priorities in medical
education, research and service delivery at the multiple sites
will be evaluated. This presentation will outline both the
emerging structure of this international network and the
methodology that will be employed to evaluate its impact.
[email protected]
POSTER NUMBER: M41
Enhancing Cancer Education Through
the Arts: Building Connections with
Alaska Native People, Cultures, and
Communities
AUTHORS: M. Cueva1, R. Kuhnley2, K.Cueva
Alaska Native Tribal Health Consortium1, CHAP2
Building upon the dynamic traditions of Alaska Native
people, which include the arts as a viable way of knowing,
the expressive arts were woven into a five-day cancer
education course for Alaska village-based Community
Health Workers (CHWs). Cancer is the leading cause of
mortality for Alaska Native people. Methods: Six cancer
education courses were provided for 57 CHWs from
throughout Alaska. 91% (52/57) of participants were female
and 63% (36/57) self described as being of Alaska Native
or American Indian heritage. Course learning modalities
included moving, drawing, sculpting, and storytelling.
Results: On written post-course evaluations, CHWs
wrote ways the course increased their cancer knowledge,
described how combining the arts with cancer education
supported their learning, identified ways they planned
to take better care of their health and their families, and
shared how the course would change their clinical practice.
During extended-interval, post-course interviews CHWs
described the arts as a culturally traditional way of knowing
and how the arts expanded their perspectives, sparked
creativity and imagination, freed/transformed emotions,
made learning more memorable/more meaningful, infused
learning with laughter, created community, and broke the
silence that often surrounds the topic of cancer in Alaska
rural communities. “The arts give a comfortable traditional
way to share experiences and healing. My people have
always shared wisdom through songs, dances, arts.” “Really
helped us bring what was on the inside out, brought out our
inner feelings and expressions.” “Opens the heart and mind
to learning.” Conclusions: The expressive arts empowered
adult learners to explore new dimensions of knowledge,
create deeper understandings, and expand their perceptions
of possibilities. “If you can’t say it out in sentences you could
put it in drawing, put your feelings out, helps bring out
what you have in your mind…makes it easier to talk about.”
[email protected]
POSTER NUMBER: M42
Digital Storytelling: Blending Traditional
and Modern Ways of Learning for
Health Promotion in Alaska Native
Communities
AUTHORS: M. David, T. Hicks
participants to acquire and demonstrate technology skills,
using multimedia tools that are often free and accessible via
the internet. DS gives participants access to develop their
own media messages for health or wellness, which area
relevant to their community. Alaska Native Tribal Health
Consortium has been providing DS workshops since
2008, and would like to share how DS has been an useful
health promotion tool in Alaska Native communities.
[email protected]
POSTER NUMBER: M43
Providing for the Unique Health Needs
of the Peoples of the Arctic by Assuring
and Integrating Access to Population
Relevant Information on Past, Present
and Future Research and Health Related
Publications and Media
AUTHOR: C. Garrett
Alaska Medical Library, UAA
Each day, people in the communities of the Arctic
face challenges to their health and traditional lifestyle
from changing climatic and environmental conditions.
Additionally, how they live and where they live can create
unique health challenges. It is critical, then, that Arctic
residents and researchers have access to timely, accurate, and
relevant information addressing their particular concerns.
Having a reliable portal to bring a myriad of sources together
can make that process easier. To meet this need, the National
Library of Medicine (NLM) and the University of Alaska
Anchorage (UAA) have developed the Arctic Health
Website, www.arctichealth.org. The website provides an
easy-to-use one-stop shop for information on the diverse
health-related aspects of the Arctic region. Topics include:
climate change; environmental health; traditional healing;
and diseases of particular import to peoples of the Arctic.
The website provides links to the most reliable research and
publications, but it also provides a repository of information
both historical and current, of material specifically produced
by and for the people of the Arctic about their health and
environment in multimedia formats. To increase the site’s
relevance, the project has established and continues to
create collaborations with researchers, communities, and
other organizations to supply publications not available
elsewhere, including gray literature, streaming video of
traditional healers, and oral histories, as well as health tools
created specifically for the needs of this unique population.
Using multiple media tools people of the Arctic can find
information from colon cancer screening to the effects of
climate change and traditional healing workshops taught
by Della Keats. At the same time they can find scientific
research being done from Alaska to Norway. Locating
and integrating information from across the Arctic is
FRIDAY ORAL
Digital storytelling (DS) blends storytelling traditions
with computer-based technology as a way for people to
be able to tell their own story using free multimedia tools.
Through the use of digital storytelling technology, people
are empowered to share a meaningful, heart-felt message,
and are moved from being passive recipients of health
messages to actively creating a way to have their voice
enter the conversation to make a difference in the story of
wellness for the Native Peoples of Alaska. DS combines
narration, images, sound, video, and technology to create
a short movie. Participants give voice to their passion and
meaningful experiences as they exercise their power to write
and create their own personal narrative. Through digital
storytelling people are empowered to be the storyteller and
the teacher. Additionally, DS provides an opportunity for
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what will make the Arctic Health Website a valuable tool
for health and well-being of the people of the Arctic.
[email protected]
POSTER NUMBER: M44
POSTER NUMBER: M45
The Prevention and Treatment of
Diabetes in Rural Alaska, A Course for
Community Health Aide/ Practitioners
Empowering Alaska’s Community Health
Workers with Wellness Education: An
Ecological Approach
AUTHOR: T. Hicks
AUTHORS: T. Hicks, M. Cueva, R. Kuhnley,
K. Cueva
Diabetes is rapidly increasing among Alaska Native people.
In 1990, 847 Alaska Native people receiving care in the
Alaska Native health care system had diabetes. In 2009,
3938 Alaska Native people had diabetes, a 365%.increase.
The Community Health Aide/Practitioners (CHA/Ps)
provides medical services and follow up at the community
level and is a vital link in the Alaska Native Tribal
healthcare system. CHA/Ps receives four training sessions,
each lasting 3-4 weeks. Due to the many medical services
and emergencies a CHA/Ps can expect to encounter, the
training sessions for CHA/Ps can only cover a limited
amount of diabetes prevention and management knowledge
and skills. The increase in diabetes prevalence among
Alaska Native people and the small amount of diabetes
training a CHA/Ps receives, was the impetus for the
Alaska Native Diabetes Program developing an advanced
diabetes training for CHA/Ps. The goal of the course is to
improve diabetes care and prevention at a community level.
Methods: The Prevention and Treatment of Diabetes in the
Villages of Alaska is an 8-week course. The course is taught
through a variety of modalities which include self-study,
distance technology and an intensive three day face-to-face
class. The course has been offered periodically since 1991.
Two university course credit hours can be earned. Results:
Approximately 450 CHA/Ps have completed the advanced
diabetes course. Course evaluations, consisting of in-depth
phone interviews given 6 months to 24 months post course,
showed CHA/Ps providing more elements of diabetes
standards of care, such as patient education.
Alaska Native people experience increased risk factors for
chronic illness such as diabetes, heart disease, and cancer. To
support Alaska’s village-based Community Health Workers
(CHWs) in promoting wellness and disease prevention,
an interactive Alaska Native Tribal Health Consortium
(ANTHC) Wellness Course was collaboratively developed
for and with CHWs, emphasizing medically accurate health
information and community presentation skills. Using an
ecological model in concert with Alaska Native people’s
traditional ways of knowing and close-knit community
relationships offered CHWs the opportunity to consider
wellness along the broader continuum of individual, social,
and community environments. Methods: Five week-long
courses grounded within Indigenous methodologies that
emphasize relationships and encourage self-determination
and empowerment, were provided for 55 CHWs from
communities throughout Alaska. Results: On written
post-course evaluations, all participants wrote detailed
descriptions of ways the course supported their learning.
As a result of course participation, 88% (46/52) of CHWs
wrote ways they would support family and community
wellness and 85% (44/52) wrote ways they planned to take
better care of their health. During in-depth interviews, five
months to 14 months post-course, CHWs described ways
the Wellness Course increased their health knowledge,
helped them in their work, and prepared them to effectively
engage with their communities to support wellness.
Learning wellness information with hands-on activities and
practicing health presentation and community engagement
skills within the course design increased participants’
wellness knowledge and skills, confidence, and motivation
to provide community wellness activities. Techniques for
active listening, engaging community and using the arts
and storytelling as culturally respectful health promotion
are tools that when used by CHWs have potential to
empower community wellness.
“Wellness lives in the heart of the community.” CHW
[email protected]
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Conclusion: Advanced Diabetes training for
CHA/Ps beyond what is taught in general CHA/Ps
training may be beneficial for patients that are living in
rural Alaska and have diabetes. It may also benefit those
at high risk for developing diabetes, because they are
receiving timely information from the CHA/Ps before
developing diabetes. The Alaska Native Diabetes program
will begin regularly offering the course starting in 2012.
[email protected]
POSTER NUMBER: M46
Relationships, Heart, and Soul:
Emancipatory Holistic Learning Towards
Village Health and Well Being
AUTHOR: D. McEachern
University of Alaska Fairbanks/Kuskokwim Campus
[email protected]
POSTER NUMBER: M47
Diploma in Arctic Specialized Nursing
AUTHOR: S. Møller
Ilisimatusarfik Univercity of Greenland
The Greenlandic health system is facing new structural
changes, which means that several smaller communities now
have nurses as the highest professional health competence.
This will place special demands on nurses working in these
areas. Department of Nursing and Health Science at the
University of Greenland in Nuuk offer a new diploma
program in Arctic Specialized Nursing. The program is a
part-time education which is equivalent to one year fulltime education, a total of 60 European Credit Transfer
System (ECTS) points. Content of the program is tailored
with the aim to provide nurses who work outside the daily
presence of doctors in the district the necessary skills
to handle emergency situations and to be able to advise
individuals, groups and the small community in health
promotion and prevention. The program has 4 modules; it
is offered from autumn 2012 and is expected to close in the
spring of 2014 with a written thesis. The teaching language
is Danish; it is a prerequisite that you can understand
and write in a Nordic language (Danish, Swedish or
Norwegian). The application deadline is August 15, 2012.
[email protected]
POSTER NUMBER: M48
Delivering Health Care Training to Rural
Alaska By Distance
AUTHORS: C. Odinzoff, D. Hight, S. Yabut,
C. Kelly
ANTHC-CHAP Rural Health Services
Background Alaska—It’s larger than Texas, California
and Montana combined and is home to one of the most
unique solutions for health care delivery in the nation.
Far from the signature suburbs of the lower 48, many
villages in rural Alaska are completely off the road
systems; most with fewer than 500 villagers. Despite the
geographic disconnect between the villages and urban
Alaska, the Internet has proved to be an efficient and
effective vehicle in which to deliver training in the field
of health care. Approach Because several hundred miles
can separate a village and a regional hospital, village health
care is primarily provided by Community Health Aide/
Practitioners (CHA/Ps). These individuals have been
selected by their villages to receive training to provide
direct medical care as part of the Community Health
Aide Program (CHAP). Approximately 550 CHA/
Ps are serving 178 village clinics under the daily clinical
guidelines of the Community Health Aide/Practitioner
Manual (CHAM). While CHA/Ps provide direct care,
consultation and overall responsibility for patient care falls
to a referral physician hundreds of miles away. Method
The Community Health Aide Program Distance Learning
Network (CHAP DLN) was developed¬¬¬ in 2009 to
deliver training and continuing education (CE) courses
by distance to health aides and supervisory employees of
FRIDAY ORAL
Abstract Western pedagogical praxis has not proven to be
fully adequate in term of indigenous people’s success in
education, especially within college settings. In 1990 at the
annual Alaska Federation of Natives (AFN) conference a
group of Elders and other native leaders gathered together
to create an “educational platform.” A network of Elders,
Native leaders and University faculty held a series of
meetings to develop a culturally relevant and academically
sound program called Rural Human Service (RHS).
The goal of the co-created curriculum was to develop
a program grounded in the Alaska Native context while
designing a curriculum which also included best practices
of western treatment and counseling methodologies.
Many of the adult indigenous students initially enter RHS
with great reservation, fear, and markedly low confidence
about “school.” Yet, most will graduate with a 34 credit
college certificate in Rural Human Services (RHS) with
a notable 85% graduation rate after two years of monthly
intensives. They then can continue on to partner cohort
programs, the Human Service AAS and BSW degrees.
Recognition and integration of indigenous knowledge,
utilization of selected emancipatory adult learning
theories, and the creation of a smoothly coordinated
academic pathway has developed into a successful model
of education delivery for the adult indigenous learner.
Many students comment that this particular model
represents the first time they have ever enjoyed education.
And, importantly, students often view their educational
experience through RHS as part of the survival of “our
people.” This presentation will report on findings from
doctoral research on how indigenous adult women
described and characterized their experiences of the Rural
Human Service (RHS) college program at the Kuskokwim
campus in Bethel, Alaska. The presentation will include
perspectives from an Elder who works with the program.
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MONDAY POSTER
Tribal Health Organizations operating within the Alaska
Tribal Health System (ATHS). CHAP DLN was created
in response to dwindling travel dollars as well as a growing
need to provide learning options for CHA/Ps. From
January 2009 to 2012, CHAP DLN offered six distance
courses: Pre-Session, Preceptorship I, Preceptorship II,
Mandatory Reporting, H1N1, and 2011-2012 Influenza
Update. Findings During this three-year period, 258
individuals were enrolled in courses. Based on post-course
evaluations, these courses have been identified as integral
components of the Community Health Aide Program.
[email protected]
POSTER NUMBER: M49
Electronic Community Health Aide
Manual (eCHAM) -From Paper To
Electronic
AUTHORS: B. Fleischer, V. Heart, S.Ferguson,
C. Moon
The Community Health Aide (CHA) Program was
developed in the 1950s in response to a number of health
concerns including the tuberculosis epidemic, high infant
mortality, and high rate of injuries in rural Alaska. In
1968, the CHA Program received formal recognition and
congressional funding. The long history of cooperation and
coordination between the federal and state governments
and the Native tribal health organizations has facilitated
improved health status in rural Alaska. Today the CHA
Program consists of a network of approximately 550
Community Health Aides/Practitioners (CHA/Ps) in over
200 rural Alaska villages. The CHA/Ps follow the detailed
guidelines of the 2006 Alaska Community Health Aide/
Practitioner Manual (CHAM), which outlines assessment
and treatment protocols. This critical healthcare tool is
currently documented in four voluminous books covering
over 1700 pages – not a highly mobile tool. A project is
underway to create an electronic version of the CHAM,
known as the eCHAM Project. The eCHAM will be a webbased and mobile solution providing the CHAM content
in an electronic format, thus taking full advantage of the
interactive capabilities of the electronic format including:
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• Intuitive navigational system and user friendly presentation.
• Portability of eCHAM in smart tools - tablets, phones.
• Multimedia integration including the photos, audio clips,
ECG, etc.
• Open architecture providing the potential to interface
with EHR systems.
• Development of a mechanism for secure and regular
update of content.
In addition to demonstrating the first version of the eCHAM
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and explaining system components and architecture, we will
also provide insight into the process of the development of
the system and how it will impact health service delivery in
Alaska. We will include feedback from some of the CHA/Ps
regarding how the eCHAM has already impacted their jobs.
[email protected]
POSTER NUMBER: M50
Lessons from the Field: Doing
Community-Based Participatory
Research (CBPR) in Canada’s Arctic
AUTHORS: C. Carry1, R. Collins2, M. Hammond2,
J. Gordon3, D. Dedam-Montour4, T. Greenland,
J. Ogina, V. Akhiatak, L. Kuptana5, A. Moses6, N.
Beauvais
National Aboriginal Health Organization1, Consultancy for
Alternative Education2, Inuvialuit Regional Corporation3, National
Indian & Inuit Community Health Representatives Org4, Inuvialuit
Regional Corporation5, Government of the Northwest Territories6
Community members and outside facilitators are
collaborating on a six-year Community-Based Participatory
Research (CBPR) project called “Changing the Culture of
Smoking” (CCS) in two Inuvialuit/Gwitch’in communities
in the Northwest Territories, Canada. Major lessons
learned to date include: • We have much to learn from the
community and the community has much to learn from
itself. What is needed is to build critical awareness. Mere
awareness is not enough to provoke change. • Research
must be planned with community realities in mind. • Plans
must be kept flexible as circumstances in the community
constantly change. • Staff turnover on the project is an ongoing challenge: expect it, budget for it, and don’t take it
personally when staff leave or resign. Over time, turnover is
sometimes mere circulation as people come and go and then
return again. • Change takes time. We need to be around
consistently over time to be taken seriously. • Repeating the
same community-based activity over several years builds
understanding of the purpose and process and increases
community ownership and participation. • CBPR needs to
focus on capacity building at every stage. • Authentic CBPR
means integrating research, education and action directly
with individuals and families in their social and cultural
environments. • CBPR engages the community in a way
that conventional research cannot. • CBPR must have three
characteristics: building critical awareness about a problem,
developing capacity, and taking action to tackle the problem.
• A caution: CBPR is essentially a form of community
development, and as such is very resource intensive. The
needs for CBPR facilitators – in communities with limited
capacity – far outstrip the supply. However, we encourage
researchers and practitioners to consider CBPR instead
of conventional research and public health interventions.
[email protected]
POSTER NUMBER: M51
Challenges in Conducting Northern
Community-Driven Research Created by
Differing Knowledge Systems and World
Views: a Researcher’s Perspective
AUTHORS: A. Colquhoun, J. Geary, K. Goodman
Increasingly, scientists are becoming aware that research
collaborations that include community partnerships can
be an effective way to broaden the scope and enhance the
impact of public health research. Such collaborations extend
the reach of academic scientists by integrating a variety of
perspectives and thus strengthening the applicability of the
research. Communication challenges can arise, however,
when attempting to address specific research questions in
these collaborations. In particular, inconsistencies can exist
between scientists and community members in the use
and interpretation of words and other language features.
Additional challenges arise from differing perceptions of the
investigative process. There may be divergent perceptions
about how research questions should be answered, and
in expectations about funding requirements and research
timelines. From these differences, misunderstandings can
occur about how the results will ultimately impact the
community. These communication issues are particularly
challenging when scientists and community members
are from different ethnic and linguistic backgrounds that
may widen the gap between knowledge structures, world
views and values, further complicating the interactions
and exchanges that are essential for effective joint research
efforts.
[email protected]
POSTER NUMBER: M52
Budgetary Considerations in Developing
Respectful CBPR Partnerships
AUTHORS: T. Hoeft1, S. Hopkins2, W. Burke3, B.
Boyer2
University of Alaska Fairbanks1, CANHR, University of Alaska
Fairbanks2, Dept of Bioethics & Humanities, University of
Washington3
Principles of community-based participatory research
(CBPR) emphasize the importance of collaborative
partnerships between community members and university
scientists in a sustainable respectful relationship.
However budgetary considerations arise as relationships
are strengthened and community members become
increasingly involved as co-researchers. Researchers at the
Center for Alaska Native Health Research (CANHR)
at University of Alaska Fairbanks and the University of
Washington are working closely with a recently formed
Community Planning Group (CPG) of Yup’ik Eskimo
community members to bring additional community
involvement and direction into the research process.
CPG members share valuable insight into cultural beliefs
and indigenous knowledge with university researchers to
discover better ways to talk about research with community
members. As co-researchers, CPG members participate in
data collection and analysis while also providing important
knowledge and guidance for culturally appropriate research
practices. Costs include extensive travel, compensating
community members for their involvement, and related
expenses such as space rental, refreshments served at
meetings, and communication expenses. Travel involves
flying to regional hubs where CPG meetings are held 3
or more times per year, to rural communities for focus
groups, and CPG member travel when co-presenting at
meetings. Another significant expense around meaningful
sharing of responsibility involves time commitments
from community members that take them away from
other priorities in their communities. As CPG members
become more involved outside scheduled CPG meetings,
the project is strengthened by meaningful sharing of
responsibility, but compensation for their time must
be offered. Both travel and food costs may be subject to
funding restrictions as a matter of policy. In addition,
questions arise around when unpaid input from community
is appropriate, how the community co-researchers’ time
is valued relative to others working on the project, and
policies at universities and NIH that may act as barriers
to forming these sustainable, equitable partnerships.
FRIDAY ORAL
Community-driven research that aims to describe the
burden of disease associated with H. pylori infection is
currently underway in northern Aboriginal communities
located in the Yukon and Northwest Territories, Canada,
with the goal of identifying effective public health
strategies for infection control. This research links
community representatives, faculty from various disciplines
at the University of Alberta, as well as territorial health
care practitioners and health authorities. This highly
collaborative work will be used to illustrate, from a
researcher’s perspective,some of the challenges of conducting
public health research in teams comprising members with
varying backgrounds. The consequences of these challenges
will be outlined and potential solutions will be offered.
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[email protected]
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POSTER NUMBER: M53
POSTER NUMBER: M55
‘My Word:’ Storytelling and Digital
Media Lab: The Evolution of an InuitOwned Digital Media and Research
Organization
Collaborative Tools for Process
Evaluation of Developing CommunityUniversity Partnerships
AUTHORS: S. Harper A. Cunsolo Willox , V.
Edge1, Rigolet Inuit Community Government
1,
1
1
Understanding that current and projected alterations in
weather, temperature, snow, ice, wildlife and vegetation
patterns in the Arctic and Sub-Arctic regions will most
likely cause negative health impacts for individuals and
communities in the North, there has been increasing
research conducted examining the connections between
climate change and Inuit health and well-being. There is
wide recognition that this research needs to be communitydriven, community-directed, and participatory, ensuring
that Inuit are leading the process and enhancing and
expanding community research capacities. Recognizing
the dual need for locally-appropriate and culturallyrelevant adaptation strategies and the development of
research capacities in the community, in 2009 the Rigolet
Inuit Government in Rigolet, Nunatsiavut, Labrador
undertook an innovative plan to develop the first Inuit-run
centre dedicated to digital media (digital storytelling and
PhotoVoice) and research (qualitative and quantitative).
Since its inception, the ‘My Word’: Storytelling and
Digital Media Lab has developed expertise in numerous
areas: facilitating digital storytelling and PhotoVoice
workshops; consulting on research proposals, designs,
and methods; conducting interviews and surveys; filming,
editing, and producing videos; consulting with multiple
stakeholders for research and adaptation goals and
strategies; disseminating information through print and
digital media; and presenting at national and international
conferences. The ‘My Word’ Lab also has also developed
particular research capacities for climate-health research
and health adaptation strategies.
This poster will explain the evolution of the ‘My Word’:
Storytelling and Digital Media Lab, and discuss the
opportunities and challenges in setting up a research and
capacity-development organization such as this. Details
will also be shared about the specific services offered by
the ‘My Word’ Lab, and the future directions and visions
for the organization. The ‘My Word’ Lab stands as an
example of community-created and community-run
research and capacity development, and can inform the
creation of other community-driven research initiatives.
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[email protected]
AUTHORS: K. West1, R. James2, L. Clough, K.
Edwards3, S. Hopkins3, S. Brown Trinidad2
University of Washington1, UW Department of Bioethics and
Humanities, CGHE2, UAF, Center for Alaska Native Health
Research3
Evaluation of community-based participatory research
(CBPR) partnerships is necessary to assess the relationshipbuilding process, be responsive to all partners’ needs, and
to share the work externally. Many models of partnership
evaluation have been tested, focusing on quantitative and
qualitative measures of engagement, collaboration, mutual
feelings of respect and progress, or social network analysis
to display developing connections. Intangible elements,
such as respect, trust, and meaningful shifts in a working
relationship, make these objective measures challenging.
Available tools provide metrics for assessing key aspects
of collaboration and CBPR principles as a means for
identifying partnership strengths and weaknesses at
various points in time. Here, we draw from models such
as LaFrance’s ‘Indigenous Evaluation Framework’, and
Smith’s ‘Decolonizing Methodologies’, to emphasize the
process evaluation of partnership development. We outline
a plan to integrate flexibility into evaluation and produce
material that can be fed back to partners for reflection on
how knowledge bases are shared, to make adjustments
that improve communication, and recognize milestones
in collaborative efforts. Methods include small mixedgroup discussions with all members addressing challenges
and strengths, large-group round-robin opportunities
for sharing insights and lessons learned, and additional
debriefing reflections on key turning-points in the
relationship’s progression. A bi-directional approach to
evaluation includes documenting the traditional and cultural
learning that the university researchers are undergoing, in
addition to the research capacity that is being built among
community members. A commitment to transparency and
demonstrated trust is required to utilize these approaches,
which can be a measure of relationship strength in itself.
Narrative products of evaluation express challenges,
tensions, insights, and success of our work, redefining
“outcomes” for the intermediate term, including indicators
of building trust and the ways in which dialogue evolves
as the relationships grow. We apply these concepts to our
on-going work within a community-university partnership.
[email protected]
POSTER NUMBER: M56
Intergenerational Dialogue Exchange
and Action (IDEA): Participatory
Research to Bridge Gaps between
Generations in Rapidly Changing Arctic
Communities
AUTHOR: L. Wexler
University of Massachusetts Amherst
The presentation describes a new approach to participatory
research that not only produces rich data, but also provides
meaningful opportunities for different generations of Alaska
Natives to communicate with each other about issues that are
important to them. In this case, the broad goal of the project was
to qualitatively investigate the narrative linkages made between
culture and resilience—the processes by which people navigate
life challenges—by three generations of Alaska Natives. This
aim came from a decade of previous collaboration, and the
IDEA process that resulted from the inquiry was developed
in response to community and youth interest. Specifically, the
study worked with local tribal organizations to recruit youth
who were involved first as participants, then as co-researchers.
These youth co-researchers identified and recruited adults and
elders who they felt represented resilience because they had
overcome much in their lives. The interview and focus group
protocols were modified to reflect the youth co-researcher’s
language and additional interests, namely learning more about
what challenges adults and elders faced and overcame while
growing up. The adult and elder interviews and focus groups had
youth as an audience. This made the data collection process itself
an opportunity for culturally-appropriate intergenerational
storytelling and sharing. After the data collection was
complete, young co-researchers were asked to synthesize
their learning by producing digital stories, short multi-media
videos. These digital stories were then shared with adult and
elder participants and other community members as a way to
show what young people learned from the process. The process
itself is now being considered as a way to build youth capacity,
generate intergenerational sharing, and useful insights. Thus,
the research approach offers an exciting new way to generate
knowledge on personal, community and academic levels.
14:30 -15:30
external or internal causes. There is a large individual
variability of response to hypoxia. The aim of this study was
to determine the susceptibility to hypoxia and ventilatory
chemosensitivity to O2 (HVR) and CO2 (HCVR),
before and after short-term cold exposure (naked, 13O,
2 hours, 10 days). Twenty-four healthy men were tested.
HVR and HCVR were measured by the rebreathing
method. Susceptibility to hypoxia was determined as
saturation slope (sSaO2) during HVR test. SaO2 is
known to be depended on pH, BE, temperature, partial
O2 and CO2 pressure. So SaO2 is an integral parameter,
which reflects gas transmission system work, including
respiratory, cardiovascular system, blood, also its regulatory
mechanisms and metabolism. It was found that HVR
and HCVR significantly increased and sSaO2 tended
to decrease after cold exposures. According to sSao2
results before cold exposures, the group was divided into
3: 1- with high susceptibility (low tolerance) to hypoxia,
2- medium, and 3 - low susceptibility (high tolerance).
Analysis of variances (MANOVA) showed the key role
of susceptibility to hypoxia and cold exposures and their
interrelation. Posterior analysis (Fisher LSD) showed that
after cold exposures, susceptibility to hypoxia significantly
decreased in the first group, tended to decrease in the
second group and tended to increase in the third group.
At the same time, HCVR significantly increased in the
first and third groups and HVR significantly increased in
the third group. While the tolerance to hypoxia increased
(almost doubled) in group 1, the difference between the
groups were not significant. Short-term cold exposures
caused an increase in functional reserves and improved
oxygen supply of tissues in group 1, whereas the subjects in
group 3 reduced their functional reserves. Group 2 showed
the most appropriate reaction mode to cold exposures.
[email protected]
POSTER NUMBER: M60
Glucose Transporter 4 Expression in
White Blood Cells of Young and Old Sled
Dogs
AUTHORS: T. Schnurr, K. Dunlap
[email protected]
University of Alaska, Fairbanks
POSTER NUMBER: M58
Background: GLUT4 is the only glucose transporter
responsive to insulin and is thought to be found exclusively
in muscle an adipose cells. Recently, Maratou et al (2007)
demonstrated that there is GLUT4 in white blood cells
(WBC) collected from human subjects in response to
insulin activation. Our study was thus designed to develop
a protocol to measure GLUT4 in white blood cells of sled
dogs and furthermore compare GLUT4 levels in young
versus old sled dogs. Additionally, we also examined the
blood insulin concentration of both populations of dogs
Susceptibility to Hypoxia and Breathing
Regulation Changes After Short-Term
Cold Exposures
AUTHORS: L. Kovtun, M. Voevoda
Institute of Physiology SB RAMS
Hypoxia is the reduction of oxygen availability due to
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before and after dinner. Materials and methods: Blood was
withdrawn from 11 healthy sled dogs. The buffy coat was
collected after centrifuging the blood samples. GLUT4
and insulin concentrations were measured using ELISA
kits. Results: GLUT4 was found in white blood cells in
sled dogs. Age and fitness level had no significant effect
in the concentration of GLUT4 between the populations
of old and young dogs. There is a significant difference
in insulin concentration pre and post meal in both dog
populations. No significant difference was found in
insulin concentration comparing old versus young dogs.
Conclusion: Our data show that we were able to
show that white blood cells have quantifiable GLUT4
levels. Finding Glut4 in white blood cells might open
up non-invasive avenues for studying the underlying
molecular mechanisms associated with insulin resistance
in more complex, dynamic and physiological systems.
[email protected]
POSTER NUMBER: M62
Reflecting Back as we Move Forward:
Lessons Learned from a Collaborative
Research Project in Nunavut, Canada
AUTHORS: M. J. Costello1, J. Garcia1, P. McDonald1,
M. Doucette2, A.Kronstal2, A. Korgak2, M. Charron2,
G. Osborne2, I. Sobol3
University of Waterloo , Government of Nunavut , Government of
Manitoba3
1
152
2
Objectives: From the perspective of researchers at a
Canadian academic institution, we report on some
lessons learned from conducting a collaborative research
project with partners in Nunavut, Canada on tobacco
use within the Territory. We share these lessons so others
can build on our experiences when conducting research
with partners in the circumpolar north. Lessons Learned
(Highlights): (1) Respect Inuit knowledge and customs,
and expect to learn about current realities directly from
community members. (2) Be mindful of history, including
existing and past relationships between governing bodies
and non-governmental organizations, and participate
to support Inuit efforts in decolonilization and strength
based self-determination for public health futures. (3) Do
not underestimate the brutality and harm that has been
inflicted on Inuit culture and society; insensitivity may
inhibit healing opportunities or cause further harms. (4)
Be sensitive when characterizing circumstances that might
be construed in a negative way; there is a longing to share
the positive attributes of northern communities. (5) A
participatory approach to research is necessary; northern
partners must have the opportunity to collaboratively shape
the research process by directing the research agenda and
owning the project data. (6) Modest resources are available
to deal with substantive health-related challenges; however,
there is willingness to generate evidence for informed
decision-making. (7) Allocate sufficient time and finances
for face-to-face meetings; visiting and/or spending time
in the north is necessary to understand research priorities
and realities faced by northern populations. Face-to-face
meetings are also an important aspect of Inuit culture
where traditional knowledge is commonly shared. (8)
Plan the annual cycle of research activities, including
training, interviewing, analysis and joint sense-making,
with an awareness of the cultural seasonal imperative of
being on the land. Acknowledgements: We thank our
northern partners for sharing their wisdom, exercising
extreme patience, and inviting us into their communities.
[email protected]
POSTER NUMBER: M63
Alaska Native People’s Perceptions,
Understandings and Expectations
for Research Involving Biological
Specimens
AUTHORS: V. Hiratsuka, J. Brown, T. Hoeft,
D.Dillard
There are no prior published studies on views of indigenous
people regarding research with biological specimens. Position
statements by researchers or tribal leaders largely constitute
the literature, with one study engaging an American Indian
community directly through focus groups. This article describes
the perceptions, understandings and expectations of Alaska
Native people about research involving the collection and
storage of biological specimens. Twenty-nine focus groups with
Alaska Native people (N=178) were conducted in fourteen
locations using a semi-structured moderator guide. ATLAS.ti
was used for thematic analysis through iterative readings and
coding. Alaska Native peoples’ perceptions, understandings
and expectations of researcher beneficence, informed consent
processes, and provision of research findings were elicited. Alaska
Native people desired extensive disclosure of information beyond
that typically provided in consent and results dissemination
processes. Information germane to the motivation and intent
of researchers and specifics of specimen storage and destruction
were specifically requested. A clear and extensive process of
informed consent and continued improvements in sharing
results may enhance the transparency of research among Alaska
Native people. Meeting expectations may improve relationships
between researchers and the Alaska Native population which
could result in an increase research participation. Our findings
offer a guide for researchers and communities when planning
and implementing research with biological specimens.
[email protected]
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POSTER NUMBER: M64
POSTER NUMBER: M65
Lessons in Health Policy Research in
Alaska Native Villages of the Arctic
North: Confessions of a Reformed
Optimist
Navigating the Cultural Geography of
an Indigenous Community’s Attitude
Toward Genetic Research is Dependant
Upon a History of Fostered Trust
AUTHOR: L. Schwarzburg
AUTHORS: M. Vawer1, P. Kaina, A. Leonard, M.
Young, C. Valdez, T. Seto
University of Alaska-Fairbanks
[email protected]
QMC 1
Context: Genetic research among Native Hawaiians (NH)
has had an uneven history with significant and appropriate
concerns about identity, control, and trust which are often
seen as barriers to scientists seeking to conduct research
with the NH community. Through our prior work, we
identified several large families with suspected familial
cardiomyopathy (FCM), but before embarking on the next
steps we felt that it was important to first investigate the
issues and attitudes concerning genetic research and familial
cardiomyopathy from the perspective of family members.
Objectives: Navigate the cultural geography of an indigenous
community using a community-based participatory research
(CBPR) approach to identify attitudes, and beliefs about
genetic research in order to inform the development of a
familial cardiomyopathy community screening program.
Design: Qualitative study in which data were gathered
from family group interviews. Participants: 74 Native
Hawaiian family members from a rural community with
an extensive history of suspected familial cardiomyopathy.
Main Findings: The primary factor to the success of a
community-based familial cardiomyopathy screening
program is the relationship between the investigator and
the community. Key concepts identified: 1) History of
trust fostered between investigator and community; 2)
Transparency of intent and action; 3) Identification of a
key community voice; 4) Demonstratemutual benefit to
investigator and family/community; and 5) Establishment
of a partnership to identify community defined needs,
goals and desired outcomes. Conclusions: It appears
feasible to conduct a familial cardiomyopathy screening
program that includes genetic research among Native
Hawaiians, but success is dependent on investigators
awareness of the cultural geography and the development
of a relationship based on trust. Culturally informed CBPR
methods play a key role in identifying and overcoming
potential barriers and designing a successful program.
[email protected]
FRIDAY ORAL
At the 14th ICCH meetings in Yellowknife NT Canada,
I presented my accepted doctoral project prospectus. I was
also honored at that time to receive The American Society
for Circumpolar Health’s 2009 Jens Peder Hart Hansen
Memorial Fellow Scholarship. My National Science
Foundation Arctic Social Science Program-supported
research was an anthropological-based set of policy
analysis tools, designed for sustainable policy development
over time. I was looking at childbirth practices as an
element in the Iñupiat Eskimo society of Kotzebue and
surrounding villages, as these changed from traditional
community-based practices to participation in a more
westernized medical model of childbirth. I set out to
provide researchers and policymakers with a new method
of measuring social impact of policies, and evaluating
costs and benefits of each childbirth practice (traditional
and present-day) in a comparative analysis. My original
study was planned to add to this body from an Arctic
standpoint as Alaska Native cultural identity was explored.
The techniques and findings would also offer an inside
look at birth in Arctic Alaska, specifically from indigenous
women’s perspectives. I would like to share how the
institutional review process and the communication gaps
between academia and agencies representing US, State and
Native-based health agencies can alter attempts to perform
even the most ethically-constructed and well-designed
research study. I would like to cover the requirements and
realities of dealing with Native Village Councils, Alaska
Native Regional Health Boards, and the Alaska Native
Tribal Health Consortium Institutional Review Board
(which is also the US Indian Health Service Area #2 IRB,
representing all of Alaska). I hope that sharing lessons I
have learned from my years-long process will help other
researchers planning health and/or policy studies in the
mostly Alaska Native-inhabited Circumpolar North.
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POSTER NUMBER: M66
Health Research Review by Tribal
Organizations in Alaska
AUTHORS: A. Willetto Wolfe1, T.Powell1,
H.S.Smith1, I.Sylvester2, K.Koller2, T.Thomas2
ANTHC1, Southcentral Foundation2
Background: Health research is necessary to improve
health care and health outcomes. Past research misconduct
among American Indian and Alaska Native people
includes misinformation about the research purpose, aims,
and methods and misrepresentation of the communities
participating in the research. These have resulted in a
general mistrust of research and community stigmatization.
Moreover, poor dissemination of research results to
participating individuals and communities has resulted in
poor relations between researchers and community members
(“researchers are like mosquitoes; they take your blood
and fly away”). Tribal health organizations in Alaska have
implemented the Tribal review process to protect Alaskan
communitiesfrom; (1) inappropriate or undesired research,
(2) stigmatization, and (3) unknown results.. Methods:
The conceptual framework for Tribal review and approval
of health research will be presented. These processes differ
based on the community and Tribal Health Organization
involved. The research review process for the Alaska Native
Tribal Health Consortium, the Alaska Area Institutional
Review Board, and a regional Tribal Health Organization
will be presented to demonstrate practical implementation
of the framework. Discussion and Conclusions: Tribal
research review empowers Alaska Native people to control
what research is conducted with their people and protects
their communities from stigmatization. These protections
are not afforded by institutional review boards, which
are charged with protecting individuals participating
in health research studies. This process is also intended
to ensure research results are disseminated back to the
community in the manner requested, before they are
shared with the broader research community and public.
[email protected]
POSTER NUMBER: M68
Health State of Native Small in Numbers
People of Republic Sakha (Yakutia)
AUTHORS: T. Burtseva, T. Uvarova, V. Chasnyk, M.
Savvina, V. Shadrin
Federal State Budgetary Institution,Yakut Centre of Science
154
Keywords: native small in numbers people, pathological
morbidity
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The goals of these work is an examination of the health and
life condition native peoples living compactly.
Materials and methods: We are examination 813 people,
living in Gigansky, Ust-Maysky, Anabarsky regions of
Yakutia. Age of patient from 17 to 86 years old, medium
age is 44,0±1,7 years old. Women is 547 (67,3%), men –
266 (32,7%). 597 is native people (evenk 324 (39,9), even
– 43 (5,3), dolgan – 230 (28,3%)). The health condition
is examination by cardiology, pulmonologist, neurology,
gastroenterology, otolaryngology, urology, gynecology,
ultrasound-examination and endoscopy. We use
International classification disease X. The level of the life
condition is examination using special social questionnaire.
Result: The first plays of the pathology profile is
gastroenterology disease (67,9 cases of the 100; 26,0%),
second plays – urinary disease (45,3; 17,3%), third - the
hard disease (44,4; 17,0%), than respiratory disease and
disease of the osteo-muscular system.
The level of the life condition is examination using special
social questionnaire. The questionnaire is consisting of the
question about education, social status, and family status.
We are questionnaire 447 peoples, 155-dolgan, 292-evenk
population. The medium square of the house is 13,9 м2- to
dolgan, 18,7 м2- to evenk. The central heating have 95,5%
dolgan, 34,9% evenk. The houses was building after 1995
of the 45,8% dolgan, 28,1% evenk. The people with bad
houses and life condition are high of the evenk population
than on the dolgan population (40,1 and 21,3%). The cause
of the bad life condition is detected deficiency of the square
of house (54,5%), absents heating (78%) and old of the
house(69,2%).
The financial status is low to evenk population than to
dolgan population (40,4% -31,0%). But the 12% of the
evenk and 6,5% of the dolgan people sreak that the money
sufficiently only food and eat. The medium returns for 1
persons is 5675 rubles to evenk, 8372 rubles to dolgan.
Conclusion:
The high spread to the native population is gastroenterology
disease (67,9 cases of the 100; 26,0%), urinary disease (45,3;
17,3%), the hard disease (44,4; 17,0%).
In evenk population disease of the gastro-intestinal system,
respiratory system, osteo-muscular system is high, than in
dolgan and even population.
The health condition is determine by the life condition,
heating and financial status.
[email protected]
POSTER NUMBER: M69
Will the Gap in Life Expectancy and
Mortality Between First Nations and All
Others Manitobans (Canada) Ever Close?
AUTHORS: B. Elias1, M. Hall1, S.P. Hong1, L. Hart2,
G. Munro3, P. Martens1
University of Manitoba1, Southeast Resource Development Council
Corp.2, Swampy Cree Tribal Council3
[email protected]
POSTER NUMBER: M70
Injury Mortality Between First Nations
and All Other Manitobans (Canada): A
Sub-Regional Profile
AUTHORS: B. Elias1, M. Hall1, S.P. Hong1, P.
Martens1, L. Hart2, G. Munro3, S. Logsetty1
This study explored injury mortality between First Nations
and All Other Manitobans. Data used in the study are from
the Population Health Research Data Repository housed
at the Manitoba Centre for Health Policy, University
of Manitoba, and were derived from data provided by
Manitoba Health and the federal First Nations registry file.
We calculated adjusted rates of injury mortality (deaths per
1000 residents aged 0 – 74 years) from 1997 – 2006 for
First Nations (FN) and All Other Manitobans (AOM),
de-aggregated by rural north, south, mid-province, and
urban region. We also charted proportion of deaths by
cause. Deaths due to injury include unintentional, violence
inflicted by others, and self-inflicted violence. Proportion of
deaths by specific cause (crude percent) was also examined
for both FN and AOM by sex. Over the 10-year period the
injury mortality rate for FN exceeded that for AOM by
more than four times (FN=1.7/1000 vs AOM=0.4/1000),
and discrepancies between the groups were evident in
all rural and urban areas. The major cause of injuryrelated mortality among FN was suicide and other selfinflicted injuries (26% of total injuries), followed by motor
vehicle collisions (17%). For AOM, the major cause was
unintentional falls (22%), followed by suicide and other
self-inflicted injuries (21%). By sex, suicide/self-inflicted
injury was the major cause for FN and AOM males (25%
and 27% respectively) and for FN females (29%). The
major cause of injury-related death for AOM females was
unintentional falls (31%). This study is one of only a few to
investigate differences in injury mortality rates comparing
FN and AOM by area of residence, and the first to examine
differences in cause by sex. More research is required to
explore differences by on-and-off reserve status, at the
regional health authority level, and among tribal areas.
[email protected]
POSTER NUMBER: M71
Ethnic Discrimination and Bullying in
Relation to Self-reported Physical and
Mental Health in Sami Settlement Areas
in Norway : The SAMINOR study
Centre for Sami Health research, Universtity of Tromsø
The primary objective of this study was to study the
prevalence of self-perceived ethnic discrimination
and bullying in Sami, Kven and majority-population
individuals, and study the hypothetical link between
ethnic discrimination and health, and, if so, analyse the
association. Self-reported health (SRH) and psychological
stress (HSCL-10) are utilised as health indicators. The
findings in our study indicate that a large proportion of
Sami individuals experience discrimination based on their
Sami background; roughly four in 10 men and one in
FRIDAY ORAL
This paper reexamines life expectancy and a select number
of mortality indicators, comparing First Nations and all
other Manitobans, to demonstrate that the historical gap
has still not closed. Data used in this study are from the
Population Health Research Data Repository housed at the
Manitoba Centre for Health Policy, University of Manitoba
and were derived from data provided by Manitoba Health
and the federal First Nations registry file. Using data from
2002 - 2006, we calculated rates for life expectancy at birth,
premature mortality rate (PMR), potential years of life lost
(PYLL), and total mortality for First Nations and all other
Manitobans, and de-aggregated these rates by north, south,
mid-province, and urban region. In Manitoba, First Nations
can expect to live 10 years less than all other Manitobans.
PMR for First Nations is nearly three times that of all other
Manitobans (8.9/1000 vs 3.1/1000), and the PYLL rate for
First Nations is more than three times greater than for all
other Manitobans (160.1/1000 vs 47.7/1000). Similarly,
the total mortality rate for First Nations is significantly
higher at more than 2.5 times that of all other Manitobans
(22.4/1000 vs 8.5/1000). The major cause of death for First
Nations during the study period was related to external
causes of injury, while for all other Manitobans, the major
cause was related to circulatory system failures. This study
shows stark inequalities between First Nations and all
other Manitobans. Recognition of a persistent pattern,
however, is not enough. Programs and service delivery to,
for, and by First Nations must be adequately resourced.
Federal and provincial governments also need to identify
and finance performance targets over the short, medium
and long term to undo this historic pattern of disparity.
14:30 -15:30
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three women. Moreover, Sami individuals living outside
the defined Administrative Area of the Sami Language
report the highest levels of discrimination. Compared to
the majority population, Sami participants are twice as
likely to respond that they have been subject to bullying.
Among respondents that reported bullying previously,
the most common location was public schools. For those
who reported bullying in the past year, the most common
locations were at work and in the local community. The
Sami respondents, furthermore, report more often (than
Kven and ethnic Norwegians) that discriminatory remarks
were the most common forms of bullying. Furthermore,
our results show that ethnic discrimination is associated
with inferior self-perceived health; Sami participants report
somewhat lower health status than Ethnic Norwegians. We
have found that discrimination and lower socio-economic
status contributes to the inequality in self-reported health
between the Sami and the general population. Additional,
our study also finds that Sami and Kven males report higher
levels of psychological distress than the general population
of males. Interestingly, in women the effect is statistically
insignificant. Generally, we know from earlier studies
that ethnic discrimination is closely related to poorer
mental health in indigenous peoples. Our study supports
this conclusion and unveils a strong association between
discrimination and psychological distress, as measured
using the Hopkins Symptoms Check List (HSCL-10).
[email protected]
POSTER NUMBER: M72
The Changing Gender Composition of
the Russian North
AUTHOR: T. Heleniak
University of Maryland
156
Similar to the Arctic periphery regions of other northern
countries, the Russian North has a higher male-female sex
ratio than the rest of the country. However, the high male
sex ratio in the Russian North needs to be viewed in the
context of Russia having the lowest male-female sex ratio
in the world. This paper examines changes in the sex ratio
in the Russian North since the economic transition which
heavily impacted both regional development practices
and demographic patterns. Data from the 1989 and 2002
population censuses will be used along with more recent
population estimates. Data on the gender and family
composition of migration will also be examined. The
results will include a descriptive section which shows the
sex ratios and changes in the sex ratio for the entire north,
the northern regions, by settlement size, ethnicity, age, and
level of education. To the extent possible these changes will
be disaggregated into those from natural increase and net
migration. More detailed results will examine the causes of
14:30 -15:30
the changing sex ratios in the northern regions of Russia
by computing the effects that the structural changes in the
regional economies had on the gender composition of the
workforce. The paper will discuss the implications of the
changes in the sex ratios for settlements and regions with
skewed sex ratios and the labor force in the Russian North.
[email protected]
POSTER NUMBER: M73
Fostering Transformative Inquiry
AUTHOR: M. Hirch
Center for World Indigenous Studies
Breaking down barriers and advancing interdisciplinary
teaching, research and engagement could not be more
important and more urgent. Promoting collaboration is
of particular interest in the vast landscapes of the North.
Collaboration in that region is crucial to the success of all
stakeholders who want to be prepared for the challenges
of the present century. From a geographic perspective
the comprehensive approach addresses interdependencies
and connectedness most relevant for overall well-being in
the extreme geographic region of the circumpolar North.
Discussing strategies and potential for adaptation shared
understandings of meaningful ‘cultural cognitive maps’ are
visualized as well as selected physical maps that illustrate
the intricate relationships between people and places.
[email protected]
POSTER NUMBER: M74
Highlights of Findings from the
Canadian IPY Adult Inuit Health Survey
2007 – 2008
AUTHORS: H. Saudny, K. Young, G. Egeland
McGill University
Introduction: The IPY Inuit Health Survey 2007-2008 was
designed to provide a broad-based assessment of health
among Inuit adults, 18 years of age and older, and residing
in three jurisdictions within the Canadian Inuit Nunangat:
Inuvialuit Settlement Region, Nunavut Territory, and
Nunatsiavut, all representing land claim areas. The survey
represents the largest geographical area ever included in a
health survey to date.
Objectives: To highlight findings from the Inuit Health
Survey 2007-2008 and identify priorities for interventions.
Methods: The survey was developed in a participatory
process involving extensive consultations with stakeholders
and the formation of steering committees within each of
the three jurisdictions. Information on demographics,
dimensions of health, diet, community and personal
wellness was collected. A clinical examination and fasting
and a 2-hour OGTT were also administered.
Results: A total of 36 communities and 1,901 households,
representing 2,595 adults 18 years of age and older,
participated in the survey. The average age was 43.3
years, and 61.5% of participants were women. 62.6% of
households were food insecure, and a greater prevalence
of food insecurity was observed in crowded homes, in
homes needing major repairs, in single adult households,
in households receiving income support and public
housing. According to Body Mass Index (BMI), 28% of
participants were overweight, 35% were obese and 17.4%
had a combination of an at-risk waist circumference and
high triglyceride levels, which was related to risk of fasting
glycemia and type 2 diabetes. Risk of osteoporosis was
greater for women <50 years of age, so was iron deficiency
and iron deficiency anemia. Nutrition transition from
declining traditional food intakes to increasing market
food consumption was a concern throughout all regions.
Conclusion: It is hoped that the public health problems
identified here will be put to good use for identifying
priorities and developing public health policies that will
make a meaningful difference in the Canadian Arctic.
[email protected]
POSTER NUMBER: M76
Research Methods: Using the Theory of
Planned Behavior to Increase Proposal
Submissions.
AUTHORS: A. Hartmann1, M.T. Norman2
University of Alaska Fairbanks1, UAF College of Liberal Arts2
[email protected]
POSTER NUMBER: M77
Adapting Survey Methodology to
Improve Response Rates for Rural
Providers: A case study from the Alaska
Tribal Health System (ATHS)
AUTHORS: S. Kelley, C. DeCourtney, K. Morgan
Background: High survey response rates from physicians
are key to obtaining valid and generalizable data regarding
attitudes toward and practices surrounding prostate cancer
screening, follow-up, and survivor care. Administering a
statewide provider survey within the Alaska Tribal Health
Systems (ATHS) poses unique challenges compared with
reaching private provider groups in urban or rural settings.
High provider turnover, non-existent statewide provider
contact lists, limited internet access, and demanding
schedules interfere with gathering statistically valid
response rates. Methods: ANTHC had successfully
administered two separate surveys of healthcare providers
of Alaska Natives by adapting survey methodology to meet
remote practice patterns, offering desirable incentives and
identifying local coordinators. In the first survey regarding
palliative care knowledge and practices, a medical staff
support was identified and, depending on the response rate
from that institution’s healthcare providers, was entered in
to a raffle for airline tickets. Providers were also given the
opportunity for a separate raffle. In remote Alaska settings,
air travel is expensive and the only means of transportation
available for work, vacation and continuing education.
Coordinators conducted follow up surveys for nonrespondents, assisted in gathering responses and encouraged
provider participation. These methodologies were adapted
and expanded for a system-wide prostate cancer survey.
Results: A total of 13 local survey coordinators assisted in
identifying 220 active providers in 13 different primary care
clinics within the ATHS. Surveys, with three follow-up
electronic mailings and one U. S Mailing, were distributed
over a two month period. Overall, 114 providers returned
completed surveys (52%). Conclusion: High response
rates from busy practicing physicians can be achieved by
enlisting local contacts and engaging them in the collection
and incentive process.
Surveys must also be relevant to clinical practice,
sponsored by a reputable organization, include a
desirable incentive, and delivered in a variety of formats.
[email protected]
FRIDAY ORAL
Research Methods: Using the Theory of Planned Behavior
to Increase Proposal Submissions. Ajzen’s Theory of
Planned Behavior (1991)is a powerful model with practical
application to a variety of situations to predict and influence
human intentions to perform a range of desirable behaviors,
including those that are important to research management.
The theory explains that the best predictor of a behavior,
such as whether a potential researcher will prepare and
submit a funding proposal, is the person’s intention to act
or not to act. This critical decision point of intending to
act is influenced by three factors: 1) the person’s attitude
toward the behavior,2) the person’s perception of the
social norm, and 3) the person’s perceived control over the
behavior. Each factor creates opportunities for the research
administrator to implement interventions to influence the
intentional behavior of a potential investigator. This poster
illustrates Ajzen’s theoretical model along with examples of
management interventions that can be directed toward each
of the three critical factors to influence the desired behavior
such as preparing and submitting research proposals.
14:30 -15:30
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TUESDAY POSTER
POSTER NUMBER: M78
The Formation of a Multicenter
Collaboration Involving Three Studies
of Cardiovascular Disease and Type
2 Diabetes in Western Alaska Native
Populations: The WATCH Study
AUTHORS: A. Willetto Wolfe, K. Koller1, J.
Metzger2, B. Howard3, C. Kaufmann4, E. Asay1, S.
Hopkins4, T. Thomas1, B. Boyer4
challenges that take time and budgetary considerations.
Publications showing prevalence and incidence in obesity,
cardiovascular disease, diabetes, and related risk factors are
being developed. [email protected]
Chronic Diseases
POSTER NUMBER: T1
Alaska Native Tribal Health Consortium , University of Alaska
Anchorage2, MedStar Health Research Institute3, University of
Alaska Fairbanks4
Ethnic Differences Body Mass Index
(BMI) in Children Yakutiya (Sakha
Republic)
The Western Alaska Tribal Collaborative for Health
(WATCH) Study combines three large studies of Alaska
Native (AN) people residing in Western Alaska. Together,
the Center for Alaska Native Health Research (CANHR),
Education and Research Towards Health (EARTH), and
Genetics of Coronary Artery Disease in Alaska Natives
(GOCODAN) comprise a cohort of 3982 participants
of Yup’ik and Inupiat descent. A Tribal Coordinating
Committee (TCC) was formed for guidance in prioritizing
community health concerns, dissemination of study findings,
future research focus, and direction for intervention based
upon WATCH findings. WATCH investigates chronic
disease risk factors and outcomes among Yup’ik and
Inupiat people of this region by consolidating baseline and
surveillance data.
AUTHORS: L. Lapteva, N. Semenova, V. Tsukanov
1
This presentation will describe methods for combining
three prospective cohort studies of Yup’ik and Inupiat
populations in rural Western Alaska. Approvals were
obtained from the Alaska Area and University of Alaska
Fairbanks Institutional Review Boards, and local tribal
review boards from each study region. A Steering
Committee was formed to provide the overall guidance for
this study. Additionally, an Operational Committee was
formed of experts from each study for identification and
harmonization of three types of variables, measurement
(anthropometric, blood lipid and glucose), medical chart
abstracted (cardiovascular disease and diabetes), and selfreported questionnaires (nutrition, physical activity, medical
and demographic). Findings will be disseminated to both
the scientific community and tribal partners through peerreviewed publications and presentations, including tribal
oversight bodies and communities.
158
14:30 -15:30
Combining cohort studies to increase sample size is the first
step in developing a robust translational research agenda for
Yup’ik and Inupiat people with significant implications for
understanding and reducing health disparities. However,
harmonizing data and standardizing surveillance methods
for three independent AN cohort studies present unique
Federal State Budget Institution, Scientific Research Instit
Excessive weight and obesity among children is one of the
most serious problems, which public healthcare system
is facing in the 21st century. In the world the number
of children with excessive weight had come beyond 42
million in a year 2010. Out of them 35 million are the
inhabitants of developing countries. Subjects and Methods.
Anthropometry for adolescents in ages from 7 to 11 years
(n=325) of native (n=242) and alien populations (n=83)
of Yakutia. Height and weight measurements in each
survey were obtained using standardized techniques and
equipment. BMI was calculated as weight (in kilograms)
divided by height (in meters squared). in regard to gender
and age. Childhood overweight is defined as a BMI-for-age
95th percentile, children with a BMI-for-age 99th percentile
to be obese. Statistical methods. Results and discussions.
The number of children with lowered weight (BMI below
5 percentile) made 4.61% (CI 2.36-6.72%) of the tested
subjects. The majority belonged to ethnic groups - 86.66%
(CI 61.65-92.95%). Overweight was marked in 16.0% (CI
12.42-20.38%) children. Obesity corresponded to 14.77%
(CI 1.43-19.04%) of all the tested subjects. There is true
distinction in the increase of the number of obesity subjects:
26.3% (CI 18.5-37.3%) among aliens against 10.74% (CI
7.45-15.28%) among natives, p=0.0005. In obesity group
the majority is represented by native girls: 69.23% (CI
49.83-83.48%) against 36.36% (CI 19.71-57.26%) of alien
girls, p=0.027. Among alien obesity subjects the majority
is represented by boys: 72.72% (CI 51.59-86.79%) against
30.76 (CI 16.52-50.18%) among natives, p=0.0058.
[email protected]
14:30 -15:30
POSTER NUMBER: T2
POSTER NUMBER: T3
Cancer in Chukotka, 1961-2010
A Men’s Cancer Survivorship Retreat
in Alaska
AUTHORS: A. Dudarev, V. Chupakhin, J. Odland
Northwest Public Health Research Centre, AMAP Secretariat
Prostate cancer is the most frequently diagnosed cancer in
men aside from skin cancer. Over the past 25 years, the 5 year
relative survival rate for prostate cancer has increased from
68% to almost 100%. While more than 90% of all prostate
cancers are discovered in the local or regional stages, their
survivorship is often complicated by urinary, bowel, sexual,
and hormonal dysfunction which challenge a man’s physical,
mental and social well-being. In general, men diagnosed with
cancer do not participate in survivorship activities. There is
an identified need from both the State of Alaska and the
Alaska Native Tribal Health Consortium Comprehensive
Cancer Plans to develop social support programs for
Alaskan prostate and testicular cancer survivors. The Men’s
Retreat for prostate and testicular cancer survivors was first
developed as a pilot program in 2009 for Alaska Native
and non-Native men living in Southcentral Alaska. The
program is now offered annually in Southcentral Alaska
and also regionally by the SouthEast Area Regional Health
Consortium for Alaska Native men in SouthEast Alaska.
The program brings together cancer survivors in a supportive
environment to discuss and share their experiences. Clinical
outreach efforts target disparate populations and rural based
Alaska Native survivors. Key findings from a process and
outcome evaluation of the Retreat included a high level
of participant satisfaction with the Retreat and increased
self-reported networking and advocacy efforts among
participants. Follow-up evaluation results confirmed a
significant increase in the participants’ level of social support
and use of resources. Men who attended the Retreat can
be good community advocates to support men diagnosed
with prostate and testicular cancer. The Men’s Retreat can
serve as a learning experience for clinical providers who
attend also. Comprehensive Cancer Programs and others
interested in cancer survivorship are encouraged to consider
implementing ongoing
men’s retreat opportunities.
[email protected]
POSTER NUMBER: T4
Cancer in Northern Populations
Workgroup
FRIDAY ORAL
[email protected]
TUESDAY POSTER
In 1991 the USSR collapsed and since 2002 Indigenous
health statistics have been lost. This district has had
consistant borders for decades and has been inhabited by
Eskimo (Inuit) who, together with coastal Chukchi, were
historically involved in sea mammal hunting. The cancer
incidence and mortality data among the general population
of Chukotka (1997-2010) was collected from the Russian
official statistical coefficients. The cancer mortality data
among the Indigenous people of the Chukotskiy district
was collected from death certificates in the civilian status
registry of the Lavrentiya township, capital of the utmost
northeastern coastal district. Cancer death cases have not
been verified. Age-standardized cancer mortality rates
(ASMR) and 95% CI were calculated by sex and cancer site
by the direct method based on Segi-Doll world standard
population. Cancer incidence rates among the general
population of Chukotka in 1997-2010 both among men
and women are relatively similar to Russia and northern
European countries and slightly lower than in Canadian
Quebec and Alaska. Lung and stomach cancers are
more prevalent among men. Breast and lung cancers are
more prevalent among women. Cancer of the esophagus
is very high among both men and women and prostate
and non-melanoma cancers are low. From the late 1990s
to 2010, there is a trend toward increasing cancers for all
sites combined and for the majority sites among both men
and women. Cancer mortality rates among the general
population of Chukotka in 1999-2010 among both among
men and women roughly correspond to the incidence rates,
but lung cancer among women is the major cause of cancer
death. Cancer mortality rates in 1961-1990 among the
Indigenous people of the coastal Chukotskiy district were
very high among both men and women (ASMR 417 vs. 359
per 100,000 respectively) and were relatively stable during
30 years. The leading cancer death causes among both
men and women were lung (28% and 23% respectively),
followed by esophagus (22% and 20%) and stomach (15%
each), while breast, brain/CNS, ovary, bladder, lymphoid/
hematopoietic tissues, pancreas, kidneys, prostate cancer
deaths remained low or very low. Coastal Chukchi and
Eskimo continue to be at extremely high risk compared
to Russia and other circumpolar (and even global)
populations for cancer of the esophagus, which has been
recognized as historically “regional” in the Russian Arctic.
AUTHORS: S. Kelley, C. DeCourtney
AUTHOR: J. Kelly
Workgroup participants from Alaska, Canada, Greenland
and the Nordic countries will present data on cancer
159
patterns among their indigenous populations. Members of
recent international collaborations on circumpolar Inuit and
Northern Canada-Alaska Indian/First Nations cancer will
present data for discussion. This workshop will provide an
opportunity for participants to discuss future collaborative
projects in cancer among Northern populations.
TUESDAY POSTER
[email protected]
POSTER NUMBER: T5
Immunological Features of Acute
Leukemia In Siberia
AUTHORS: V. Manchuk, O. Smirnova, S. Smirnova
State Medical Research Institute for Problems of the North
The purpose of study was to examine the cellular and humoral
immunity features in patients with acute lymphoblastic
(ALL) and with acute no lymphoblastic leukemia (ANLL)
in Siberia. Material and methods: there were 100 patients
with ANLL, 73 patients with ALL and 120 healthy
individuals of similar age. All patients were divided in 4
groups: primary attack, complete remission, recurrence and
control group. The population content of lymphocytes was
assessed by indirect immunofluorescence using monoclonal
antibodies. The IgA, IgM, IgG concentration was
determined by immune enzyme method. Statistical analysis
was carried out in the application package of Statistica 7.0.
Results: The state of cellular immunity in ANLL patients
in primary attack was characterized by decrease in T cells
and CD4 +-lymphocytes, in remission – by reduction in
leukocytes, T-, CD4 -, cytotoxic lymphocytes, NK-cells
, B-lymphocytes and HLA-DR- cells, in recurrence by
decrease in leukocytes, in T-, CD4 + -, NK-cells and cytotoxic
lymphocytes and HLA-DR cells. There was no abnormality
in the state of humoral immunity in first attack of ANLL,
in remission there was a IgG concentration reduction, in
recurrence IgA, IgM, IgG concentration were reduced. The
state of cellular immunity in patients with ALL in attack
was characterized by increase in lymphocytes and decrease
in T-cells, in remission by decrease in lymphocytes, T-,
NK-, B cells and HLA-DR cells, in recurrence by reduce
in T-lymphocytes. There was no abnormality in the state
of humoral immunity in first attack, in remission there
was IgA and IgG concentration reduction, in recurrence
there was IgA and IgM concentration reduction.
Conclusion: The patients with ANLL in recurrence stage
had combined immunodeficiency. The reduction of CD4
- cells to the cytotoxic lymphocytes ratio contributed to
the appearance of primary attack in patients with ALL.
A feature of ALL recurrence was the NK-cells increase.
[email protected]
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POSTER NUMBER: T7
Serological Markers of Atrophic Gastriris
May Determine the Risk of Gastric
Cancer in a Population-Based Study
AUTHORS: O. Reshetnikov, S. Kurilovich, T.
Openko, G. Simonova, S. Malyutina, Y. Ragino, M.
Voevoda
Instutite of Internal Medicine
Chronic atrophic gastritis (AG) is considered as one of
the most important predictors of gastric cancer (GC).
A set of noninvasive tests named “Gastropanel” (Biohit,
Finland) has recently been designed including three
various markers of gastric atrophy pepsinogen I (PGI),
pepsinogen II (PGII) and gastrin-17 (G-17), as well as
antibodies to Helicobacter pylori. Objective: To assess
the value of biomarkers of AG tested with “Gastropanel”
for early detection of GC. Methods: 10,000 subjects
aged 45-69 were studied from the general population of
Novosibirsk in 2003-2005. Population Cancer Registry
identified 25 novel cases of GC until 2009. For each case
of GC, two control cases were selected matching on sex
and age. Results: Indicators of gastric atrophy (OR; 95%
CI) were associated with GC for PGI (3.75; 1.36-10.32),
PGII (6.83; 1.26-37.16) and PGI/PGII ratio (4.31; 1.4912.45), but nor with G-17 (1.65, 0.57-4.75), neither with
the presence of antibodies to H. pylori (1.76; 0.56-5.59).
H. pylori antibodies were equally distributed between
both groups with high prevalence of 74%. Multivariate
regression analysis including sex and age showed a low
level of PGI (4.82; 1.61-14.48) as the only significant
indicator in the model. Conclusions: In a retrospective
cohort study the use of a set of serological tests showed
that low levels of PGI significantly increase the risk of GC.
[email protected]
POSTER NUMBER: T8
Features of Cellular and Humoral
Immunity in Patients with Chronic
Leukemia In Siberia
AUTHORS: O. Smirnova, S. Smirnova
State Medical Research Institute for Problems of the North
The purpose of study was to examine the features of
cellular and humoral immunity in patients with chronic
mieloleukemia (CML) and with chronic lympholeukemia
(CLL) in Siberia. . Materials and methods: we observed 44
patients with CML, 57 patients with CLL and 120 healthy
individuals of similar age. All patients were divided in 3
groups: developed stage, terminal stage and control group.
[email protected]
POSTER NUMBER: T9
Arterial Hypertension (AH) in Children
of the North
AUTHORS: L. Evert1, L. Polikarpov2, E. Prakhin1, V.
Tsukanov
Institute of Medical Problems of the North, SD RAMS1, Krasnoyarsk
State Medical University2
[email protected]
POSTER NUMBER: T10
Some Cardiovascular Diseases Risk
Factors in Natives of Chukotka
AUTHORS: L. Gyrgolkau, L. Shcherbakova, M.
Ivanova, M. Voevoda
Institute of Internal Medicine SB RAMS
According to official statistics in the structure of the
deaths of indigenous people of Chukotka from 1992
to 2002 mortality from cardiovascular disease (CVD)
is in the second place after the accidents’ mortality, so
the study of the prevalence of CVD risk factors among
natives seems relevant. Materials and Methods: Three
cross-sectional epidemiological studies have examined
the indigenous inhabitants of Chukotka aged 25-64
years, 696 persons were examined in total, the indicators
are standardized for age and body mass index. Results:
The frequency of individuals with blood pressure levels
in range of 140/90) - 22%, meanwhile the frequency of
stage 1 hypertension was detected in 14% of individuals,
stage 2 hypertension in 6% and stage 3 in 2%. All surveyed
people were divided by the level of total cholesterol (TC)
as follows: the normal level according to NCEP ATP
III ( 240) - 15 %; according to LDL-C level: optimal (
190) - 5%; according to HDL-C level: high (> 60) - 44%,
medium (60-40) - 40.1%, low ( 200) - 3.3%. According to
the body mass index all surveyed people were distributed
as follows: underweight ( 40) - 1.5%. Conclusion: Thus,
among the indigenous inhabitants of Chukotka, the
proportion of people with normal blood pressure, normal
levels of blood lipids and normal body weight is high
enough, and, accordingly, the frequency of individuals with
hypertension, dyslipidemia and obesity is relatively low.
[email protected]
FRIDAY ORAL
Urgency of the problem is caused by the prevalence of AH
among children population and high probability of it strans
form ation into is chemic and hypertonic diseas esin their
adult ages; the poor study of epidemiological mechanisms
for this group of diseases among children of North districts;
lack of coordination among the data on functional state
of cardio-vascular and VNS in children of the Extreme
North, on the peculiarities of AH clinical progression in
various ethnic groups; poor know ledge on epidemiology
of risk factors in children, in habiting different climatic
geographical areas. Aim of the research: To study the
prevalence of risk factors of arterial hypertension in children
of different regions of Siberia. Subjects of Research:
Children living under the conditions of the North regions
(Taymir, Evenkia, Yakutia, Yamal-Nenetz autonomous
district). The obtained data had been compared to the result
so fanalogues research for central and southern regions. We
have examined 6 863 children totally. Obtained Results: AH
prevalence among children population in northern regions is
two times higher than in central and four times higher than
in southern regions. Among population characteristics the
concentration of AH risk factors is also higher in children,
in habiting the North as compared to other regions.
In children of native people FR concentration is lower
than in alien. In children the interconnections between
clinical-functional, biochemical and regulatory indices are
more evidently manifested. The same refers to structuralfunctional peculiarities of a heart, characteristics of cerebral
blood circulation. The combination of signs is proving high
possibility of AH development in the children of the North.
TUESDAY POSTER
The population content of lymphocytes was assessed by
indirect immunofluorescence using monoclonal antibodies.
The IgA, IgM, IgG concentration was determined by
immune enzyme method. Statistical analysis was carried
out in the application package of Statistica 7.0. Results: The
state of cellular immunity in CML patients in developed
stage was characterized by decrease in T cells, CD4 +
and cytotoxic lymphocytes, by increase in B-, HLA-DR
lymphocytes, in terminal stage – by decrease in leukocytes,
lymphocytes, T-, CD4 +- and cytotoxic lymphocytes,
NK-, B cells and HLA-DR lymphocytes, and increase
in B-lymphocytes. There was IgA, IgM concentration
reduction in the state of humoral immunity in developed
and terminal stages. The state of cellular immunity in
patients with CLL in developed stage was characterized by
increased in leukocytes, lymphocytes, T , CD4 , cytotoxic
lymphocytes, NK-, B cell and HLA-DR lymphocytes, in
terminal stage by increased in lymphocytes, B-lymphocytes,
T-lymphocytes, CD4 +- cells, cytotoxic lymphocytes.
There was decrease the IgA, IgG concentration in the
state of humoral immunity in developed stage, in terminal
stage there was IgA, IgM, IgG concentration reduction.
Conclusion: In patients with CML in developed and
in terminal stages T-immunodeficiency appeared. The
feature of CML terminal stage was the NK-cells and B
cells reduction. In patients with CLL in the developed
stage there was condition characterized by increase of
T-and B-lymphocytes and NK-cells content. A feature
of CLL terminal stage was combined immunodeficiency.
14:30 -15:30
161
POSTER NUMBER: T11
Monitoring Hearings Migrants
- Northerners with Diseases
Cardiovascular System
AUTHORS: I. Ignatova, V. Tsukanov
TUESDAY POSTER
Research Institute of Medical Problems of the North
Relevance of the topic is due to the high prevalence of
otopathology; due to modification of its clinical forms.
This is especially important for those in eastern Siberia,
due to extreme climatic conditions. In recent years there
has been an upward trend in the number of patients with
hearing loss in the Russian Federation, of more than 13
million people. Objective. To investigate the effect of age,
disease duration, etiology, nosology, and length of residence
in the north of northern migrants who have diseases of
the cardiovascular system in the developmental forms
and stages of hearing loss. Material and Methods. The
ENT conducted a comprehensive audiologic examination
using the diagnostic audiometer AD-226; otoscoped
migrant Northerners (n=197) aged 50 to 80 years with
cardiovascular pathology, cardiology, and statistics - adaptometry correlation. Results. The observed features
of hearing loss among northern workers revealed the
existence of reliable causal correlation between the ages
of 50-60 years (G=132,57); period of residence in the
north, the largest being four decades of living (G=147,
59); the etiology of stress, stroke and smoking with disease
duration in the group with the greatest periods of illness
(G=156,47); from severity of illness of the cardiovascular
system to the third stage of sensorineural hearing loss.
The past decades, however, have seen rapid changes in
the Arctic region, giving rise to new concerns about the
continued cardiovascular health of Alaska Native peoples.
Methods: WATCH is a collaboration between the
Education and Research Towards Health (EARTH), the
Center for Alaska Native Health Research (CANHR),
and the Genetics of Coronary Artery Disease in Alaskan
Natives (GOCADAN), each conducting cohort studies in
western Alaska. The combined WATCH cohort consists of
3,985 Alaska Native participants >= 18 years old enrolled
between 2000 and 2006. Baseline CHD risk factors were
categorized according to ATP III guidelines. Associations
between CHD and metabolic syndrome risk factors as
well as socio-demographic variables were assessed. Results:
While only 51 (1.3%) had prevalent CHD at baseline,
men were more likely than women to have prevalent CHD
(1.5% vs 1.0%). The age-adjusted prevalence of CHD
was 4.5% in WATCH compared to 6.0% reported in the
Behavioral Risk Factor Surveillance System. High waist
circumference, systolic blood pressure, triglycerides, and
fasting plasma glucose along with low levels of HDLcholesterol were all significantly associated with prevalent
CHD.
Discussion and conclusions: While the WATCH cohort
had a low prevalence of CHD in part due to the young
relative age, the age-adjusted prevalence revealed a level
much closer to the national average. This may be reason for
concern given the numerous associations between CHD
and metabolic risk factor profiles that may be worsening
among Alaska Native people due to the significant
changes in subsistence lifestyles in the Arctic region.
[email protected]
[email protected]
POSTER NUMBER: T14
POSTER NUMBER: T13
Prevalence of Arterial Hypertension
Among the Newly Arrived Population
and Aboriginal Population of Extreme
North
Prevalence of Coronary Heart Disease
(CHD) and it’s Associations with CHD
risk factors in The Western Alaska Tribal
Collaborative for Health (WATCH) Study
AUTHORS: J. Metzger1, K. Koller2, S. Hopkins3, B.
Boyer3, B. Howard4, C. Kaufmann3, J. Umans4, S.
Jolly, E. Asay
University of Alaska – Anchorage1, ANTHC2, Center for Alaska
Native Health Research3, MedStar Health Research Institute 4
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Significance: Much of the research on the health of
Native peoples in the Arctic region has indicated a very
low incidence of coronary heart disease (CHD). A diet
consisting in large part of fish and marine mammals,
along with physical activity associated with subsistence
lifestyles, is assumed to be protective against CHD.
AUTHORS: L. Polikarpov1, R. Yaskevich1, I.
Hamnagadaev2, E. Derevyannykh3, V. Tsukanov
State Medical Scientific Institute for Northern Problems1, Belgorod
State University2, Krasnoyarsk State Medical University3
A long-term observation (n= 2268 immigrant population
and n=713 aboriginal population) of the North aged 30-59
was carried out with the purpose of arterial hypertension
prevalence study and detecting the factors that influence
the evolution and the clinical course of disease. Methods
of study: Epidemiological, measurement of blood pressure
with a mercurial sphygmomanometer, tachooscillographia,
mathematical modeling.The arterial hypertension prevalence
study has shown, that among the immigrant population,
[email protected]
POSTER NUMBER: T15
Readaptation of Patients with Arterial
Hypertension, Residing in the Far
North for a Long Time to New Climate
Conditions
AUTHORS: L. Polikarpov1, R. Yasckevich1, E.
Dereviannych2, M. Rossovskaya2, V. Tsukanov
State Research Institute of the North Problems1, Krasnoyarsk State
Medical University2
[email protected]
Risk Factors of COPD Development in
Citizens of the Central Zone of the Sakha
Republic (Yakutia)
AUTHORS: A. Sivtseva, A. Argunova, A. Palshina, A.
Khorunov, M. Ivanova, T. Burtseva
North-Eastern Federal University
Keywords: epidemiology, chronic bronchitis, chronic
obstructive bronchitis, respiratory diseases.Clinicalinstrumental screening of 2856 citizens of the Yakutsk
city and Churapcha village showed considerably higher
spread of COPD in the urban and especially rural citizens
of the central zone of the Sakha Republic(Yakutia)
than that of Russian Federation. COPD morbidity was
significantly higher in rural citizens (20.5%) than in
those living in Yakutsk (14.1%).One of the main reasons
for that is a high prevalence of tobacco smoking among
urban and even higher among rural citizens of Yakutia.
In Yakutsk 57.4% of males are smokers and 54.3% are in
Churapcha. The prevalence of smoking (among males) in
urban areas is approximately the same among different
age groups. In rural areas high prevalence of smoking was
found among senior groups both for males and females
while urban citizens gradually quit that has a say in the
prevalence of COPD. COPD morbidity in rural citizens
over 60 years old is almost 2 times higher in males than
in females, that is 7.1% and 3.3% correspondingly, while
morbidity in urban areas is approximately the same
among males and females. Socio-economic status of those
examined has an ascertain influence on COPD morbidity
especially among urban citizens. According to our data
frequency of cold was 33.9% in urban areas and 43.4%
in rural areas that can be explained by severe climatic
conditions and is one of the risk factors for COPD.
[email protected]
POSTER NUMBER: T17
The Peculiarities of Components Shares
of Body Mass in Male Migrants to the
Extreme North, Arterial Hypertension
Patients
AUTHORS: R. Yaskevich1, L. Polikarpov1, I.
Hamnagadaev2, E. Derevyannykh3, V. Tsukanov
State Medical Scientific Institute for Northern Problems1, Belgorod
State University2, Krasnoyarsk State Medical University3
The research involved 36 former male inhabitants of Norilsk
and Dudinka towns with arterial hypertension, who were
living in the Extreme North and are now living in Central
Siberia (city of Krasnoyarsk) permanently. We examined
FRIDAY ORAL
Readaptation to new climate conditions in alien population
is different in different age groups. The number of
hypertensive subjects among aliens in the North is increasing
with increasing of time period subject stay in the North. In
subjects who have stayed in the North more than 10 years
arterial hypertension has special quality characteristics. The
follow up of migrants, coming to the central part of eastern
Siberia have shown that subjects who stayed in the North
10 years and more often have blood pressure instability and
peak elevations in comparison with those who stayed in
the North more than 5 years and less than 10 years (22,4%
and 12,5% ). High level of neurotic reactions connected
with social and economic factors (change of place of
work, profit decrease, change of psychological climate
in the family) seemed to be the reason of blood pressure
elevation and high frequency of heart ischemic disease
attacks. In some patients the main morphological and
functional systems were strongly exhausted which lead to
lethal outcome in new climate conditions, sharply different
from high widths, especially at persons over 50 years old
and having several risk factors. It should be mentioned that
depression, alarm, neurotic reactions in alien population
are dependent of duration of work in polar conditions
and age of the subject. Two thirds of subjects with somatic
pathology have depression. The strongest depression
was revealed in patients with ischemic heart disease and
arterial hypertension. Clinically significant depression was
revealed in 87.5 % migrants with arterial hypertension.
POSTER NUMBER: T16
TUESDAY POSTER
the disease occurs more often among the people who have
been living under conditions of the North exceeding a 10year term. Among the patients with arterial hypertension
the ratio of people having combinations of 2-3 risk factors
is higher, compared to healthy people. The mathematical
model of the prognosis for evolution and clinical course
of arterial hypertension based on tachooscillographic data
is designed. Multivariate statistical analysis has allowed
for the determination of the quality changes in elastic
type vessels for patients with different levels of blood
pressure and different tenure terms of living in the North.
14:30 -15:30
163
TUESDAY POSTER
50 male inhabitants of Central Siberia (Krasnoyarsk) with
arterial hypertension as the control group. For the research
we implemented common clinical methods, including
anthropomorphic ones. In order to determine components
of body mass we used the technique of mass fractionization
of muscle, bone and fat components. Analysis indicated
that arterial hypertension male subjects, former inhabitants
of the North, show median and low quartile Kettle indices
to be higher than in control. Percent indices of tissues
share in men, arriving from the North, appeared to be
higher by median, upper and low quartiles as compared to
men inhabiting Central Siberia. Per cent share of muscular
tissue by median, upper and low quartiles in migrants was
smaller than in control. Proportion between percent hares
of muscular and fat tissues in the compared groups didn’t
differ from one another by median. Indices for upper and
low quartiles were higher in men living in Central Siberia
as compared to migrants. Male migrants from Extreme
North to Central Siberia with arterial hypertension have
much higher indices of fat share and smaller indices of
muscular share in comparison with arterial hypertension
men permanent inhabitants of Central Siberia.
[email protected]
POSTER NUMBER: T18
Strategies for Curbing the Type 2
Diabetes Epidemic: Is SMBG the Answer?
AUTHORS: D. Priestley, D. Belanger
Canadian Agency for Drugs and Technologies in Health
164
Type 2 diabetes is a major health concern in Aboriginal
communities. Canadian statistics show that the prevalence
of diabetes is higher among First Nations individuals
compared with other Canadians. The prevalence of diabetes
in Inuit communities — currently comparable to the
general Canadian population — is expected to rise given
that risk factors such as obesity are high. Using the most
effective strategies to manage the growing type 2 diabetes
epidemic is crucial. But while self-monitoring of blood
glucose (SMBG) using test strips is common practice
for most people with type 2 diabetes, research from the
Canadian Agency for Drugs and Technologies in Health
(CADTH) shows that time and money would be better
spent elsewhere. CADTH synthesized existing data on the
clinical and cost-effectiveness of SMBG and found that
most adults with type 2 diabetes who aren’t using insulin
don’t need to test as frequently as they currently do. Testing
less will save patients time, pain, and inconvenience; and
it won’t negatively affect their health. Although more
frequent SMBG may help diabetes management in some
patients (e.g., those who are newly diagnosed, pregnant, or
with a history of hypoglycemia), most adults with type 2
diabetes not using insulin have more to gain from focusing
14:30 -15:30
on proven self-management techniques, such as physical
activity, following a healthy diet, ensuring good foot and
vision care, regularly visiting their doctor, and taking
medications as prescribed. England, Scotland, Sweden,
Germany, and the U.S. have reached the same conclusions.
Furthermore, the Canadian Diabetes Association
recently published a statement recognizing that limiting
government reimbursement for test strips may be
reasonable in patients not taking insulin. This is good news
— if practice changes to reflect the evidence, about $200
million per year could be freed up in Canada alone to invest
in strategies proven to lead to improved patient outcomes.
[email protected]
POSTER NUMBER: T19
Working Together to Achieve Healthier
Weights in Yukon Communities
AUTHORS: J. Butler Walker1, M. Van Bibber1,
K. Friendship1, B. Blottner1, L. McGinty2,
A. Van Bibber2, C. Gibbons3, M. Martin3,
D. Baumgartner4, A. Morgan5, I. Parker6, A. Aram6,
P. Pasquali6, N. Rassi, J. Jones
Arctic Institute of Community-Based Research1, Selkirk First
Nation2, Kwanlin Dun First Nation3, Tr’ondëk Hwëch’in (First
Nation)4, Recreation and Parks Association Yukon5, Yukon Gov.
Health & Social Services Dept6
Funding from Phase 1 of the Public Health Agency of
Canada’s Innovation Strategy has provided opportunities
for collaboratively working to promote healthy living and
improve health and well-being in Yukon, Canada. Phase
1 (2011/2012) has involved identifying ways to improve
weights and healthy lifestyle options, strengthening
partnerships between organizations, and informing
policy. The project has been grounded in communitybased, participatory research principles. Led by the Arctic
Institute of Community-Based Research (AICBR) and
developed in partnership with three Yukon First Nation
communities, the Recreation and Parks Association of
the Yukon (RPAY), and the Yukon Government-Health
and Social Services (YG-H&SS), Phase 1 activities have
demonstrated successes that can be further developed and
also shared with others in the Yukon and elsewhere in the
North. Yukon First Nation communities’ initiatives have
included: activities that promote culture and healthy diet,
including cooking classes; an extensive personal trainerled fitness program; building accessible raised garden beds
for elders and single parent families to facilitate access to
fresh and healthy produce and that engaged youth in their
construction; and developing an evaluation framework and
then evaluating currently offered fitness-related programs
that focus on healthy weights for various age groups that can
be shared with other communities to facilitate knowledge
14:30 -15:30
translation. YG-H&SS conducted a secondary analysis of
the Yukon portion of the Health Behaviour of Schoolaged Children survey. RPAY created a database of existing
Yukon policies and programs that support healthy weights
in Yukon communities. They also completed a literature
review of risk factors for overweight and obesity that was
shared with the project team to inform project development.
We are currently developing a 4 year proposal for Phase 2.
POSTER NUMBER: T21
POSTER NUMBER: T20
Alaska Native Tribal Health Consortium1, University of Alaska
Anchorage2, MedStar3, University of Alaska Fairbanks4
Obesity Studies in the Circumpolar Inuit:
A Systematic Review
AUTHORS: T. Galloway1, H. Blackett2,
S. Chatwood3, C. Jeppessen4, K. Kandola5, J. Linton6,
P. Bjerregaard4
McGill University1, University of Toronto2, Institute for
Circumpolar Health Research3, National Institute of Public Health4,
Government of the Northwest Territories5, University of Manitoba6
[email protected]
Background & Significance: Despite
historically low type 2 diabetes (DM2) prevalence, reported
dramatic changes in lifestyle among western Alaska Native
people raise concerns for increasing DM2 prevalence. DM2
is a major risk factor for cardiovascular disease (CVD),
a leading cause of mortality in this population. Limited
population-based data are available on prevalence of DM2
and its risk factors in Inupiat and Yup’ik/Cup’ik people.
Methods: Baseline data were obtained during 2000 – 2010
from three prospective cohort studies of Inupiat and Yup’ik/
Cup’ik people living in two western Alaska regions. These
studies have been consolidated into the Western Alaska
Tribal Collaborative for Health cohort. DM2 prevalence
was determined based on America Diabetes Association
2010 criteria. Risk factors associated with DM2 and
CVD were defined using National Cholesterol Education
Program Adult Treatment Panel III recommendations.
Differences in demographic characteristics and risk factors
between those with and without diabetes were tested using
chi square and t tests.
Results: In this cohort of western Alaska Native people
(n = 3,973; median age, 39.0 years, range 18-95 years),
overall DM2 prevalence was 4%; prevalence was 3.4% in
men and 4.8% in women. Those with DM2 were more
likely to be older, have a history of cigarette use, and have
a family history of diabetes. Individuals with diabetes had
significantly higher mean waist circumference, systolic
blood pressure, triglycerides (all p < 0.0001) and percent of
low HDL (p = 0.0162 in men, p < 0.0001 in women).
Discussion and conclusions: Compared
with 2005-2006 NHANES data indicating a 12.9%
crude prevalence in the US general population, DM2
prevalence remains low in western Alaska Native people;
however, those with DM2 have elevated levels of several
CVD risk factors. These data provide the baseline for
prospectively exploring the interrelationship between risk
factors, DM2, and CVD in western Alaska Native people.
FRIDAY ORAL
Objectives. The present study undertakes a scoping
review of research on obesity in the circumpolar Inuit.
Methods. Online databases were used to identify papers
published 1992-2011, from which we selected 38 studies
from Canada, the US, and Greenland that used obesity
as a primary or secondary outcome variable in = 30 nonpregnant Inuit or ‘Eskimo’ participants. Results. The
majority of studies (92%) were cross-sectional in design
while 8% examined retrospective cohorts. All but one of
the studies collected measured data. Eighty-four percent
of studies examined obesity in adult participants. Those
examining obesity in children focused on early childhood or
adolescence and used BMI as the sole metric for assessing
body size. The majority of adult studies (78%) employed
a combination of biometrics including BMI, WC, WHR,
bioelectrical impedance and skinfold thicknesses. None
of the studies examined undertook direct measurement
of adiposity. Using modified STROBE criteria, 29% of
studies achieved an ‘A’ quality ranking, while 16% and
39% achieved quality rankings of ‘B’ and ‘C’ respectively.
Conclusions. While the quality of studies is generally
high, research on obesity among Inuit would benefit
from direct measures of adiposity in adults and children,
studies of preadolescent children, and prospective cohort
studies linking early childhood exposures with obesity
outcomes throughout childhood and adolescence.
AUTHORS: K. Koller1, J. Metzger2, B. Howard3, T.
Thomas1, E. Asay1, J. Umans3, S. Jolly, S. Hopkins4, C.
Kaufmann4, B. Boyer 4
TUESDAY POSTER
[email protected]
Diabetes Prevalence in Western Alaska
Native People: The Western Alaska Tribal
Collaborative for Health (WATCH) Study
[email protected]
165
POSTER NUMBER: T22
Some Blood Lipid Profile Features of the
Population of Siberia
TUESDAY POSTER
AUTHORS: Y. Nikitin1, K. Makarenkova1, O.
Tatarinova2, E. Kylbanova3, M. Voevoda
Institute of Internal Medicine SB RAMS1, Yakutsk Science Centre
SB RAMS2, Yakutsk State University3
Purpose: to study possible blood lipid profile features of
the population of Siberia and of indigenous and arrived
population of Yakutia. Materials and Methods: There were
surveyed representative samples of the population of 45-69
years old in Novosibirsk, Russia (n=791) within HAPIEE
International Project, and of the arrived population in
Udachnyiy, Yakutia (n=260). Blood lipid profile features
were studied in 281 Yakuts and in 275 Caucasoids older
than 60 living in Yakutsk. The samples are representative.
Results: Compared to Novosibirsk citizens, the arrived
population of Yakutia has lower HDL-Ch in both sexes:
1.37 and 1.64 in men, and 1.34 and 1.61 in women – 1.40
and 1.67 mmol/l (p<0.001). There were not detected any
reliable differences in the levels of TC, LDL-Ch, TG.
Both sexes of Yakuts older than 60 have average TC
levels equal to 5.4; LDL-Ch – 3.5; HDL-Ch – 1.45; TG
– 1.2 mmol/l. The same rates of arrived population are
5.6; 3.6; 1.35; 1.4 mmol/l. There were not also detected
any statistically significant gender-ethnic differences in
TC, LDL-Ch levels, although they are somewhat lower
in indigenous population than in the arrived one. HDLCh levels are higher (p<0.01), and TG level is lower in
the indigenous population (p<0.01) than in the arrived
population of the same age. Conclusion: Blood lipid profile
of the arrived population of Yakutia has lower HDL-Ch
levels than the population of Novosibirsk. Indigenous
population of Yakutia has lower blood TG level and higher
HDL-Ch levels than Caucasoids living in the same city.
[email protected]
POSTER NUMBER: T23
Hormonal Status and Prevalence of
Endocrine Diseases in Workers of
Diamond Company “YakutAlmaz”.
AUTHORS: I. Osokina, V. Tsukanov
State Research Institute for Medical Studies of the North
166
Objectives: The Diamond Company “YakutAlmaz” is
the largest in Russia and located in the Mirny district of
the Saha (Yakutia) Republic (western part). The workers
of “YakutAlmaz” live in extreme climatic conditions in
the North of Siberia. Aim: To study the hormonal status
14:30 -15:30
and prevalence of endocrine diseases among the workers
of the Diamond Company “YakutAlmaz”. Methods:
In the Mirny region of the Saha (Yakutia) Republic,
we examined 380 patients (median age = 42 years, 156
men). The assessment included clinical examinations and
measurement of weight and height, thyroid ultrasound
scan, an oral glucose tolerance test, plasma lipids, glucose,
hormone enzymes: TSH, free thyroxine (fT4), and
antibodies to thyroid peroxydase. Results: We found
a high prevalence of thyroid diseases ( i.e., diffuse and
nodular goiter, autoimmune thyroiditis, hypothyrosis,
and 2 cases of thyroid cancer) and type 2 diabetes. The
average level of TSH = 2.38 mU/l, free T4 = 15.0 pmol/l.
Hypothyroidism was revealed in 15 patients (after thyroid
surgery and autoimmune thyroiditis), hyperthyroidism was
diagnosed in 5 cases (there were 2 cases of Graves’disease
and 3 cases of toxic nodules). Endemic goiter was found
in 19.2%. Metabolic syndrome was diagnosed according
to a classical definition in 16.0%. Thirty-two patients
had diabetes type 2 (6 cases were diagnosed for the first
time). Conclusion: We found a high prevalence of thyroid
diseases, diabetes type 2, obesity, and metabolic syndrome
among the workers of Diamond Company “YakutAlmaz”.
[email protected]; [email protected]; [email protected]
POSTER NUMBER: T24
Features of Lipid-Metabolic Disorders
among Indigenous Small in Numbers
People of Yakutia with Arterial
Hypertension
AUTHORS: S. Sofronova1, M. Voevoda2, S.
Chugunova
Yakut Scientific Center of Complex Medical Problem SB of RAMS1,
Research Institute of Therapy SB of RAMS2
To study the peculiarities of lipid-metabolic disorders
among indigenous people of Yakutia with the presence
of arterial hypertension. A set of material for research is
collected in expedition conditions in places of compact
residence of indigenous small in numbers people of
Yakutia Dolgans and Evenks, while conducting complex
examination. Indigenous small in numbers people of Yakutia
of working age from 30 to 59 years who were divided into
2 groups were the object of the study. Dolgans and Evenks
with hypertension (80 persons) made up the I, main group.
Among them: women - 52 (65%), men - 28 (35%). II
control group was represented by the same ethnic groups
without hypertension and other cardiovascular diseases
according to routine inspection and the absence of chronic
disease in their medical history (106 persons). Among
them: women (62,3%), men - 40 (37.7%). Laboratory
Methods include: identification of blood lipid profile (total
cholesterol, triglyceride (TG), LDL-cholesterol, HDL-
14:30 -15:30
Allaichovsky (19.5 per 1000), Nizhnekolymsky (20.2 per
1000), Verchnekolymsky (18.9 per 1000), and Nerungrinsky
(17.6 per 1000). The age group with the highest rate of
type 2 diabetes morbiditywas in 41-60 years(56.3% total;
16.9% male; 38.4% female), in 18-40 years ( 6.2% total;3%
female,3.2% male), more than 60 years ( 38.5% total; 9.9%
male, 28.6% female). The age structure of type 2 diabetes
in Yakutia is 18-40 years, 13.7%; 41-60 years 51.8%; older
61 years38.5%. Conclusion. According to data from the
diabetes register the prevalence and morbidity of type 2
diabetes in Yakutia has rapidly increased in the past 10 years.
[email protected]
POSTER NUMBER: T26
Institute of Internal Medicine is monitoring morbidity,
mortality and prevalence of diabetes mellitus according
to epidemiologic criteria in certain parts of Asian Russia.
The prevalence of officially registered diabetes mellitus
cases among adults of Siberian Federal District is 2400,
among adults of Far Eastern FD this number is 2200 that
is lower than average Russian value – 2600:100,000 (year
of 2008). The prevalence of I type diabetes mellitus in the
same districts is 145, 140 and 240:100,000 accordingly. In
Northern (subpolar) as well as in Southern Siberian regions
both types of diabetes are rarer in native population than in
Caucasoids. In Novosibirsk diabetes mellitus cases doubled
during the last 10 years. Epidemiological screening is showing
incomplete registration of diabetic patients: actual prevalence
of diabetes mellitus is 5.6% at the age of 25-65, 11% at the
age of 45-69. The prevalence of metabolic syndrome at the
same age (45-69 years old) is 30% in Novosibirsk. Frequency
and long-term trends of prevalence of metabolic syndrome
basic components were studied, and the results darken the
diabetes mellitus prevalence forecast for the next 7-10 years.
The Prevalence and Morbidity of
Diabetes in the Sacha (Yakutia) Republic
AUTHORS: I. Osokina1, P. Ignatyev2, F. Platonov2, V.
Tsukanov
State Research Institute for Medical Studies of the North1, Yakut
Institute of Health2
POSTER NUMBER: T27
Diabetes Mellitus in Asian Part of Russia
AUTHORS: G. Simonova, S. Mustafina, E.
Shubnikov, O. Sazonova, Y. Nikitin, M. Voevoda
[email protected]
POSTER NUMBER: T28
The Peculiarities of Food Allergy
According to the Level of Respiratory
Tract Affection in East Siberia
Inhabitants
FRIDAY ORAL
The Sacha (Yakutia) Republic is located in Eastern Siberia.
Two-third of the territory is located above the arctic circle.
Diabetes is the most widespread endocrinological disease in
Sacha (Yakutia) Republic. The aim: To study the dynamics
of diabetes epidemiological indices in the Sacha (Yakutia)
Republic in 10 years. Methods: We analysed data from a
diabetes register in the Sacha (Yakutia) Republic. Results:
The prevalence of diabetes in 1998 was 7.7 per 1000, in
2008 the prevalence was 22.7 per 1000; the morbidity in
1998 was 1.5 per 1000 and the morbidity in 2008 was 3.15
per 1000. Further analysis of diabetic types revealed: The
prevalence of type 1 diabetes was 0.8 per 1000 in 1998,and
1.68 per 1000 in 2008; the morbidity was 0.18 per 1000
and 0.15 per 1000 accordingly. The prevalence of type 2
diabetes in 1998 was 6.9 per 1000, in 2008 the prevalence
of type 2 diabetes was 20.8 per 1000; the morbidity in 1998
was 1.27 per 1000 and in 2008, the morbidity was 2.9 per
1000 accordingly.The prevalence and morbidity of type
2 diabetes in Yakutia rapidly increased according to the
diabetes register in 10 years. Diabetes type 2 compromise
94.5% of all diabetes cases (85% in Russian Federation
as whole). The man/woman ratio of type 2 diabetes was
30/70. The highest prevalence of type 2 diabetes registered
were in the northern districts: Aldansky (22.0 per 1000),
[email protected]
TUESDAY POSTER
cholesterol) and glucose level. Comparative analysis of the
frequency of HCH, hypo-a-CH, HTG and HG revealed
statistically significant differences in HCH frequency in
patients with hypertension (nearly 2 in times), in particular
LDL hypercholesterolemia and HG (2.3 times) (p<0,001).
HCH was present in 72.5% of patients with hypertension
and 37.7% of healthy persons, LDL hypercholesterolemia
was present in 77.5% in Group I and 48.1% in the control,
which is higher in 1.5 times (p<0,001).The frequency
of TG in patients with hypertension was 31.3% in the
control group – 24.5%. One of the important risk factors
is disorder of carbohydrate metabolism. In individuals
with hypertension and HG rate was high 41.3%,which
is significantly higher than in the control group (17.9%)
(p<0,005). Thus, we have obtained convincing evidence
of statistically significant differences in the frequency
of dyslipidemia and hyperglycemia among patients
with hypertension versus persons without hypertension,
among indigenous small in numbers people of Yakutia.
AUTHORS: I. Borisova, S. Smirnova
State Medical Institute for Northern Problems of Russian Academy
of Medical Sciences Siberian Division, Krasnoyarsk
Russia Aim: to determine the peculiarities of the condition
167
TUESDAY POSTER
of food allergy in children according to the level of
respiratory tract affection. Materials and methods: We
examined 70 children in ages from 2 to 16 years with food
sensitizing. We formed two groups: I (n=32) – with upper
and middle respiratory tract diseases (rhinitis, laryngitis,
tracheitis); II (n=38) – with lower respiratory tract
diseases (bronchial asthma). We carried out allergic and
immunologic examination. Individual elimination diets
were prescribed. Results: First symptoms of respiratory
tract affection in I group were mostly marked in the ages
until 12 months, in II group from 3 to 7 years. Isolated food
sensitizing was registered more often in I group than in II
group (36%versus 8%). In the structure of etiologic factors
in I group we determined: hen eggs in 82%, cow milk – 64%,
wheat flour – 55%, vegetables and fruit – 14%, fish – 9%. In
II group: hen eggs in 90%, cow milk – 76%, vegetables and
fruit – 52%, wheat flour – 48%, meet –14%, fish – 9%. Atopic
mechanisms of food allergy were marked more often in II
group than in I group (53% versus 32%). IgA deficit was
determined in 34%, irrespective of the level of respiratory
tract affection. The peculiarity of respiratory signs of food
allergy is all-the-year-round course (I group – 72%, II
group – 100%). On the background of elimination diet the
stability of pathology process was marked in the whole I
group and in 56% cases in II group. Conclusion: The course
of food allergy is connected with the level of respiratory
tract affection as well as wider spectrum of sensitizing.
Results: In the Cree/Ojibway, prevalence of RF was 88%
in RA, 34% in FDR, 9% in NC, and 5% in CC; prevalence
of anti-CCP in the 4 groups was 81%, 9%, 4%, and 0%
respectively. In the Alaska Native population, prevalence of
RF was 53% in RA and 0% in FDR; anti-CCP prevalence
was 75% in RA and 33% in FDR. HLA-DRB1 alleles
*0404 and *1402 were prevalent in the Cree/Ojibway
population (>65%), and *1402 was prevalent in the Alaska
Native population (>70%). Multiplex cytokine analysis
indicated that most cytokines were highest in RA while
17/40 (43%) cytokines were significantly higher in the
FDR compared to controls. FDR had markedly higher
MCP-1 and hsCRP levels than INA controls, but there
was no association with RA autoantibodies. Conclusions:
Both INA populations demonstrated a high prevalence
of anti-CCP in the FDR and a high frequency of disease
predisposing alleles. Levels of multiple cytokines and
hsCRP are higher in FDR compared to controls, although
a relationship with RA autoantibodies is not clear.
[email protected]
POSTER NUMBER: T29
Background: Alaska Native people are a heterogeneous
population of approximately 130,000 distributed in a
vast geographic area throughout the largest state in the
United States. Rheumatologists are based in the tertiary
hospital in Anchorage, the Alaska Native Medical Center,
and are responsible for providing services statewide. The
prevalence of several rheumatologic diseases, including
rheumatoid arthritis, spondyloarthropathy, and systemic
lupus erythematosus are high in the population. Because
of these challenges, a field clinic system has been
implemented by several subspecialties at the Alaska
Native Medical Center, including rheumatology. Methods:
Review the history of clinical services, including timing of
implementation of rheumatology field clinics and current
capacity. Sources include personal interviews and annual
reports by rheumatologists to administration regarding
number and location of field clinics and number of patients
seen by diagnosis. Results: Rheumatology field clinics
have been ongoing for more than 25 years. These clinics
were initially funded by research projects in the areas of
spondyloarthropathy and rheumatoid arthritis, but have
continued with support by the hospitals since the last project
stopped funding the clinics in 1996. Each year, 16 different
field clinic sites are visited at least two times for 1-5 days
each visit by a rheumatologist. Patients from the region are
brought to the hub for these clinics when possible. In 2010
Risk Factors for Rheumatoid Arthritis in
Predisposed Indigenous North American
Populations
AUTHORS: E. Ferucci1, H. El-Gabalawy 2
Alaska Native Tribal Health Consortium1, University of Manitoba2
168
14:30 -15:30
Objective: Rheumatoid arthritis (RA) is prevalent in
indigenous North American (INA) populations, with a
high frequency of multi-case families. We are following
the first-degree relatives (FDR) of INA RA patients
in two geographically distinct populations: the Cree/
Ojibway People of Central Canada and the Alaska Native
people. We present data on risk factors for RA at baseline.
Study populations: Cree-Ojibway: RA patients (n=105),
FDR (n=273), and healthy controls (NC) with no family
history of autoimmune disease (n=200); Alaska Native:
RA patients (n=65), FDR (n=107); Caucasian controls
(CC) (n=150). Research methods: We analyzed HLADRB1 alleles and SNPs in non-HLA genes shown to
be RA associated in other populations. Prevalence of the
autoantibodies anti-CCP and RF was determined. Serum
cytokine profile and hsCRP was tested using multiplex
and ELISA techniques (Cree/Ojibway population only).
[email protected]
POSTER NUMBER: T30
Provision of Rheumatology Care for the
Alaska Native Population
AUTHORS: E. Ferucci, D. Templin
[email protected]
POSTER NUMBER: T31
Prevalence of GERD Symptoms at
Schoolchildren of Indigenous Tyva
Population
AUTHORS: V. Gritsinskaya, S. Sendi, V. Tsukanov
Institute of Medical Problems of the North
[email protected]
POSTER NUMBER: T32
Experience with Cochlear Implants for
Greenlanders with Deafness Living in
Greenland
AUTHORS: P. Homøe, T. Andersen, L. Percy-Smith,
M. Bille
Cochlear implant (CI) treatment was introduced to the
world in the early 1990’s as a treatment for congenital
or acquired prelingual deafness or acquired postlingual
deafness. The treatment requires access to highly skilled
surgery and usually longterm postoperative speech therapy
treatment and follow-up. Despite the lack of these facilities
in Greenland, a total of 11 Greenlandic patients have been
treated with CI. Of these were 7 children born between
2001-2007. From an epidemiological point of view,
approximately 1- 2 children below 6 years of age are in
need of a CI every second year in Greenland. However, the
incidence of meningitis, which may cause postinfectious
deafness, is high in Greenland. Otoacoustic emission
(OAE) examination of newborns have been started in
Greenland, which enables early diagnosis of deafness and
thereby also early treatment with CI. The OAE attendance
rate is not known. CI surgery is performed in two centers in
Denmark. The logistics, the employment situation, and the
economy hampers optimal facilities for control and speech
therapy of CI patients in Greenland. This study aims to
describe the results of CI treatment in Greenlanders
and the outcome of the CI operations, along with the
speech and hearing outcomes in the patients operated on.
Finally, we present a suggestion for future CI treatment
and recommendations for an increased effort in the
treatment and rehabilitation of deaf persons in Greenland.
[email protected]
POSTER NUMBER: T33
Factors of Pterygium Generation in
Population of Tyva Republic
AUTHORS: V. Ivanov1, G. Soyan2, I. Novitzkiy1, S.
Tereshchenko1, S. Smirnova
Medical Research Institute for Northern Problems1, Hospital #1 of
Tyva Republic2
Pterygium belongs to the group of dystrophic or
degenerative diseases of conjunctiva and corneal, which
results in blurring in neglected cases. The clinical course of
pterygium is characterized by relatively slow progression
and frequent recurrence after surgery, which leads to
further visual deterioration. The prevalence of pterygiums
is exceptionally variable and rank from 0.1 % to 13.7 %.
Aim. To determine the main factors, which influence the
generation of pterygiums in the Tyva Republic. Materials
and Methods. The Tyva population amounts to nearly
387,000 inhabitants. Among them, 62.35% are Tyvins.
The evaluation was based on the incidence of outpatient
visits to Kyzil polyclinics and district hospitals. Results.
Natural and climatic conditions in the territory of Tyva are
uncomfortable for living and are similar to the extreme north
FRIDAY ORAL
Epidemiological screening of gastroesophageal reflux
disease symptoms by means of clinic Mayo questionnaire
at 1737 Tuvinians at the age from 7 till 17 years living in
extreme environmental conditions of Republic Tyva is spent.
Pains in epigastral areas were found out at 19% of children;
and at 28% of children pain took place some times a month;
at 5% – once a week; some times a week at 4 % of children.
The discomfort connected with food intake was marked
by 25% of children. The most characteristic symptom
GERD – a heartburn was marked by 18% of children. The
heartburn disturbed some times a month 18% of children;
at 5% the heartburn was marked some times a week. The
heartburn disturbed more in the afternoon (33%) and in
the evening (23%), than in the mornings (12%); at 32% of
children it is not revealed dependences of a heartburn on
time of a day. The sensation of acid and/or bitterness in a
throat took place at 10% of children, in most cases (56%)
it disturbed less often, than once a month.11% of children
complained of sensation of acid and/or bitterness in a throat
once a month; some times a month – 21%; some times a
week – 11% of schoolchildren. Belching the food marked
at 6% of children, an eructation – at 25% of children. The
frequent eructation was marked in 88% of cases. To thicket
the eructation by air (68%), food (15%) and sour (13%)
was marked; less often bitterness (3%) and rotten (2%).
Dept. Otolaryngology Head & Neck Surgery, Rigshospitalet
TUESDAY POSTER
and 2011, 1247 and 1196 individual patients were seen for
a total of 1596 and 1450 visits, respectively. In 2010, the
majority (977, or 78%) were seen only once in the calendar
year. Of all the visits in 2010 and 2011, 349(22%) and
330(23%) were for an initial consultation.The most common
primary diagnosis was rheumatoid arthritis (454(36%) in
2010 and 497(41%) in 2011). Conclusions: Rheumatology
field clinics with visits by a specialist to a remote hub are an
effective mechanism to provide care to remote populations.
14:30 -15:30
169
TUESDAY POSTER
in the terms of discomfort. Pterygiums had been marked
among both aboriginal and alien Europoid inhabitants
after 30 years of age (adults over 21 years of age were
62.7 %). The clinical course and frequency of pterygiums
development do not differ in aboriginal subjects and in
Europoid Tyva permanent inhabitants. The frequency of
3rd – 4th stage Pterygium after out-patient visits statistics
were 1.3 %, and after medical inspection data no less
than 12-14 %. Conclusion. The prevalence of pterygium
in the Tyva Republic demands purification. Age, climate
peculiarities, and, probably, genetic predisposition should
be regarded as risk factors. Ethnic factors had not been
revealed in the development and prevalence of pterygiums.
[email protected]
POSTER NUMBER: T34
Features of Redox Status in Cases of
Bronchial Obstruction
AUTHORS: A. Latysheva, S. Smirnova
Scientific Research Institute for Medical Northern Problems
170
Russia Aim: To study the features of oxidant-antioxidant
system depending the way bronchial obstruction. We
studied: atopic bronchial asthma (?BA, n=31), asthmatic
triade (??, n=16), COLD I (n=35), control (health, n=24)
in the age from 16 to 72. Were assessed: superoxide
dismutase (SOD), transferrin (Tr), ceruloplasmin(Cp),
methemoglobin (Met-Hb), erythrocyte free radicals
(R), catalase (Cat) by electron paramagnetic resonance
(EPR). Results: Bronchial obstruction developed observed
increase of oxidants (Met-Hb and R) and extracellular
antioxidant (Tr) compared to control. In AT higher level
of Met-Hb, which was, by indirection, characterized by
peroxide oxidation of lipids (POL) compared to ABA and
COLD. In ?A the analysis of antioxidant capacity of blood
erythrocytes revealed reduction of SOD and Cat compared
to control and COLD. In COLD registered increase of
SOD and Cat compared to control. Assessing extracellular
antioxidants discovered the following regularities: regardless
the nature of bronchial obstruction: Tr was higher than in
control; the level of Cp in BA was lower than in control
and COLD; in COLD the level of Cp was higher than
in BA and in control. In blood Tr and Cp form a buffer
system, regulating the concentration of recovered ions Fe2+
and determining synergistic antioxidant activity of serum
to Fe2+ induced by POL. One discovered increased level
of Tr/Cp and Met-Hb/SOD indexes in BA compared
to control and COLD. Conclusion: In COLD increased
the levels of oxidants is followed by increase in the level
of extracellular antioxidants. In BA abnormalities in the
oxidant-antioxidant system has been found in AT and
are characterized by the lower level of antioxidant activity.
[email protected]
14:30 -15:30
POSTER NUMBER: T35
The Ethnic Differences of Stroke in
Yakutia
AUTHORS: T. Nikolaeva1, C. Sargilana2, S.
Chugunova
North-Eastern Federal University named after M.K. Ammosov1,
Yakut Centre of Science of Complex Medical Problems of the SB of
RAMS2
Background. Yakutia is the biggest region of Russia
situated in North-Eastern Siberia. Total population approx
950000 people. The major ethnic groups are indigenous
(Yakuts, Evenks, Evens, Yukagirs) and Russians. The stroke
morbidity and mortality has been gradually increasing
during the last two decades in Yakutia, especially among
the indigenous ethnicities. Aims. We investigated ethnic
differences of stroke among patients of indigenous and
Russian nationality who were admitted to Regional
Vascular Centre (RVS), Yakutsk. Methods. We used data
from Hospital Stroke Register which logs cases of acute
stroke in 2011. The type and etiology of stroke were
confirmed with the clinical assessment, CT-scan, MRI,
cerebral angiography, ultrasound imaging of brain vessels.
Findings. 1108 patients were hospitalized in total (51,4 %
male; n=569). Mean age – 60,5 ± 12,9 years, male 59,2 ±
12,9, female 61,9 ± 12,9. 592 ischemic stroke cases (IS)
(53,4%), 236 hemorrhagic stroke cases (HS) (21,3%),
280 (25,3%) transitory ischemic attacks (TIA) were
diagnosed. Three groups of patients were created including
indigenous (n=411; 49,6%), Russians (n=347; 41,9%),
other nationalities (n=62; 7,5%). Indigenous patients had
255 IS (62 %), 156 HS (38 %). Russian patients had 277
IS (79,8%), 70 HS (20,2%). Patients of other nationalities
had 53 IS (85,5%), 9 HS (14,5%). Comparison of HS cases
in different ethnic group reveals that patients of indigenous
nationality have more HS than Russians (38% vs. 20,2
%, p<0,05) (Adjusted odds ratio=2,42; 95% confidence
interval: 1,72-3,41). Mean age of IS and HS in indigenous
group had no differences compared to Russians (p=0,687;
p=0,201). Conclusion. Hemorrhagic stroke has a greater
prevalence in Yakutia compared to other regions of Russia.
Moreover, hemorrhagic stroke occurred more often in
patients of indigenous nationality compared to Russians.
Further research to explain this difference is needed.
[email protected]
14:30 -15:30
POSTER NUMBER: T36
POSTER NUMBER: T38
Preventable Blindness: A New Approach
to Screening for Primary Angle Closure
(PAC)
Some Results of 30 Years Stroke
Morbidity Monitoring in Siberia
Nunatsiavut
Indentation gonioscopy(1) requires a slit-lamp, goniolens,
and the requisite skills (an Ophthalmologist). Inuit eyes
share an anterior segment morphology similar to those
in Mongolia and people of Simian descent (China/
Japan)(2), and suffer high rates of both acute and chronic
narrow angle glaucoma, in many cases bilateral and
irreversible(3). Indentation Ultrasound Biomicroscopy
is a reliable, and now inexpensive and portable method
with a flat learning curve. Video and still images from
Inuit of Nunatsiavut demonstrate this. Appropriate
treatment and followup are essential and have resulted in
significant reduction in blindness in Canada’s north and
in Greenland(4) References: (1) Indentation Gonioscopy
and Efficacy of Iridotomy in Angle Closure Glaucoma.
M.Forbes, Trans Am. Ophthalmol. Soc., 1974, 400515 (2) Angle-Closure Glaucoma in East Asian and
European People; Different Diseases? M. H.E., P.J.
Foster, G.J. Johnson,Eye 2005. (3) The Number of
People with Glaucoma Worldwide in 2010 and 2020,
H.A. Quigley, BJO 2006. (4) Strategy for Decentralized
Prevention of Angle Closure Glaucoma in Greenland,
P.H. Alsbirk, Int. Journal ofCircumpolar Health, 2004.
Institute of Internal Medicine has been monitoring annual
values of stroke morbidity and mortality since 1982 in
Novosibirsk using cross-sectional methods and screenings,
and in some Asian parts of Russia: Yakutia, Chukotka, and
Transbaikalia. MONICA, Eurostroke, HAPIEE and some
other international project programs were used. During
30 years of observation stroke morbidity varied within the
limits of 330-460 cases for 100,000 of population aged 2574. Stroke mortality was from 90 to 175 cases these years,
with mortality in men higher than in women. Tendency
toward these indicators decrease including lethality were
discovered last 10 years. In Siberian and Far-Eastern regions
morbidity and mortality rates are the same as in Novosibirsk.
In East Siberia, Transbaikalia and Far East they are even
higher, especially in south-eastern part of Asian Russia.
Meanwhile obvious west-to-east gradient was detected. In
structure of cerebral stroke the rate of haemorrhagic and
thromboembolic forms are shifted toward the first ones
compared to Novosibirsk and European part of Russia.
High prevalence of strokes in Siberia is associated with high
frequency of hypertension among the population, as well
as smoking, overweight, and alcohol abuse. Last 10 years
small tendency toward decrease of some cardiovascular
diseases risk factors prevalence was detected that
reassures stroke morbidity forecast to the certain extent.
[email protected]
POSTER NUMBER: T37
Life Quality and Improvement Ways of
Medico-Social Aid to Celiac Children
AUTHORS: A. Savvina, N. Savvina
North Eastern Federal University
[email protected]
[email protected]
POSTER NUMBER: T39
Association of Psoriases and
Asthma with the IL-4 and IL-10 Gene
Polymorphism in Siberian
AUTHORS: M. Smolnikova, S. Smirnova
Research Institute of Medical Northern Problems
It is supposed that there is genetically caused predisposition
to the development of multifactorial diseases, such as asthma
and psoriatic arthritis, when cytokine genes are playing
important role as main mediators of immune response.
The aim of this study was to assess association between
IL4 (C-590T), IL10 (C-597A) genes polymorphism and
severity of psoriasis, asthma in the European population of
Siberia. DNA from 79 psoriasis patients (51 with psoriatic
arthritis), and 64 asthma patients (31 with controlled
asthma and 33 non-controlled) was genotyped by PCR-
FRIDAY ORAL
We estimated the life quality of celiac patients and
healthy children by international general questionnaire
Pediatric Quality of Life Inventory – PedsQLtm 4.0
(Varni et al., USA, 2001). Celiac children aged 13-18
answers had more higher parameters of quality of life on
all according to all scales: emotional (to 22.3%, p0.05) life
quality parameters in scales: physical (+13.5%), emotional
(+15.1%), role (+7.1%) and psychological functioning
(+7.8%). Summary. The results of our research were the
evidence of high effect of restorative and preventive
rehabilitation treatment of the patient. Quality of life
serves a criterion of effectiveness of clinic treatment.
TUESDAY POSTER
AUTHOR: P. Price, M. Jong
AUTHORS: S. Shishkin,Y. Nikitin, G. Simonova, V.
Feyigin, M.Voevoda
171
TUESDAY POSTER
RFLP method. We found the prevalence of ??-590IL4
genotype (60% in health, 62% in psoriasis, 56% in asthma)
as typical for European populations. The prevailing of
??-597IL10 genotype was shown (73% in health, 58% in
psoriasis, 63% in asthma). We found significant association
of ?-590IL4 allele with the development of psoriatic arthritis
in psoriasis patients (frequency 0.83; OR 2.57; ?=0.01). ??597IL10 genotype prevailed in atopic asthma in females as
compared to males (OR 0.35; ?=0.01). Our results confirm
the key role of polymorphism of cytokine genes in psoriasis
and asthma pathogenesis. Psoriasis patients with allele
?-590IL4 have high risk of development of more severe
form of psoriasis – psoriatic arthritis. Interconnection
of the two factors is also very important (gender and
genotype IL10 (C-597A) in asthma development),so,
females are predisposed to more difficult control of asthma.
[email protected]
POSTER NUMBER: T41
The Prevalence of Barrett’s Esophagus in
the Population of Eastern Siberia
AUTHORS: V. Tsukanov1, N. Butorin2, E. Kasparov1,
O. Shtygasheva3, D. Kuklin4, V. Timoshenko1, T.
Bichurina5, A. Vasyutin1
SRI MPN SD RAMS1, Khakassian Republican Hospital2,
Khakassian State University3, Taimyr Central Regional Hospital4,
Krasnoyarsk State Medical University5
172
Aim. To study the prevalence of Barrett’s esophagus (BE),
heartburn and esophagitis in Mongoloids and Europoids
in various regions of Eastern Siberia. Methods. We carried
out cross-section epidemiological study in Kyzyl (Tuva)
Abakan (Khakassia) and Dudinka (Taimyr). 572 Tuvins
(202 men, 370 women), 1489 Khakases (593 men and 896
women), 14270 Europoids (6957 men and 7313 women)
underwent upper digestive tract endoscopy. Esophagitis
was defined on the basis of Los-Angeles classification
(1994). BE was diagnosed using methylene blue staining
with biopsy and morphological examination (Vakil N.
et al., 2005). The results of clinical examination and
interviews were recorded using modified questionnaire of
Mejo clinic (Locke G.R., Talley N.J. et al., 1994). Results.
The prevalence of BE was 1.5% in Europoids (1), 4,4%
in Tuvins (2), 2,9% in Khakases (3) (P1-2<0,001, P13<0,001, P2-3=0,09). The prevalence of weekly heartburn
was 12.3% in Europoids (1), 12,9% in Tuvins (2), 10,3%
in Khakases (3) (P1–3<0,001, P2–3<0,001). The prevalence
of esophagitis in Europoids (1) was 5,4%, in Tuvins (2)
5,1%, in Khakases (3) 3,6% (P1–3<0,001, P2–3<0,001).
The prevalence of BE and esophagitis was higher in male
in all ethnic groups, the prevalence of weekly heartburn
was higher in female. Conclusion. The ethnic differences
in the prevalence of BE and esophagitis in population
14:30 -15:30
of various regions of Eastern Siberia were established.
[email protected]
Healthy Families
POSTER NUMBER: T42
Creating Healthy Partnerships in
Nunavut for Sexual Health
AUTHORS: M. Arseneau1, G. Osborne2, T. Koonoo1,
A. Lalany2
Public Health Agency of Canada/Government of Nunavut1,
Government of Nunavut Department of Health and Social Services2
In Nunavut gaps have been identified in sexual health
programming ranging from primary prevention to
clinical treatment of infections. In response, the Nunavut
Department of Health and Social Services has developed
a territorial sexual health framework which will provide
strategic direction on this important issue. Increasing
networks and partnerships between community and
territorial stakeholders during the framework development
process was identified as a priority. Currently there is a lack
of information on how to operationalize such networks
and partnerships in an arctic context to achieve meaningful
collaboration. Challenges in operationalizing networks and
partnerships to achieve meaningful collaboration will be
shared (i.e. budgeting, time, human resources, information
constraints, geographical isolation and ensuring a culturally
safe approach). The focus of the presentation will be
on the tools and strategies developed to overcome these
challenges. A framework which conceptualizes the process
will be presented along with key successful outcomes. It
is hoped sharing information about how the Nunavut
sexual health framework was developed will assist other
public health practitioners developing similar frameworks
or policies to improve the health of Arctic populations.
[email protected]
POSTER NUMBER: T43
Acculturation Among Sami - What
Indicators Are of Value?
AUTHOR: S. Hassler
University West
Objectives: The acculturation process has often been
referred to when describing the health of indigenous
peoples, just as concepts such as sense of coherence (SOC)
and empowerment also have proven to be fairly reliable
indicators for health in more general terms. The aim of this
study is to seek a better understanding of the process of
acculturation and its effect on health among indigenous
[email protected]
POSTER NUMBER: T45
“Healthy Mind is a healthy life:” Alaskan
Native Experiences of Acculturation,
Enculturation, and Coping
AUTHORS: J. McKay, A. Vasquez, C. DeCou, E.
Lopez, M. Skewes
[email protected]
POSTER NUMBER: T46
Living in Two Worlds: Alaska Native
Experiences of Acculturation, Stress,
Academic Success, and Well-Being in the
Rural-to-Urban Transition to College
AUTHORS: A. Vasquez1, J. McKay1, C. DeCou1, E.
Lopez2, M. Skewes2
University of Alaska Fairbanks1, Center for Alaska Native Health
Research2
American Indian and Alaska Native (AI/AN) students
from rural areas may be especially susceptible to stress
during the transition to college, thereby reducing the
likelihood of completing their college degree. Previous
research has identified factors impairing AI/AN student
academic success in college, including affordability, lack of
academic preparedness, family and cultural responsibilities,
cultural tensions, racism, lack of engagement, and
invisibility. Still, little is known about how the rural-tourban transition uniquely affects AI/AN college students.
Researchers have found that an increase in the number and
severity of stressors can greatly impact a person’s physical
and mental health. This qualitative study explored Alaska
Native students’ perceptions of acculturation/enculturation,
access to resources, and stress as it relates to academic
success and well-being at a the University of Alaska
Fairbanks. Semi-structured one-on-one interviews were
conducted with ten university students who self-identified
as Alaska Native, and who migrated to UAF from a rural
Alaskan community. Participants were interviewed about
their university life and the challenges and facilitators they
encountered in their transition from rural Alaska. Using a
grounded theory approach, team-based consensus coding
was used to analyze the transcripts.
Experiences of trauma and disharmony between western
and traditional education emerged from the data as themes.
Also identified were several unique stressors that impacted
FRIDAY ORAL
The increasing popularity of multicultural studies, cultural
identity, and the concepts of acculturation and enculturation
reveal a lack of research that explores the Alaska Native
and American Indian experience. It is important to
understand these experiences so that culturally appropriate
interventions and programs can be developed. Students
enter the University of Alaska Fairbanks with diverse
ethnic backgrounds and may develop multiple cultural
identities that can influence their coping styles in college.
These students may also possess protective factors that
help them succeed in the transition to an urban setting.
Yet, the move to attend school may serve to alienate these
students from their rural villages and cultural values, thus
contributing stressors that may be maladaptive coping
behaviors. Little research exists about how Alaska Native
students themselves perceive and navigate the rural-tourban transition and the acculturation/enculturation
process. This study utilized qualitative methods to explore
the perceptions of acculturation and coping among Alaska
Native college students in the rural-to-urban transition.
Ten interview transcripts from a larger research study on
suicide were analyzed using a constructivist grounded
theory framework. From this data, four themes of coping
emerged: the use of traditional Alaska Native ways
(e.g. subsistence activities), resorting to alcohol and/
or substances, using spirituality (e.g. traditional ideas of
spirituality, organized religion), and utilizing Western
methods (e.g. counseling). A relationship emerged
between the participants’ chosen coping mechanism(s)
and their experiences of acculturation/enculturation
and access to resources. This research constitutes a first
step toward understanding ways in which acculturation/
enculturation and coping influence college student health.
TUESDAY POSTER
populations by studying and comparing the conceptions
of the Sami and the majority population regarding selfidentity, value systems, SOC and empowerment. These
indicators of the degree of assimilation or integration will
be analysed at an individual and a group level as well as
from a contextual point of view in order to enhance the
understanding of how the Sami culture and the culture
of the majority population relate to each other. Study
Design: A cross-sectional survey Methods: The study will
be based on a questionnaire on self-perceived integration
and identity, SOC and value systems. The conception of the
individual through these variables will be analyzed based
on the theories of adult development. The questionnaire
will be distributed to a random sample (2 000) of the
Sami in Sweden eligible to vote in the Sami parliament.
Results/Conclusions: We expect the result of the study
to variegate the concept of integration and assimilation
among the Sami. We also expect to elucidate the concept
of empowerment and SOC in a minority setting and
the bearing of these concepts on the perception of
integration and/or assimilation to the majority society. The
survey will be conducted during the spring of 2012 and
preliminary results presented at the congress (ICCH15).
14:30 -15:30
173
TUESDAY POSTER
rural students’ mental health and well-being, including
cultural barriers encountered in the university setting
(e.g., lack of cultural competency, micro-aggressions,
racism). Research has shown that identifying stressors
and providing health information on stress reduction
can help students learn to better cope with stressful
experiences. These results may be useful in developing
intervention strategies to empower indigenous college
students who have migrated from rural areas to manage
stress and bolster student well-being by addressing issues
that affect academic success and quality of life in college.
[email protected]
POSTER NUMBER: T50
Prenatal Screening in Greenland
AUTHORS: I. Nielsen1, P. Kern2, M.L. Bisgaard1, H.
Eiberg1
Faculty of Health Science1, Queen Ingrids Hospital2
Six years prenatal screening of pregnant women for two
lethal autosomal recessive inherited diseases: Cholestasis
Familiaris Groenlandica and Propionic Acidemia. The
diseases are frequent, serious and the mortality rate is high.
The genetic causes have been found, prenatal diagnosis
possible and screening carried out since 2006. Cholestasis
Familiaris Groenlandica (CFG): A total of 46 cases of
CFG (Progressive Familiar Intrahepatic Cholestasis type
1 (PFIC1) have been diagnosed in Greenlandic Inuit
children since 1943. Only three are still alive. The carrier
frequency varies geographically from 1-27 %. Propionic
Acidemia (PA): A metabolic disease caused by deficiency
of the enzyme propionic CoA-carboxylase. Since 1976,
ten Greenlandic Inuit children have been diagnosed. All
children have died within the first days after birth. Several
other children among the affected children´s closest
relatives have died from sudden unexpected death. It is
suspected that PA could be the cause. The carrier frequency
varies geographically from 2-7%. PREVENTION:
Due to the high carrier frequency in Greenland of both
CFG and PA, the Greenland Home Rule decided to
offer a screening for carrier status to all pregnant women
from the 1st of January 2006. If the woman is a carrier,
the husband is screened, and if they are both carriers of
the same disease, they are offered prenatal diagnosis.
RESULTS: Analyses: 4.499 pregnant women, 473 men,
23 children and 30 foetuses. Normal tests: 4656. Carriers
of CFG or PA: Women 184/117. Men 20/12. Children
7/1. Foetuses 12/2. Carriers of both CFG and PA: Nine
women, two men, one child and one foetus. Homozygous
foetus of CFG: One and pregnancy terminated.
[email protected]
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14:30 -15:30
POSTER NUMBER: T51
Phenotypic Peculiarities of Heart and
Vessels Structure in Newborn Infants
Under Polar Region Conditions
AUTHORS: A. Pulikov, V. Tsukanov
State Medical Scientific Institute for Northern Problems
We have implemented the methods of divided weighting
and morphometry in order to study hearts of live- and deadborn infants without cardio-pulmonary pathology, labored by
mothers, who have lived under polar region conditions over
3 years. We found out that under Extreme North conditions
during the last months of antenatal period the right ventricle
mass is growing faster as compared to common increase of heart
mass. Ventricular index (VI) was the highest in full-term deadborn subjects (1.3-1.46) and clearly correlated to the indices of
right and left ventricles; Fulton index. Heart index in premature
infants was considerably lower (4.5-4.8 g/kg) as compared to
full-term subjects (5.3-5.38 g/kg). Early start of the function
of pulmonary circulation in premature infants makes right
ventricle to gap the period of active mass growth. During the
first postnatal days full-time infants show the increase of blood
outflow tract and fast decrease of cardio-growth index for right
ventricle as compared to the left. On the basis of data complex
estimation we have marked direct dependence between
climatic geographical conditions and peculiarities of heart
structure and function in new-born infants of Polar regions.
[email protected]
POSTER NUMBER: T53
Reproductive Health Profile of the
Children Living of the Northern Region
of Yakutia
AUTHOR: T. Burtseva
Yakut reseach center SB RAMS
Reproductive health condition of the gels and teenagers
is not good. By the official date of the health ministry of
the republic of Sakha Yakutia incidence of the gynecology
disease in gels 0-14 years increases from 28,4‰ to 65,5‰,
in gels 15 to 17 years - from 81,3‰ to 112,3‰. By the
official date of the health ministry of the republic of Russia
incidence of the common gynecology disease in gels
increases to 21,6%, teenagers –to 24,1%, 65-70% teenagers
have a some chronic somatic disease, 112‰ gels detected
reproductive disease. High spread gynecology disease by
the gels in Russia (12—15%). In Republic of Sakha Yakutia
incidence of the gynecology disease have an increase
tendency.The first please in structure is inflammation disease
(42%), than dismenorrhea (27%), and than tumor (3%). The
14:30 -15:30
[email protected]
POSTER NUMBER: T54
Teaching Children About Health
Through Genograms
AUTHOR: P. Ciniero
Itinerant Public Health Nurse
Health Through Genograms is an educational session
focused on teaching children in grades four through six
about the relationship between hereditary health risks and
opportunities for prevention.
Students from three schools in the villages in the Interior
of Alaska participated in these educational sessions. They
filled out genealogy charts for their nuclear family. Then,
the children tracked all family members on the charts for
history of heart disease, diabetes and cancer.
Following the completion of the Health Through
Genograms exercise, discussion focused on the children’s
risk for identified health disparities and what the children
can do to prevent getting the diseases.
Prevention such as the “Store Outside Your Door” concept,
exercise and current diet was discussed.
[email protected]]
POSTER NUMBER: T55
Novel Mutation in ATP13A2 Widens the
Spectrum of Kufor-Rakeb Syndrome
(PARK9)
AUTHORS: H. Eiberg , L. Hansen, L. Korbo , I.
Nielsen1, K. Svenstrup4, S. Bech1, L. Pinborg3, L.
1
2
Institute of Cellular and Molecular Medicine1, Department of
Neurology, Bispebjerg Hospital2, NRU and epilepsy clinic, Dep.
of Neurology,RH3, Neurogenetics Clinic, Rigshospitalet4, Medical
Centre of Middle-Greenland5
Kufor-Rakeb syndrome (KRS) is a rare autosomal recessive
inherited juvenile parkinsonian syndrome caused by
mutations in ATP13A2. We describe six patients from a
large consanguineous Greenlandic Inuit family, homozygous
for a novel frame-shift mutation in exon 22 of ATP13A2
(c.2473C>AA, p.Leu825AsnfsX32). Disease onset varied
from 10 to 29 years of age, the latest reported for KRS.
Symptoms at onset were asymmetric in three patients, and
the clinical features were highly variable within a wide
spectrum of an extrapyramidal-pyramidal syndrome with
cognitive/psychiatric features in all patients. Ataxia was seen
in two patients and electrophysiologically verified axonal
neuropathy in one, features not previously related to KRS.
Dopamine transporter (DAT) scans showed symmetrical,
severely reduced uptake in striatum in two patients. MRI was
without atrophy in one patient despite disease duration of 17
years, and cerebral and cerebellar atrophy was seen in another
patient after disease duration of four years. The molecular
pathogenic mechanisms of ATP13A2 mutations are
discussed. The observation that the mutant transcript is not
degraded by nonsense mediated RNA decay, and the fact that
none of the 8 heterozygous carriers from the family have KRS
symptoms, suggest that the mutant protein does not interfere
and destroy the function of the wild-type ATP13A2 protein.
[email protected]
POSTER NUMBER: T56
Hearing Loss among Greenlandic
Children and Adolescents
AUTHORS: R. Jensen1, A. Koch2, P. Homøe1
Rigshospitalet University Hospital1, Statens Serum Institute2
Introduction: Chronic suppurative otitis media (CSOM)
affects 65-330 million people in the developing part of
the world. Knowledge of the long-term effects on hearing
is scarce. Hearing loss (HL) can cause reduced ability to
communicate, impair language development and academic
skills.
We determined the prevalence of HL in a population with
a high-risk of CSOM and estimated the risk of permanent
hearing loss among children with CSOM.
Methods: Ten and 15 years follow-up of two populationbased children cohorts in Greenland. Participants
underwent ear examination and hearing evaluation. Risk
factors for HL were analyzed, using binomial logistic
FRIDAY ORAL
Finally, discussion on how to use this genogram
for the children’s extended family, starting with
first cousins, was initiated. There will be follow up
education starting with this part of the extended family.
Hjermind4, L. Friborg4, O. Olsen5, J. Nielsen1
TUESDAY POSTER
pathology profile of the gynecology disease gels 23,4 to 100
examined. Every each of 3-4 gels has gynecology problems
and need consultation of gynecologist. In structure the first
please is vulvitis (40,3%). About the case history of gels
vulvitis provide over 1 year. The second places is disorder
of menstrual cycle (36,6%) and the second – disorder of
the sexual development (7,6%). Incidence of the pathology
profile boys living of the northern region of Yakutia is
low (10,3 to 100 examined ), but the some disease of the
boys have a operation (see the table 3). The boys, living
the northern region, need to transport to Yakutsk and
operated to Pediatric center. In structure the first please
is fimosis (39,4%), than varikocele (21%), synechii (15,7).
175
TUESDAY POSTER
regression analysis.
POSTER NUMBER: T58
Results: 438 individuals aged 11-15 years and 18-24 years
participated. Using the American Speech-LanguageHearing Association’s definition of HL the prevalence was
50% (95% CI 45.3 – 54.7). Using the WHO definition of
HL the prevalence was 2.5% (95% CI 1.1 – 3.98). CSOM
was the main cause of HL. Present CSOM (OR 16.7, 95%
CI 8.29 – 33.65), spontaneous healing from CSOM (OR
3.75, 95% CI 1.62 – 8.67), and male gender (OR 2.2, 95%
CI 1.28 – 3.78) were associated with HL. Ninety-one
percent of children with CSOM developed a permanent
hearing loss > 15 dB.
Recurrent Abdominal Pain (RAP) in
Schoolchildren in Evenkia in Accordance
with Rome criterion III (ROMEIII)
Conclusion: The prevalence of hearing loss in this
population was high and mainly due to CSOM.
The majority of children with CSOM developed a
permanent hearing loss despite spontaneous healing or
surgical intervention. The WHO definition of hearing
loss underestimates the burden of hearing loss among
children and adolescents in indigenous populations and
developing countries with a high prevalence of CSOM.
[email protected]
POSTER NUMBER: T57
Role of Structured Water in the
Regualion of Fluidity of the
Phospholipid Layer of the Erythrocyte
Membranes int eh Children of Evenkia
AUTHORS: T. Kolodyazhnaya, O. Zaitseva, V.
Manchuk, S. Smirnova
Institute of Medical Problems of the North, SB RAMS
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14:30 -15:30
The aim of this work was to study the influence of structured
water on the lipid bilayer of erythrocyte membranes in children
not native to the population of Evenkia in comparison with
children of Krasnoyarsk City living in the middle climate
zone of the Krasnoyarsk Territory. Erythrocyte membranes
in healthy non-native children of Evenka and Krasnoyarsk
City from the ages of 1 - 12 years old were investigated by
the method of spectrofluorimetry using fluorescent probes
pyrene and dimethylaminochalcone. The increase of the
content of structured water and the reduction of fluidity of
the deep layers of lipid bilayer in the erythrocyte membranes
in the children of the northern territory in comparison with
children of Krasnoyarsk City was established. Thus, in the
conditions of the northern latitudes of Evenkia, increased
level of structured water in erythrocyte membranes in
children of the non-native population contributes to
the stabilization of phospholipids and it is an adaptive
device (adaptation) of a child’s organism at the cellular
and molecular level to subextremal living conditions.
[email protected]
AUTHORS: L. Lapteva, S. Tereshchenko, N.
Gorbacheva, V. Tsukanov
Federal State Budget Institution «Scientific Research Instit
Urgency. Recurring abdominal pain in children and
adolescents is extremely prevalent reason of visits to
pediatric physicians. Afterresearchdata 10 to 20 % of
schoolchildren show RAP symptoms. Subjects and
Methods. We have carried out questionnaire survey for 112
children in ages from 14 to 17 years, Evenkia inhabitants.
Special questionnaire ROME III had been implemented.
We have used statistical methods of analysis. Results and
discussions. RAP frequency in schoolchildren in Evenkia
Autonomous District reached 13.39% (CI 8.31-20.95).
Among girls RAP syndrome was met 2 times more often:
17.24 (CI 9.69-28.96) % as compared to 9.25 (CI 4.1119.95)% in boys, (?=0.2). The term “functional dyspepsia”
(FD) in accordance with ROMEIII criteria includes pain
and discomfort upwards umbilicus, appearing over 1 time
a week during two months and more. 14.28% among
the examined children had pains upwards the umbilicus
once a week and more, at the same time the pains over 2
months were marked in 8.92% of all the examined subjects.
Additionally the term FD includes such criterion as the
absence of pains in the stomach upwards the umbilicus
after defecation. So the number of children with upper
abdominal pain, not connected with intestine, (that is with
FD) had come to 3.57 (CI 1.45-8.8)% of all the subjects.
Differences between FD frequencies in regard to gender
had not been obtained. Conclusion. The frequency of RAP
among Evenkia school children does not differ from RAP
prevalence median, determined after the results of numerous
population research and reaches over 13.39 (CI 8.3-20.9) %
after ROMEIII criteria, with some predomination in girls.
[email protected]
POSTER NUMBER: T60
Epidemiolgoy of Erosive-Ulcer Diseases
in Gastro-Duodeum Area in Populations
of Siberia Schoolchildren
AUTHORS: T. Polivanova, V. Tsukanov
Aim: To study the prevalence of erosive-ulcer diseases of
gastro-duodenum area in mongoloid and europoid children
of Siberia. Material and Methods: We have carried out
clinical cross-section survey for 1 906 schoolchildren of three
[email protected]
POSTER NUMBER: T61
Features of Functioning of
Cardiovascular System at Schoolchildren
with Various Somatotypes in Tyva
AUTHORS: N. Sanchat, V. Gritsinskaya, V.
Tsukanov
Institute of medical problems of the North
[email protected]
POSTER NUMBER: T63
The Fatty Acids Composition in
Erythrocyte Membrane and Ventricular
Ectopy in Siberian Adolescents with
Structurally Normal Hearts
Medical Research Institute for Northern Problems
Experimental studies have indicated that n-3 fatty acids
increase the arrhythmia threshold and effectively prevent
ventricular fibrillation in animal and in vitro models.
Ventricular premature complexes (VPCs) are a common
form of arrhythmia that are themselves innocent but that may
trigger more serious arrhythmic events, such as ventricular
tachycardia or ventricular fibrillation. It supposed that ω-3
fatty acids might intervene in the occurrence of PVCs by
slowing down the spontaneous beating rate or by prolonging
the refractory period. However, to our knowledge, no studies
have examined the relation between fatty acid status and
ventricular ectopy in healthy adolescents. AIM: To examine
the association between erythrocyte membrane ω-3 fatty
acids content and number of PVCs over 24-h period
in asymptomatic adolescents with structurally normal
hearts. METHODS: The total number of PVCs over
24-h period was determined by 24-h Holter monitoring
in 36 healthy adolescents (11-17 years, boy/girl ratio was
19/17). We studied absolute (mg/l) content of erythrocyte
membrane fatty acids using a gas chromatograph–mass
spectrometer (6890/5975C, “Agilent Technologies”,
USA). Data are shown as median (25-75% quartiles), the
Mann–Whitney test was used. RESULTS: According
to Holter monitoring two groups were generated: with
PVCs>100/24-h (case group, PVCs median – 400.5/24-h,
n=8) and PVCs<100/24-h (control group, PVCs median
– 1.5/24-h, n=28). 35 fatty acids were detected (from 9:0
to 24:1 ω11) in erythrocyte membrane. From ω-3 fatty
acids group only for docosahexaenoic acid (DHA, 22:6
ω3) we revealed decreasing in case group (28.5 (14.6-55.5)
mg/l) as compared with control group (58.7 (36.4-73.2)
mg/l), p=0.017. CONCLUSION: Thus, a greater content
of DHA in erythrocyte membrane was associated with
lower ventricular ectopy in adolescents with structurally
normal hearts. We suppose that DHA may have the direct
antiarhythmic activity by modulation of calcium ion fluxes
177
AUTHORS: S. Tereshchenko, I. Novitzkiy, S.
Smirnova
[email protected]
FRIDAY ORAL
The activity of the cardiovascular system influences
the health of children living in extreme climate and
geographical conditions. 1,676 schoolchildren of
Indigenous population of Tyva are surveyed. Comatotypes
are defined under Dorokhov’s scheme, Bahrah and
Vorontsova. Mesosomatotype is defined at 59% of boys
and 56.3% of girls. Microsomatotype is defined at 24.5%
of boys and 25.3% of girls. Macrosomatotype was defined
at 16.5% of boys and 18.4% of girls. Boys have higher
indicators of systolic arterial pressure (CAP) than girls of all
somatotypes: at MiC (<0.05); at MeC and MaC (<0.001).
Level of diastolic arterial pressure (DAP) and frequency of
warm reductions (FWR) had no authentic difference in sex
at children of all somatotypes. The functional condition of
cardiovascular system at children of MiC was characterized
by lower level the CAP and DAP, more FWR in comparison
with children of MeC(<0.01) and MaS (<0.001). The
average level the CAP and DAP at MaC was authentically
higher, than at schoolchildren with MeC (<0.001);
FWR essentially didn’t differ at these representatives of
somatotypes. Results reveal that the accessory of children
and teenagers to MaC is one of risk factors of occurrence
of arterial hypertension and metabolic syndrome.
TUESDAY POSTER
regions of Siberia in ages from 7 to 16 years. The children
were represented by 1 472 Europoids and 434 Mongoloids
(the Tyvins and the Evenks). We have carried out diagnosis
for dyspepsia syndrome (DS) (Rome I, II). In order to
determine the character of lesions in gastro-duodenal area
in representative groups of children with gastrointestinal
complaints of each population we have worked out
endoscopic tests. The analysis of statistical meaning for
differences between quality characters had been carried
out by Chi-square criterion, which was estimatedp<0.05.
Results: Europoid school children showed severe lesions of
mucosa in gastro-duodenal area, which was proved by the
presence of ulcer diseases in 1.3% of the children, while
in Mongoloids the same index was 0.23%. Erosive-ulcer
lesions in Mongoloids as a whole had been diagnosed 3 times
less frequent than in the Europoids. Erosive gastritis was
the prevailing nosological unit in the structure of erosiveulcer pathology in schoolchildren of all the examined
populations. In school children of Europoid groups the
frequency of combinatory erosive-ulcer lesions of abdomen
and duodenum mucosa (D) had increased (1.5 times) as
compared to Mongoloids. So, the prevalence of erosiveulcer lesions of gastro-duodenal area and ulcer diseases has
its peculiarities in different ethnic populations of Siberia.
They are diagnosed more frequently in Europoid children.
14:30 -15:30
POSTER NUMBER: T64
Immunologic Parameters at Severe
Bronchial Asthma in Children of
Krasnoyarsk Territory (Siberia)
TUESDAY POSTER
AUTHORS: O. Tyutina, S. Smirnova, M.
Smolnikova
Scientific Institute of Medical Problems of the North
The Aim of our study was to investigate the main indices
of humoral and cellular links of immunity, peculiarities
of cytokine regulation of cellular interactions at children
with severe/moderate atopic bronchial asthma (BA) with
different levels of disease control. We have examined
2 groups of children – with controlled (n=50) and noncontrolled (n=50) of severe/moderate severe BA. We
have defined the indices of cellular link of immunity
by fluorescent microscopy method using monoclonal
antibodies to surface receptors. Humoral link indices and
the level of cytokines in blood serum had been defined by
ELISA method. We have revealed significant peculiarities
in controlled and non-controlled BA in the level of IgE in
blood serum (227,9±24,7 g/l and 359,6±31,2 g/l, р=0,0057),
IL-4 (8,1±1,0 pg/ml and 9,2±2,6 pg/ml, р=0,0019),TNF-a
(21,5±2.6 pg/ml and 37,4±7,1 pg/ml, р=0,001). Significant
differences between the levels of IgA, IgM, IgG, IL-10,
IL-2 had not been found. We have revealed statistically
significant distinctions between some indices of cellular
link of immunity in controlled and non-controlled BA:
CD3+ cells (1467,0±258,0 cells/mkL and 837,0±3,9 cells/
mkL, р=0,014), CD4+ cells (880,0±13,6 cells/mkL aand
984,0±12,8 cells/mkL, р=0,007). Our data shows that at
children with non-controlled atopic BA higher level of
IgE, IL-4, TNFa in blood serum as well as higher number
of CD3+-cells and the increase of sub-population of
Т-helpers (CD4+-cells) as compared to controlled BA.
[email protected]
POSTER NUMBER: T65
Severe Bronchial Asthma in Children
of Krasnoyarsk Territory: Clinical
Anamnesis Peculiarities
AUTHORS: O. Tyutina1, S. Svetlana1, N. Ilienkova2
Scientific Institute of Medical Problems of the North1, Krasnoyarsk
State Medical University2
178
Aim of research: to study anamnesis and clinical
data on severe/ moderate severe atopic bronchial asthma
with different level of control, determine the main risk
factors of the formation of BA non-controlled course in
14:30 -15:30
infants. Materials and Methods: we have examined 100
infants, severe/ moderate severe atopic BA patients in
average ages of 10.9 ± 1.1. We have studied anamnesis,
carried out the specific allergy examination, estimated
the results of instrumental research. We have formed 2
groups – with controlled BA course (n=50) and noncontrolled BA course (n=50). Results: living under
unfavorable living conditions (wooden homes with damp,
mould, stove heating, overcrowding) had been marked in
34% cases in group with non-controlled BA course and
in 28% in group with controlled BA (p=0.012). One or
two smoking parents had been marked in 36% cases in
controlled BA course and in 48% in non-controlled BA
(p=0.007). Analysis of family structure revealed that 48%
children of group of good control and 74% of group of
absence of control live in sole-parent families (p<0.001).
Conclusions: We have determined anamnesis predictors
of non-controlled BA course in children: living in home
with stove heating with damp, smoking inside. When
estimating social status of the families in BA children
with non-controlled course we have stated frequent
occurrence of sole-parent families with low income.
[email protected]
POSTER NUMBER: T66
Epidemiology of Erosive-Ulcer
Diseases in Gastro-Duodenum Area in
Populations of Siberia Schoolchildren
AUTHORS: V. Vshivkov, T. Polivanova, V. Tsukanov
Aim: To study the prevalence of erosive-ulcer diseases of
gastro-duodenum area in mongoloid and europoid children
of Siberia. Material and Methods: We have carried out
clinical cross-section survey for 1 906 schoolchildren of
three regions of Siberia in ages from 7 to 16 years. The
children were represented by 1 472 Europoids and 434
Mongoloids (the Tyvins and the Evenks). We have carried
out diagnosis for dyspepsia syndrome (DS) (Rome I, II).
In order to determine the character of lesion in gastroduodenal area in representative groups of children with
gastrointestinal complaints of each population we have
worked out endoscopic tests. The analysis of statistical
meaning for differences between quality characters
had been carried out by Chi-square criterion, which
was estimated under p<0.05. Results: Europoid school
children showed severe lesions of mucosa in gastroduodenal area, which was proved by the presence of ulcer
diseases in 1.3% of the children, while in Mongoloids
the same index was 0.23%. Erosive-ulcer lesions in
Mongoloids as a whole had been diagnosed 3 times less
frequent than in the Europoids. Erosive gastritis was the
[email protected]
POSTER NUMBER: T67
Peculiarities of Goitrous Endemy in
Children and Adolescents of Nenets
Autonomous Area
AUTHORS: L. Zubov, E. Sibileva
Northern State Medical University, Arkhangelsk, Russia
[email protected]
Infant Mortality: Persistent Differences
Between First Nations and All Other
Manitobans (Canada)
AUTHORS: B. Ellias1, M. Hall1, S.P. Hong1, L. Hart2,
G. Munro3, P. Martens1
This study explored differences in infant mortality rates
between First Nations and All Other Manitobans. Data
used in the study are from the Population Health Research
Data Repository housed at the Manitoba Centre for Health
Policy, University of Manitoba, and were derived from data
provided by Manitoba Health and the federal First Nations
registry file. Using data from 1997 - 2006, we calculated
crude rates of infant mortality (per 1000 newborns aged
0 – 364 days) for First Nations and All Other Manitobans,
de-aggregated by rural north, south, mid-province, and
urban region. We also charted proportion of deaths by
cause. The crude annual infant mortality rate over the
ten-year period was significantly higher for First Nations
than All Other Manitobans (10.7/1000 vs 5.7/1000).
Significant differences were found between First Nations
and All Other Manitobans in all areas regardless of where
they live (rural or urban). The two major causes of infant
mortality were similar for First Nations and All Other
Manitobans: congenital anomalies and short gestation/
low birth weight. For First Nations the 3rd cause of death
was sudden infant death syndrome, followed by respiratory
system failure and external causes of injuries. For All Other
Manitobans the 3rd cause of death was complications
of labor, followed by maternal conditions/complications
and respiratory system failure. Historically, while marked
gains have been made in decreasing infant mortality rates
in the First Nations population by improving access to
health services, rates are still significantly higher than
for All Other Manitobans. This persistent difference
is surprising given recent research that found no
difference between the Metis and All Other Manitoban
population for the same time period and aggregate areas.
[email protected]
POSTER NUMBER: T71
Associations Between Maternal Age and
Infant Health Outcomes in Yakutsk
FRIDAY ORAL
Complex assessment of goitrous endemy degree of severity
was carried out in the Nenets autonomous area (NAA)
according to the WHO criteria. Medical examination
of children and adolescents has revealed that goitrous
endemy indicated a light to moderate degree of intensity.
Intensity of goitrous endemy according to the indicator of
clinically significant goiter was low. The median of iodine
concentration in urine was in a range from normal iodine
maintenance to a deficit.. Iodine maintenance in children of
different ethnical groups differed: the median of iodine urine
concentration in the Nenets children was 45.0 mkg/l, in the
Russian children – 63.7 mkg/l. Ultrasound examination
detected decreased thyroid volume or insignificant excess of
standards. The results of the 2 five-year periods of neonatal
screening have revealed goitrous endemy intensity growth
according to the neonatal hyperthyreotropinemia indicator
in the NAA from 26.8 to 38.6 %. The determined sporadic
frequency of a goiter and absence of thyreomegalia in
children and adolescents if any light and moderate iodine
insufficiency allows to determine a distinctive “tundra zone
phenomenon” that specifies functioning peculiarities of the
thyroid gland in children, living in the subarctic region in
conditions of iodine deficiency. During complex evaluation
of health of the native population children in the North, it is
necessary to take into account regional and ethnic features.
POSTER NUMBER: T68
TUESDAY POSTER
prevailing nosological unit in the structure of erosiveulcer pathology in schoolchildren of all the examined
populations. In school children of Europoid groups the
frequency of combinatory erosive-ulcer lesions of abdomen
and duodenum mucosa (D) had increased (1.5 times) as
compared to Mongoloids. So, the prevalence of erosiveulcer lesions of gastro-duodenal area and ulcer diseases has
its peculiarities in different ethnic populations of Siberia.
They are diagnosed more frequently in Europoid children.
14:30 -15:30
AUTHORS: N. Grigorieva, N. Savvina
Introduction: Till now reproductive health of teenagers,
179
TUESDAY POSTER
health condition of children, who have been born by young
mothers, have been poorly studied, and in Yakutsk such
researches were not performed earlier. Purpose: To compare
obstetric and neonatal complications of teenage mothers
with adult mothers. Material and methods: A retrospective
case control study was performed over a period of 4 years.
The basic group was formed from 894 teenager mothers
(younger than 19 years old). The group under control was
formed from 714 women (20-34 years old). Results: The
share of young mothers was 5.4% from the general number
of all deliveries. Majority of the teenagers were primigravida
(86% vs. 38%, p< 0.01). Structure of the somatic pathology
in teen-mothers: increasing of thyroid gland (26% vs.
35.4%), chronic pyelonephritis (22% vs. 31.6%), diseases
of cardiovascular system (15.1% vs.33%). Frequency of
laboratory confirmed ureaplasmosis in group of teenage
pregnant women makes 144 (16.1 %), a chlamidiosis-109
(12 %), a mycoplasmosis - 104 (11.6 %), in the control
group 7.7%, 7.7% and 5.6 % accordingly. Among pregnancy
complications in the group of teenage mothers gestosis
develop more often (21%), than in the control group (15%),
eclampsia (6.2% vs. 4%). Weakness of birth activity meets in
7.5% of teenage mothers, against 3.6% in the control group.
Teenage mothers also had increased incidence of low birth
weight (25% vs. 12%, p< 0.05), premature delivery (6.6% vs.
2%, p< 0.05) and neonatal morbidities like perinatal asphyxia
(11.7% vs. 1.9%, p< 0.01), respiratory distress syndrome
(1.9% vs. 0.3%, p<0.05), neonatal mortality (0.8% vs. 0.1%).
Conclusion: Carried out researchers have shown, that
complications of pregnancy and delivery in young mothers
in Yakutsk exceed pathological conditions of newborns
similar to women at advanced age, and constitute a group
with increased risk for obstetric and perinatal pathologies.
First Nations women living on reserve, or women living in
institutions. Regions defined as “Northern” include Yukon,
Northwest Territories and Nunavut, while “Southern”
include British Columbia, Alberta, Saskatchewan,
Manitoba, Ontario, Quebec, Nova Scotia, New Brunswick,
Newfoundland and Prince Edward Island. Results: Overall,
77.6% of surveyed women knew that taking folic acid prior
to conception could help protect against NTD. Despite
longstanding national guidelines for supplementation, there
were large regional variations in knowledge and use of folic
acid. Women in Nunavut and Northwest Territories were
least aware of the benefits of folic acid compared to women
in Yukon (35.1%, 59.0% versus 86.3%) and fewer women
in Nunavut reported taking folic acid (14.1%) than did
women in any other province or territory. When looking
at Aboriginal women within the two regions, women
residing in Northern Canada reported less awareness
and use of folic acid than their southern counterparts
(34.9% versus 65.1%, and 40.0% versus 60.0%), p<0.001.
Logistic regression shows that regional differences in folic
acid awareness and use remain, even after controlling
for age, parity, education, Aboriginal status and income
(p<0.008). Conclusions: The data indicate clear regional
differences among Canadian women with respect to their
knowledge and use of folic acid. These findings provide
information for educational or interventions strategies.
[email protected]
POSTER NUMBER: T72
High indexes of prenatal death rates, obstetrics traumatism,
delivery and postnatal bleedings had been marked till new
Conception of public health services development was
adopted in the Russian Federation, in Yakutsk (Republic
of Sakha (Yakutia)).
Regional Differences in Folic Acid
Knowledge and Folic Acid use among
Canadian women
AUTHORS: C. Nelson1, J. Evans2, L. Arbour
Public Health Agency of Canada1, University of Manitoba2
180
14:30 -15:30
Regional differences in folic acid knowledge and use among
Canadian women Background: Although the benefit of
folic acid to reduce risk of neural tube defects (NTD) is
well established, not all women take supplements in the
periconceptional period. This study used data from the
Public Health Agency of Canada’s Maternity Experiences
Survey to evaluate regional differences in awareness of folic
acid among recently pregnant women in Canada, and the
extent to which that translated into actual supplement
usage. Methods: The methodologies for the survey have
been reported extensively elsewhere. It did not include
[email protected]
POSTER NUMBER: T73
Health Protection of Pregnant Women
AUTHORS: U. Novgorodova, N. Savvina
Research aim: To study health condition of pregnant
women, puerpera, to carry out the indexes analysis of
delivery flow, postnatal period on the basis of medicaldemographic indexes from 2006 to 2011.
Research material: analysis of the statistical data in
obstetrics hospitals of Yakutsk was carried out from 2006
to 2011.
Research results: Last years the growth of delivery quantity
in Yakutsk was marked: in 2006 - 3.682; 2011 - 5.135 that
led to the growth of birthrate index to 22.9 in 2011 (2006 –
16.7). The pregnancy complications with serotinal gestosis
in 2011 remains at the former level, but severe cases - 4,3%
Conclusion: According to the given analysis, realization
of the national project “Health”, modernization of health
service have improved the quality of medical help to
pregnant women, but conserved high extragenital diseases
rate:
1. The birthrate index is growing.
2. Operative work of obstetrics hospitals is growing;
the number of operations with organs removal has
been reduced, there were no any cases of obstetrics
traumatism, peritonitis after Cesarean section.
3. Indexes of perinatal death rates have been decreased.
[email protected]
POSTER NUMBER: T74
Low Birth Weight in Siberian (Tuva)
Newborns is Associated with Decreasing
Erythrocyte Membrane Fluidity
AUTHORS: S. Tereshchenko, I. Novizkiy,
S. Smirnova
Medical Research Institute for Northern Problems
[email protected]
POSTER NUMBER: T75
Modern Conception About Women
Fertility in the Republic of Sakha
(Yakutia)
AUTHORS: A. Yavorsky, N. Savvina, Y. Rad
North East Federal University named after M.K.Ammosov
The Sakha Republic (Yakutia) takes the 55 th place in
population among the units of Russian Federation, the
third highest in the Far East Federal district and consists
of 958,000 people. The population of the Sakha Republic
(Yakutia) had a steady growth in the 20th century until
1990. Maximum accession rate in population of the
republic was in 1960s and increased by 33, 8%. Beginning
with the last decade of the 20th century, the accession
rates in the Sakha Republic (Yakutia) were similar to the
Russian Federation with negative maximum . Total fertility
rates in the first decade of the new century has improved
and has increased in comparison with 1999 by28.2% and
was 16. 8% in 2010. In 2010 the population of the Sakha
Republic (Yakutia) can be, referred to as a stationary type
of the age structure, as the numberof people older than 50
years of age is equal to the number of children. According
to the demographic ageing score of UUN the population
of the republic is in anility boundary and the percentage
of people older than 65 years of age was 5. 7%. Women of
fertility age, in Sakha Republic (Yakutia), represent 53.9
% (2009, 54.8 %) of the total female population. Women
fertility study by the separate age (five years) groups gives a
better under standing of birth intensity changes.
In 1990 the highest women fertility rates in Yakutia was
registered in the groups of 20-24 years old and 25-29 years
old, followed by women of 30-34 years old. The age group
of 15-19 years old was the 4th highest and exceeded the
age group of 35-39 years old. During the last decade of the
20th century a sharp fall of total fertility rate was registered
in all age groups. In the beginning of 2010 the following
changes took place: the age group of 20-24 with a fertility
marker of 122.7remains the highest. Second highest was
the 25-29 years old age group with the fertility growth at
1.3 times, the third highest was the 30-34 years old group
FRIDAY ORAL
Previous studies, mainly among populations with high
consumption of seafood, have suggested that increased
marine n-3 polyunsaturated fatty acid (PUFA) intake
during pregnancy promotes longer gestation and higher
birth weight [Muthayya S., Dwarkanath P., Thomas T. et
al., 2009]. On the other hand, PUFA supplementation can
modulate cell membrane fluidity. The relationship between
birth weight and cord blood erythrocyte membrane fluidity
has not been studied well. Aim: We hypothesized that
decreased fetal growth would be associated with decreased
cord blood erythrocyte membrane fluidity that may reflect
low PUFA consumption in pregnancy. Methods: Cord
blood erythrocyte membrane fluidity of lipid bilayer were
investigated in 71 full-term Tuvinian newborns by means
of eximerization coefficients of fluorescent probe pyrene
(the fluorescent spectroscopy technique, Hitachi MPF-4,
Japan). Data are shown as median (25-75% quartiles), the
Mann–Whitney test was used. Results: The decrease of
cord blood erythrocyte membrane fluidity was revealed in
newborns with birth weight <3034 g, n=17 (25 percentile in
our cohort) in comparison to newborns with birth weight
= 3034 g, n=54 (0.550 (0.487-0.630) and 0,610 (0,5220,711), respectively, p=0.088). Conclusion: We suppose that
decrease cord blood erythrocyte membrane fluidity in lower
birth weight newborns reflects the nutritional status of the
mother during gestation with insufficient PUFA intake.
TUESDAY POSTER
(2009 – 2,3%) have increased. Extragenital diseases of
pregnant women are at the high level (for 1000 females):
anaemia – 217.8; diseases of cardiovascular system – 126.9;
urinary tracts – 87.8; chronic virus hepatitis – 61.9; HIVinfected in 2011 – 1.7 (2010 – 1,0; 2009 -0,6). Last years
indexes of operative delivery tend to increase: 2011 –
27.3 % (2009 - 23 %). The basic indications to operative
deliveries were uterine scars, anatomically contracted
pelvis and anomalies of delivery. Perinatal death rate has
decreased from 9.5% to 9.03%. The index of natimortality
rate was 6.59% in 2011 in comparison to 6.1% in 2008.
Early neonatal death rate has decreased from 3.5% in 2009
to 2.5% in 2011.
14:30 -15:30
181
TUESDAY POSTER
with stable growth of 1.3 times, the fourth highest went
to women of 35-39 years old with growth of fertility 1.35
times. Fertility markers among “young mothers”(15-19
years old) has decreased 1.12 times while the older age
groups was registered the tendency towards increase in
births. So, women fertility has increased in the young
(25-29 years old) and middle (30-34 and 35-39 years old)
ages that led to the birth increasing. The age content of
the population of the Sakha Republic (Yakutia) is referred
to the stationary type, “on the anility boundary”. In the
modern stage its necessary to search the ways of saving
every child’s life, and to anchorinmother and child health.
[email protected]
History/Anthropology
POSTER NUMBER: T76
Health Aspects of Arctic Exploration:
Based on the Research Files of Dr. Robert
Fortuine Donated to the University of
Alaska Anchorage Consortium Library in
2006
AUTHOR: K. Murray
182
Dr. Robert Fortuine was a well-known and highly respected
medical historian. He wrote on the history of medicine in
the Arctic regions for his entire career. Dr Fortuine was
named Alaska Historian of the Year in 1990 for his book
“Chills and Fever: Health and Disease in the Early History
of Alaska” and again in 2005 for his book “Must We All Die?
Alaska’s Enduring Struggle with Tuberculosis.” He was an
Adjunct Professor of Medicine at the University of Alaska
Anchorage from 1989-2008 and was also a Fellow of the
Arctic Institute of North America, a founding member of
the American Society for Circumpolar Health, and a cofounder of the Amundsen Educational Center in Soldotna (a
Christian vocational school for Alaska Natives). He wrote six
books, edited and co-edited two proceedings of international
conferences, and collaborated on three major published
bibliographies on the health of the indigenous peoples of
North America. In addition, he published many papers,
notably in the areas of the impact of disease on Alaska history,
Alaska Native traditional medicine, and medical aspects of
arctic exploration. This poster reflects the work begun during
my sabbatical in the fall of 2010. Work has continued on this
project with one product being a master bibliography, created
using RefWorks, of references Dr. Fortuine collected during
his career. The master bibliography is searchable by subject,
author, title, or keyword. This poster will demonstrate how to
access these references and will provide a listing of the range
of subjects Dr. Fortuine researched during his long career.
[email protected]
14:30 -15:30
POSTER NUMBER: T77
Medical Records of Sami Psychiatric
Patients in the Age of Scientific Racism
AUTHORS: S. Elgaroy1, P. Aaslestad2
SANKS1, NTNU2
The study examined how Sami psychiatric patients at
Ronvik hospital, Northern Norway, were described
between 1900 and 1940, at a time when issues of race and
eugenics were considered important in western societies.
According to anthropological race-theory at the time, the
Sami people were “short skulls” and inferior to the “long
skulled” Norwegian people. The Sami were sometimes
described as “degenerated” and heading towards extinction.
A selection of medical records was studied, looking for
influences of race- theory as well as ordinary prejudice. The
ethnicity of all patients was noted in the medical records.
While Norwegian patients were designated simply as
“Norwegian”, we found 24 different designations of the
Sami patients. This seemed to underline the “otherness”
of the Sami patients. A tendency was found for Sami
patients to be described as different in negative ways.
This often seems to reflect ordinary prejudice, sometimes
perhaps also the influence of race-theory. Many Sami
patients understood little Norwegian, possibly leading to
unfortunate consequences as the hospital staff had little
knowledge of the Sami language. Sometimes other patients
were used as interpreters. This made diagnostics difficult for
the hospital doctors, and put the patients in danger of being
treated with less understanding by the staff. Between 1908
and 1923 most patients regardless of ethnicity had their
skulls measured. There was no indication as to how this
information was used. We found no mention of sterilization
or other eugenic practices. Treatment methods were few
and unspecific, like work, bath (patients were often put in
bathtubs for many hours in order to calm them down), and
having to stay in bed for a long time. No differences in
treatment given to Sami and Norwegian patients were found.
[email protected]
14:30 -15:30
Social Determinants of Health
POSTER NUMBER: T79
POSTER NUMBER: T78
Ethnic Discrimination and Psychological
Distress: a Study of Sami and Non-Sami
Populations in Norway
Repairing the Holes in the Net: Women,
Homelessness and Mental Health in
Canada’s three Northern Territories
Four Worlds Centre for Development Learning1, Qulliit Nunavut
Status of Women Council2, Yukon Status of Women Council3, YWCA
Yellowknife4, The Yellowknife Women’s Society5, BC Centre of
Excellence for Women’s Health6
[email protected]
The prevalence of psychological distress and the association
between ethnic discrimination and psychological distress
was examined among 13,703 participants (36 to 79
years of age) in a population-based study of health
and living condition in areas with indigenous Sami,
Kven (descendants of Finnish immigrants) and Ethnic
Norwegian populations (the SAMINOR study). Sami
and Kven males reported greater levels of stress than
Ethnic Norwegians. Ethnic discrimination was strongly
associated with elevated levels of psychological distress.
Given this substantiation, ethnic discrimination is a
major potential risk factor regarding mental health
which may contribute to ethnicity-related inequalities in
mental health between Sami and non-Sami populations.
[email protected]
POSTER NUMBER: T80
The Polar Bear in the Room: Diseases of
Poverty in the Arctic
AUTHOR: C. Nelson
Seattle Central Community College
In the face of global warming, budgetary austerity,
and impoverished Arctic residents, the nations of the
Circumpolar region are presented with a number of difficult
choices regarding the provision of health care to the farflung and isolated regions of their northernmost provinces.
Complicating that picture is the reality of neglected
tropical disease in areas far from their perceived normal
equatorial range as well as endemic food-borne disease
including protozoan and helminth parasites, respiratory
and gastrointestinal disease, and vaccine-preventable
illnesses. This paper discusses the problems of caring for the
health and wellbeing of indigenous populations suffering
from extreme poverty, isolation and discrimination in the
Circumpolar area. After presenting difficulties as supported
by the extant literature, the paper continues by suggesting
solutions to the situation by including discussions of novel
telenursing applications, targeted distance-educational
programs, and local community-based health care assistant
(HCA) vocational training that all provide for cost-effective
care that increases life-spans, improves quality of life, and
provides opportunity to distressed populations in isolated
FRIDAY ORAL
An alarming number of women in Canada’s North face
the intersecting challenges of a shortage of adequate
housing, poverty, devastating experiences with violence
and trauma, substance use and mental health problems,
and a lack of culturally safe service environments. Clearly
new conceptual and intervention models are required
that more adequately address these critical, intersecting
health and social issues. Repairing the Holes in the Net
is a 2-year, applied health services study designed to foster
collaboration among key decision makers and mental
health service providers in both government and nongovernment sectors with the aim of improving social policy
and health services for homeless and at-risk northern
women with mental health challenges. Repairing the Holes
in the Net is employing a multilevel participatory action
research approach to inform the development of culturally
safe and gender-specific services for northern women. Its
methods include: 1. Interviewing homeless women who
feel they have mental health issues to learn more about
their experiences in trying to access services (what worked,
what didn’t, what they feel would make a difference) 2.
Mapping the current policies and services in each territory
3. Examining literature and service models to consider what
is working elsewhere 4. Holding regular reflection, learning
and planning (community of practice) sessions with
decision makers and service providers who want to develop
effective services aimed at evolving innovative approaches
to improving the service response for homeless and at-risk
women (both on the territorial and pan-territorial levels) 5.
Implementing small service innovations to test the utility
of the knowledge gained through the research strategies
described above 6. Sharing innovations with colleagues
across the North, elsewhere in Canada and around the world
Centre for Sami Health research, Universtity of Tromsø
TUESDAY POSTER
AUTHORS: J. Bopp1, S. Elliott2, C. Hrenchuk3, L.
Fuller4, A. Haché5, N. Poole6
183
rural communities of the Far North. The toolkit presented
in the paper is intended to be used to spur discussion and
adoption of community health programs to address the
proper and humane care of marginalized Arctic populations
in an extreme and rapidly changing environment.
[email protected]
TUESDAY POSTER
Health Services
POSTER NUMBER: T81
Outcomes for Orthopedic and
Psychiatric Medevacs Sent to the
Stanton Territorial Hospital Emergency
Department in Yellowknife
AUTHORS: A. Hoechsmann, J. White
Yellowknife Heath and Social Services Authority1, Stanton
Territorial Health Authority2
Introduction: A retrospective review of one year of medevacs
sent to the Stanton Territorial Hospital Emergency
Department in Yellowknife, NT conducted in 2008-09
revealed a large proportion of patients with orthopedic and
psychiatric emergencies. Some patients with these kids of
problems were sent not by medevac, but by commercial
scheduled flights. This study is an attempt to follow the
outcome of these patients and to determine if there are
any predisposing factors that can help predict outcome
and potentially prevent unnecessary medevacs. Methods:
Chart review using hospital charts and hospital electronic
patient tracking system to record outcomes including
admission status, ER length of stay, whether they required
an operation and whether they were sent for further care
in Edmonton, our tertiary referral center. Results: For
orthopedic emergencies there were 65 medevacs and 18
patients sent by scheduled flights. There were a significantly
greater number of proportion of patients requiring surgery
than in the scheduled flight group. For psychiatric
emergencies there were 47 medevacs and 19 patients sent
by commercial flights. Their admission rates were 83%
and 68% respectively. The average length of stay for the
psychiatric admissions were 7 for medevacs and 5.5 for
schedule flight patients. Conclusions: Patients requiring
more hospital services tend to be sent on medevacs. Health
care professionals working in the remote northern regions of
the Northwest Territories are quite good at triaging urgency
of transport for psychiatric and orthopedic emergencies.
[email protected]
14:30 -15:30
POSTER NUMBER: T82
To the Evaluation of the Polar Electrojets
Influence on Physiological Parameters of
a Man at Phonic Conditions While Using
Unmedical Heliomagnitoprotective
Remedies
AUTHORS: A. Trofimov
Int.Sci-Res.Institute of Cosmic Anthropoecology
Biotrop influence of ionosphere electric currents
(electrojets) and of electromagnetic disturbance in the zone
of auroral oval on electric homeostas of healthy people
were under research. These researches were done with the
people from the middle parts of Russia at the end of the
first year working at the Far North (Dikson settlement of
Krasnoyarsk region, 73 degree, 30 minutes of the Northern
latitude).The research was done under conditions of
unmedicinal helio-magnitoprotective remedies aprobation.
During the Polar night period, when 120 men volunteers
of 19-20 years took part in the research experiment, electrocardiographic parameters (R,PQ,QT) and electroconductance on acupuncture points of heart meridian
were registered on PEP-1 apparatus. Frequency of systole
and arterial pressure on automatic measuring instruments
at different manifestation of electrojet(on the riometric
data) and electromagnetic environmental disturbance
(according to Ak index) were registered. The regime of the
research was: before and after drinking 50,0ml. of heliomagnitoprotective water, prepared according to ISRICA
technology.
After statistical calculation it was shown that all the
registered physiological parameters of the people under
experiment with (P < 0,05) were changing at the periods
of increase of cosmophysical factors intensity.The test
introduction of heliomagnitoprotective in the volunteers
drinking water considerably lessens(P< 0,05) functional
dependence of human organism on solar corpuscular and
electromagnetic currents and disturbances in magnetic
ionosphere.
We see as a good perspective to use heliomagnitoprotective drink water for prophylactic
measures against helio-depending diseases, crisis state
and their hemodynamic life dangerous consequences
for the people living near the world polar regions.
[email protected]
184
Nutrition
POSTER NUMBER: W1
Store Outside Your Door: Traditional
Foods, Contemporary Chef
[email protected]
Alaska Native Traditional Foods for
Health Digital Storytelling
AUTHORS: L. Maher1, A. Fears2, F. Deacon
University of Alaska Fairbanks1, University of Alaska Fairbanks
,Rural Nutrition Service2
A group of Rural Nutrition Services students had the
exceptional opportunity to collaborate with the Alaska
Native Tribal Health Consortium to receive training
[email protected]
POSTER NUMBER: W3
Seasonal and Annual Variation in Intake
of Traditional Marine Food by a Yup’ik
Eskimo Population: a Sequential Dietary
Record from Hair Stable Isotope Analysis
AUTHORS: K. Choy, S. Nash, E. Orr, S. Hopkins, D.
O’Brien
There has been considerable research and public health
interest in the potentially protective effects of traditional
diets on disease risk in Alaska Natives. In Yup’ik Eskimos,
traditional diets include high levels of fish and marine
mammal intake, which provide omega-3 fatty acids, vitamin
D, and other protective nutrients. However, methods of diet
assessment (whether FFQ or 24-h recall) do not capture
seasonal patterns of intake, and these are known to vary
widely for traditional diets. Here we investigate seasonal
patterns of traditional marine mammal and fish intake in
Yup’ik Eskimos by measuring variations in a biomarker of
marine intake, the nitrogen isotope ratio, sequentially along
the participants’ hair. We focused this study on participants
of the CANHR II Biomarker Validation Study who met
2 criteria: Their traditional marine intake was high based
on either of two measures, self reported dietary intake or
RBC nitrogen isotope ratios, and their hair was longer
than 6 cm, which corresponds to approximately 6 months
of dietary record (hair growth = ~1 cm/month). There were
19 participants who satisfied these criteria, with the longest
hair sample providing a record of 56 cm, or approximately
4.5 years. We measured the marker in 3 mm sections of hair,
spaced every 1 cm. There were two key results from these
analyses. First, there were pronounced seasonal variations
in the nitrogen isotope ratio, and these variations were
observed synchronously across participants whose hair was
sampled at the same time in the same village. These included
shifts of up to 2 [per thousand mil] occurring over as little
as 4 months of hair growth. We interpret these variations as
reflecting seasonal differences in the availability of specific
FRIDAY ORAL
POSTER NUMBER: W2
in Digital Storytelling. Our group of Alaska Native
women learned the technology to compose powerful
health promotion messages, including our very personal
connections with our traditional Native foods. We dug
deep inside to tell these stories through a composition
of own pictures and public images. The important role of
our traditional foods in building healthy families through
nourishment, spirituality and relationship is evident in our
varied digital stories. Our vision of health for our people is
central to our stories. We would like to share a series of these
short (2 – 3 minutes each) and meaningful stories with you,
and to tell you how we have used them for health promotion.
WEDNESDAY POSTER
The Wellness and Prevention Department at the Alaska
Native Tribal Health Consortium (ANTHC) is excited
to introduce the Traditional Foods, Contemporary Chef
Project. Traditional Foods, Contemporary Chef is a
“webisode,” (web-based video) series highlighting Alaska
Native foods available in the diverse regions of our state.
To date 24 webisodes ranging in length from 4-6 minutes
have been created in six different regions of Alaska. The
webisodes are being distributed at no cost throughout
the Alaska Native Tribal Health System and countless
venues across the state including mass distribution on
Facebook and other forms of social media. The mission of
this innovative project is to promote the health benefits,
awareness, and accessibility of Alaska Native foods. A
spin off from the ANTHC concept “the store outside
your door” this program highlights traditional foods, their
regional diversity, cultural value and contemporary ways to
incorporate them into everyday cooking. This project also
seeks to engage and educate young Alaskan Native families
and individuals and can be used as a resource to combat high
rates of obesity, diabetes and cancer within our population
by incorporating nutrient dense traditional foods into the
everyday diet. The Traditional Foods, Contemporary Chef
Project website (hosted by ANTHC) includes dialogue
about each of the webisodes and expands on cultural
stories and the nutrient information from the foods of
each region. A culturally appropriate evaluation method
was developed in partnership with the University of Alaska
Fairbanks indigenous evaluation team. The producers of
the TFCC series will discuss the development of the series,
initial community reactions and next steps for the project.
14:30 -15:30
185
fish and marine mammals, as different species are known to
vary in the nitrogen isotope ratios. A pronounced summer
peak in nitrogen isotope ratio was found, corresponding to
increased salmon availability.
Secondly, because variations occurred fairly consistently
across participants, their ranking with respect to
traditional food intake tended to stay constant.
This is particularly relevant for the Center for
Alaska Native Health Research (CANHR) Study,
as participation varied seasonally and participants
were recruited primarily during the winter months.
[email protected]
POSTER NUMBER: W5
WEDNESDAY POSTER
Iodine Deficiency in Teenagers and
Adults in West Siberia in 1995-2010
AUTHORS: G. Simonova, Y. Nikitin, O. Rymar, S.
Mustafina, S. Malyutina, D. Denisova, M. Voevoda
University of Washington1, University of Alaska Fairbanks,
CANHR2
Fish oil has been widely studied for its protective effects
against heart disease. These effects are attributed to ?-3
polyunsaturated fatty acid (PUFA) content, which are
also found in sea mammals in addition to fish. However,
fish oil consumption is associated with anecdotal bleeding
effects in humans and is shown to reduce clotting factor
activity in rats. This study examines the effect of ?-3 PUFA
consumption on clotting factors among Yup’ik participants,
for whom fish and sea mammals are a dietary staple.
Measures of clotting potential include clotting factors II,
V, IX, PIVKA-II, INR, PT, and soluble P-selectin. These
data were paired with 15N/14N ratio assay results, which
is strongly correlated with ?-3 PUFA intake and allowed
grouping of high, intermediate, and low ?-3 PUFA dietary
intake. Genetic variants of the vitamin K cycle-associated
genes; CYP4F2, VKORC1, and GGCX, were also
determined, to assess gene-environment interactions. In 99
(out of a planned 1000) participants, several trends were
observed.
Purpose: to analyse iodine supply among Novosibirsk
citizens during 1995-2010. Materials and Methods:
Under International Programs MONICA and HAPIEE
representative samples of both sexes were studied optionally,
the samples consisted of 200 persons aged 25-35 in 1995,
280 persons aged 45-64 in 2005 and 215 teenagers in 2010.
Iodine concentration in urine was detected by ceriumarsenitnym method. Standard level of thyrotropic hormone
(TTH) is 0.167 – 4.05 mU/L. Results: In 1995 iodine
deficiency of mild and moderate degree was detected in
83% persons. Ioduriy median was 47 mkg/l. Frequency of
diagnosed hypothyroidism and thyrotoxicosis was 1.5%. In
2005 ioduriy was 50-100 mkg/l in 33% people, <50 mkg/l
– in 13% of people, and median was 107 mkg/l. There were
diagnosed different forms of hypothyroidism in 9% of
people, and thyrotoxicosis – in 1.4% of surveyed. Iodine
concentration in urine in teenagers is lower 100 mkg/l in
61%, while 7% have it lower 50 mkg/l. Ioduriy median is
93 mkg/l. Subclinical hypothyroidism accounted for 5% of
functional disorders. There were not detected any teenagers
with thyrotoxicosis. Conclusion: Iodine deficiency of
mild and moderate degree remained unchanged in
adults and teenagers in Novosibirsk during 1995-2010.
The data corroborate earlier findings for indigenous
people of Greenland of diminished platelet activation
and may suggest that platelet activity (as measured by
P-selectin) varies with ?-3 PUFA content in blood. In
contrast, a positive association was observed between
vitamin K-dependent clotting factors (II and IX) and
independent clotting factors (V) and ?-3 PUFA levels.
When considering CYP4F2, VKORC1 and GGCX
genotypes, there were consistent trends across the
genotypes with lower levels of PIVKA-II, a marker
of vitamin K insufficiency, in participants with known
low function variant alleles. This suggests that clotting
factor activity is increased to compensate for reduced
platelet activity. More data are needed to validate these
early observations and to evaluate the effect of variants
in vitamin K-cycle associated genes on Yup’ik health,
particularly in individuals treated with drugs such as
warfarin that directly inhibit vitamin K cycle function.
POSTER NUMBER: W6
AUTHORS: A. Bersamin1, B. Izumi2, B. Luick1, Q.
Fong1, P.C. Xu3
[email protected]
Effect of Fish Oil Consumption on
Coagulation in Yup’ik Eskimos
186
14:30 -15:30
AUTHORS: N. Au1, A. Rettie1, K. Thummel1, J.
Yracheta1, W. Burke1, F. Farin1, S. Hopkins2, J. Black2,
D. O’Brien2, B. Boyer2
[email protected]
POSTER NUMBER: W7
Fisheries to School: a Model for
Promoting Food Security in Alaska
Native Communities
University of Alaska Fairbanks1, Portland State University2,
California State University, Fresno3
The National School Lunch Program (NSLP) emerged, in
14:30 -15:30
[email protected]
POSTER NUMBER: W8
Knowledge Sharing about Inuit Food
Security in Canada
AUTHORS: C. Carry , J. Martin , S. Hamilton , L.
Carfagnini3
1
2
2
National Aboriginal Health Organization1, Service Open2Learn2,
University of Waterloo3
[email protected]
Healthy Communities
POSTER NUMBER: W10
www.arctichealth.org: Corralling WideRanging Information on Arctic Climate
Change
AUTHOR: S. Brudie
Alaska Medical Library
Declining sea ice, thawing permafrost, coastal erosion,
extreme weather, tundra fires, carbon releases, methane
bursts, habitat loss, shrinking glaciers, organic blooms,
ocean acidification, food-web disruptions, emerging
pathogens--all are calamities linked to climate change
in the Arctic, and all have impacts on the activities, diet,
safety, and health of people in the Far North. When the
National Library of Medicine (NLM) decided in 2009 to
add a climate change section to the Arctic Health website
(www.arctichealth.org), a site managed jointly by NLM and
University of Alaska Anchorage (UAA), the goal was to
only collect information relating specifically to the human
health impacts of climate change in the Arctic. Such topics
as shrinking ice caps and stressed polar bears were felt to be
outside the site’s human focus. In evaluating information
to add to the site, however, it became apparent that nearly
all dynamics of Arctic climate change pose threats to the
infrastructure, sanitation, and food and water security of
Arctic communities. Erosion caused by loss of protective sea
ice and by thawing permafrost has direct health impacts on
coastal villages. Displacement of marine mammals, caribou,
berries, and other traditional food species affects the diet,
FRIDAY ORAL
In 2004, Inuit Tuttarvingat, the Inuit-specific centre of
the National Aboriginal Health Organization, published
“Hunger in the Arctic: Food (In)Security in Inuit
Communities: A Discussion Paper.” It outlined some of
the challenges and then current programs, and shared some
alarming statistics. Since then, a surge in research to learn
about and address Inuit food insecurity has occurred. In
2009, Inuit Tuttarvingat’s Governing Committee requested
that we identify new knowledge-based contributions to
make in the areas of Inuit nutrition and/or food security.
After a review of existing research and initiatives, and
discussions with stakeholders, a lack of knowledge
translation tools on Inuit food security issues became
apparent, particularly with respect to targeting youth. With
concept approval, we continued to build partnerships and
began a document review process, to inform the content
for an on-line learning tool, with high school students
as the primary target. An advisory committee, consisting
of Inuit elders, school board representatives, educators,
researchers and community representatives, established
priority themes for the tool and gave guidance concerning
Inuit values and approaches. Initial knowledge translation
products include a selected bibliography, published in 2011,
and a small prototype of the on-line food security learning
resource, created in early 2012. Further development of
the online learning resource continues through 2012-13,
as does the creation of video and text profiles of selected
programs that contribute to food security and videos of
selected food security research processes and findings. This
poster describes this initiative for developing knowledge
translation resources for research findings on Inuit food
security, and the context for that development. It includes:
definitions of knowledge sharing, food security and key
food security concepts; statistical evidence of the extent
of food insecurity in Inuit regions; learning tool overview
and priority themes; excerpts of Inuit elder wisdom;
and information on completed and future products.
WEDNESDAY POSTER
part, as a response to the need to improve food security
among school children. The USDA defines food security
as “access by all people at all times to enough food for an
active, healthy life.” Conceptualization of food security in
Alaska Native communities-- also known as “traditional
food security”-- goes beyond food access to encompass
the rich socio-cultural history of Alaska Natives, and the
state’s unique geography and food resources. As currently
implemented the NSLP is poorly contextualized and may not
support traditional dietary patterns, which in many Alaska
Native communities are the underpinning of diet quality
and food security. The NSLP may therefore inadvertently
serve to widen the disconnect that exists between school
children and their local food system, which provides high
quality, culturally important foods. The Fisheries-to-School
program is a community-based participatory research
project designed to increase food security and improve diet
quality in Alaska Native communities while simultaneously
strengthening local and regional markets for sustainably
harvested fish by reconnecting school children with their
local food system. In this presentation we will describe the
process by which the Fisheries-to-Schools program was
developed. We will also discuss its potential to increase food
security, improve health, and support a more sustainable
food system in one of the most disadvantaged regions
in the nation while creating viability in local economies.
187
nutrition, and subsistence lifestyle of Arctic residents.
With the decision to include both human and nonhuman
aspects of Arctic change, the Climate Change page grew to
over 2,500 links including books, reports, articles, abstracts,
interviews, websites, blogs, proceedings, videos, and other
sources. The challenge was to organize this wide-ranging
information into categories meaningful to everyone, from
worldwide researchers to Arctic residents. This poster
displays the categories that were chosen to help navigate
the varied content of the webpage. The next time you seek
information on climate change in the Arctic, we hope you
visit the Arctic Health website and then want to visit again.
[email protected]
WEDNESDAY POSTER
POSTER NUMBER: W11
188
Changing Climate, Changing Health,
Changing Stories: Climate-Health
Research and Promotion in Rigolet,
Nunatsiavut, Labrador, Canada
Rigolet Inuit Community Government
In 2009, the Rigolet Inuit Community Government
in Nunatsiavut, Labrador undertook a multi-year,
community-driven, participatory, storytelling project
dedicated to examining the impacts of changes in snow,
ice, weather, wildlife and vegetation on health and wellbeing in the community. Using an EcoHealth approach,
the community of Rigolet worked with social science
researchers and epidemiologists to gather data about
climate change in the region, climate-health relationships,
and current and possible adaptation strategies. This project
combined participatory digital media (digital storytelling
and PhotoVoice) with qualitative methods (in-depth
interviews, focus groups, and two surveys) to gather this
data collaboratively with the community. Results from
this research include observed changes in climate and
environment by Rigolet residents, and the impact of these
changes on human health and well-being. In particular,
residents reported impacts of climate change on food
security, water quality and access, changes in vegetation
and wildlife, and changes in ice and snow conditions in
the Nunatsiavut region, and discussed the subsequent
implications for physical, mental, and emotional health and
well-being. Rigolet residents were involved in all stages of
the research, and through this process, community members
expanded research capacities, increased confidence to
independently examine and study climate-related issues,
and created the ‘My Word:’ Storytelling and Digital Media
Lab in Rigolet to continue to conduct research and create
health communication videos.
14:30 -15:30
These findings demonstrate the interconnection between
climatic and environmental change and health and wellbeing, and demonstrate the importance of engaging
communities through participatory methods to design
and conduct health research. These findings also indicate
the need for health adaptation strategies and for health
programming and support to address the impacts of climatic
and environmental change on the health and well-being of
Indigenous, remote, or resource-dependent communities.
[email protected]
POSTER NUMBER: W12
The Impact of Climate Change on
the Tick-Borne Encephalitis and
Salmonellosis in the Arkhangelsk
Region, Northwest Russia: WHO Study
AUTHORS: N. Pshenichnaya1, N. Tokarevich2, R.
Buzinov3, V. Boltenkov4, A. Grjibovski5, Z. Varakina6,
E. Yurasova1, J. Nurse1
World Health Organization, Country Office in Russia1,
St.Petersburg Pasteur Research Institute2, Rospotrebnadzor3, Center
for Hygiene and Epidemiology for Arkhangelsk Oblast4, Norwegian
Institute of Public Health5, Northern State Medical University6
Aim: To investigate associations between salmonellosis
(SL) in 1992-2008, TBE in 1980-2009 and air temperature
in the Arkhangelsk region (AR), Northwest Russia.
Methods: Associations between monthly counts of SL
and climatic variables with lags 0-2 were studied by three
different models: 1) negative binomial regression with
adjustment for long-term trend by fitting a polynomial
of time and seasonality modelled using trigonometric
functions, 2) negative binomial model with dichotomous
indicator variables for each year and month, 3) linear
regression model using logarithmically transformed,
detrended and deseasonalized monthly counts of SL and
deseasonalized values of temperature and precipitation.
Statistical associations between TBE and climate changes
was conducted on number of the ticks victims, TBE
incidence rate, air temperatures on northern, central and
southern areas of the AR by dispersive, correlation and
regression analyses. Publication has been developed within
the WHO/BMU project on protecting health from climate
change in Europe. Results: Linear association between
the number of reported cases of SL and mean monthly
temperature with a lag of 1 month across the whole range
of temperatures was observed. An increase by 1°C was
associated with a 2.04% (95% CI: 0.25, 3.84), 1.84% (95%
CI: 0.06, 3.63) and 2.32% (95% CI: 0.38, 4.27) increase
in the number of cases in models 1, 2 and 3, respectively.
Only one of the three models suggested an increase in the
number of cases by 0.24% (95% CI: 0.02, 0.46) with the
increase in precipitation by 1 mm in the same month. For
the AR, comparative analysis of long-time surveillance
of TBE (2000-2009 in comparison with 1980-1989) has
shown a significant increase in morbidity (by almost 60
times). In 2000-2009 the mean annual air temperature was
+ 2.0°?, that was +1.3°? above the level of 1960-1989.
Mathematical analysis revealed a distinct correlation
between TBE incidence and the growth of average
annual air temperatures in 1990-2009 in AR. In
northern districts, the first victims appear as annual
average temperatures exceed +1°?. A steep increase in the
number of victims follows as annual average temperature
exceeds 1.5°?. Conclusions: Higher temperatures may be
associated with higher monthly counts of SL even in high
latitudes while the association with precipitation was less
certain. The climate warming may thus be substantially
responsible for the rise of TBE incidence in AO.
[email protected]
Paralytic Shellfish Poisoning —
Southeast Alaska, 2011
AUTHORS: D. Fearey1, K. Porter2, L. Castroldale1, J.
McLaughlin1, D. Bensyl2, T. Esposito1
State of Alaska1, CDC2
[email protected]
POSTER NUMBER: W15
Development of Circumpolar Medicine
in Russian North
AUTHORS: G. Degteva, N. Simonova, Y. Korneeva,
L. Zubov
Northern State Medical University
The report substantiates the approaches developed
under the new direction of medical science and practice
– a circumpolar medicine. It is a system of scientific
knowledge and practical activities, whose objectives are
to strengthen and preserve the health of the population
living and/or working in the Arctic zone and adjacent
to the Arctic Circle high-latitude areas, life extension,
prevention and treatment of human diseases. Active oil
field development in the North of European Russia will
result in active flow-in of human resources to that territory,
where besides industrial factors, workers are heavily
affected by climatic factors, their joint affect can lead to
increased morbidity and reduced life duration. Analyzed
following the strategy of development of circumpolar
medicine: a regional, marketing, innovation, environmental,
ethnic, multidisciplinary, integral and target-oriented.
[email protected]
POSTER NUMBER: W19
Community Water Fluoridation in Alaska
Communities: Lessons Learned
AUTHORS: L. Albertson1, B. Whistler2
University of Alaska Fairbanks1, State of Alaska2
Community water fluoridation has long been recognized
as a cost-effective equitable approach to reducing dental
caries. While Alaska boasts extremely high rates of dental
decay, particularly in young children, many communities are
resistant to water fluoridation. Despite consistent support
for this public health intervention from health provider
organizations, governmental health agencies and scientific
researchers, the decision to fluoridate is still hotly debated.
Recently, several prominent communities in Alaska have
opted to move away from fluoridation while others have
started or re-affirmed their support for fluoridation
FRIDAY ORAL
Background: Paralytic shellfish poisoning (PSP) is a
potentially fatal neuroparalytic condition resulting from
ingestion of saxitoxins accumulated in bivalve mollusks.
On June 6, 2011, the Alaska Section of Epidemiology
(SOE) was notified of a case of PSP in Southeast Alaska
and informed that other community members had also
recently experienced PSP symptoms after consuming
noncommercially harvested shellfish. We launched an
investigation. Methods: Investigators conducted active
case finding, interviewed ill persons, posted warnings
at local beaches, and collected clinical specimens and
shellfish for testing. A probable case of PSP was defined
as a compatible illness in a person after consumption of
noncommercially harvested shellfish from Alaska during
May–June 2011. A confirmed case met the probable
case definition and had detectable saxitoxins in urine or
had consumed shellfish with =80 µg saxitoxins/100 g of
meat before illness onset. Results: Four suspected PSP
patients were reported to SOE. Case finding identified
13 probable and 8 confirmed PSP cases in 2 neighboring
communities. Of these 21 cases, 15 (71%) were associated
with consumption of cockles, 4 (19%) with blue mussels,
1 (5%) with butter clams and cockles, and 1 (5%) with
unspecified clams. Shellfish from both communities tested
positive for high levels of saxitoxins, and urine from 2 ill
persons was positive for saxitoxins. All 21 patients reported
experiencing paresthesias. Four patients were hospitalized;
none died. Conclusions: Active case finding enabled
epidemiologists to identify previously symptomatic persons
who had not sought care and therefore were not reported.
The burden of PSP in Alaska is likely substantially
underestimated through lack of reporting. An inexpensive
test providing rapid identification of saxitoxins can benefit
persons who consume noncommercially harvested shellfish.
WEDNESDAY POSTER
POSTER NUMBER: W14
14:30 -15:30
189
programs. Through a series of case studies examining water
fluoridation decisions in several Alaska communities, this
presentation will examine what shapes these decisions on
the local level. We will explore what factors are shared by
successful fluoridation initiatives. We will also examine
what forces have lead some communities to abandon
fluoridation. The role of local experts such as healthcare
providers and water-plant operators will be addressed
specifically. This presentation will examine social factors
such as how trust of public officials, scientific literacy and
information asymmetry contribute to acceptance of a health
intervention. While this presentation will focus specifically
on the issue of water fluoridation, it should be relevant to
anyone interested in why population-based public health
interventions succeed or fail at the community level.
[email protected]
WEDNESDAY POSTER
POSTER NUMBER: W20
Renewable Energy and Sustainable
Communities: Alaska’s Wind Generator
Experience in Rural and Remote Regions
AUTHOR: S. Konkel
UAA
Alaska’s wind generation capacity has advanced over past
decades. Policies initially developed and supported by Gov.
Jay Hammond’s 2nd Administration led to additional
energy programs and investment in research, development,
and demonstration of energy efficiency projects and
conservation and renewable energy investments. In 1984,
Alaska’s Dept. of Commerce and Economic Development
issued Alaska’s first inventory and economic assessment of
wind generators. This report documented installed wind
generator capacity and the economics of replacing dieselfuel generated electricity. Presentations on the economic
impacts of Alaska’s energy programs on rural energy use
were presented at Alaska’s Alternative Energy conferences.
Over the past 25 years, policies and incentives driving
installation of wind generators have evolved, yet the high
cost of diesel fuel remains paramount in rural and remote
Alaskan villages. The policy and program landscape of
Alaska has been driven by several factors, including:
1) Concern regarding the human health impacts and costs
of climate change,
2) Better understanding and characterization of the wind
energy potential through resource assessments, and
3) Experience gained through 5 years of funding of the
Renewable Energy Fund (approximately $250,000,000 in
appropriations).
190
Design and location of wind generators, capacity and
14:30 -15:30
reliability, the challenge of storage of energy, upgrading
diesel generation system to address efficiency in meeting
electrical loads, and the potential for addressing sustainable
utilities in Alaska’s rural and remote villages are now
at the forefront of development of renewable energy
technologies in Alaska. The high cost of providing
electricity and sustainable utilities is a top policy issue.
We will tackle the lessons learned from Alaska’s wind
generator experience up through the publication of
the 2011 Renewable Energy Atlas of Alaska. This
presentation will also review several Administrations
efforts to facilitate long-term Alaskan energy planning.
[email protected]
POSTER NUMBER: W21
Inuit Environmental Health Guides
AUTHORS: T. Nancarrow1, S. O’Hara2, S. Edmunds3,
T. Buckle4, A. Guertin5
Inuit Tapiriit Kanatami1, Inuvialuit Regional Corporation2,
Nunavut Tunngavik Incorporated3, Nunatsiavut Government4,
First Nations Inuit Health Branch, Health Canada5
Inuit Environmental Health Guides were produced
in collaboration with three out of four Inuit Land
Claim Organizations (Inuvialuit Regional Corporation,
Nunavut Tunngavik Inc., and Nunatsiavut Government),
Inuit Tapiriit Kanatami, and Health Canada. Regional
consultations were held to develop the content of the
guides. In total three guides for adults and three guides
for youth were produced. Guides cover both indoor and
outdoor environmental health under a variety of topics
including indoor air quality, drinking water quality, travel
by land and water, hunting, ice and animal safety. This
collaboration represents a partnership between ITK, the
Inuit Land Claim Organizations and Health Canada
to bring relevant, Inuit-specific environmental health
messaging to Inuit communities. The guides will be
published and distributed in 2012 are will be available in
Inuktitut (syllabics and roman orthography), Innuinaqtun,
Siglitun, Nunatsiavut dialect, English and French.
[email protected]
POSTER NUMBER: W22
Extension Disaster Education NetworkSharing Resources to Reduce the Impact
of Disasters
AUTHOR: L. Tannehill
University of Alaska Cooperative Extension Service
Disasters can happen anytime, anywhere. All disasters
are local. Disasters affect families, individuals, businesses
[email protected]
POSTER NUMBER: W23
Roles of Cuisine and Aesthetics in
Shaping Human Relationships with
Freshwater Resources, Examples from
Communities Near the Bering Strait
AUTHORS: S. Yamin-Pasternak1, L. Alessa2, A.
Kliskey2, P. Schweitzer1
University of Alaska Fairbanks1, University of Alaska Anchorage2
POSTER NUMBER: W24
HCC in Greenland – a Serious Problem?
AUTHORS: M. L. Børresen1, M. Andersson1, K.
Ladefoged2, M. Melbye1, A. Koch1
Statens Serum Institut1, Dronnning Ingrids Hospital2
Background In the Greenlandic population the prevalence
of hepatitis B surface antigen (HBsAg) carriage, reflecting
chronic hepatitis B (HBV) infection, is 5-10%. However,
standardized incidence rates for hepatocellular carcinoma
and liver cirrhosis for chronic carriers seem to be lower
than rates in chronic carriers in other populations. We
evaluated all registered HCC-cases in Greenland since
1987 to elucidate the association with HBV infection.
Methods Through linkage of the Central Registration
System, the Patient Discharge Registry (PDR) and the
Cancer Registry (CR) covering Greenland we identified
persons born in Greenland diagnosed with HCC between
1987 and 2009. To characterize HBV status of cases we
linked the HCC cases to the Greenlandic Hepatitis B
register. Biopsies from liver cancer cases were identified in
the Danish Pathology register. Incidence rate ratios (IRRs)
were estimated using log-linear Poisson regression. Results
We identified 67 persons born in Greenland with the
HCC diagnosis, hereof 70% men and 97% Inuit. Mean age
at time of diagnoses was 60 years, 21% were 70 years of age.
HBV status was register-recorded in 30% of HCC cases,
hereof were 9 chronic carriers. In total, 61/67 (91%) had
biopsies registered in the Pathology Register, hereof were
34% diagnosed with biopsy-verified liver cancer .Only two
biopsies were positive for HBV, genotype unknown. The
adjusted IRR for persons born in Greenland vs. in Denmark
was 2.02 (95%Cl:1.54,2.60). Conclusion The IRR for
HCC was 2-fold higher among persons born in Greenland.
However, age of HCC diagnosis in Greenlanders was
high compared with HBV high-endemic countries
suggesting a more benign cause of HBV-related HCC in
Greenland. We observed a discrepancy between registered
cases in the PDR and CR vs. biopsy-verified cases in the
Pathology Register which could suggest misclassification
or an even lower incidence of HCC in Greenland.
[email protected]
FRIDAY ORAL
Recognition of the essential value of fresh water, integrated
with a way of life adapted for its minimal use, has
been a part of the Indigenous social-ecological system
throughout the Arctic. Today’s household water usage is
far greater than in the past, measuring not in the number
of carrying vessels, but in the hundreds of gallons per
month. Our research on the municipal water systems,
and their impacts on the resilience of the Bering Strait
communities in Chukotka and Alaska, helps develop a
holistic perspective on people’s changing relationships
with fresh water resources. This presentation provides an
overview of the environmental and infrastructural concerns
surrounding fresh water access in the Bering Strait
communities and discusses the roles of living aesthetics
and cuisine in shaping the contemporary use of fresh water.
Infectious Diseases
WEDNESDAY POSTER
and governments in rural and urban areas. The Extension
Disaster Education Network (EDEN) was created to
improve disaster preparedness through education. EDEN
is a federation of land-grant extension services across the
United States. Since 1993 excellent resources have been
developed and shared to help in mitigation, preparedness,
response, and recovery. This poster will highlight
some of EDEN’s most current resources including
ReadyBusiness designed to teach small businesses how
to prepare for disaster. The Family Financial Disaster
Toolkit is an excellent resource to use in working with
families on insurance, savings, and other strategies
that are helpful in disaster recovery. EDEN’s Animal
Agrosecurity and Emergency Management and Plant
Biosecurity Management courses help producers develop
a plan. Annually EDEN partners with Federal Emergency
Management Agency to promote National Preparedness
Month and offers resources available on the EDEN website
at EDEN.lsu.edu. The goal of National Preparedness
Month is to increase preparedness in the United States.
Learn how this network connects people experiencing
disasters in Alaska with resources from across the country.
14:30 -15:30
[email protected]
191
POSTER NUMBER: W25
POSTER NUMBER: W26
The Changing Epidemiology and
Etiology of Hepatocellular Carcinoma
between 1969 and 2011 in Alaska Native
People
Fatal Pulmonary Hypertension in a
Patient with Chronic Hepatitis D.
AUTHORS: M. Connelly1, N. Kassebaum, M. Bruce2,
L. Bulkow2, M. Snowball1, B. Brian
Hvidovre Hospital, Dronning Ingrids Hospital1, Dep. of Int. Med.
Dronning Ingrids Hospital2, SSI , Dep. of Pediatrics, Hvidovre
Hospital3
Alaska Native Tribal Health Consortium1, CDC
WEDNESDAY POSTER
14:30 -15:30
BACKGROUND Alaska Native people have an increased
rate of primary hepatocellular carcinoma (HCC) compared
to the overall US population. Hepatitis B Virus (HBV)
has been identified as a major etiologic agent in Arctic
Indigenous people. With the introduction of HBV
immunization in 1982, as well as the emergence of Hepatitis
C Virus (HCV) in this population, the epidemiology and
etiology of HCC in Alaska may be changing. We reviewed
all cases of both viral and non-viral associated HCC in
Alaska Native persons from 1969 to 2011. RESULTS Over
the study period, 143 cases of HCC were identified in 131
Alaska Native persons. The age distribution for HCC was
bimodal with peaks in the second and sixth decades of life
(early peak due to HBV). The overall HCC rate was 3.63
per 100,000 and did not change significantly over the study
period. (However, HCV-associated HCC increased from
zero cases prior to 1985 to 38 since 1995, representing 27%
of viral associated HCC. The rates of HBV-associated HCC
varied widely (1.26-3.79 per 100,000) but did not show a
significant trend over the study period. The age distribution
of HBV-associated HCC demonstrated a shift towards
presentation later in life. From 1969 to 1999, 29% of HBV
associated HCC cases were under 20 years of age; after
2000, no cases were under age 20. Non-viral HCC rates
ranged from 0.3 to 2.04 cases per 100,000 but demonstrated
no significant trend over time CONCLUSIONS HCC
rates in Alaska Natives remained stable over the study
period, but the epidemiology and etiology are changing.
HCV has emerged as an important cause of HCC since
1995. Two decades after mass hepatitis B immunization,
the HCC age distribution has shifted to cases presenting
later in life. This is consistent with the presence of an
aging HBV-infected population with no new chronically
infected young persons coming into the population.
[email protected]
AUTHORS: P. Duch1, K. Ladefoged2, M. Børresen3
Hepatitis B (HBV) is highly prevalent in Greenland.
Recently, hepatitis D (HDV) super-infection has been
described among children. Pulmonary hypertension
(PH) is a rare complication of HBV; however no former
rapport on HDV and PH has been described. Here we
describe the case of a 22 year old girl who developed PH
in association with viral hepatitis activity. She was known
HBsAg positive since 2004 and HDV RNA positive
since 2007. She was followed annually, had suppressed
HBV DNA but high HDV RNA levels and ALT levels
far above upper limit of normal (range 80-342 IU/l). In
May 2011 a liver biopsy showed slight inflammation and
grade 2 fibrosis. In May 2011 she had an uterine evacuation
for missed abortion. July 9th, 2011 she was admitted due
to increasing tiredness and dyspnoea developed over 2-3
weeks. Echocardiography showed severe PH. Pulmonary
embolism was excluded. July 15th she was transferred
to Copenhagen University Hospital in Denmark.
Despite treatment with epoprostenol and sildenafil the
condition deteriorated rapidly. On July 26th urgent lung
transplantation was performed. No immediate postoperative
complications, but about 2 weeks later she developed
severe neutropenia irresponsive to G-CSF stimulation
and subsequently sepsis, Disseminated Intravascular
Coagulation (DIC) and multi-organ dysfunction. August
25th she died. We will present the case and discuss the
possible pathogenesis of PH in HBV/HDV patients.
[email protected]
POSTER NUMBER: W27
The Prevalence and Long Term Outcome
of Occult Hepatitis B Virus Infections in
Community Based Populations
AUTHORS: G. Minuk1, K. Kowalec3, S. Caouette3, B.
Larke3, C. Osiowy2
University of Manitoba1, Public Health Agency of Canada2,
University of Alberta3
192
Features of occult hepatitis B infection (OBI) in communitybased populations have yet to be described. In this study
we documented: 1) the prevalence and demographics, 2)
associated serology and viral loads and 3) clinical outcomes
14:30 -15:30
University of Manitoba1, Canadian Blood Services2
POSTER NUMBER: W28
Genetic differences in immune regulators influence
disease resistance and susceptibility patterns. There
are major discrepancies in immune regulated diseases
between Caucasians and Aboriginal peoples in Canada,
as well as with other indigenous people of the Americas.
Environmental factors offer a limited explanation as
Aboriginal peoples demonstrate a rare resistance to chronic
hepatitis C virus infection. Killer immunoglobulin-like
receptors (KIR) are known modulators of autoimmune
diseases and viral responses. The possibility that variation
in KIR cluster profiles contribute to the health outcomes
of Aboriginal people was evaluated with 93 Caucasian
(population controls) and 86 Aboriginal (Oji-Cree, Cree
or Métis) individuals from Manitoba. The KIR cluster
is comprised of 14 genes assigned to either the A or B
haplotypes. Relative to Caucasians, the Aboriginal KIR
cluster displayed a greater immune activating phenotype
associated with genes of the B haplotype, as opposed to
the more common A haplotype. The relative difference
between Caucasians and Aboriginal KIR profiles emulated
published differences in KIR profiles found in chronically
HCV infected patients relative to individuals who
spontaneously cleared acute HCV infection, supporting
epidemiological studies. The gene profiles of these
Caucasian and Aboriginal cohorts associated with distinct
genotype and haplotype relationships suggestive of the
maintenance of a linkage shift between regions of the B
haplotype within the Aboriginal cohort. Importantly,
Genetic Diversity of Hepatitis B
Virus Genotypes B6, D and F among
Circumpolar Indigenous Individuals
AUTHORS: C. Osiowy1, K. Kowalec1, G. Minuk2, M.
L. Børresen3, A. Koch3, B. McMahon4, B. Simons4
National Microbiology Laboratory1, University of Manitoba2,
Statens Serum Institut3, Alaska Native Tribal Health Consortium4
Hepatitis B virus (HBV) infection is highly prevalent
in circumpolar indigenous peoples. However, the
clinical outcome is extremely variable, such that while
hepatocellular carcinoma (HCC) is uncommon in
Canadian Inuit, the incidence of HCC is slightly higher
in Greenlanders than in Danes, and it is especially high
in Alaska Native people infected with HBV genotypes
F (HBV/F) and C (HBV/C). These differences may
be associated with the genomic variability of the
predominant HBV genotype in each group. The purpose
of this study was to determine the rate, nature and
regional susceptibility of HBV genomic mutations among
circumpolar indigenous individuals. Paired serum samples,
separated by 5-6 years, were analyzed from Canadian and
Greenlandic Inuit infected with HBV/B6 and HBV/D,
respectively, and from Alaska Native people infected
with HBV/F, each having subsequently developed HCC.
POSTER NUMBER: W29
Unique Immune Regulatory KIR Gene
Cluster Patterns May Influence Hepatitis
C Virus Infection Profiles in Aboriginal
Peoples
AUTHORS: J. Rempel1, E. Lande2, P. Nickerson1
FRIDAY ORAL
[email protected]
[email protected]
WEDNESDAY POSTER
Phylogenetic and mutational analyses were performed on
full genome sequences, and the dynamic evolution within
the quasispecies population of each patient group was
determined by clonal analysis of the non-overlapping core
coding region. Mutations associated with severe outcomes
predominated in HBV/F, mostly within the precore/core
and PreS1 region. HBV/B6 genomes exhibited higher
diversity compared to HBV/D and HBV/F, particularly
within the core coding region. Thus, differing mutational
profiles and genetic variability was observed among
different HBV genotypes predominating in circumpolar
indigenous patients. The unusual observation of persistently
high genetic variability with HBV/B6 despite clinical
inactivity could be due to the evolution of a host-pathogen
balance but other possible factors also need to be explored.
TUESDAY POSTER
of OBI in community-based populations. Hepatitis B
surface antigen (HBsAg) -negative sera collected from three
Northern Canadian communities (HBsAg prevalences:
11-12%) in 1983-85 were tested for HBV-DNA by nested
stage polymerase chain reaction. OBI patients were defined
as those testing positive in two different genomic regions
with sequence confirmation. Of 706 HBsAg negative sera,
9 (1.3%) were HBV-DNA positive. The median age of
OBI patients at the time of sampling was 9.8 years (range
3.1-50.4 years) and six (67%) were female. Two (22%)
individuals were anti-HBs positive (in the absence of prior
vaccination). Viral loads were undetectable in all but two
samples (2.40 and 2.86 Log10 IU/ml). Only one of the five
(20%) OBI patients who were assessed clinically, remained
HBV-DNA positive at 25-30 year follow-up. There was
no clinical, biochemical or radiologic evidence of chronic
hepatitis, cirrhosis or hepatocellular carcinoma in these
individuals or on review of the remaining four OBI patient
charts. The results of this study suggest that in communitybased populations: 1) OBI is not as common as HBsAg
positive infection, 2) the majority of OBI infected subjects
are young females, 3) a minority are anti-HBs positive,
4) viral loads are either undetectable or low and 5) in the
absence of concurrent liver disease, OBI does not appear
to be associated with long term adverse clinical outcomes.
193
Caucasian KIR cluster patterns reflected published studies
on Caucasians globally, as well as Asians. In contrast,
the distinct pattern of the Manitoban Aboriginal cohort
mirrored the phenotype of other indigenous peoples of the
Americas, but not that of other ethnicities. Taken together,
this data may reflect a common ancestry of indigenous
peoples in the Americas and/or a historical immune
selection processes, as occurred upon the introduction
of “old world” diseases. Nonetheless, these and other
inherited immune profiles could influence current disease
resistance and susceptibility within Aboriginal peoples.
[email protected]
POSTER NUMBER: W30
WEDNESDAY POSTER
Hepatitis B, D and C among Inuit
migrated to Denmark and in High
Endemic Greenland
194
AUTHORS: K. F. Rex1, H. Krarup2, P. Laurberg3, S.
Andersen1
Arctic Health Research Centre, Aalborg University Hospital1,
Department of Clinical Biochemistry, Aalborg University Hospital2,
Department of Endocrinology, Aalborg University Hospital 3
Objective. Infection with hepatitis B virus (HBV) is
endemic among Arctic populations. Migration influences
other diseases while the relation of HBV to migration
to low endemic areas is unknown, as it is for hepatitis
D and C, and details on the influence of delta virus at
a population level are lacking. Material and methods
Population based investigation of Greenlanders living
in Denmark (n=136) and in Greenland (n=441). We
tested for HBsAg, anti-HBs, anti-HBc, HBeAg, antiHBe, HBV-DNA, HBV genotypes, anti-HDV, HDVRNA, anti-HCV, HCV-Elisa test, HCV-RNA, aspartate
aminotransferase, gamma-glutamyl transferase, bilirubin
and albumin, and performed a physical examination.
Results. Participation rate was 52/95% in Denmark/
Greenland. Half of participants in Denmark had lived
more than half of their lives in Denmark, and 54.5 % had
been exposed to HBV. This was similar to 53% among
Greenlanders living in West Greenland (p=0.76). HBsAg
was positive in 4.4% of Greenlanders in Denmark (n=6),
who all were anti-HBe positive and had low viral load.
Serological signs of HBV infection associated with having
both parents born in Greenland (p=0.007) and with IV
drug use (p=0.03). We found serological signs of HDV
exposure among participants in Denmark/Greenland in
0.7/1.1% (n=1/5) and HCV exposure in 1.5/0.0% (n=2/0).
Liver biochemistry was elevated in Greenlanders exposed
to HDV. Conclusions: Hepatitis B, D and C occurrences
among Greenlanders in Denmark mirrored that of
Greenland. Importantly, previously undetected exposure to
Delta virus associated with elevated liver biochemistry and
14:30 -15:30
the introduction of Delta virus is a liability to Greenlanders.
[email protected]
POSTER NUMBER: W32
Assessing the Longevity of Protection of
the Current 2-dose Hepatitis A Vaccine
in Children
AUTHORS: T. Thomas1, L. Bulkow2, S. Negus1, M.
Snowball1, C. Zanis2, P. Spradling2, E. Teshale2, B.
McMahon1
Alaska Native Tribal Health Consortium1, Centers for Disease
Control and Prevention2
Background: Since hepatitis A (HAV) child vaccine
introduction (1995), US acute HAV incidence declined
90%, primarily due to expanded child vaccination. There are
few studies assessing duration of protection into adulthood
(when infection results in increased morbidity) of childhood
vaccination. We report long-term immunogenicity of the
current licensed 2-dose childhood HAV vaccine. Methods: We
selected a convenience sample of 101 volunteers from a cohort
of Alaska Native individuals, aged 10-20 years, participating
in a long-term hepatitis B vaccine study who had received,
during childhood, two doses of 720 EU of GlaxoSmithKline
HAV vaccine given = 5 months apart with initial dose given =5
years ago. Serological testing for HAVantibodies (anti-HAV)
was done using ELISA (Diasorin) with anti-HAV levels =
20mIU/ml considered protective. Participants were stratified
by age at vaccination and duration since second dose. We
compared anti-HAV geometric mean concentrations (GMC)
of individuals who received the 2-dose to those who received
the earlier 3-dose vaccine.
Results: The average age of the 101 participants was 17.6
(range: 12.7–23.4) years and the last immunization was an
average of 11.1 (3.5–15.1) years prior. For any given duration
post second dose, the anti-HAV GMC levels did not differ by
age of vaccination. Regardless of age at first vaccination GMC
levels at 7.5-<9 years, 9-<11 years, 11-<13 years, and 13-<15
years post second dose were 105, 174, 144, and 43 mIU/ml
respectively. Five (5%) participants, all =11 years post second
dose, had GMC = 20mIU/ml. For any given duration post
second dose GMC levels were higher among 3-dose vaccine
recipients. Conclusions: This analysis demonstrates that the
current licensed 2-dose regimen of hepatitis A vaccine, when
given in childhood, is able to provide protection for at least
11 years; however continued observation and testing will be
necessary to determine when booster doses are indicated.
[email protected]
14:30 -15:30
POSTER NUMBER: W33
POSTER NUMBER: W34
Serological Approaches for the
Measurement of Type Specific
Antibodies to Haemophilus Influenzae
Type A (Hia)
Emergence of Invasive Haemophilus
Influenzae Type a Disease in Northern
Ontario Aboriginal Population
AUTHORS: K. Rudolph , M. Bruce , T. Hennessy ,
S. Romero-Steiner3, D. Schmidt3, G. Carlone3, N.
Messonnier3
1
2
2
Centers for Disease Control and Prevention1, Arctic Investigations
Program/CDC2, Division of Bacterial Diseases/NCIRD/CDC3
Before the introduction of pediatric conjugate vaccine
against H. influenzae type b (Hib), Indigenous populations
of North American Arctic experienced one of the highest
incidence rate of invasive Hib disease worldwide. In the
post-vaccination era, while Hib disease rates significantly
decreased, cases of invasive disease caused by H. influenzae
serotype a (Hia) became more commonly reported in
North America. Our recent studies in Northwestern
Ontario (Canada), a vast geographical area of 235,000
habitants with 20% Aboriginal population, identified
13 cases of invasive Hia disease during 2004-2011 (11
Aboriginal and 2 unknown ethnicity). Among these cases,
there were 8 children between 1 month and 6.5 years of age,
one teenager (15 years old) and 4 adults aged 34-65 years.
Pneumonia was the most prevalent clinical presentation in
both children and adults (9 cases, including 3 severe cases
with pleural effusion/empyema). There were two cases of
pediatric meningitis (in 8-month and 18-month old) with
severe complications and 2 cases of septic arthritis. Both
cases of meningitis were identified during the last 2 years,
suggesting a potential shift toward more severe disease in
pediatric population. In the majority of cases, significant
underlying medical conditions were present that might
potentially decrease immunity. Although the cases did
not appear to be epidemiologically related, laboratory
analysis of the Hia isolates showed striking similarities
in their genotypic and phenotypic characteristics. Our
findings indicate that Hia circulates among the Northern
Ontario Aboriginal population and can cause severe
invasive disease similar to Hib. It is unknown whether
there are any specific factors underlying an increased
susceptibility of Aboriginal people to invasive Hia disease
and whether emergence of invasive Hia disease in the
post-Hib vaccine era is the result of serotype replacement.
The development of a new vaccine to prevent invasive
Hia disease in Indigenous populations is warranted.
[email protected]
FRIDAY ORAL
[email protected]
Northern Ontario School of Medicine1, National Microbiology
Laboratory 2
WEDNESDAY POSTER
Haemophilus influenzae type a (Hia) has been recognized
as an endemic pathogen in the United States, especially
in Navajo and Alaska Native populations, and in other
countries causing invasive diseases such as pneumonia,
meningitis, and otitis media. We developed a quantitative
enzyme linked immunosorbent assay (ELISA) to measure
immunoglobulin G (IgG) in human sera and a serum
bactericidal assay to measure total functional antibody
specific to Hia. We prepared a standard reference
reagent using purified immunoglobulin with an assigned
concentration of 4.1 µg/ml IgG. The ELISA was found
to be highly specific (only 5% cross-reactive with Hib)
and sensitive (lower limit of quantification of 1.28 ng/
ml). The functional assay followed the same methodology
previously established for Hib (Clin. Diagn. Lab. Immunol.
2004;11:89-93) using both viability and fluorometric
endpoints in the serum bactericidal assay (SBA). We
identified strain AK1435C3, a blood isolate from an
Alaskan resident, as the reference strain for the SBA after a
strain variability study with 12 clinical isolates (7 invasive,
5 non-invasive). ELISA and SBA assays were found to
correlate (r=0.66) when a panel of cord blood sera was
evaluated (n=64). Of these two assays, the ELISA assay was
implemented in acute and convalescent sera from 3 cases
in children less than 2 years of age identified through the
Arctic Investigations Program. Antibodies were low in the
convalescent sera ([less than or equal to] 0.1 µg/ml). We
were unable to successfully implement the SBA in sera from
cases due to the presence of antibiotics or other inhibitory
agents present in these sera. Development and application
of serological assays is the first step in the elucidation of
adaptive immune responses to Hia infection. We conclude
that serological assays may have a limited utility in the
follow up of cases in children <2 y. Additional studies
may show an application in population sero-surveillance.
AUTHORS: M. Ulanova1, L. Kelly1, W. McCready1,
R. Tsang2
195
POSTER NUMBER: W35
POSTER NUMBER: W36
The Occurrence of [Alpha]-1,6-Glucan
in Clarithromycin-Resistant Canadian
Helicobacter Pylori Isolates
Community-Driven Research on
Helicobacter Pylori Infection in the
Canadian Arctic: The Old Crow H.Pylori
Project
AUTHORS: E. Altman1, B. Harrison1, V. Chandan1,
R. Slinger2
WEDNESDAY POSTER
National Research Council Canada1, Children’s Hospital of Eastern
Ontario, University of Ottawa2
Background: Lipopolysaccharide (LPS) is a major cell
surface component of Helicobacter pylori consisting of
an O-chain polysaccharide, a core and lipid A moiety. The
majority of H. pylori strains display type 2 and/or type 1
Lewis (Le) blood group determinants that mimic those
present on human gastric and tumour cells. In addition, the
outer core region of H. pylori LPS contains two unusual
polymeric components, DD-heptan and [alpha]-1,6glucan. Objective: We sought to examine whether the
resistance to clarithromycin is linked to the distribution
of Le antigens, [alpha]-1,6-glucan, DD-heptan and CagA
expression. Forty one Canadian isolates of H. pylori (23
clarithromycin-resistant, 18 clarithromycin-sensitive)
were studied. Methods: The isolates were characterized by
whole-cell ELISA (WCE) using commercial anti-Le and
anti-CagA antibodies, anti-[alpha]-1,6-glucan-specific
monoclonal antibodies (mAbs) developed in our laboratory,
sugar analysis and serum bactericidal assays. Results: Of 41
isolates tested, 30 strains reacted with anti-[alpha]-1,6glucan mAbs in WCE (73%). Co-expression of [alpha]1,6-glucan and Lex and/or Ley antigens was detected in
25 strains (61%) and 5 [alpha]-1,6-glucan-positive isolates
were non-typeable. The occurrence of type 1 Leb and
Lea antigens was detected in 5 clarithromycin-resistant
strains (5/23, 21.7%). Substantially higher prevalence
of [alpha]-1,6-glucan was detected in clarithromycinresistant H. pylori isolates (19/23) than in clarithromycinsensitive strains (11/18). Clarithromycin-resistant isolates
were also characterized by the absence (44.4%) or low
expression levels of CagA (OD450 0.20-0.30, 43.5%).
Furthermore, elevated levels of DD-heptose in LPS of
clarithromycin-resistant H. pylori isolates were linked
to resistance to serum bactericidal activity. Conclusions:
Clarithromycin-resistant isolates of H. pylori use a wide
repertoire of surface antigens to establish a successful
infection. The results of this study suggest that while the
presence of [alpha]-1,6-glucan cannot serve as a sole
indicator of H. pylori susceptibility to clarithromycin, it is
nevertheless an important antigenic and surface biomarker
that could be used for characterization of these isolates.
[email protected]
196
14:30 -15:30
AUTHORS: L. Aplin1, J. Geary1, S. Veldhuyzen van
Zanten1, B. Hanley2, K. Goodman1, D. Kirchgatter2,
Old Crow H. pylori Planning Committee,
University of Alberta1, Yukon Government2
Background: H.pylori infection has been a growing health
concern in northern Canada. In response to concerns raised
by community leaders and their health care providers, the
Canadian North Helicobacter pylori (CANHelp) Working
Group established the Old Crow H.pylori Project in
November 2010 in Old Crow, Yukon (population=250,
~90% Aboriginal). This project aims to address community
concerns about health risks from H.pylori infection and
generate evidence to inform local healthcare policy. This
abstract reports progress on the Old Crow H.pylori Project
to date. Methods: The Old Crow H.pylori Project was
designed in collaboration with a local planning committee
and includes six main components: surveys of health
and socio-environmental factors, urea breath test (UBT)
screening for H.pylori infection, endoscopy, treatment,
knowledge exchange, and policy development. Results:
193 residents consented to participate in the Old Crow
H.pylori Project. Of those, 140 completed questionnairebased interviews; 186 had a UBT (UBT positivity=71%);
65 consented to upper gastrointestinal endoscopy, with
biopsies for culture and histopathology obtained from
63; and 72 consented to participate in a treatment trial
comparing two of the best available H pylori therapies.
Examination of stomach biopsies is currently taking place
at the University of Alberta. The forthcoming analysis
will reveal the frequency of endoscopically visible gastric
abnormalities, estimate the prevalence of gastric disease
outcomes, as well as the prevalence of bacterial virulence
factors and resistant H.pylori strains. Treatment trial
participants will also undergo a follow-up UBT to determine
the effectiveness of each therapy. Discussion: Communities
in northern Canada are disproportionately affected by
H.pylori infection. The success of the Old Crow H.pylori
Project, as demonstrated by the high level of participation,
is a result of close partnership with the local planning
committee and ongoing community engagement. This will
help strengthen the CANHelp Working Group’s ability to
effectively address community concerns about this infection.
[email protected]
POSTER NUMBER: W37
H. Pylori Incidence and Re-Infection in a
Canadian Arctic Community
AUTHORS: S. Carraher, H. Chang, K. Goodman,
the CANHelp Working Group
POSTER NUMBER: W38
Helicobacter Pylori Infection in Evenkia
Schoolchildren of Families with
Predisposition to Ulcer Disease
AUTHORS: N. Gorbacheva, T. Polivanova, V.
Tsukanov
[email protected]
POSTER NUMBER: W39
Association Between Untreated Water
Consumption, H. pylori Status and
Gastritis Observed in a Northern
Canadian Community
AUTHORS: E. Hastings, A. Wynne, H. Chang, S.
Girgis, K. Goodman
The role of water in the acquisition of H.pylori and
development of associated disease is not yet understood
in the scientific community. This analysis examines two
hypotheses regarding how the ingestion of untreated
water may affect digestive health. First, untreated water
may act as a vehicle for the transmission of H.pylori
organisms. Second, water consumption may be a
potential determinant of the severity of gastritis due to
the potential presence of chemical irritants. Residents of
Aklavik, Northwest Territories, located on the Mackenzie
River, participated in a community-based H. pylori
research project. Participants were screened for H.pylori
FRIDAY ORAL
[email protected]
Aim: To study H. Pylori contamination in Evenkia
schoolchildren with dyspepsia syndrome in families
with predisposition to ulcer disease. Materials and
Methods: We have carried out clinical examination for
alien (394 Europoid subjects) and native children (114
Evenk subjects), the inhabitants of Evenkia in ages from
7 to 16 years and collected the data on ulcer disease in
their parents. At the same time we have worked out
esophagogastro-duodenalscopy including biopsy of antral
section for 163 children (83 native and 80 alien) with
dyspepsia. Gastritis in bioptic specimen was evaluated after
coloring with haematoxylinin-eosin in accordance with
Sydney classification. H.Pylori diagnosis had been carried
out after Gimsa coloring. Analysis of statistical meaning of
differences between quality signs had been carried out by p
criterion under 0.05. Results: In the Europoids of families
with ulcer disease the contamination with H. pylori was
higher. It was 92.6% while in subjects wi�th out family
predisposition it was 67.9%; p=0.0136. They showed higher
bacterization stage in regard to H.Pylori (the 2nd and 3rd
stages had been marked in 59.3% and 33.9% children with
family ulcer anamnesis, p=0.0286). In the Evenks with ulcer
family anamnesis the increase of H.Pylori bacterization in
children (in 93.8% and in 84.4% correspondingly) and the
increase of H. pylori bacterization stage (37.5% and 18.8%
correspondingly; p=0.1) had not been marked as compared
to children without hereditary load. Conclusion: So In
children, the alien population Evenkia with trouble family
history of ulcer family anamnesis has increased the degree of
contamination and infection H. pylori of the antral mucous.
WEDNESDAY POSTER
The Aklavik H. pylori Project is a community-driven
study of H. pylori infection and its influence on health in
an Aboriginal community in the Northwest Territories.
This project brings together health care providers, the
Aklavik Health Committee, and University of Alberta
researchers to address community concerns regarding
the high prevalence of H. pylori infection locally and its
association with stomach cancer. Initial research revealed
that of 333 project participants submitting a urea breath
test between November 2007 and June 2010, 58% were
H. pylori-positive. From 2008-2010 the project offered
treatment to H. pylori-positive participants, and 113
consented to treatment. Objectives: This study will
estimate the H. pylori incidence in Aklavik H. pylori
Project participants who initially tested negative and the
re-infection frequency in initially positive participants
who were successfully treated. Methods: Participants who
were initially H. pylori-negative or who were negative
after treatment for H. pylori were eligible for inclusion.
Beginning in November 2011 (ongoing through March
2012) participants were offered 13C-urea breath tests for
H. pylori infection at the local clinic. Breath samples are
analyzed using infrared spectroscopy (IRIS). Participants
with a positive test result will be classified as new cases,
incidence among participants testing negative at baseline
and re-infections among those successfully treated for H.
pylori infection. Incidence and re-infection frequencies
will be reported for demographic subgroups based on age,
sex, and ethnicity (self-identified). Preliminary results:
Of 52 participants aged >15 years old and tested by
January 11, 2012, ¬¬¬4 tested H. pylori-positive, with an
incidence proportion of 11% (95% CI = -4.7-26%) and a
re-infection proportion of 8.7% (95% CI = -3.8-%-21%).
14:30 -15:30
197
WEDNESDAY POSTER
infection by urea breath test (UBT). In 2008, consenting
participants underwent upper endoscopy. Gastric biopsies
were examined by histopathology to detect H.pylori and
assess gastritis, graded as mild, moderate or severe. Data on
demographics, medical history, and frequency of untreated
river water consumption were collected via structured
interviews. Using logistic regression, odds ratios (OR) and
95% confidence intervals (CI) were estimated for the effect
of consuming any untreated river water in the past year on
H.pylori prevalence and on severe gastritis prevalence. Of
278 participants, 64% were H.pylori -positive. Compared
to those who reported consuming no untreated water,
individuals who consumed untreated water had 1.4 (CI,
0.75-12) times the odds of H.pylori infection, adjusting
for age, gender, ethnicity and education. Among 106 H.
pylori-positive participants with biopsies evaluated, 43%
had severe gastritis. In this group, the OR for the effect
of untreated water consumption on severe gastritis was
2.3 (CI, 0.94-5.7) adjusting for age, gender, ethnicity,
smoking, chronic NSAID use and alcohol consumption.
Our results suggest an association between consuming
untreated river water and severe gastritis in this Arctic
community, though there was insufficient data for precise
estimation of this effect. Our ongoing research will add
data from other Arctic communities for further analysis.
[email protected]
POSTER NUMBER: W40
The Incidence of Gastric Cancer
Biomarkers in Elderly Residents of
Yakutsk, Depending on the Age and
Ethnic Parameters
AUTHORS: S. Kurilovich1, O. Reshetnikov, O.
Tatarinova2, K. Abramova3, M. Voevoda
Institute of Internal Mediine1, Yakut Scientific Center of Complex
Medical Problems of SB R2, Republic Hospital #33
198
Chronic atrophic gastritis and Helicobacter pylori are
risk factors for gastric cancer. To identify features of
gastrointestinal disorders, random samples of the of
Yakutsk population of different ethnic origin (Caucasian
and Mongoloid) aged 45-80 years were examined. A total
of 81 respondents participated, representing the newcomers
(mostly of Slavic origin) and 72 - Yakut (aboriginal)
nationality. Thus, blood level of pepsinogen I (criterion of
atrophy was a level of PGI < 25 ng / ml) and antibodies to
H. pylori have been identified in 153 persons. In the city
of Yakutsk prevalence of atrophic gastritis in Caucasoid
population was 9.1-12.3%, and in Mongoloid population
of Yakutia – 15.3-26.7%. The prevalence of gastric
atrophy in newcomer and indigenous males was 7.1% and
12.5%, respectively, while for women the corresponding
figures were 15.1% and 17.5%. Low levels of PGI was
14:30 -15:30
significantly associated with age of persond surveyed:
atrophy was observed in 7.4% in persons aged under 60
years, in 10.5% aged 61-70 years and in 16.5% over the
age of 70 years (p = 0.03). Helicobacter pylori infection
was detected with similar high proportion in all surveyed
(72.2-74.1%). Thus, the incidence of atrophic gastritis
increases with age. The high prevalence of atrophic gastritis
and infection with H. pylori may partially explain the high
incidence of gastric cancer in Russia, and, especially in the
indigenous population of the republic of Yakutia (Sakha).
[email protected]
POSTER NUMBER: W42
The Risk Factors of Gastroduodenal
Bleedings in Patients with Liver
Cirrhosises in Inhabitans of Eastern
Siberia
AUTHORS: V. Tsukanov, M. Krasnova2
SRI MPN SD RAMS1, City Hospital # 3 2
Aim. To study factors associated with gastroduodenal
bleedings in patients with liver cirrhosis (LC). Methods. In
hepatological hospital 169 patients with LC Child-Pugh
class B, C were observed. All subjects underwent general
examination, upper digestive tract endoscopy and biopsy
specimens were taken. Helicobacter pylori were diagnosed
by histological and ELISA methods in all patients.
Results. Gastroduodenal ulcers were observed in 20,5%
of persons with alcoholic LC(ALC), in 10,5% of patients
with alcoholic-viral LC (AVLC), in 9,8% of patients with
viral LC (VCL) and in 2,9% of persons with other LC
(OCL) ?1-3<0,05; ?1-4<0,02. Gastroduodenal bleedings
were recorded in 27,3% of persons with ACL, in 13, %
of patients with AVLC, in 9,7 % of patients with VCL
and in 5,7% of persons with OCL (?1-3<0,05; ?1-4<0,01).
Gastroduodenal bleedings were associated with Child-Pugh
status (?=0,001), serum albumins concentration (?=0,03),
prothrombin ratio (?=0,01), presence of Helicobacter
pylori (?=0,05) has not been fixed association of bleedings
with bilirubin concentration and level of transaminases.
Conclusions. Gastroduodenal bleedings were associated
with alcoholic etiology of cirrhosis, severity of disease, serum
albumins concentration, prothrombin ratio and presence
of Helicobacter pylori in patients with liver cirrhosis.
[email protected]
POSTER NUMBER: W43
Untreated Water and Helicobacter
Pylori: Perceptions and Behaviours in a
Northern Canadian Community
AUTHORS: A. Wynne, E. Hastings, A. Colquhoun,
K. Goodman, CANHelp Working Group
POSTER NUMBER: W44
Immune Response to Vaccination Under
Extreme North Conditions
AUTHORS: A. Borisov, A. Savchenko, A. Dubov, S.
Smirnova
Institute for Medical Problems of the North
The results of immunization to great extent depend from the
[email protected]
POSTER NUMBER: W45
Antimicrobial Resistance: Can
Collaboration and Partnerships Make a
Difference?
AUTHOR: K. Bunzeluk, A. Poetz
National Collaborating Centre for Infectious Diseases
Antimicrobial resistance (AMR) is a complex, multisectoral
issue that affects communities big and small. Historically,
it was considered an issue that only concerned large
hospitals and healthcare facilities. However, we know that
resistant bacteria can also spread easily in communities,
often prolonging illness and increasing treatment costs.
Despite ongoing efforts to prevent the emergence and
spread of antimicrobial resistant bacteria, activities have
sometimes been disjointed or duplicated. There has been
little communication or coordination among sectors, and
opportunities have been missed to share resources and
lessons learned. This presentation will explore the efforts
FRIDAY ORAL
[email protected]
state of immune system at the time of vaccine introduction.
This is especially important for the North, because on the
account of extreme environment influence the disturbances
of immune homeostasis regulation can happen. This
is resulted in imperfect immune response to different
antigens, including infectious ones. In order to study the
mechanisms of immune response formation to vaccination
under Extreme North conditions we have carried out
clinical immunologic monitoring for subjects vaccinated
with live parotitis vaccine. Before vaccination and during
6th – 8th day and 20th – 22nd day after vaccination we have
carried out clinical examination and estimated laboratorial
immunological parameters. There search had shown that
after manifesting live parotitis vaccine the immunology
indices have changed. We could define at least three types
of the changes in process. The first type is immune active,
fast. It is characterized by the increase in the number of cells
of immune system even on the 7th day after vaccination.
The changes in immune status had been determined in later
periods as well (on the 21st day). The second type is immune
active, slow. In early period there are no changes in immune
status indices. In later period the number of cells of immune
system is changing. The third one is immune insensitive. For
this type we haven’t reveal true changes in population and
sub-population content of lymphocytes both in early and
late periods of time. Further analysis of working out specific
antibodies had allowed us to determine that in children with
immune insensitive response the antibodies to epidemic
parotitis virus had not been worked out at all. We had found
that in group with immune insensitive type of response the
majority of children had clinical signs of immune ones.
WEDNESDAY POSTER
The role of water in the transmission of H.pylori has been a
contentious issue in the scientific community due to difficulty
detecting the live organism in aqueous environments. Some
residents of Aklavik, Northwest Territories, located on the
Mackenzie River, have reported the belief that water is a risk
factor for transmission of the bacterium, and that this is a
reason for community concern. This cross-sectional analysis
aims to estimate the proportion of Aklavik residents who
believe that water is a source of H.pylori transmission, and to
assess how this perception affects consumption of untreated
water. Data on frequency of drinking untreated river water
and beliefs about H.pylori transmission were collected in
structured interviews for a community-based, participatory
research project during 2008-2010. Proportion differences
were used to estimate the association between risk perceptions
and water use. Of 278 participants with complete data, 20%
asserted that people get H.pylori from water, 32% reported
consuming untreated water in the past year, and 67% during
their lifetime. Of those who believed water is a source of
H.pylori transmission, 36% had consumed untreated water in
the past year, 5% (95% CI: -18.6% to 9.3%) higher than people
who did not identify water as a source. O

15th International Congress On Circumpolar Health M CO

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