International Journal of Circumpolar Health

In Arctic populations, a primary route of exposure to contaminants is through the diet. The health risks associated with these exposures can be characterised by conducting human health risk assessments. However, while there is guidance from many international and national organisations, there are limited examples of human health risk assessment in the Arctic. The 2022 AMAP Human Health Assessment Report was the first AMAP report to describe, in one place, the utility of food-based, dietary intake-based and human tissue-based contaminant data in estimating risk. Here, we present available tools, case studies and challenges associated with conducting human health risk assessments in the Arctic. Future efforts in the Arctic should be able to use this information to best interpret human exposure to contaminants in a risk-based context.

This study aims to estimate the prevalence of cardiovascular disease, kidney disease, and other selected diseases including hypertension, atrial fibrillation, asthma, chronic obstructive lung disease, osteoarthritis, osteoporosis, psoriasis and depression among Greenlanders living in Nuuk with and without type 2 diabetes (T2D). The study was designed as a cross-sectional case-control study based on data from the electronic medical record (EMR) in Greenland. Persons with a registered T2D diagnosis in EMR and residence in Nuuk (N = 435) were included. The prevalence of cardiovascular disease was 17.9% among persons with T2D and significantly higher compared to the control group (10.1%). In addition, our results showed a significantly higher prevalence of ischaemic heart disease, hypertension, heart failure, atrial fibrillation, osteoarthritis and psoriasis among persons with T2D compared to the control group.Our study found a higher prevalence in five out of 10 selected diseases in regularly followed persons with T2D in Nuuk compared to unselected controls. This enlightens the importance of a broad multifaceted approach in combination of changing primary health care to focus on early detection of controllable risk factors and chronic conditions care in Artic Greenland.

This study examines trends in health, well-being, and risk behaviours among high school students in Finnmark, Norway, and compares them with the national average. Data were drawn from the Ungdata survey, covering three waves between 2014 and 2023. The sample included 6,084 high school students in Finnmark and 254,048 students nationwide. MANOVA with polynomial contrasts assessed linear trends among students in Finnmark, and MANOVA with difference contrast tested pairwise differences between Finnmark and national samples. Trend analysis revealed that 26 out of 63 variables, including digital use, school-related variables, antisocial behaviours, and depressive thoughts, increased over time, while 25 variables, such as physical activities, local environment, and bullying remained unchanged. Relationships with parents and substance use improved. Pairwise comparisons showed worse outcomes for Finnmark students in 43 and 41 out of 63 variables across waves, except for substance use and antisocial behaviours. This study indicates limited improvement in health and risk behaviours among high school students in Finnmark. Public health policies tailored to adolescents in Finnmark should focus on mental health services, promoting physical activity, and reducing antisocial behaviours and bullying. Further research should explore Finnmark’s multiethnic context, including the Sámi and Kven populations.

Patients with psychotic disorders exhibit elevated mortality and morbidity rates compared to the general population primarily due to comorbid somatic diseases. This study aims to describe the prevalence of selected risk factors and somatic disorders among psychiatric patients with a diagnosis of psychotic disorder. Material and methods: Data were retrieved from Greenland’s nationwide electronic medical record. The study population consists of 104 patients diagnosed with a psychotic disorder, encompassing schizophrenia or schizotypal and delusional disorders, residing in Nuuk. The study population comprised 104 patients (68 males and 36 females) with a mean age of 40 years. More than 80% were daily smokers, and 68% had harmful use of cannabis. More than half had dyslipidemia (any imbalance in lipids), while over a quarter were classified as obese with body mass index of 30 kg/m2 or higher. Eighteen percent had hypertension, and six percent suffered from diabetes. This study revealed a notable prevalence of risk factors for somatic diseases, particularly smoking and cannabis use among patients with schizophrenia in Nuuk, indicating that a high prevalence of somatic diseases might be expected as the population gets older and the risk of developing somatic diseases becomes greater. Increased focus on monitoring and preventing those as part of the health care is recommended.

The global use of pesticides is increasing; however, few studies have examined the exposure of current-use pesticide exposure in Inuit populations. Some current use pesticides are also capable of long-range transport, potentially increasing exposures to northern populations. The study aim was to analyse pesticide (chlorophenoxy, organophosphates, and pyrethroid pesticide) biomarker levels in pooled samples from an Inuit population in Nunavik, Quebec. Thirty pooled samples from the Qanuilirpitaa? 2017 survey (Q2017) from individuals aged 16-80 years were included. Creatinine-adjusted arithmetic (AM) were compared by sex, age, and region sub-groups, and geometric mean concentrations (GM) were compared to those in the Canadian Health Measures Survey (CHMS). Most analysed pesticide biomarkers were detected, and PNP (a metabolite of methyl and ethyl parathion), trans-DCCA (a metabolite of pyrethroids), and 3,5,6-TCP (a metabolite of chlorpyrifos) had the highest concentrations. Concentrations in Q2017 were largely similar to or less than CHMS concentrations. Although not significant, there was a general increase in 2,4-D (a chlorophenoxy biomarker), 3,5,6-TCP, 3-PBA (a metabolite of pyrethroids), and trans-DCCA with increasing age. Concentrations were also somewhat higher in females versus males, but these were not significant. Environmental exposures to current use pesticides were detected in Nunavik and concentrations were similar to or less than those in the general Canadian population. Regular monitoring of current use pesticide exposures is recommended given the increasing global use of pesticides.

The “Kinguaariit Inuunerissut” (KI) camps, meaning “generations in well-being” in Greenlandic, was a pilot initiative designed to enhance cultural identity and intergenerational connections through culturally relevant activities. The outcomes of the KI-camps have informed the development of a broader KI-concept aiming at tailoring and implementing elements from KI-camps into early childhood education services, after-school programmes, and schools. In this paper we present the results from three workshop held in January 2024 in Sisimiut, Greenland where 28 older participants and 28 professionals were asked about essential knowledge and skills to be passed down to younger generations. The focus was on songs, storytelling/myths, the spiritual world, animals, plants, skills in nature/home, and handicrafts. Results shows that older people and professionals agree on the importance of passing down cultural knowledge through all the different categories and support the need to integrate these elements into educational programmes to preserve cultural heritage and strengthen community cohesion. The findings will guide the integration of intergenerational activities into municipal institutions and contribute to culturally relevant health promotion strategies in Greenland.

Frequent sauna bathing has been associated with a reduced risk of cardiovascular disease and proposed as a mediator for improved health. Therefore, the aim was to describe and compare sauna bathers with non-sauna bathers in northern Sweden based on their demographics, health and life attitudes, and to describe sauna bathers’ sauna habits. Questions on sauna bathing habits were included in the questionnaire for the participants in the Northern Sweden MONICA (multinational monitoring of trends and determinants in cardiovascular disease) study, conducted during spring of 2022, inviting adults 25–74 years living in the two northernmost counties of Sweden (Norr- and Västerbotten), randomly selected from the population register. Of the 1180 participants in MONICA 2022, 971 (82%) answered the question about sauna bathing. Of these, 641 (66%) were defined as sauna bathers. Sauna bathers reported less hypertension diagnosis and self-reported pain. They also reported higher levels of happiness and energy, more satisfying sleep patterns, as well as better general and mental health. Sauna bathers were younger, more often men and found to have a healthier life-profile compared to non-sauna bathers. Additionally, the results suggest that the positive effects associated with sauna bathing plateaued from 1–4 times per month.

Indigenous People in Canada possess rich cultural traditions, intertwined with a strong connection to nature. However, colonisation and contemporary challenges have given rise to changes in lifestyle and culture, resulting in health and nutrition disparities within these communities. The goal of this review was to explore the available literature of existing Indigenous nutrition programs for adults in Canada. Arksey and O’Malley’s scoping review protocol was used to conduct the search between July 2020 and February 2023. Articles were obtained from MEDLINE (Ovid), PsycInfo, Embase (Ovid), CINAHL (EBSCO), Web of Science, Scopus (Elsevier), Canadian Business and Current Affairs (Proquest), and Google Scholar. We identified 24 publications, with 19 being unique interventions. Common themes among programs included integrating traditional foods and cultural values, adapted programming to local needs, empowering community members, using a multidisciplinary collaboration, and leveraging social activities, all of which highlight the need for holistic strategies amid complex historical, social, and environmental factors. Overall, this review emphasises the need for continued support and development of Indigenous-led nutritional initiatives to promote health and well-being among Indigenous adults in Canada. Ensuring culturally relevant and sustainable solutions is crucial for addressing nutritional health disparities and fostering long-term positive outcomes.

Despite decades of Inuit accessing services in Manitoba, Inuit-centric services remain scant and have only begun to emerge. This article reports on Inuit utilisation of mental health services in Manitoba. In this study, we focused on two interrelated cohorts: Inuit living in Manitoba and Inuit from the Kivalliq region who come to Winnipeg to access specialised services. We used administrative data routinely collected by Manitoban agencies. The study was conducted in partnership with the Manitoba Inuit Association, and Inuit Elders from Nunavut and Manitoba. Our results show that mental health-related consults represent between 1 in 5 and 1 in 3 of all consults made by Inuit in Manitoba. Rates of hospitalisation for mental health conditions are considerably lower than those of residents from the Manitoba northern health authority. Given that Nunavut has the highest rate of suicide in the world, our results suggest underserved needs rather than lower needs. Kivalliq and Manitoba Inuit utilise mental health services in Manitoba extensively, yet these services for the most part remain western-centric. Epistemological accommodations in the provision of mental health services have yet to be implemented. This is now the focus of our work.

Inuit youth in Nunavut (NU) are resilient but face a protracted suicide crisis. The SPARX serious game and e-intervention, developed originally in New Zealand, teaches youth cognitive behavioural therapy (CBT) skills to ameliorate stress and depression. Inuit youth in NU reviewed and culturally adapted SPARX and an existing wellness outcome measure for Inuit. One hundred and twenty-one youth, aged 13 to 24, across NU then tested, played, and evaluated I(nuit)-SPARX, showing improvement in several areas of wellbeing post-play. Youth completed a CBT skills survey, engaged in sharing circles to assess CBT skill retention, and shared their thoughts about the usefulness and cultural fit of I-SPARX with Inuit Qaujimajatuqangit (IQ). Communication Skills, Listening Skills, and Problem Solving emerged as the most helpful learned CBT skills, and NU youth provided real-world examples of using I-SPARX skills to support their mental wellness. Several principles of IQ were exemplified and upheld in the content of the adapted SPARX tool and the process of the project as a whole. Empirically grounded, asynchronous e-tools, developed in collaboration with Inuit communities to ensure cultural specificity, may support psychological wellness in communities where mental health resources are scarce.

Cold climate and unique genetic and environmental factors may influence the prevalence of skin diseases in Greenland. However, there is a lack of epidemiological studies on skin diseases in the adult Greenlandic population. To address this unmet need a cross-sectional study, run by dermatologists from Denmark, the UK, and Switzerland estimated the prevalence and clinical manifestations of skin diseases among adults in East Greenland in May 2022. All adults ≥18 years in the town of Tasiilaq were invited, and 295 individuals aged 18–78 years participated (22.5% of the overall adult population in Tasiilaq). Two-hundred and three participants (69%) had visible signs of current skin disease, and among these, 242 cases of dermatoses were identified. The most common skin diseases were hand eczema (22.4%), lichen simplex (9.5%), discoid eczema (7.1%), psoriasis, atopic dermatitis and acne vulgaris (5.8% each). Scabies was the most frequent infectious skin disease (4.4%). No cases of skin cancer were identified. Atopic dermatitis and psoriasis presented with disease that was of limited extent and different from the classical presentations. Skin diseases showed a high prevalence among adults in East Greenland, and some of them were severe. This indicates a noteworthy public health problem that warrants better access to dermatologist support.

Over the last three decades, the Arctic Monitoring and Assessment Programme has published five human health assessments. These assessments have summarised the current state of the science regarding environmental contaminants and human health in the Arctic. The 2021 Human Health Assessment Report had a particular focus on dietary transitions, in addition to human biomonitoring levels and trends, health effects, risk assessment methodologies, risk communication and multi-disciplinary approaches to contaminants research. The recommendations and research priorities identified in the latest assessment are summarised here to assist decision- and policy-makers in understanding and addressing the impacts of contaminants on human populations in the Arctic.

Etuaptmumk/Two-Eyed Seeing (E/TES) is a Mi'kmaw guiding principle that emphasises the importance of bringing together the strengths of Indigenous knowledges and Western knowledges to improve the world for future generations. Since its introduction to the academic community, E/TES has been taken up more frequently in Indigenous health research. However, as it is increasingly used, Elders and scholars have affirmed that it is at risk of being watered down or tokenised. This article reports on how E/TES was used in a community-engaged research study that examined hospital-based Indigenous wellness services in the Northwest Territories, Canada. As a living, relational, and spiritual principle, E/TES was used in the study in three interrelated ways. E/TES: (1) guided the study ontologically, shaping the research team's conceptualisation of knowledge and knowledge generation; (2) informed the research team's approach to relationship-building; and (3) guided reflexivity amongst team members. By reporting on how E/TES was used in the study, and critically reflecting on the strengths and challenges of the approach, this article seeks to contribute to growing scholarship about how E/TES is characterised and taken up in Indigenous health research.

The Arctic Monitoring Assessment Program (AMAP) is tasked with monitoring and assessing the status of environmental contaminants in the Arctic, documenting levels and trends, and producing science-based assessments. The objectives of this paper are to present the current levels of persistent organic pollutants (POPs) across the Arctic, and to identify trends and knowledge gaps as detailed in the most recent AMAP Human Health Assessment Report. Many Arctic populations continue to have elevated levels of these contaminants, and the highest levels of POPs were observed in populations from Greenland, Faroe Islands, and Nunavik (Canada), as well as populations in the coastal Chukotka district (Russia) for legacy POPs only. Concentrations of most POPs are declining in Arctic populations in regions where time trends data exist, although the declines are not consistent across all regions. The exceptions are per- and polyfluoroalkyl substances, with concentrations of some long-chain PFAS such as perfluorononanoic acid increasing in populations in Nunavik, Greenland and Sweden. This paper provides a more extensive summary of levels of contaminants in adults, pregnant women, and children across the Arctic than previous AMAP human health assessments, particularly for levels of long-chain PFAS, which are currently under consideration for inclusion in the Stockholm Convention.

The COVID-19 pandemic exposed long-standing gaps in health service systems and realities of environmental changes impacting Native nations and Indigenous communities in the US and circumpolar regions. Despite increased awareness and funding, there is limited research and few practical resources available for the work. This is a scoping review of the current literature on social determinants of health (SDOH) impacting Indigenous peoples, villages, and communities in the US and circumpolar region. The review used the York methodology to identify research questions, chart, and synthesize findings. Thirty-two articles were selected for full review and analysis. The articles were scoping reviews, evaluations, and studies. The methods used were 44% mixed (n = 14), 31% quantitative (n = 10) and 25% qualitative (n = 8). The synthesis identified four areas for discussion: 1) systemic and structural determinant study designs, 2) strengthening Indigenous health systems, 3) mapping the relationship of co-occurring health conditions and SDOH, and 4) emergent areas of inquiry. While the scoping review has limitations, it provides a snapshot of broad SDOH and shared Indigenous social determinants of health (ISDOH) to create tailored frameworks for use by tribal and urban Indigenous health organisations, with their partners, in public health and system strengthening.

Doctors who work in areas of workforce shortage, such as regional, rural and remote areas or areas of low socioeconomic means need to be more self-motivated, adaptable and self-directed than their metropolitan counterparts. This study aimed to examine the goal orientation and learning characteristics of students recruited into two medical programmes, one from the Northern hemisphere and one from the Southern hemisphere; both with a commitment to producing doctors to practice medicine in rural locations. Three survey tools were administered to 263 medical students: 1. achievement goal orientation survey; 2. learning characteristics survey and 3. the study process questionnaire. Medical students from both cohorts showed a learning goal orientation, which significantly increased with age (P0.007). In terms of learning characteristics, the students from the south had significantly higher scores for curiosity (P0.003), while the northern students had significantly higher scores for methodical (p < 0.001). Both cohorts were similar for adaptability and consciousness. Across the entire student cohort, three of the four learning disposition characteristics were also seen to correlate with learning goal orientation. In both cohorts of medical students deep learning scores exceeded surface learning scores. Selection of students with a learning goal orientation and learning characteristics of curiosity, adaptability and conscientiousness could potentially help students to flourish in rural placement environments.

Poor mental health among youth in Greenland is a major challenge, childhood conditions are critical for mental health later in life. The study aimed to examine the clustering of childhood conditions by considering risk and protective factors for mental health among youth and young adults in Greenland and to explore the relationship between these clusters and mental health outcomes in youth. The study included 565 participants aged 15–34 living in Greenland. Seven indicators including childhood adversities (ACEs), childhood residence, language, and cultural indicators (protective factors) were used to define clusters via latent class analysis (LCA). The associations between clusters and mental health outcomes (satisfaction with life (Cantrill’s ladder), self-esteem, self-efficacy, loneliness, psychological distress (General Health Questionnaire) and mental illness (Kessler 6)) were assessed by logistic regression. Four clusters were identified through LCA. While most participants reported positive childhoods, 40% (in two clusters) experienced ACEs. The two clusters differed as more participants in one cluster had experienced protective factors than the other. ACEs were associated with increased odds of negative aspects of mental health in youth. However, participants who faced high levels of adversity and few protective factors also had reduced odds of positive aspects of mental health in youth.

Helicobacter pylori is a bacterium that may colonise and proliferate in human stomachs, leading invariably to chronic inflammation and, to a lesser extent, to peptic ulcers and cancer. The main objective of this study is to describe the epidemiology surrounding H. pylori in Nunavik’s Inuit population using the 2004 and 2017 Health Surveys. Estimated prevalences were 70.9% for bacterial colonisation using a stool antigens test (SAT), 72.5% for anti-H. pylori antibodies, 12.7% for faecal occult blood in participants aged ≥ 50 and respectively of 28.4%, 11.2% and 2.4% for a prior diagnosis of colonisation, gastritis and peptic ulcer in the medical charts, with under five cases of gastric cancer reported. Variables associated with higher SAT+ prevalence were the number of household members (prevalence ratio [PR] = 1.03) and age (quadratic relationship), whereas mainly drinking municipal (PR = 0.84) and natural water (PR = 0.72) compared to bottled water, and increasing alcohol consumption (PR = 0.96) were associated with reduced prevalence. Despite current regional guidelines targeting high risk individuals in the context of high prevalence, Nunavik’s health authorities must remain vigilant by following gastric cancer incidence and the rapid evolution of guidelines, while considering local realities.

Workers who use handheld vibrating machines such as grinders, hammers and chainsaws expose themselves to hand-arm vibration (HAV). Exposure to HAV may cause injuries to both the neurological and the vascular system. The occupational health services (OHS) in Sweden use a formal guideline for secondary prevention focusing on early detection of vibration-related injuries. The guide includes several screening tools, such as a screening questionnaire, clinical examinations, and laboratory tests. There are no studies, to our knowledge, on the diagnostic value of the separate items on symptoms in the screening questionnaire in relation to the laboratory tests or the clinical examinations performed during a medical examination among patients exposed to HAV. Furthermore, the recently presented ISO standard for HAV measurements (ISO/TR 18,750) has only been tested for vascular injuries and not neurological injuries. This research roadmap aims to evaluate separate items in a screening questionnaire on neurological symptoms in relation to laboratory and clinical tests among HAV exposed workers in the Arctic region of Northern Sweden. It also covers a comparison of the dose-response of the current ISO 5349-1 measurement standard and the new suggested standard ISO/TR 18,750 with the neurosensory outcomes. This manuscript describes the study rationale, design, methods, and significance.