ICCH14 Abstract Book

July 11 – 16, 2009Yellowknife, Northwest Territories, Canada

www.icch2009.com

ABSTRACT BOOK

14th International Congress onCircumpolar Health

Securing the IPY Legacy:From Research to Action

Front Cover Art: “Top of the World” by Dawn OmanBack Cover Art: “Inukshuks” by Dawn Oman

About the Artist: Dawn Oman was born in Yellowknife of Chipewyan and Welsh descent. Originals, Limited Edition Prints, and many otherexciting products featuring her exuberant work can be purchased or viewed at: www.dawnoman.com

14th International Congress on

Circumpolar Health

Abstract Book

5 Table of Contents: By Session & Venue

Table of Contents

By Session & Venue

Table of Contents ......................................................................................................................................................... 5

By Session & Venue ................................................................................................................................................................... 5

SESSION 1 .................................................................................................................................................................. 21

Sunday, July 12, 1:30-3:30 PM ..................................................................................................................................... 21

VENUE 1 .................................................................................................................................................................................. 21

Mental Health & Wellness #1 – Holistic & Healing Community Programs ................................................................................. 21

DEVELOPING SÁMI MENTAL HEALTH SERVICE: FROM VISION TO IMPLEMENTATION .............................................................................................................21 FROM THE HEART PLACE - HOLISTIC HEALTH ..............................................................................................................................................................................21 THE UTILIZATION OF NATURE IN HEALING FOR CANADA’S ABORIGINAL PEOPLES .................................................................................................................21 THE EMERGING ISSUE OF CRYSTAL METHAMPHETAMINE USE IN FIRST NATIONS COMMUNITIES ........................................................................................21 HIGH RATE OF SELF-PERCEIVED HIV-RELATED STIGMA AMONG A COHORT OF INDIVIDUALS ACCESSING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY IN BRITISH COLUMBIA ................................................................................................................................................................................................................... 22

VENUE 2 ................................................................................................................................................................................. 22

Indigenous Research #1 ........................................................................................................................................................... 22

JOURNEY OF AN OUTSIDER: IN SEARCH OF A RESPECTIVE RESEARCH PARADIGM ................................................................................................................. 22 CONSTRUCTING AN INDIGENOUS-CENTERED AND DECOLONIZING RESEARCH METHODOLOGY........................................................................................ 22 “IT’S NOT AS COOL AS SHOOTING BIRDS”: BUILDING RESEARCH RELATIONSHIPS WITH ABORIGINAL COMMUNITIES ...................................................... 22 QUALITATIVE RESEARCH FOR CULTURAL GROUPS REDEFINED ................................................................................................................................................23 THE ROLE OF ETHICAL GUIDELINES IN THE DELIVERY OF FRONTLINE MENTAL HEALTH AND ADDICTIONS PROGRAMMING IN CANADIAN INDIGENOUS COMMUNITIES ................................................................................................................................................................................................................................23

VENUE 3.................................................................................................................................................................................. 23

Indigenous Health & Wellness #1 ............................................................................................................................................. 23

INCORPORATING TRADITIONAL KNOWLEDGE, TEACHINGS, AND PRACTICES TO REVIVE HEALTH AND WELLNESS IN A DENE COMMUNITY NORTH OF 60 .....................................................................................................................................................................................................................................................23 A LABRADOR COMMUNITY GRAMMAR: LANGUAGE HEALING ...................................................................................................................................................23 THE MEDICAL-SOCIAL AID TO THE ABORIGINES OF THE RUSSIAN NORTHERN TERRITORIES CONDUCTING TRADITIONAL VITAL ACTIVITY ................... 24 PAN-ARCTIC TV SERIES ON INUIT WELLNESS: PRELIMINARY EVALUATION FINDINGS AND LESSONS LEARNED ................................................................ 24 CULTURAL CONTINUITY AND RESILIENCE: INVESTIGATING THE WAYS THAT THREE GENERATIONS OF INUPIAQ OVERCOME HARDSHIPS .................... 24 ABORIGINAL SELF-GOVERNMENT AND SOCIAL SUFFERING ..................................................................................................................................................... 24

VENUE 4 ................................................................................................................................................................................. 24

Population Genetics - CPT1A P479L in the North: Risk Factor, Protective Factor, or Both? ....................................................... 24

INTRODUCTION AND OVERVIEW.................................................................................................................................................................................................. 25 CPT1 P479L IN NEWBORNS OF THE KIVALLIQ REGION OF NUNAVUT ....................................................................................................................................... 25 THE EXPERIENCE WITH CPT1 NEWBORN SCREENING IN ALASKA ............................................................................................................................................. 25 ESTIMATE OF BRITISH COLUMBIA CPT1P479L PREVALENCE AND REVIEW OF MEDICALLY ASCERTAINED PEDIATRIC AND SUDDEN DEATH CASES FROM BC .................................................................................................................................................................................................................................................... 25 CPT1 P479L PREVALENCE IN LIVE NEWBORNS AND SUDDEN DEATH CASES IN YUKON, NORTHWEST TERRITORIES, AND NUNAVUT ............................. 25 CARNITINE PALYMITOYLTRANSFERASE IA POLYMORPHISM P479L IS COMMON IN GREENLAND INUIT AND IS ASSOCIATED WITH ELEVATED PLASMA APOLIPOPROTEIN AI ..................................................................................................................................................................................................................... 25 COULD CPT1P479L INFLUENCE OBESITY IN ADULTS IN ALASKA? ............................................................................................................................................. 25 MANAGING UNCERTAINTY: IMPLICATIONS OF CPT1A P479L FOR ETHICS AND POLICY.......................................................................................................... 25 DISCUSSANT PANEL: (DISCUSSANTS FROM ALASKA, YUKON, NWT, NUNAVUT AND GREENLAND TBA) .............................................................................. 25

VENUE 5 ................................................................................................................................................................................. 25


Community Participatory Research Methods #1 ...................................................................................................................... 25

UNDERSTANDING ABORIGINAL COMMUNITY-BASED RESEARCH IN CANADA ........................................................................................................................ 25 THE REALITIES ENCOUNTERED WHILE INTRODUCING THE COMMUNITY-BASED PARTICIPATORY RESEARCH APPROACH IN GREENLAND .................... 25 STRATEGIES FOR COMMUNICATING HEALTH RESEARCH FINDINGS TO MEMBERS OF AN ARCTIC ABORIGINAL COMMUNITY .......................................... 26 AN ABORIGINAL COMMUNITY INITIATIVE TO PARTNER WITH ACADEMICS: DEVELOPING EVIDENCE-BASED STRATEGIES TO IMPROVE THE HEALTH & WELL-BEING ................................................................................................................................................................................................................................... 26 HOW GREENLAND ORGANIZED PREVENTATIVE AND HEALTH PROMOTION WORK ............................................................................................................... 26 A DAY IN THE LIFE OF THE IPY INUIT HEALTH SURVEY LAND TEAM: PREPARING COMMUNITIES .......................................................................................... 26 PARTICIPATORY APPROACHES FOR A COMMUNITY-BASED CHRONIC DISEASE PREVENTION PROGRAM IN TWO CANADIAN INUIT COMMUNITIES: DEVELOPMENT OF HEALTHY FOODS NORTH .............................................................................................................................................................................. 27 COMMUNITY-DRIVEN RESEARCH ON HELICOBACTER PYLORI INFECTION IN A CANADIAN ARCTIC HAMLET ....................................................................... 27

VENUE 6 .................................................................................................................................................................................. 27

Human Biology #1 ................................................................................................................................................................... 27

IODINE DEFICIENCY IN THE NORTH OF KRASNOYARSK TERRITORY .......................................................................................................................................... 27 FACTORS THAT INFLUENCE THE BIOCHEMICAL CHARACTERISTICS AND HORMONES OF HYPOPHYSEAL-THYROID-ADRENAL SYSTEM OF MEN .......... 28 RESULTS OF RESEARCH OF FREE RADICAL OXIDATION IN POPULATION OF YAMALO-NENETS AUTONOMOUS OKRUG (RUSSIA) ................................... 28 SYSTEM OF XENOBIOTYCS METABOLISM AMONG NATIVE PEOPLE ON FAR EAST. ROLE OF THIS SYSTEM IN THE DEVELOPMENT OF DISEASES .......... 28 THE IMPACT OF ARTIFICIAL AND NATURAL RADIOACTIVITY IN THE LICHEN -> CARIBOU -> HUMAN FOOD CHAIN ............................................................. 29 AN ESTIMATION OF COSMIC RAY BACKGROUND EXPOSURE IN NORTHERN TERRITORIES ................................................................................................... 29 POSTNATAL EXPOSURE, BUT NOT IN-UTERO EXPOSURE, TO MIXTURES OF NORTHERN CONTAMINANTS ALTERS THE ADULTHOOD GLUCOCORTICOID STRESS RESPONSE IN MALE RATS ............................................................................................................................................................................................... 29 SOME FEATURES OF HEALTH STATE OF INDIGENOUS POPULATION’S CHILDREN IN THE NORTH OF RUSSIA ..................................................................... 29 NEW SERUM MARKERS OF AGING AND ATHEROSCLEROSIS: CHITOTRIOSIDASE, MATRIX METALLOPROTEASE ACTIVITY, AND CYSTATIN C CONCENTRATION ...........................................................................................................................................................................................................................30

SESSION 2 .................................................................................................................................................................. 30

Sunday, July 12, 4-5:30 PM .......................................................................................................................................... 30

VENUE 1 .................................................................................................................................................................................. 30

Mental Health & Wellness #2 – Holistic & Healing Community Programs ................................................................................. 30

CANADIAN INUIT COMMUNITY ENGAGEMENT IN SUICIDE PREVENTION ..................................................................................................................................30 POSTPSYCHIATRY IN THE REGIONS OF RUSSIAN NORTH ...........................................................................................................................................................30 “THE WAY I SEE IT”: HOW STIGMA AND DEPRESSION AFFECT SELF-PERCEIVED BODY IMAGE AMONG HIV-POSITIVE INDIVIDUALS ON HAART .............. 31 MENTAL HEALTH PROMOTION AND PREVENTION IN 12-18 YEAR OLD INUIT YOUTH IN NUNAVIK ........................................................................................ 31

VENUE 2 .................................................................................................................................................................................. 31

Clinical Care #1 ........................................................................................................................................................................ 31

TRANSITION TO END OF LIFE CARE: THE INUIT EXPERIENCE IN MONTREAL ............................................................................................................................. 31 MY 11 YEARS TREATING SKIN DISEASES ON BAFFIN ISLAND, NU, CANADA. WHAT I SAW, WHAT I DID .................................................................................. 31 THE QUALITY AND COST OF WOUND DRESSING PROCEDURES BEFORE AND AFTER INSTITUTION OF A STANDARADIZED STERILE NO TOUCH PROTOCOL ......................................................................................................................................................................................................................................32 IN-PATIENT CARE UTILIZATION AMONG SÁMI IN SWEDEN ........................................................................................................................................................32 FREQUENCY OF ATOPY IN THE ARCTIC STILL INCREASING ........................................................................................................................................................32 THE PARADOX OF ANEMIA WITH HIGH MEAT INTAKE: IS THERE MULTIFACTORIAL ETIOLOGY OF ANEMIA AMONG THE INUIT? ....................................... 33

VENUE 3 .................................................................................................................................................................................. 33

Social Determinants of Health #1 – Men’s Health ..................................................................................................................... 33

SOCIAL DETERMINANTS OF INUIT HEALTH .................................................................................................................................................................................. 33 DYNAMIC ATTITUDE TO HEALTH PROBLEMS IN THE MALE POPULATION DURING SOCIAL AND ECONOMIC CRISIS IN RUSSIA (WHO-MONICA-PSYCHOSOCIAL PROGRAM)........................................................................................................................................................................................................... 33 MEN’S ATTITUDE TO OWN HEALTH UNDER THE MICROSCOPE ................................................................................................................................................. 33 THE SOCIAL ECONOMY AND HEALTH IN NORTHERN CANADA ................................................................................................................................................. 34 USING KNOWLEDGE SYNTHESIS, TRANSLATION, AND EXCHANGE TO PUT THE DETERMINANTS OF HEALTH INTO ACTION IN NORTHERN COMMUNITIES ............................................................................................................................................................................................................................... 34 INUIT MEN TALK ABOUT HEALTH ................................................................................................................................................................................................. 34


VENUE 4 ................................................................................................................................................................................. 34

Database & Surveillance #1 ..................................................................................................................................................... 34

POPULATION HEALTH INDICATORS FOR FIRST NATIONS IN ALBERTA .................................................................................................................................... 34 MÉTIS HEALTH/WELL-BEING DATA COLLECTION: CONCEPTUAL SNAPSHOT OF FACTORS BEHIND DATA-PAUCITY AND ACTION STEPS........................ 34 COMMON DISEASES IN SIBERIAN NATIVES .................................................................................................................................................................................. 35 USING HEALTH NEEDS ASSESSMENT TO INFORM PRIMARY HEALTH CARE PLANNING .......................................................................................................... 35 ESTABLISHING AN INTERNATIONAL CIRCUMPOLAR COLLABORATIVE TUBERCULOSIS WORKING GROUP .......................................................................... 35 THE GREENLANDIC NATIONAL INPATIENT REGISTER AS A TOOL FOR HEALTH MONITORING AND RESEARCH IN GREENLAND ........................................ 35 NORTHERN RSV SURVEILLANCE: OBJECTIVES, METHODS, AND PRELIMINARY RESULTS ...................................................................................................... 36 ESTABLISHING A SENTINEL SURVEILLANCE SYSTEM FOR HIV-ASSOCIATED RISK BEHAVIOURS AMONG ABORIGINAL POPULATIONS IN CANADA ....... 36

VENUE 5 ..................................................................................................................................................................................37

Community Participatory Research Methods #2 .......................................................................................................................37

CLIMATE CHANGE AND HEALTH ADAPTATION IN NORTHERN FIRST NATION AND INUIT COMMUNITIES PROGRAM .......................................................... 37 YOUTH DRIVEN PARTICIPATORY RESEARCH IN AKLAVIK, NWT ................................................................................................................................................. 37 COMMUNITY-BASED APPROACH TO HEALTH RESEARCH IN THE ARCTIC: A CASE STUDY FROM NUNAVUT, CANADA ........................................................ 37 WATCHING OUR YOUTH LISTEN TO OUR ELDERS: BUILDING YOUTH CAPACITY TO INVESTIGATE HEALTH IMPACTS OF CLIMATE CHANGE AND OIL AND GAS DEVELOPMENT IN THE NWT .................................................................................................................................................................................................. 37

VENUE 6 ................................................................................................................................................................................. 38

Food Security #1 – Politics of Food .......................................................................................................................................... 38

ASSESSMENT OF CONTAMINANT AND DIETARY NUTRIENT INTERACTIONS IN THE INUIT HEALTH SURVEY ........................................................................38 MERCURY IN FISH AS A RESULT OF THE JAMES BAY HYDROELECTRIC DEVELOPMENT: PERCEPTIONS AND REALITIES ......................................................38 CONTAMINANTS, HEALTH, AND EFFECTIVE RISK ASSESSMENT & COMMUNICATION IN THE CIRCUMPOLAR NORTH.........................................................38 FOOD SECURITY REFERENCE GROUP: BUILDING THE EVIDENCE TO SUPPORT DECISION-MAKING AT POLICY AND COMMUNITY PLANNING LEVELS AND IMPROVE FOOD SECURITY FOR FIRST NATIONS AND INUIT...............................................................................................................................................38 COMMUNICATION PATHWAYS: HOW YOUNG INUIT WOMEN IN NUNATSIAVUT GET INFORMATION ON NUTRITION, HEALTH, AND ENVIRONMENTAL CONTAMINANTS ............................................................................................................................................................................................................................ 39 LEVELS OF ARSENIC, CADMIUM, LEAD, MERCURY, SELENIUM, AND ZINC IN VARIOUS TISSUES OF MOOSE HARVESTED IN THE DEHCHO, NORTHWEST TERRITORIES .................................................................................................................................................................................................................................. 39 THE INFLUENCE OF PSYCHOSOCIAL FACTORS ON FOOD RELATED BEHAVIOURS AMONG INUIT COMMUNITIES IN NUNAVUT: RESULTS FROM HEALTHY FOODS NORTH .............................................................................................................................................................................................................. 39

VENUE VIEWING ROOM ......................................................................................................................................................... 40

Video Session #1 ..................................................................................................................................................................... 40

“MAKKUKTUVUNGA, UPIMMAVUNGA” - I AM YOUNG AND I AM PROUD: A SCREENING OF A LIVE-TO-TAPE 2 HOUR CALL-IN PROGRAM ABOUT INUIT YOUTH, COPING SKILLS, AND ENDURANCE ................................................................................................................................................................................ 40

SESSION 3 .................................................................................................................................................................. 40

Monday, July 13, 8:30-10:00 AM .................................................................................................................................. 40

VENUE 1 .................................................................................................................................................................................. 40

Cancer #1 ................................................................................................................................................................................ 40

THE ROLE OF INTERLEUKIN-1 AND INTERLEUKIN RECEPTOR ANTAGONIST IN HEAD AND NECK SQUAMOUS CELL STUDIES: INITIAL STUDIES .............. 40 SURVIVAL OF HEAD AND NECK CANCER IN GREENLAND .......................................................................................................................................................... 40 DEVELOPING A TRADITIONAL FOOD GUIDE FOR ALASKA NATIVE CANCER PATIENTS ............................................................................................................41 THE PREVALENCE OF PROGNOSTIC AND TREATMENT FEATURES FOR BREAST CANCER SURVIVAL: ARE THEY DIFFERENT FOR FIRST NATIONS WOMEN COMPARED TO OTHER WOMEN IN ONTARIO, CANADA? ............................................................................................................................................................41

VENUE 2 ................................................................................................................................................................................. 41

Indigenous Research #2 .......................................................................................................................................................... 41

THE NATIONAL INUIT COMMITTEE ON ETHICS AND RESEARCH (NICER) ...................................................................................................................................41 TOWARDS DEVELOPING PRINCIPLES OF ETHICAL RESEARCH IN MÉTIS COMMUNITIES ........................................................................................................ 42 WHEN SCIENCE OUTPACES NATIVE POLITICAL WILL ................................................................................................................................................................. 42 EXPLORING PROCESSES IN HEALTH RESEARCH ETHICS IN CANADA’S NORTH ....................................................................................................................... 42 IN PURSUIT OF AN ‘INDIGENOUS’ EDUCATION: STUDENT REFLECTIONS IN ABORIGINAL HEALTH RESEARCH IN CANADA ............................................... 42


VENUE 3 .................................................................................................................................................................................. 43


BUILDING COMMUNITY CAPACITY - YUKON FIRST NATIONS’ HEALTH PROMOTION PLANNING SCHOOLS ......................................................................... 43 TLICHO COMMUNITY-BASED RESEARCH AND EVIDENCE-BASED INTERVENTIONS FOR STI PREVENTION .......................................................................... 43 HEALTH CARE DECISION-MAKING IN AN INUIT COMMUNITY .................................................................................................................................................... 43 THE DEVELOPMENT OF A HEALTH ACTION PLAN FOR CIRCUMPOLAR INUIT .......................................................................................................................... 43 WORKING ON THE LAND, WORKING OFF THE LAND .................................................................................................................................................................. 43

VENUE 4 ................................................................................................................................................................................. 44

Infectious Diseases #1 – HPV .................................................................................................................................................. 44

THE PREVALENCE OF HUMAN PAPILLOMAVIRUS AND ITS IMPACT ON CERVICAL DYSPLASIA IN NORTHERN CANADA ..................................................... 44 EVALUATING THE INTRODUCTION AND IMPACT OF THE HUMAN PAPILLOMAVIRUS VACCINE AMONG ALASKA NATIVE WOMEN ................................... 44 IMPROVING HPV PREVENTION AMONG ABORIGINAL PEOPLES ................................................................................................................................................ 44 INCIDENCE OF TYPE-SPECIFIC HPV IN A POPULATION OF INUIT WOMEN IN NUNAVIK, QUEBEC .......................................................................................... 45 HPV SURVEILLANCE: CORRELATION OF TYPE-SPECIFIC ONCOGENIC HPV WITH CERVICAL CANCER SCREENING FINDINGS IN NUNAVUT, CANADA ...... 45

VENUE 5 .................................................................................................................................................................................. 45

Food Security #2 – Politics of Food .......................................................................................................................................... 45

A COMMUNITY BASED INITIATIVE TOWARDS A SUSTAINABLE FOOD SECURITY STRATEGY FOR THE COMMUNITY OF OLD CROW, YUKON................... 45 WHAT DOES ‘FOOD SECURITY’ MEAN TO INUIT? INPUT INTO AN INUIT STRATEGY FOR INUIT OF NUNAAT ........................................................................ 45 FROM SURVIVAL TO NECESSITY: FOOD STORIES FROM THREE GENERATIONS OF LABRADOR INUIT-MÉTIS ...................................................................... 46 INDIGENOUS PEOPLES’ FOOD SYSTEMS FOR HEALTH: THREE CANADIAN INUIT AND FIRST NATIONS PROJECTS ............................................................. 46 ORAL HISTORY CONTRIBUTIONS TO UNDERSTANDING FOOD SECURITY TRENDS AND ADAPTATIONS: VUNTUT GWITCHIN FIRST NATION, YUKON, CANADA.......................................................................................................................................................................................................................................... 46 PROMOTING HEALTHIER FOOD OPTIONS IN CONJUNCTION WITH HEALTH FOODS NORTH: A RETAIL PERSPECTIVE ......................................................... 47 BUILDING CULTURAL PRIDE WITH TRADITIONAL FOODS (VIDEO) ............................................................................................................................................. 47

VENUE 6 .................................................................................................................................................................................. 47

Health Promotion & Social Marketing ...................................................................................................................................... 47

DON’T BE A BUTTHEAD CAMPAIGN- 5 YEARS EXPERIENCE WITH A SOCIAL MARKETING CAMPAIGN TARGETED TO YOUTH TOBACCO REDUCTION ...... 47 CLOTH DIAPER PILOT ..................................................................................................................................................................................................................... 47 HEALTHY SMILE HAPPY CHILD: RESEARCH AND EVALUATION OF A CAPACITY BUILDING ORAL HEALTH PROMOTION INITIATIVE .................................. 48 YOUTH AND TOBACCO: WORKING WITH THE K’ÁLEMI DENE SCHOOL .................................................................................................................................... 48 NORTH STARSS (START THINKING ABOUT REDUCING SECONDHAND SMOKE) ...................................................................................................................... 48

VENUE 7 ................................................................................................................................................................................. 48

Clinical Care #2 ....................................................................................................................................................................... 48

PHYSIOTHERAPY IN NUNAVUT: OBSERVATIONS AND CHALLENGES FOR PRACTICE ............................................................................................................. 48 DEATH & DYING: PERSPECTIVES OF A FIRST NATIONS COMMUNITY IN THE NORTHWEST TERRITORIES ............................................................................. 48 ABORIGINAL PATIENT NAVIGATORS: FACILITATING ACCESS TO MAINSTREAM HEALTH SERVICES FOR ABORIGINAL PEOPLE ......................................... 49 PARTNERSHIPS IN HEALTH CARE INFRASTRUCTURE DEVELOPMENT IN NUNAVUT ............................................................................................................... 49

SESSION 4 .................................................................................................................................................................. 50

Monday, July 13, 1:30-3:30 PM .................................................................................................................................... 50

VENUE 1 .................................................................................................................................................................................. 50

Indigenous Pedagogy in Mental Health Workshop: Healing Teachings for Mental Health Workers, Valuable Knowledge for Clients ..................................................................................................................................................................................... 50

VENUE 2 .................................................................................................................................................................................. 50

Education & Building Resource/Research Capacity #1 .............................................................................................................. 50

DEVELOPING A PHYSICIAN SERVICES PROGRAM IN NUNAVUT 1999-2009 .............................................................................................................................. 50 PROPOSAL FOR A STANDARD PRIMARY CARE PHYSICIAN COMMUNITY COVERAGE MODEL FOR THE NORTHWEST TERRITORIES ................................... 51 DISTRIBUTION OF PHYSICIANS, NURSES, AND PHARMACISTS IN NORTHERN CANADA .......................................................................................................... 51 COMMUNITY-BASED HEALTH CARE IN ACTION ........................................................................................................................................................................... 51


HEADING A SÁMI HEALTH INSTITUTION: EXPERIENCE AND CHALLENGES .............................................................................................................................. 52 LAND BASED EXPERIENTIAL INDIGENOUS CULTURE AND HEALTH TRAINING ........................................................................................................................ 52 IMPROVING ACCESS AND OUTCOMES IN CANADA’S NORTHERN TERRITORIES ...................................................................................................................... 52

VENUE 3.................................................................................................................................................................................. 52

Indigenous Wellness & Medical History #3 ............................................................................................................................... 52

HISTORICAL AND SOCIAL EFFECTS OF LEGISLATION AND POLICY IN ABORIGINAL HEALTH ................................................................................................. 52 A SOCIAL AND ENVIRONMENTAL HISTORY OF HEALTH CARE RELOCATIONS IN THE CANADIAN NORTH SINCE 1890 ......................................................... 53 “ARE YOU NOW A QALLUNAQ?” INUIT TUBERCULOSIS EVACUEES IN THE 1940S-1950S ......................................................................................................... 53 HISTORICAL AND SCIENTIFIC PERSPECTIVES ON HEALTH OF CANADA’S FIRST PEOPLES....................................................................................................... 53 THE HEALTH OF FIRST NATIONS CHILDREN UPON ADMISSION TO A RESIDENTIAL SCHOOL IN A NORTHERN MANITOBA COMMUNITY .......................... 53 MY GRANDMOTHER’S MOCCASINS ............................................................................................................................................................................................. 54 CAREGIVING IN CONFINEMENT: JAPANESE IMMIGRANT MIDWIVES DURING WORLD WAR II ................................................................................................ 54

VENUE 4 ................................................................................................................................................................................. 54

Infectious Diseases #2 – Tuberculosis ...................................................................................................................................... 54

HARMONY, BALANCE, AND RESILIENCE: ENHANCING ADHERENCE TO TB TREATMENT IN CANADIAN ABORIGINAL POPULATIONS ............................... 54 VITAMIN D RECEPTOR GENE POLYMORPHISMS IN A CANADIAN FIRST NATIONS POPULATION WITH TB ............................................................................ 54 REVIEW OF MANAGEMENT OF THE 2007 YELLOWKNIFE TB OUTBREAK ...................................................................................................................................55 TUBERCULOSIS AND VITAMIN D IN GREENLAND.........................................................................................................................................................................55 TUBERCULOSIS INFECTION AMONG INUIT CHILDREN IN GREENLAND .....................................................................................................................................55 MANITOBA'S ABORIGINAL PEOPLE AND TB: HOW SOCIAL CONDITIONS AND BEHAVIOURS CONTRIBUTE TO THE ELEVATED RATES ............................. 56

VENUE 5 ................................................................................................................................................................................. 56

Food Security #3 – Factors affecting Food Security .................................................................................................................. 56

FACTORS INFLUENCING DIET AND THE FOOD ENVIRONMENT IN TWO INUIT COMMUNITIES IN NUNAVUT: QUALITATIVE FORMATIVE RESEARCH RESULTS FROM HEALTHY FOODS NORTH .................................................................................................................................................................................. 56 CLIMATE CHANGE IMPACTS AND ADAPTATION: IMPLICATIONS FOR DIET AND HEALTH IN TWO FIRST NATION COMMUNITIES IN THE YUKON, CANADA......................................................................................................................................................................................................................................................... 56 CLIMATE CHANGE AND FOOD SECURITY AMONG FEMALES IN AN INUIT COMMUNITY ......................................................................................................... 56 INUIT WOMEN AND CLIMATE CHANGE ......................................................................................................................................................................................... 57 PREVALENCE AND DETERMINANTS OF FOOD SECURITY AMONG INUIT HOUSEHOLDS WITH PRESCHOOL AGED CHILDREN ............................................ 57 HEALTH BELIEFS AND DIETARY COMPOSITION AMONG INUIT LIVING IN NUNAVUT, CANADA .............................................................................................. 57 THE IMPACT OF HELIOPHYSICAL FACTORS ON MAN LIFESPAN IN THE CIRCUMPOLAR REGIONS. PERSPECTIVES OF USAGE OF THE HELIO-GEROPROTECTORS ........................................................................................................................................................................................................................ 57

VENUE 6 ................................................................................................................................................................................. 58

Chronic Diseases #1 ................................................................................................................................................................ 58

INFLAMMATORY MARKERS FOR PATIENTS ISCHEMIC HEART DISEASE (IHD) IN THE CONDITIONS OF YAKUTIA ................................................................. 58 ASSOCIATION OF THE CONTENTS OF BASAL INSULIN WITH LIPIDE METABOLISM AND PREVALENCE OF CHOLELITHIASIS AND ISCHEMIC HEART DISEASE IN POPULATION OF EASTERN SIBERIA ......................................................................................................................................................................... 58 VITAL EXHAUSTION AND MYOCARDION INFARCTION (EPIDEMIOLOGICAL RESEARCH ON BASIS OF PROGRAM WHO MONICA-PSYCHOLOGICAL) ....... 58 DO THE OBESE GREENLANDERS CONSIDER THEMSELVES OBESE? BODY SIZE PERCEPTION AND OBESITY IN RELATION TO DEMOGRAPHIC FACTORS58 STUDY OF LEFT VENTRICULAR STRUCTURALLY-FUNCTIONAL CONDITION IN PATIENTS WITH CORONARY ARTERY DISEASE AND ACCOMPANYING ARTERIAL HYPERTENSION ............................................................................................................................................................................................................ 59 SPECTRUM OF FATTY ACIDS IN BLOOD SERUM AND PREVALENCE OF CHOLELITHIASIS IN MONGOLOIDS AND EUROPOIDS OF SIBERIA ....................... 59 ADAPTATION OF CARDIOVASCULAR SYSTEM AT HIGH PHYSICAL ACTIVITY IN THE NORTH ................................................................................................. 59 COMMUNITY DIABETES WORKERS COME TO LIFE ..................................................................................................................................................................... 60 TRADITIONAL DIET FOR OBESITY AND DIABETES IN A FIRST NATIONS COMMUNITY ............................................................................................................. 60

VENUE 7 .................................................................................................................................................................................. 60

Injury Prevention ..................................................................................................................................................................... 60

DROWNING PREVENTION IN THE NWT & NUNAVUT: RESULTS FROM A THREE YEAR STUDY ................................................................................................ 60 FIRST NATIONS AND INUIT CHILDREN AND YOUTH INJURY INDICATORS PROJECT ................................................................................................................ 61 A SURVEY OF INJURIES PRESENTING TO HOSPITAL AND A COMMUNITY HEALTH CENTRE IN NUNAVUT, CANADA ........................................................... 61


WORKER FATALITIES IN THE ALASKA TOURISM INDUSTRY: 1990-2008 .................................................................................................................................... 61 HEALTH HAZARDS OF THE ARCTIC/SUBARCTIC MOOSE ............................................................................................................................................................ 62 HEALTH HAZARDS OF NORTH AMERICAN ANIMAL VEHICLE ACCIDENTS ................................................................................................................................ 62 THE CANADIAN RED CROSS EXPERIENCE IN INJURY PREVENTION ........................................................................................................................................... 62 COMMUNITY-BASED PARTICIPATORY RESEARCH APPROACH TO UNINTENTIONAL INJURY PREVENTION IN THE YUKON ................................................ 62

SESSION 5 .................................................................................................................................................................. 62

Monday, July 13, 4:00-5:30 PM .................................................................................................................................... 62

VENUE 1 ................................................................................................................................................................................. 62

Mental Health & Wellness #3 – Trauma at the Front Line ........................................................................................................ 62

MENTAL HEALTH AND ADDICTIONS IN THE NORTHWEST TERRITORIES: PERSPECTIVES FROM THE FRONTLINE SERVICE PROVIDERS ........................... 62 BEYOND VICARIOUS TRAUMA - HELPING OURSELVES AS WE HELP OTHERS .......................................................................................................................... 63 SECONDARY TRAUMA AND NORTHERN HELPING PRACTITIONERS ......................................................................................................................................... 63 ETHNIC DISCRIMINATION AND BULLYING IN THE SÁMI AND NON-SÁMI POPULATIONS IN NORWAY: THE SAMINOR STUDY ........................................... 63 MEASURING THE HEALTH EFFECTS OF HISTORICAL AND CONTEMPORARY CULTURAL LOSSES .......................................................................................... 63

VENUE 2 ................................................................................................................................................................................. 64

Sexual Health #1 ..................................................................................................................................................................... 64

LIFE QUALITY IN HIV-INFECTED GREENLANDERS ....................................................................................................................................................................... 64 AN ADOLESCENT FOCUS GROUP PROJECT ON SEXUALLY TRANSMITTED DISEASE, HIV/AIDS, AND UNPLANNED PREGNANCY ...................................... 64 COMING OF AGE: HOW YOUNG WOMEN IN THE NORTHWEST TERRITORIES UNDERSTAND BARRIERS AND FACILITATORS TO POSITIVE, EMPOWERED, AND SAFER SEXUAL HEALTH ........................................................................................................................................................................................................ 64 HIV/AIDS AND THE LIFESAVERS CAMPAIGN: PREVENTION AND EDUCATION ACROSS INUIT NUNAAT................................................................................. 64 SOCIAL AND CULTURAL FACTORS INFLUENCING SEXUAL HEALTH IN GREENLAND .............................................................................................................. 65 THE IMPORTANCE OF COMMUNITY INVOLVEMENT IN IDENTIFYING BARRIERS TO CONTRACEPTIVE USE AMONG ADOLESCENTS IN RURAL AND REMOTE SETTINGS ........................................................................................................................................................................................................................ 65

VENUE 3 .................................................................................................................................................................................. 65

Genetics .................................................................................................................................................................................. 65

ASSOCIATION BETWEEN PERIODONTITIS AND RHEUMATOID ARTHRITIS IN CREE AND OJIBWAY POPULATIONS: A STUDY OF GENE-ENVIRONMENT EFFECTS .......................................................................................................................................................................................................................................... 65 EXPLORING THE IMPACT OF LONG QT SYNDROME IN A BRITISH COLUMBIA FIRST NATIONS COMMUNITY ........................................................................ 66 A REVIEW OF COMMUNITY-BASED PARTICIPATORY APPROACH TO GENETIC AND GENOMIC RESEARCH IN AMERICAN INDIAN/ALASKA NATIVE POPULATION ................................................................................................................................................................................................................................. 66 GENETIC VARIABILITY IN CIRCADIAN RHYTHMS IN AN ARCTIC MAMMAL THAT MAY HAVE HEALTH IMPLICATIONS FOR PEOPLE LIVING IN CIRCUMPOLAR REGIONS............................................................................................................................................................................................................... 66 GENETIC REGULATION OF CIRCULATING FATTY ACIDS IN ALASKAN ESKIMOS ....................................................................................................................... 66 INTERETHNIC DIFFERENCES IN FREQUENCY OF ALLELES AND GENOTYPES OF POLYMORPHIC MARKERS OF CARDIOVASCULAR DISEASES IN YAMALO-NENETS AUTONOMOUS OKRUG (RUSSIA) ...................................................................................................................................................................................67 POLYMORPHISMS AND MUTATIONS IN GJB2 ASSOCIATED WITH HEREDITARY HEARING LOSS IN EAST GREENLANDERS .................................................67 APOLIPOPROTEIN E POLYMORPHISM IN NATIVE POPULATION OF MOUNTAIN SHORIA (WEST SIBERIA) AND ITS ASSOCIATION WITH SERUM GLUCOSE LEVELS .............................................................................................................................................................................................................................................67

VENUE 4 ................................................................................................................................................................................. 68

Infectious Diseases #3 – Tuberculosis ...................................................................................................................................... 68

PREVALENCE OF LATENT TB INFECTION (LTBI) AMONG SCHOOL CHILDREN IN GREENLAND ............................................................................................... 68 TUBERCULOSIS AMONG CHILDREN AND YOUTH IN THE ARCTIC FROM GREENLAND POINT OF VIEW ................................................................................. 68 ASSESSING THE EPIDEMIOLOGICAL METHODS USED IN A TUBERCULOSIS OUTBREAK IN NORTHWEST TERRITORIES, CANADA ..................................... 68 THE DETERMINANTS OF TUBERCULOSIS TRANSMISSION IN THE CANADIAN-BORN POPULATION OF THE PRAIRIE PROVINCES: THE QUALITATIVE FINDINGS IN MANITOBA................................................................................................................................................................................................................ 68 TUBERCULOSIS IN INDIGENOUS PEOPLE OF MURMANSK REGION, RUSSIA ............................................................................................................................ 69 RIDING THE WAVES OF RECENT TB & SYPHILIS OUTBREAKS IN YELLOWKNIFE, NT- PLANNING, PARTNERSHIPS, PERSISTENCE ...................................... 69

VENUE 5 ................................................................................................................................................................................. 69

Climate Change – Health Impacts ............................................................................................................................................ 69

IS HEAT A MORTALITY RISK IN THE CANADIAN ARCTIC? WILL IT BE? ........................................................................................................................................ 69


CLIMATE CHANGE IMPACT ON PUBLIC HEALTH IN THE RUSSIAN ARCTIC- FIRST ASSESSMENT ............................................................................................. 70 CLIMATE CHANGE IMPACT ON HUMAN EXPOSURE TO PERSISTENT CONTAMINANTS IN ARCTIC RUSSIA ............................................................................ 70 CLIMATE CHANGE CHALLENGES TO ARCTIC HEALTH (AN EXAMPLE OF THE NORTHERN PEOPLES OF YAKUTIA) ............................................................... 70 SEASONAL VARIATIONS OF MORTALITY FROM CLIMATE-RELATED CAUSES IN ARCTIC CITIES .............................................................................................. 70 THE HEALTH OF ARCTIC POPULATIONS: DOES COLD MATTER? ................................................................................................................................................ 71

VENUE 6 ..................................................................................................................................................................................71

Pathways to Knowledge, Pathways to Health Workshop ..........................................................................................................71

VENUE VIEWING ROOM ..........................................................................................................................................................71

Video #2 ..................................................................................................................................................................................71

NUTARAQTAARNIQ NUNALINGNIRMIUNUT ALIANAIPPUQ- BIRTH A JOYOUS COMMUNITY EVENT: A SCREENING OF A LIVE-TO-TAPE 2-HOUR CALL-IN PROGRAM ABOUT INUIT MATERNITY CARE ................................................................................................................................................................................. 71

SESSION 6 .................................................................................................................................................................. 72

Tuesday, July 14, 8:30-10:00 AM ................................................................................................................................. 72

VENUE 1 .................................................................................................................................................................................. 72

Mental Health & Wellness #4 – Suicide & Addictions ............................................................................................................... 72

SUICIDE ATTEMPTS AND ALCOHOL DEPENDENCE IN GREENLAND........................................................................................................................................... 72 SUICIDE AMONG INDIGENOUS SÁMI IN ARCTIC NORWAY 1970-1998 ......................................................................................................................................... 72 A CULTURAL MODEL OF SUICIDE PREVENTION FOR CARRIER FIRST NATIONS YOUTH ........................................................................................................... 72 THE ETHNIC AND CULTURAL FEATURES OF COURSE OF ALCOHOLISM IN INDIGENOUS PEOPLES OF THE NORTH OF KHABROVSK TERRITORY ............. 73 GAMBLING: A NEW PLAYER IN GREENLANDIC PUBLIC HEALTH RESEARCH .............................................................................................................................. 73

VENUE 2 ..................................................................................................................................................................................73

Women’s & Family Health & Well-Being #1 – Fetal Alcohol Spectrum Disorder .........................................................................73

CULTURALLY APPROPRIATE RESPONSES TO FASD .................................................................................................................................................................... 73 VIEWING AND UNDERSTANDING FETAL ALCOHOL SPECTRUM DISORDER FROM A DISABILITY PERSPECTIVE..................................................................... 73 A COMPREHENSIVE APPROACH TO FETAL ALCOHOL SPECTRUM DISORDER .......................................................................................................................... 74 AN EDUCATION OF HEART, HAND, MIND, AND SPIRIT- THE BLANKET TOSS TOOLS FOR SCREENING, ASSESSMENT, AND INTERVENTION OF FASD AND OTHER DEVELOPMENTAL CONDITIONS- A RELATIONAL SYSTEMS APPROACH ...................................................................................................................... 74 PERSONAL ECOLOGY AND ENVIRONMENTAL STRUGGLES FOR BIRTH MOTHERS OF CHILDREN WITH FETAL ALCOHOL SPECTRUM DISORDER ............ 74 YUKON FAS DIAGNOSIS TEAM; DEVELOPMENT OF A TEAM- MOUNTAINS TO CLIMB, VALLEYS TO CROSS .......................................................................... 74

VENUE 3.................................................................................................................................................................................. 74

Food Security #4 – How Are We Eating? .................................................................................................................................. 74

PEOPLE DO NOT EAT N-3 FATTY ACIDS, THEY EAT MEALS ......................................................................................................................................................... 74 DETERMINANTS OF CHANGE IN FAT CONSUMPTION PATTERNS IN NAIN, NEWFOUNDLAND ................................................................................................ 75 THE ASSESSMENT OF BONE MINERAL DENSITY, CALCIUM, AND VITAMIN D INTAKE AND EXPOSURE IN BRITISH ANTARCTIC SURVEY PERSONNEL ...... 75 AN ASSESSMENT OF DIETARY INTAKE IN AN INUVIALUIT POPULATION TO HIGHLIGHT FOODS FOR A NUTRITIONAL INTERVENTION PROGRAM TO IMPROVE DIETARY INTAKE: RESULTS FROM HEALTH FOODS NORTH ...................................................................................................................................... 75 FOOD AND NUTRIENT INTAKE OF INUIT ADULTS AND THE DEVELOPMENT OF A QUANTITATIVE FOOD FREQUENCY QUESTIONNAIRE TO EVALUATE A NUTRITIONAL AND LIFESTYLE INTERVENTION PROGRAM AIMED AT IMPROVING DIETARY INTAKE AND HEALTH: RESULTS FROM HEALTHY FOODS NORTH .............................................................................................................................................................................................................................................76 QUALITY ASPECTS OF THE INUIT DIET IN GREENLAND ...............................................................................................................................................................76 INFLUENCE OF CASUAL WEAR AND EVERYDAY DIET ON HEALTH .............................................................................................................................................76

VENUE 4 .................................................................................................................................................................................. 77

Infectious Diseases #4 – Hepatitis............................................................................................................................................. 77

FREQUENCY AND DISTRIBUTION OF HEPATITIS B VIRUS GENOTYPES IN GREENLAND ASSOCIATION WITH PRECORE AND BASAL CORE PROMOTER MUTATIONS .................................................................................................................................................................................................................................... 77 GENOTYPIC CHARACTERIZATION OF HEPATITIS B VIRUS FROM CHRONIC CARRIERS LIVING IN THE CANADIAN NORTH .................................................... 77 A POPULATION BASED PERSPECTIVE AND RETROSPECTIVE STUDY OF LIVER RELATED MORTALITY IN ALASKA NATIVE PEOPLE WITH HEPATITIS C INFECTION ....................................................................................................................................................................................................................................... 77 ABORIGINAL IMMUNITY: POTENTIAL CONTRIBUTION TO THE OUTCOME OF HEPATIC INFECTION AND DISEASE ............................................................... 77 LONG-TERM PROTECTION AFTER HEPATITIS B IMMUNIZATION IN ALASKA NATIVE PEOPLE................................................................................................. 78


MOLECULAR EPIDEMIOLOGY OF VIRAL HEPATITIS B, C, AND D IN THE CHUKOT REGION ....................................................................................................... 78

VENUE 5 .................................................................................................................................................................................. 78

Education and Building Resource/Research Capacity #2 ........................................................................................................... 78

BY THE NORTH FOR THE NORTH: A PAN-TERRITORIAL STRATEGY TO BUILD PUBLIC HEALTH CAPACITY............................................................................. 78 PUBLIC HEALTH PROFESSIONAL DEVELOPMENT ONLINE: SUCCESSES AND CHALLENGES ...................................................................................................79 PUBLIC HEALTH SKILLS ONLINE: PILOT FOR NORTHERN ABORIGINAL WORKERS ...................................................................................................................79 CREATING HEALTH RESEARCH CAPACITY: THE ABORIGINAL HEALTH NETWORK PARTNERSHIPS FOR BRITISH COLUMBIA AND THE WESTERN ARCTIC79 THE NATIONAL COLLABORATING CENTRE FOR ABORIGINAL HEALTH: A CENTRE FOR SHARING KNOWLEDGE ................................................................. 80 SUSTAINING HEALTH RESEARCH ACTIVITIES IN CANADA’S NORTHERN TERRITORIES ........................................................................................................... 80 A PAN-ARCTIC COLLABORATIVE FOR E-HEALTH: NEED, VALUE, AND LESSONS ..................................................................................................................... 80 INTRODUCING INTERNET COMMUNICATIONS TECHNOLOGIES TO A NORTHERN HEALTH CONTEXT: BEST PRACTICES AND POTENTIAL IMPLICATIONS......................................................................................................................................................................................................................................................... 80

SESSION 7 .................................................................................................................................................................. 81

Tuesday, July 14, 1:30-3:30 PM .................................................................................................................................... 81

VENUE 1 .................................................................................................................................................................................. 81

Housing & Infrastructure .......................................................................................................................................................... 81

HOUSING CONDITIONS AND TUBERCULOSIS: EXPLORING THE RELATIONSHIP BETWEEN DISEASE AND ENVIRONMENT IN NORTHERN FIRST NATIONS COMMUNITIES ................................................................................................................................................................................................................................81 YOU JUST BLINK AND IT CAN HAPPEN: WOMEN’S HOMELESSNESS NORTH OF 60 ..................................................................................................................81 EVERYONE WANTS TO HAVE A PLACE?: UNDERSTANDING HOMELESSNESS AS HOUSING INSECURITY IN THE NORTHWEST TERRITORIES, CANADA ...81 ACUTE INFECTIOUS DIARRHEAL ILLNESS IN A FIRST NATIONS COMMUNITY IN NORTHERN MANITOBA, CANADA: EPIDEMIOLOGY AND THE IMPACT OF WATER, SANITATION, AND HOUSING ...........................................................................................................................................................................................81 ALASKA’S GREAT THIRST: WATER, ENERGY, AND HEALTH IN IÑUPIAQ COMMUNITIES OF THE NORTHWEST ARCTIC BOROUGH ..................................... 82 THE ROLE OF HOUSING AS A DETERMINANT OF HEALTH FOR INUIT IN CANADA ................................................................................................................... 82 LESSONS FOR HERE AND NOW. PUVALLUTUQ: THE ESKIMO POINT TB EPIDEMIC OF 1963 AND THE CONTEMPORARY HOUSING CRISIS IN INUIT COMMUNITIES ............................................................................................................................................................................................................................... 82 INDOOR AIR QUALITY ISSUES IN FIRST NATIONS AND INUIT COMMUNITIES IN CANADA ...................................................................................................... 82

VENUE 2 .................................................................................................................................................................................. 83

Women’s Health & Well-Being #2 ............................................................................................................................................ 83

CAN THE FETAL FIBRONECTIN ASSAY AT TERM BE USED TO SAFELY DELAY EVACUATION OF RURAL WOMEN FROM THEIR HOME COMMUNITIES? .....83 SPECIAL DELIVERY: TRANSPORTING IÑUPIAT MOTHERS AND BABIES IN NORTHWEST ALASKA ...........................................................................................83 ARE INCREASING NUMBERS OF CESAREAN SECTIONS PLACING A BURDEN ON CANADA’S HEALTH CARE SYSTEM? ..........................................................83 INUIT MIDWIFERY AND MATERNAL CHILD HEALTH .................................................................................................................................................................... 84 MÉTIS CONCEPTS OF HEALTHY PREGNANCY: A LOOK AT EFFECTIVE HEALTH PROMOTION, CULTURAL SAFETY, AND CONCEPTS OF WELL-BEING ..... 84 “KEEPING MYSELF WELL”: THE RELATIONSHIPS OF PERINATAL HEALTH BENEFITS AND HEALTH PROMOTION PRACTICES OF TLICHO WOMEN .......... 84 INTRODUCTION OF MIDWIFERY SERVICES AND CLIENT SATISFACTION .................................................................................................................................. 85 HISTORICAL NARRATIVES AND HUMAN KINDS: THE EVOLUTION OF INUIT CHILDBIRTH INTO THE 21ST CENTURY ............................................................ 85

VENUE 3 .................................................................................................................................................................................. 85


BILL C-51: PROPOSED FEDERAL REGULATION OF TRADITIONAL MEDICINE ............................................................................................................................ 85 ENHANCING EXISTING COMMUNITY HEALTH CAPACITY AND INFRASTRUCTURE BY FOCUSING ON THE INTEGRATION OF INUVIALUIT, GWICH’IN, AND WESTERN MEDICINE APPROACHES TO PALLIATIVE CARE ......................................................................................................................................................... 85 INDIGENIZING CHILD WELFARE MODELS: METHODS AND OUTCOMES ................................................................................................................................... 85 GETTING IT RIGHT: USING POPULATION SPECIFIC, COMMUNITY-BASED RESEARCH TO ADVANCE THE HEALTH AND WELL-BEING OF FIRST NATIONS, INUIT, AND MÉTIS IN CANADA ...................................................................................................................................................................................................... 86 GEGENOATATOLTIMG (SHARING THE KNOWLEDGE): A TRADITIONAL FIRST NATIONS GATHERING TO SUPPORT HEALTH AND HEALING IN CANADA 86

VENUE 4 ................................................................................................................................................................................. 86

Infectious Diseases #5 – H.Pylori, Superbugs, etc. ................................................................................................................... 86

EPIDEMIOLOGY OF HAEMOPHILUS INFLUENZAE SEROTYPE A FROM 2000-2007, AN EMERGING PATHOGEN IN NORTHERN CANADA AND ALASKA ..... 86 MYCOPLASMA GENITALIUM IN GREENLAND: PREVALENCE, MACROLIDE RESISTANCE, ETHICAL CONSIDERATIONS, AND POLICY IMPLICATIONS ........ 87


MONITORING AND MITIGATING PARASITIC RISKS TO HUMAN HEALTH IN AN INDIGENOUS COMMUNITY FROM NORTHERN SASKATCHEWAN.............. 87 SUPERBUGS IN THE NWT ............................................................................................................................................................................................................... 87 CA-MRSA OUTBREAK IN NUNAVUT, CANADA: KNOWLEDGE OF SOCIAL NETWORKS IS KEY TO TARGETING CONTROL MEASURES ................................ 88 CA-MRSA IN A NORTHERN COMMUNITY DESCRIPTION OF OUTBREAK AND POSSIBLE CONTROL ....................................................................................... 88 METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS: A COMMUNITY-ASSOCIATED CONCERN IN LABRADOR ................................................................ 88

VENUE 5 ................................................................................................................................................................................. 88

Education and Building Resource/Research Capacity #3 .......................................................................................................... 88

PROVIDING LIBRARY SERVICES TO CONTRIBUTE TO CAPACITY BUILDING AND KNOWLEDGE TRANSLATION IN THE CANADIAN NORTH ....................... 88 KSTE AND THE NORTH: HOW KNOWLEDGE SYNTHESIS, TRANSLATION, AND EXCHANGE OF EVIDENCE CAN INFORM CIRCUMPOLAR HEALTH ............ 89 THE CIRCUMPOLAR HEALTH BIBLIOGRAPHIC DATABASE ......................................................................................................................................................... 89 THE ARCTIC HUMAN HEALTH INITIATIVE: THE ONLINE RESOURCE AT WWW.ARCTICHEALTH.ORG...................................................................................... 89 BRINGING EVIDENCE TO THE NORTH: CADTH’S LIAISON OFFICERS ASSIST WITH INFORMED DECISION MAKING............................................................... 90 A CONTENT ANALYSIS OF WEBSITES FEATURING INUIT HEALTH INFORMATION ................................................................................................................... 90 AN INTERNATIONAL PALLIATIVE CARE SYMPOSIUM: USING VIDEO TELECONFERENCING AND VIRTUAL TECHNOLOGY TO MEET THE NEEDS OF RURAL HEALTH CARE PROVIDERS ............................................................................................................................................................................................................ 90 COLLABORATIVE PRACTICE: WALKING THE TALK ...................................................................................................................................................................... 90

VENUE 6 ................................................................................................................................................................................. 91

Chronic Diseases #2 ................................................................................................................................................................ 91

CVD AND ITS RELATION TO RISK FACTORS IN ALASKA ESKIMOS: THE GOCADAN STUDY ..................................................................................................... 91 HEART RATE IS ASSOCIATED WITH RED BLOOD CELL FATTY ACID CONCENTRATION: THE GOCADAN STUDY ................................................................... 91 RELATIONSHIPS AMONG LIPOPROTEIN SUBFRACTIONS AND CAROTID ATHEROSCLEROSIS: THE GOCADAN STUDY ....................................................... 91 CARDIOVASCULAR DISEASES IN NATIVE POPULATION OF YAMAL PENINSULA (RUSSIA) ...................................................................................................... 92 DIFFERENT TYPES OF CORONARY LESIONS AND THEIR IMPACT ON COURSE AND OUTCOMES OF EARLY ACUTE MYOCARDIAL INFARCTION IN THE RUSSIAN NORTH ............................................................................................................................................................................................................................ 92 CARDIOVASCULAR DISEASES AND THEIR RISK FACTORS IN THE ASIAN PART OF RUSSIA ..................................................................................................... 92 NEW METHOD OF RESPIRATORY BIOFEEDBACK ........................................................................................................................................................................ 92 EPIDEMIOLOGY OF CORONARY HEART DISEASE IN A POPULATION OF THE CIRCUMPOLAR REGION (RUSSIA) .................................................................. 92

SESSION 8 .................................................................................................................................................................. 93

Tuesday, July 14, 4:00-5:30 PM ................................................................................................................................... 93

VENUE 1 .................................................................................................................................................................................. 93

Mental Health & Wellness #5 – Children & Youth ..................................................................................................................... 93

THE INFLUENCE OF RELIGIOUS FACTORS ON DRINKING BEHAVIOUR AMONG YOUNG INDIGENOUS SÁMI AND NON-SÁMI PEERS IN NORTHERN NORWAY ........................................................................................................................................................................................................................................ 93 SNUFF USE AND CIGARETTE SMOKING AMONG INDIGENOUS SÁMI AND NON-SÁMI 10TH GRADERS IN NORTHERN NORWAY 2003-2005 ...................... 93 CHALLENGING THE STEREOTYPE: A PORTRAIT OF HEALTHY INDIGENOUS YOUTH PARTICIPANTS AT THE COWICHAN (BRITISH COLUMBIA, CANADA) 2008 NORTH AMERICAN INDIGENOUS GAMES ........................................................................................................................................................................... 93 FAMILY HEALTH AND WELL-BEING: RESEARCH, RESPONSIBILITY, REACTION ........................................................................................................................ 94 THE APPLICATION OF STRENGTH BASED ASSESSMENTS AND INTERVENTIONS WITH CHILDREN AND ADOLESCENTS EXPERIENCING MENTAL HEALTH DIFFICULTIES .................................................................................................................................................................................................................................. 94 THREE CHILDREN ON ONE BIKE: AN ANTHROPOLOGICAL STUDY WITH ON WHAT CHILDREN ARE CAPABLE OF AND WHAT CHILDREN WANT .............. 94

VENUE 2 ................................................................................................................................................................................. 94

Occupational Health ................................................................................................................................................................ 94

PSYCHODYNAMIC ANALYSIS OF ANTARCTIC INTERGROUPS RELATIONS ............................................................................................................................... 94 RASCH ANALYSIS OF THE OSWESTRY DISABILITY INDEX .......................................................................................................................................................... 94 OCCURRENCE AND RISK FACTORS OF FROSTBITES AT THE POPULATION LEVEL WITH A SPECIAL EMPHASIS ON WORKING LIFE .................................... 95 NUTRITION, VITAMINS, SERUM LIPIDS, AND CARDIOVASCULAR DISEASES RISK IN DRIVERS WORKED IN GAS INDUSTRY ON THE NORTH OF RUSSIA .. 95 PSYCHOPHYSIOLOGICAL ASPECTS OF ADAPTATION OF OIL SHIFT WORKERS ....................................................................................................................... 95 HUMAN HEALTH RISK ASSESSMENT AND BEYOND – THE COMMUNITY HEALTH ................................................................................................................... 96

VENUE 3.................................................................................................................................................................................. 96

Newborn & Child Health #1 – Birth Defects.............................................................................................................................. 96


THE INCIDENCE OF SEVERE CONGENITAL DEFECTS IN NORWAY AND NORTHWEST RUSSIA ................................................................................................ 96 CHART REVIEW ANALYSIS OF MATERNAL FACTORS AND MAJOR MALFORMATIONS ON BAFFIN ISLAND 2000-2005 ......................................................... 96 CONGENITAL ANOMALIES IN CANADA’S NORTHERN TERRITORIES ......................................................................................................................................... 96 RATES OF HOSPITALIZATION FOR LUNG INFECTION OF INUIT INFANTS FROM THE BAFFIN REGION AND ASSOCIATION WITH HEART DEFECTS 2000-2005 ..................................................................................................................................................................................................................................................97 THE STATE OF BIRTH DEFECTS AND BIRTH OUTCOME SURVEILLANCE IN THE CIRCUMPOLAR REGIONS OF THE WORLD IN 2008 .....................................97

VENUE 4 .................................................................................................................................................................................. 97

Education and Building Resource/Research Capacity #4 ........................................................................................................... 97

THE SAFETY OF SMALL DRINKING WATER SYSTEMS IN CANADA: DISCUSSING THE NORTHERN PERSPECTIVE ...................................................................97 BUILDING INDIGENOUS CAPACITY TO MEET HEALTH NEEDS AND COMBAT HEALTH DISPARITIES: A MANITOBA (CANADA) EXPERIENCE ...................... 98 INCREASING HIV/AIDS COMMUNITY-BASED RESEARCH CAPACITY IN NORTHERN ABORIGINAL COMMUNITIES IN CANADA ............................................. 98 YUKON FIRST NATION ................................................................................................................................................................................................................... 98 ANISHINABE HEALTH PLAN .......................................................................................................................................................................................................... 98 ONTARIO FIRST NATIONS PUBLIC HEALTH PROJECT: TRIPARTITE APPROACH ....................................................................................................................... 99 THE TRIPARTITE FIRST NATIONS HEALTH PLAN- A FUNDAMENTAL CHANGE IN GOVERNANCE OF HEALTH SERVICES FOR THE FIRST NATIONS OF BRITISH COLUMBIA, CANADA ....................................................................................................................................................................................................... 99 COLLABORATIVE RESEARCH IN NUNAVUT: A CASE HISTORY ................................................................................................................................................... 99

VENUE 5 ................................................................................................................................................................................ 100

Community Participatory Methods #1 (workshop) ................................................................................................................. 100

COMMUNITY-BASED PARTICIPATORY RESEARCH – CBPR 101 FOR THE ARCTIC: OVERVIEW OF THE HISTORY, DISTINCTIVE FEATURES, ADVANTAGES, AND PRACTICAL TIPS CONCERNING THIS EMERGING APPROACH IN HEALTH RESEARCH .....................................................................................................100

VENUE 6 ................................................................................................................................................................................ 100

Chronic Diseases #3 ............................................................................................................................................................... 100

WHAT AGE GROUPS AND WHICH CAUSE OF DEATH CONTRIBUTE MOST TO THE LOWER LIFE EXPECTANCY OF THE INUIT-INHABITED AREAS OF CANADA? .......................................................................................................................................................................................................................................100 DIABETES AMONG ALASKA NATIVE PEOPLE – A 21 YEAR OVERVIEW ......................................................................................................................................100 THE EFFECT OF TRADITIONAL FOODS ON INSULIN RESISTANCE AMONG INUIT IN GREENLAND AND NUNAVIK ...............................................................100 DO-IT-YOURSELF DIABETES PREVENTION ACTIVITIES: AN INTERACTIVE MANUAL FOR COMMUNITY-BASED DIABETES EDUCATION ............................ 101 INDIVIDUAL SATURATED FATTY ACIDS ARE ASSOCIATED WITH DIFFERENT COMPONENTS OF INSULIN RESISTANCE AND GLUCOSE METABOLISM: THE GOCADAN STUDY ......................................................................................................................................................................................................................... 101 TYPE II DIABETES MELLITUS IN GREENLAND: THE IMPACT OF ELECTRONIC DATABASE IMPLEMENTATION ON THE QUALITY OF DIABETES CARE ....... 101 A DESCRIPTION OF PHYSICAL ACTIVITY AND BODY MASS INDEX IN THREE INUVIALUIT COMMUNITIES: RESULTS FROM HEALTHY FOODS NORTH ....102 IMPLEMENTATION OF A PROGRAM TO PREVENT CHRONIC DISEASE RISK AMONG THE INUVIALUIT: PROCESS EVALUATION FINDINGS FROM HEALTHY FOODS NORTH ..............................................................................................................................................................................................................................102 CONSUMPTION OF HIGH FAT, HIGH SUGAR FOODS BY INUVIALUIT ADULTS: RESULTS FROM HEALTHY FOODS NORTH .................................................102

VENUE VIEWING ROOM ........................................................................................................................................................ 102

Video #3 ................................................................................................................................................................................ 102

ANGUTIILLI QANUILIQPAT… HOW ARE WE AS MEN? A SCREENING OF A LIVE-TO-TAPE 2-HOUR CALL-IN PROGRAM ABOUT INUIT MEN’S HEALTH .....102

SESSION 9 .................................................................................................................................................................103

Wednesday, July 15, 8:30-10:00 AM ...........................................................................................................................103

VENUE 1 ................................................................................................................................................................................ 103

Mental Health & Wellness #6 – Children and Youth ................................................................................................................ 103

CAMP COHO: A CULTURALLY APPROPRIATE GRIEF CAMP FOR ALASKA NATIVE CHILDREN ................................................................................................. 103 THE ROLE OF MENTORING ABORIGINAL YOUTH PARTICIPANTS OF THE COWACHIN (BRITISH COLUMBIA, CANADA) 2008 NORTH AMERICAN INDIGENOUS GAMES .................................................................................................................................................................................................................... 103 INFLUENCE OF ADVERSE ECOLOGICAL FACTORS ON PSYCHOPHYSIOLOGICAL AND EMOTIONAL CONDITION OF TEENAGERS LIVING IN THE EUROPEAN NORTH OF RUSSIA .................................................................................................................................................................................................... 103 SEXISM/SEXUAL HARASSMENT IN SCHOOLS AND ITS CONNECTIONS WITH SEXUALIZED VIOLENCE IN INTIMATE RELATIONSHIPS IN ADULTHOOD...104 ON THE LAND CANOE TRIP FOR YOUTH AND ELDERS SUPPORTING MENTAL HEALTH AND WELLNESS ............................................................................104

VENUE 2 ................................................................................................................................................................................ 104

Service Delivery & Infrastructure #1 – Health Service Delivery ................................................................................................ 104


HEALTH TECHNOLOGY ASSESSMENTS ON TELEHEALTH ........................................................................................................................................................104 TELEHEALTH IN GREENLAND ......................................................................................................................................................................................................104 IMPLEMENTING ON E-HEALTH PROGRAM IN CANADA’S MOST CHALLENGED REGION ........................................................................................................ 105 EXPANDING CLINICAL TELEHEALTH IN ALBERTA FIRST NATIONS ........................................................................................................................................... 105 TELESPEECH LANGUAGE PATHOLOGY ...................................................................................................................................................................................... 105 VIDEO RESUSCITATION SAVE LIVES IN REMOTE COMMUNITIES .............................................................................................................................................. 105

VENUE 3................................................................................................................................................................................ 105

Education and Building Resource/Research Capacity #5 – Nursing Education ........................................................................ 105

NURSING IN THE ARCTIC: GREENLANDIC NURSE’ PERSPECTIVE .............................................................................................................................................. 105 “I HAVE TOLD MY COLLEAGUES: WHEN I WORK I AM WHITE” ABOUT THE EXPERIENCES OF GREENLANDIC AND INUIT NURSES AND NURSING STUDENTS .................................................................................................................................................................................................................................... 106 NURSES FOR NUNATSIAVUT ...................................................................................................................................................................................................... 106 THE NURSE AS CARE ASSESSOR AND PRACTITIONER IN GREENLAND ................................................................................................................................... 106 SHIFTING FROM CULTURAL COMPETENCE TO CULTURAL SAFETY ........................................................................................................................................ 106 PERSPECTIVES OF SOCIAL DETERMINANTS OF HEALTH: A COMPARATIVE ANALYSIS OF NURSING AND SOCIAL WORK EDUCATION ............................ 107

VENUE 4 ................................................................................................................................................................................ 107

Infectious Diseases #6 ............................................................................................................................................................ 107

PREVALENCE OF CHRONIC OTITIS MEDIA IN GREENLAND OVER A 25-YEAR PERIOD ............................................................................................................. 107 AKLAVIK H.PYLORI PROJECT TREATMENT PHASE: SEEKING AN EFFECTIVE THERAPY FOR A CANADIAN ARCTIC HAMLET ............................................... 107 GASTRIC EPITHELIAL CELL APOPTOSIS IN PATIENTS WITH CHRONIC HELICOBACTER PYLORI ASSOCIATION ANTRUM GASTRITIS AMONG NATIVE AND ALIEN INHABITANTS OF EASTERN SIBERIA ................................................................................................................................................................................ 107 A HAART FULL OF LIFE: VARIATIONS IN QUALITY OF LIFE AMONG ABORIGINAL AND NON-ABORIGINAL PEOPLES EVER ON ANTIRETROVIRAL THERAPY........................................................................................................................................................................................................................................................108 THE INCIDENCE RATES OF THE GASTRIC CANCER AND PREVALENCE OF HELICOBACTER PYLORI AT THE POPULATION OF EASTERN SIBERIA .............108 THE ASSOCIATION OF HELICOBACTER PYLORI CAG A STRAINS PREVALENCE WITH ULCER DISEASES IN SIBERIA MONGOLOIDS ...................................108

VENUE 5 ............................................................................................................................................................................... 109

Food Security #5 – Food Security and Indigenous Wellness: Knowledge to Action PART A..................................................... 109

SESSION 10 .............................................................................................................................................................. 109

Wednesday, July 15, 1:30-3:30 PM ............................................................................................................................. 109

VENUE 1 ................................................................................................................................................................................ 109

Focusing on Children and Families in Northern Canada: Moving Forward with University/Community Partnerships ............... 109

CHILD HEALTH RESEARCH IN A NORTHERN CANADIAN CONTEXT: ROLES AND RESPONSIBILITIES OF AN ACADEMIC DEPARTMENT OF PEDIATRICS . 109 OPTIMAL DRUG THERAPY FOR CHILDREN ................................................................................................................................................................................ 109 COMMUNITY-BASED INJURY SURVEILLANCE RESEARCH ........................................................................................................................................................ 109 FASD RESEARCH ACROSS THE PROVINCE ................................................................................................................................................................................. 109 COMMUNITY READINESS TO ENGAGE IN FASD RESEARCH ..................................................................................................................................................... 109 FIRST NATION-UNIVERSITY PARTNERSHIP: LAXGALTS’AP VILLAGE GOVERNMENT’S PARTNERSHIP WITH UNIVERSITY-BASED RESEARCHER ............. 109 A PARTICIPATORY APPROACH TO ADDRESSING LONG QT SYNDROME IN A LARGE NORTHERN BC COMMUNITY ........................................................... 109

VENUE 2 ............................................................................................................................................................................... 109

Indigenous Pedagogy on Mental Health Workshop ................................................................................................................ 109

VENUE 3................................................................................................................................................................................ 109

Newborn & Child Health #2 – Maternal Health & Surveillance ................................................................................................ 109

A DETAILED COMPARISON OF PERINATAL MORTALITY BETWEEN NORTHERN NORWAY AND MURMANSK COUNTRY (RUSSIA) ................................... 109 REMOTE MIDWIFERY IN NUNAVIK: PERINATAL OUTCOMES 2000-2007 ................................................................................................................................... 110 BIRTH OUTCOMES AMONG FIRST NATIONS, INUIT, AND NON-INDIGENOUS WOMEN IN NORTHERN QUEBEC .................................................................. 110 THE DEVELOPMENT OF A COMPREHENSIVE MATERNAL CHILD HEALTH SURVEILLANCE SYSTEM FOR NUNAVUT ........................................................... 110 THE ANAANA PROJECT: MATERNAL HEALTH SURVEY IN THE QIKIQTANI REGION OF NUNAVUT ........................................................................................ 110 BREASTFEEDING INITIATION, DURATION, AND DETERMINANTS AMONG CANADIAN INUIT IN NUNAVUT .......................................................................... 111 DEVELOPMENT OF A PERINATAL SURVEILLANCE SYSTEM FOR THE NORTHWEST TERRITORIES, CANADA ....................................................................... 111


VENUE 4 ................................................................................................................................................................................ 111

Infectious Diseases #5............................................................................................................................................................ 111

INTERNATIONAL CIRCUMPOLAR SURVEILLANCE OF INVASIVE NON-TYPEABLE HAEMOPHILUS......................................................................................... 111 COMPARISON OF INVASIVE PNEUMOCOCCAL DISEASE RATES IN ALASKA AND NORTHERN CANADA FOLLOWING PCV7 INTRODUCTION.................... 112 RESPIRATORY SYNCYTIAL VIRUS: POTENTIAL TRENDS IN INFECTION OF CHILDREN IN NUNAVUT, CANADA .................................................................... 112 A TWO-YEAR SURVEILLANCE OF RESPIRATORY VIRUS IN SICK AND HEALTHY CHILDREN IN GREENLAND ......................................................................... 112 INVASIVE PNEUMOCOCCAL DISEASE IN ALASKAN CHILDREN: THE ROLE OF WATER SUPPLY AND THE SEVEN VALENT PNEUMOCOCCAL CONJUGATE VACCINE (PCV7) ............................................................................................................................................................................................................................. 113 A RANDOMIZED, PLACEBO-CONTROLLED TRIAL OF HEAT RECOVERY VENTILATORS FOR THE PREVENTION OF LOWER RESPIRATORY TRACT ILLNESS IN INUIT CHILDREN ....................................................................................................................................................................................................................... 113

VENUE 5 ................................................................................................................................................................................ 113

Food Security #5 – Food Security and Indigenous Wellness: Knowledge to Action PART B ..................................................... 113

VENUE 6 ................................................................................................................................................................................ 113

Service Delivery & Infrastructure #2 – Health Service Delivery ................................................................................................ 113

SPEECH LANGUAGE PATHOLOGY TELESPEECH SERVICE DELIVERY MODEL FOR REMOTE COMMUNITIES ........................................................................ 113 THE MANITOBA FIRST NATIONS PATIENT WAIT TIME GUARANTEE PILOT PROJECT.............................................................................................................. 114 VIRTUAL COMMUNITIES AS LOCATIONS .................................................................................................................................................................................... 114 TRACKING PUBLIC HEALTH FROM ORBIT: CSA EO SUPPORT TO EMERGENCIES, DISASTERS, DISEASES, ENVIRONMENT ................................................. 114 MEDICAL IMAGING IN NORTHERN CANADA: A STUDY BY THE CANADIAN RADIOLOGICAL FOUNDATION.......................................................................... 114 ABORIGINAL NURSES ASSOCIATION OF CANADA – CHANGING THE PICTURE OF ABORIGINAL HEALTH ............................................................................. 115

VENUE 7 ................................................................................................................................................................................ 115

Social Determinants of Health #2 .......................................................................................................................................... 115

SOCIAL DETERMINANTS OF INDIGENOUS HEALTH: THE JOURNEY OF CANADA’S FIRST NATIONS, INUIT, AND MÉTIS VOICES AT THE INTERNATIONAL LEVEL ............................................................................................................................................................................................................................................. 115 LOW PHYSICAL ACTIVITY AT WORK IS ASSOCIATED WITH SEX, OCCUPATION, AND COMMUNITY SIZE AMONG INUIT OF GREENLAND ......................... 115 REDUCING HEALTH DISPARITIES AND PROMOTING EQUITABLE ACCESS TO HEALTH CARE FOR ABORIGINAL PEOPLES ................................................. 116 SOCIAL CAPITAL AND THE WELL-BEING OF ABORIGINAL SINGLE MOTHERS ......................................................................................................................... 116 ROLE OF EDUCATION IN INFLUENCING COMMUNITY WELL-BEING ......................................................................................................................................... 116

SESSION 11 ...............................................................................................................................................................116

Thursday, July 16, 8:30 – 10:00 AM .............................................................................................................................116

VENUE 1 ................................................................................................................................................................................ 116

Mental Health & Wellness #7 – Attitudes and Experiences in Mental Health ........................................................................... 116

NATIONAL STRATEGY TO PREVENT ABUSE IN INUIT COMMUNITIES AND NATIONAL INUIT RESIDENTIAL SCHOOLS HEALING STRATEGY .................... 116 PSYCHOSOCIAL RISK FACTORS AMONG SÁMI WOMEN OF REINDEER HERDING FAMILIES ................................................................................................... 117 BORDERLANDS: A NARRATIVE INQUIRY INTO FIRST NATIONS’ WOMEN’S EXPERIENCES OF DEPRESSION ........................................................................ 117 EFFECTS OF CLIENT AND THERAPIST ETHNICITY AND ETHNIC MATCHING ............................................................................................................................. 117 AWARENESS OF THEIR HEALTH & HEALTH ATTITUDES IN MALES AND FEMALES AGED 25-64 YEARS DURING SOCIAL AND ECONOMIC CRISIS IN RUSSIA (MONICA-PSYCHOSOCIAL PROGRAM) ........................................................................................................................................................................................ 117 RESILIENCY AND INHALANT ABUSE TREATMENT ..................................................................................................................................................................... 118 MAKING THE PATH BY WALKING IT: A COMPREHENSIVE EVALUATION OF THE WOMEN AND CHILDREN’S HEALING AND RECOVERY PROGRAM ......... 118

VENUE 2 ................................................................................................................................................................................ 118

Sexual Health #2 ................................................................................................................................................................... 118

EVIDENCE-BASED STRATEGIES FOR SEXUAL HEALTH EDUCATION: ARE THEY CULTURALLY SAFE FOR ABORIGINAL COMMUNITIES? ........................... 118 PARTNERSHIP AND PROCESS IN COMMUNITY-BASED RESEARCH IN THE NORTH ................................................................................................................. 119 CONNECTING THE DOTS: SOCIAL DISPARITIES AMONG PEOPLE LIVING WITH HIV ON HAART ............................................................................................ 119 YOU’RE BREAKING MY HAART: HIV AND VIOLENCE AMONG A COHORT OF WOMEN ON TREATMENT IN BRITISH COLUMBIA, CANADA ........................ 119 REPORTING FROM GROUND ZERO: A SURVEY OF NUNAVUT HEALTH CARE PROFESSIONALS’ PERCEPTIONS ON SEXUALLY TRANSMITTED INFECTIONS........................................................................................................................................................................................................................................................ 119

VENUE 3 ................................................................................................................................................................................ 120


Human Biology #2................................................................................................................................................................. 120

IMMUNE HOMEOSTASIS IN CHILDREN OF THE FAR NORTH AT DIFFERENT VARIANTS OF VEGETATIVE MAINTENANCE OF ACTIVITY .............................120 THE BLOOD LYMPHOCYTES METABOLISM IN STRANGE POPULATION OF EVENKIAY, HEALTHY, AND WITH IMMUNE REACTIVITY DISTURBANCES .....120 THE DISTURBANCE OF IMMUNE SYSTEM FUNCTION IN PATIENTS WITH ACUTE LEUKEMIA IN SIBERIA ..............................................................................120 IMMUNE STATE CHARACTERISTICS IN NATIVE (SCANTY) POPULATION OF THE RUSSIAN FAR NORTH (YAMALO-NENETS AUTONOMOUS OKRUG) ..... 121 MICRO ELEMENTAL STATUS AND STRUCTURE OF SICKNESS RATE......................................................................................................................................... 121 POPULATION AND SUB-POPULATION CONTENT OF BLOOD LYMPHOCYTE AND CYTOKIN PROPHILE UNDER DIFFERENT CLINICAL PATHOGENIC FORMS OF ALLERY RHINOSINUSOPATHY .................................................................................................................................................................................. 121 THE BIOACTIVITY OF COMPLEX POP MIXTURES IN HUMAN SERUM AND THE POTENTIAL RELATION TO HEALTH EFFECTS .............................................122

VENUE 4 ............................................................................................................................................................................... 122

Database & Surveillance #2 ................................................................................................................................................... 122

IPY HEALTH SURVEY DATABASE MANAGEMENT SYSTEM AND META DATA 2007-2008 ........................................................................................................122 HEALTH SURVEILLANCE FOR FIRST NATIONS: DATA SOURCES AND LIMITATIONS ...............................................................................................................122 LINKING THE CANADIAN INDIAN REGISTRY SYSTEM TO THE MANITOBA PROVINCIAL HEALTH REGISTRY: LESSONS LEARNED ..................................... 123 MORTALITY OF MÉTIS CANADIAN AND REGISTERED INDIAN ADULTS: AN 11 YEAR FOLLOW-UP STUDY ............................................................................ 123 DOCUMENTATION CENTRE ON CHILDREN AND YOUTH IN GREENLAND ................................................................................................................................ 123

VENUE 5 ................................................................................................................................................................................123

Newborn & Child Health #3 – Child Health Determinants ........................................................................................................123

MORTALITY AFTER ADMISSION IN THE PEDIATRIC EMERGENCY DEPARTMENT OF REPUBLIC SAKHA (YAKUTIA).............................................................. 123 EARLY CHILD DEVELOPMENT AS A DETERMINANT OF HEALTH: EXPLORING THE CONTRIBUTION OF HOME VISITING ....................................................124 THE MAIN PROBLEMS OF CHILDREN’S HEALTH IN THE RUSSIAN FAR NORTH ........................................................................................................................124 PROPOSING INDICATORS REGARDING CHILD HEALTH ON THE FOCUS AREAS IN THE GREENLANDIC PUBLIC HEALTH PROGRAM..................................124 UNDERSTANDING OF ABORIGINAL CHILDREN IN ALBERTA - AN ANALYSIS OF CANADIAN ABORIGINAL CHILDREN’S SURVEY ........................................ 125 CORRELATES OF EMERGING OBESITY AMONG PRESCHOOL AGED CHILDREN: NUNAVUT CHILD INUIT HEALTH SURVEY ................................................ 125 PROGRESS TOWARDS OPTIMAL PEDIATRIC DRUG THERAPY: A NORTHERN CHILD/YOUTH HEALTH IMPERATIVE ............................................................. 125

POSTER SESSIONS .................................................................................................................................................. 126

Tuesday & Wednesday, July 14-15, 12:15-3:30 PM ..................................................................................................... 126

A B C ..................................................................................................................................................................................... 126

DEVELOPMENT AND IMPLEMENTATION OF AN ABORIGINAL FRAMEWORK AND MEASURES OF COMMUNITY HEALTH IN NORTHERN SASKATCHEWAN, CANADA........................................................................................................................................................................................................................................ 126 CULTURAL SAFETY AND KNOWLEDGE SHARING: WORK ON MENTAL WELLNESS AT THE INUIT TUTTARVINGAT OF NAHO ........................................... 126 BEHIND THE SCENES: MANAGEMENT OF LARGE EXTENDED FAMILY TREES FOR GENETIC ANALYSIS ............................................................................... 126 ARCTIC HEALTH WEB SITE: AN INFORMATION PORTAL TO ISSUES AFFECTING THE HEALTH AND WELL-BEING OF OUR PLANET’S NORTHERN-MOST INHABITANTS ............................................................................................................................................................................................................................... 126 FRUIT AND VEGETABLE CONSUMPTION AMONG INUVIALUIT OF THE NORTHWEST TERRITORIES: RESULTS FROM HEALTHY FOODS NORTH ............. 127 CHALLENGES TO TUBERCULIN SCREENING AND FOLLOW-UP IN AN URBAN ABORIGINAL SAMPLE IN MONTREAL, CANADA.......................................... 127 KNOWLEDGE AND PERCEPTIONS OF TUBERCULOSIS AMONG A SAMPLE OF URBAN ABORIGINAL PEOPLE ...................................................................... 127 CENTRE FOR SÁMI HEALTH RESEARCH ......................................................................................................................................................................................128 ELECTRONIC BULLYING IN TWO PROVINCIAL NORTH ELEMENTARY SCHOOLS ....................................................................................................................128 AURORA COLLEGE’S INTRODUCTION TO ADVANCED PRACTICE PROGRAM: PRODUCING ADVANCED-PRACTICE NURSES WITH NORTHERN-SPECIFIC SKILLS ............................................................................................................................................................................................................................................128 FOOD SECURITY IN NUNAVUT: A KNOWLEDGE SHARING TOOL FOR POLICY-MAKERS ........................................................................................................128 A RAPID, HIGHLY DISCRIMINATORY GENOTYPING METHOD FOR MYCOBACTERIUM TUBERCULOSIS ISOLATES IN MANITOBA, CANADA ......................128 PAN-TERRITORIAL PARTNERSHIP: SOCIAL MARKETING TOOLS IN SEXUAL HEALTH PROMOTION ..................................................................................... 129

D E F...................................................................................................................................................................................... 129

FOOD SOURCES AND DIETARY INTAKE OF VITAMIN D AND CALCIUM AMONG INUVIALUIT IN THE NWT: RESULTS FROM HEALTHY FOODS NORTH ... 129 RESILIENCY AND INHALANT ABUSE TREATMENT .................................................................................................................................................................... 129 PLACE OF RESIDENCE AND NEONATAL OUTCOME IN THE NORTHWEST TERRITORIES ........................................................................................................ 130 INTEGRATIVE APPROACHES TO INFECTIOUS DISEASE PREVENTION AND CONTROL IN CANADA’S NORTH ....................................................................... 130 PROVIDING LIBRARY SERVICES TO CONTRIBUTE TO CAPACITY BUILDING AND KNOWLEDGE TRANSLATION IN THE CANADIAN NORTH ...................... 130


A FOLLOW-UP STUDY OF BLOOD LEVELS OF PERSISTENT TOXIC SUBSTANCES (PTS) AMONG INDIGENOUS PEOPLE OF THE COASTAL CHUKOTKA, RUSSIA, 2001-2007 ........................................................................................................................................................................................................................ 131 CADTH’S HEALTH TECHNOLOGY INQUIRY SERVICE .................................................................................................................................................................. 131 EVALUATION OF HELICOBACTER PYLORI INFECTION IN PATIENTS WITH PATHOLOGY OF THE GASTROINTESTINAL TRACT ........................................... 131 EVALUATING THE TOXIC EFFECTS OF METHYLMERCURY ON NEUROTROPHIN CONFORMATION ....................................................................................... 132 ASSESSMENT OF DIETARY INTAKE IN AN INUVIALUIT POPULATION: RESULTS FROM HEALTHY FOODS NORTH .............................................................. 132 CARDIOVASCULAR REACTIONS IN HYPERTENSIVE PERSONS IN THE FAR NORTH ................................................................................................................. 132 ENDOTHELIAL DYSFUNCTION AND MYOCARDIAL REMODELING IN HYPERTENSIVE PATIENTS IN THE FAR NORTH.......................................................... 132 INTERCONNECTION OF CARDIAC STRUCTURAL-FUNCTIONAL CHANGES IN HYPERTENSIVE PATIENTS IN THE FAR NORTH ............................................ 133 RESILIENCY OF VASCULAR WALL IN HYPERTENSIVE PATIENTS IN THE FAR NORTH .............................................................................................................. 133 FACTORS THAT INFLUENCE THE BIOCHEMICAL CHARACTERISTICS AND HORMONES OF HYPOPHYSEAL-THYROID-ADRENAL SYSTEM OF MEN ......... 133

G H I ....................................................................................................................................................................................... 134

SLEEP DISTURBANCE AND RISK CARDIOVASCULAR DISEASES THE PERIOD OF 10 YEARS IN MEN 25-64 YEARS OF AGE IN RUSSIA ................................. 134 ARTERIAL HYPERTENSION AND PSYCHOSOCIAL FACTORS IN MALES AGED 25-64 YEARS IN RUSSIA (WHO MONICA-PSYCHOSOCIAL PROGRAM) ....... 134 AVERAGE LEVELS OF ARTERIAL PRESSURE AND PSYCHOSOCIAL FACTORS IN MALES AGED 25-64 YEARS IN RUSSIA (WHO MONICA-PSYCHOSOCIAL PROGRAM) .................................................................................................................................................................................................................................... 134 EPIDEMIOLOGY OF INVASIVE BACTERIAL DISEASES IN NORTHERN CANADA, 1999 TO 2007 ................................................................................................ 134 INFLAMMATORY MARKERS FOR PATIENTS WITH ISCHEMIC HEART DISEASE (IHD) AFFECTED BY CONDITIONS IN YAKUTIA ............................................ 135 A MEASURE OF RURAL PARTURIENT WOMEN’S EXPERIENCES OF PREGNANCY .................................................................................................................... 135 PLANNING THE OPTIMAL LEVEL OF LOCAL MATERNITY SERVICE FOR SMALL RURAL COMMUNITIES: A SYSTEMS STUDY IN BRITISH COLUMBIA ........ 135 HYPERTENSION IN CHUKOTKA INDIGENOUS POPULATION DURING THE LAST 20 YEARS .................................................................................................... 136 FIERY AVENS GIRLS EMPOWERMENT GROUP ............................................................................................................................................................................ 136 RANGIFERINE BRUCELLOSIS ON SOUTHAMPTON ISLAND, NUNVUT ...................................................................................................................................... 136 CLIMATE CHANGE, WATER QUALITY, AND HUMAN HEALTH IN NUNATSIAVUT, CANADA .................................................................................................... 136 PREVALENCE, RISK FACTORS AND CONSEQUENCES OF VITAMIN D DEFICIENCY AMONG INUIT CHILDREN ....................................................................... 137 SHARING HEALTH RESEARCH KNOWLEDGE AMONG NORTHERN COMMUNITIES: A MULTI-PRONGED APPROACH .......................................................... 137 EXPLORING PROCESSES IN HEALTH RESEARCH ETHICS IN CANADA’S NORTH ...................................................................................................................... 137 USE OF THE FETAL FIBRONECTIN TEST FOR DETECTING PRE-TERM LABOUR IN NUNAVUT 2004-2007................................................................................ 138 “SAFE IN A SWIM VEST” – COMMUNITY HEALTH REPRESENTATIVES AS WATER SAFETY CHAMPIONS ............................................................................... 138 ACUTE MASTOIDITIS IN GREENLAND BETWEEN 1994-2007 ...................................................................................................................................................... 138 NUTRIENT INTAKE AMONG INUIT IN THE CANADIAN ARCTIC: RESULTS FROM HEALTHY FOODS NORTH........................................................................... 138 QAMANITUAP NIQISIALIRIJIQUTINGIIT NUTARAQSALINGNUT: A COMMUNITY BASED PROGRAM FOR PRENATAL NUTRITION IN BAKER LAKE, NUNAVUT, CANADA ..................................................................................................................................................................................................................... 139 DEVIATIONS OF COGNITIVE FUNCTIONS IN OBESE HYPERTENSIVE PATIENTS ...................................................................................................................... 139 FINDING GENES FOR TYPE 2 DIABETES IN YAKUT POPULATION .............................................................................................................................................. 139 THE ARCTIC SOCIAL INDICATORS PROJECT ............................................................................................................................................................................... 139

J K L ....................................................................................................................................................................................... 140

MERCURY EXPOSURE AND LINKS TO HUMAN HEALTH IN A COMMUNITY IN TROMSØ, ARCTIC NORWAY ..........................................................................140 TRADITIONAL FOOD USE AND DIETARY ADEQUACY AMONG NUNAVUT PRESCHOOL CHILDREN .......................................................................................140 DEVELOPMENT OF A FOOD FREQUENCY QUESTIONNAIRE TO MEASURE DIETARY INTAKE IN AN ALASKAN NATIVE POPULATION ...............................140 THE FIRST HUMAN CASE OF Q FEVER IN THE ARCTIC - AN UNDERDIAGNOSED OR EMERGING INFECTION? ....................................................................... 141 A COST ANALYSIS OF THE UNIVERSITY OF MANITOBA NORTHERN MEDICAL UNIT’S DIABETIC RETINAL SCREENING PROGRAM FOR RURAL AND REMOTE COMMUNITIES ............................................................................................................................................................................................................... 141 DIABETIC RETINAL SCREENING IN RURAL/REMOTE FIRST NATION COMMUNITIES IN MANITOBA: SUCCESSES AND CHALLENGES ................................. 141 THE INDICATORS OF LIPID METABOLISM FROM THE RESIDENTS OF YAKUTIA....................................................................................................................... 141 TRACKING RISK: A REVIEW OF INFECTIOUS DISEASES WITHIN CIRCUMPOLAR POPULATIONS ............................................................................................142 MÉTIS HEALTH/WELL-BEING DATA COLLECTION: CONCEPTUAL SNAPSHOT OF FACTORS BEHIND DATA PAUCITY AND ACTION STEPS .......................142

M N O .................................................................................................................................................................................... 142

A REVIEW OF INUIT ONCOLOGY PATIENTS TREATED AT THE OTTAWA HOSPITAL CANCER CENTRE ..................................................................................142 THE PSYCHOSOCIAL DETERMINANTS OF DIET-RELATED BEHAVIORS AMONG THE INUVIALUIT: RESULTS FROM HEALTHY FOODS NORTH .................142 ENVIRONMENTAL DETERMINANTS OF PERIPHERAL CIRCULATION IN NORTHERN AND SOUTHERN SIBERIAN POPULATIONS - A COMPARISON .......... 143


SHARING YOUTH PERSPECTIVES ON MENTAL HEALTH AND WELLNESS: PHOTOVOICE PROJECT ...................................................................................... 143 PREVALENCE OF CLINICAL RISK FACTORS FOR OSTEOPOROSIS IN WOMEN 50 TO 69 YEARS; THE BONE HEALTH NUNAVIK (BOHN) PROGRAM .......... 143 CLIMATE CHANGE IMPACTS ON DIETARY NUTRIENT STATUS OF INUIT IN NUNAVUT, CANADA ..........................................................................................144 FROM RESEARCH TO PREVENTION IN GREENLAND ..................................................................................................................................................................144 THE HEALTH OF SÁMI ...................................................................................................................................................................................................................144 INNOVATIONS IN KNOWLEDGE TRANSLATION: CHILD INUIT HEALTH SURVEY RESULTS DVD ............................................................................................144 NEGOTIATING PATHWAYS TO ADULTHOOD: SOCIAL CHANGE, MENTAL HEALTH AND INDIGENOUS CULTURE ............................................................... 145 PROGRESSION OF RESEARCH IN CANADA’S ARCTIC: INTRODUCTION OF INUIT RESEARCH ADVISORS ............................................................................... 145 A REPORT OF THE JAPAN WORKSHOP ON ANTARCTIC MEDICAL RESEARCH AND MEDICINE – WE NEED A BROAD NETWORK OF ANTARCTIC MEDICAL RESEARCH ..................................................................................................................................................................................................................................... 145 THE STATUS OF LIPID PEROXIDATION OF SPORTSMEN IN CONDITIONS PREVAILING IN YAKUTIA ..................................................................................... 146 THE CYTOTOXICITY OF INDUSTRIAL AEROSOLS FORMED IN DIAMOND ................................................................................................................................ 146 HORMONAL STATUS AND PREVALENCE OF ENDOCRINE DISEASES IN WORKERS OF GOLD COMPANY “POLE” ............................................................... 146

P Q R S ................................................................................................................................................................................... 147

RISK FACTORS FOR IRON DEFICIENCY ANEMIA AMONG INUIT CHILDREN, AGES 3–5, LIVING IN NUNAVUT......................................................................... 147 A COST-CONSEQUENCE ANALYSIS OF THE NEW 10-VALENT PNEUMOCOCCAL NON-TYPEABLE HAEMOPHILUS INFLUENZAE PROTEIN-D CONJUGATE VACCINE SYNFLORIX™ AND PREVNAR™, ON THE REDUCTION OF ACUTE OTITIS MEDIA IN CHILDREN .............................................................................. 147 BACTERIAL VS. VIRAL PATHOGENS: A SYSTEMATIC REVIEW OF THE ETIOLOGY OF ACUTE OTITIS MEDIA ......................................................................... 147 INVASIVE PNEUMOCOCCAL DISEASE CAUSED BY SEROTYPES 1, 5 AND 7F IN CIRCUMPOLAR REGIONS ............................................................................. 147 IMMUNE HOMEOSTASIS IN CHILDREN OF THE FAR NORTH AT DIFFERENT VARIANTS OF VEGETATIVE MAINTENANCE OF ACTIVITY .............................148 NUTRIENT INTAKES AND VITAMIN D STATUS IN INUIT WOMEN 40 YEARS OF AGE AND OLDER ...........................................................................................148 ENVIRONMENTAL HEALTH – FROM EXPOSURE TO BIOMARKERS ...........................................................................................................................................148 DO PSYCHOLOGICAL STRENGTHS ACT AS PROTECTIVE FACTORS AGAINST EARLY ADOLESCENT BULLYING IN SCHOOLS? .......................................... 149 THE ASSOCIATION BETWEEN PSYCHOLOGICAL STRENGTHS AND THERAPEUTIC OUTCOME AMONG ADOLESCENTS RECEIVING RESIDENTIAL TREATMENT FOR SUBSTANCE ABUSE AT PROGRAM COMPLETION AND THREE MONTH FOLLOW-UP .............................................................................. 149 A JOURNEY TO THE TEACHINGS: A COMMUNITY APPROACH TO INJURY PREVENTION (2009) ............................................................................................ 149 USING A DVD TO ADMINISTER INFORMED CONSENT: IPY CHILD INUIT HEALTH SURVEY .................................................................................................... 149 FOOD SECURITY IN NUNAVUT: PRELIMINARY RESULTS FROM THE IPY ADULT INUIT HEALTH SURVEY .............................................................................. 150 A DAY IN THE LIFE OF THE IPY INUIT HEALTH SURVEY SHIP TEAM: PARTICIPANTS VISITING THE CCGS AMUNDSEN ......................................................... 150 THE PARTICIPATORY APPROACH TO THE IPY INUIT HEALTH SURVEY 2007/2008 ................................................................................................................... 150 DECLINE IN THE PREVALENCE OF NEURAL TUBE BIRTH DEFECTS, ALASKA, 1996-2004 ........................................................................................................ 151 INCREASED RISK OF HIRSCHPRUNG’S DISEASE AMONG ALASKA NATIVES IDENTIFIED FOLLOWING VERIFICATION OF REPORTED CASES, 1996-2006 . 151 THE EPIDEMIOLOGY OF TUBERCULOSIS IN THE CIRCUMPOLAR REGION OF CANADA, 1997 TO 2006 .................................................................................. 151 WHAT’S IN YOUR FREEZER? TRADITIONAL FOOD USE IN TWO FIRST NATIONS COMMUNITIES IN YUKON, CANADA ........................................................ 152 DYNAMICS OF HEMATOLOGICAL INDICATORS AS CLINICO-DIAGNOSTIC TEST SPORTSMEN’S ADAPTATION OF YAKUTIA TO PHYSICAL EXERCISES ... 152 COLLABORATION AND CONSULTATION IN INFECTIOUS DISEASE SURVEILLANCE AND PREVENTION IN CANADA’S NORTH ........................................... 152 PHYSICAL DEVELOPMENT AS A FACTOR OF CHILDREN’S HEALTH IN THE FAR NORTH (RUSSIA) ......................................................................................... 152 ASSESSMENT OF INTELLECTUAL DEVELOPMENT IN NATIVE CHILDREN OF YAMALO-NENETS AUTONOMOUS OKRUG (RUSSIA) ................................... 153 THE SÁMI PSYCHIATRIC YOUTH TEAM: A CULTURAL SENSITIVE TREATMENT APPROACH OF SUICIDAL BEHAVIOUR PROBLEMS AND SUBSTANCE ABUSE IN INDIGENOUS SÁMI ....................................................................................................................................................................................................... 153 PRIMARY BIRTHING ATTENDANTS AND BIRTH OUTCOMES IN REMOTE INUIT COMMUNITIES - A NATURAL “EXPERIMENT” IN NUNAVIK, CANADA ...... 153 ACTUAL NUTRITION AND CARDIOVASCULAR RISK FACTORS IN SIBERIA (1985-2005) ............................................................................................................ 154 SYSTEMATIC REVIEW OF EDUCATIONAL INTERVENTIONS TO INCREASE HIGH SCHOOL GRADUATION AMONG INDIGENOUS HIGH SCHOOL STUDENTS........................................................................................................................................................................................................................................................ 154

T U V W X Y Z ........................................................................................................................................................................ 154

SOME DEMOGRAPHIC PECULIARITIES OF LONGEVITY IN THE INDIGENOUS MINORITIES OF RUSSIA NORTH-EAST REGIONS .......................................... 154 THE CAREGIVER’S JOURNEY ........................................................................................................................................................................................................ 155 FEATURES OF THE CORONARY ARTERIES ATHEROSCLEROSIS AND ITS EVOLUTION IN INHABITANTS OF YAKUTIA FOR 40-YEAR PERIOD .................... 155 INFLUENCE OF MIGRATION AND DURATION OF RESIDING IN CONDITIONS OF THE NORTH ON ATHEROSCLEROTIC PROCESS CURRENT ...................... 155 THE BASIC DIRECTIONS OF WORK OF THE YAKUT SCIENCE CENTRE OF COMPLEX MEDICAL PROBLEMS SB RAMS ........................................................... 156 WAY OF DEFINITION OF DEEP TISSUES TEMPERATURE AFTER COLD IMPACT IN PRE-REACTIVE PERIOD............................................................................ 156 HEALTH STATE OF SMALL IN NUMBERS PEOPLE CHILDREN OF THE NORTH OF YAKUTIA .................................................................................................... 156


THE POPULATION HISTORY OF SAKHA (YAKUTS) IN CONNECTION WITH PREVALENCE OF SOME HEREDITARY DISEASES .............................................. 157 FEATURES OF CLINICAL -FUNCTIONAL CHANGES IN ABORIGINALS OF YAKUTIA WITH THE VERIFIED CORONARY ATHEROSCLEROSIS ......................... 157 IMPLEMENTING A NUTRITION INTERVENTION PROGRAM AMONG THE INUIT IN NUNAVUT: STORE-CENTERED ACTIVITIES OF HEALTHY FOODS NORTH........................................................................................................................................................................................................................................................ 157 ETHICAL ASPECTS IN THE ENVIRONMENTAL HEALTH RESEARCH ........................................................................................................................................... 157 THE CLINICAL-MORPHOLOGICAL PECULIARITIES OF GASTRODUODENAL PATHOLOGY IN EVENKIAY CHILDREN ............................................................. 158 THE REASONS OF SUICIDAL BEHAVIOUR OF SIBERIA NATIVE POPULATION .......................................................................................................................... 158 CREATING MODELS FOR MOTHER’S WELLNESS THROUGH PARTNERSHIP RESEARCH: A COMMUNITY PARTNER EXPERIENCE ....................................... 158 NORTHERN BREASTFEEDING VIDEO ........................................................................................................................................................................................... 158 IMPACTS OF CLIMATE CHANGE ON INUIT DIET IN THE WESTERN ARCTIC: LINKS BETWEEN CLIMATE CHANGE, FOOD SECURITY AND NUTRITIONAL HEALTH.......................................................................................................................................................................................................................................... 159 ETHICAL AND CULTURAL IMPLICATIONS OF SPECIMEN BANKING AMONG ALASKA NATIVE PEOPLE: HISTORICAL PROJECT. ......................................... 159

Presenters’ Index ...................................................................................................................................................... 160

By Initials & Surname ............................................................................................................................................................. 160

Notes ........................................................................................................................................................................ 165

21 SESSION 1: VENUE 1

SESSION 1 Sunday, July 12, 1:30-3:30 PM

VENUE 1 Mental Health & Wellness #1 – Holistic & Healing

Community Programs

DEVELOPING SÁMI MENTAL HEALTH SERVICE: FROM VISION TO IMPLEMENTATION

V. Stordahl

Sámi National Centre for Mental Health (SANKS)

In the mid 1980s the county municipality of Finnmark, Norway, decided with the chairman’s casting vote, to establish an institution with a particular responibility to develop a mental health service for the Sámi people in the county.

The vision of those arguing for the need of an mental health institution in the hearth of Sámiland was to develop a service that were responsive to the Sámi people’s need. Those who were against this idea, politicians and pofessionals alike, either argued that this was violating the Norwegian notion of equality or that it would be impossible to staff it with the required specialists/clinicians.

In 2002 the institution achieved status as a Sámi national centre for mental health. In twenty years time the institution had gone from a staff of 8, none of them specialists, to a staff of close to 120 staffed by specialist as well as researchers, and a budget of 77 million Norwegian kroner (11 million US Dollar).

This paper identifies and analyses how the challenges in developing a mental health service for the Sámi people integrated in the ordinary Norwegian health services, were met by the staff. Contact: Vigdis Stordahl ([email protected])

FROM THE HEART PLACE - HOLISTIC HEALTH

M. Petit

Churchill Regional Health Authority

The present health care system of the High North can be argued is a reflection on Southern Health Care principles which has failed the North at not fault of anyone. A new approach needs to be examined one that reflects prevention and care plans that are designed by Northern Aboriginals. Therefore this presentation will focus on what Northern Health means for Northern residence and look at the 5 domains of Aboriginal health and Sothern care workers can incorporate these five domains into health care plans. The reality is that a majority of health care is presently provided in Southern hospitals and clinics with little to no insight on the reality of the North. The five domains are Emotional Health, Mental, Physical and Spiritual Health which are defined in a wheel developed when I was a director of social services in Nunavut. Contact: Michel Petit ([email protected])

THE UTILIZATION OF NATURE IN HEALING FOR CANADA’S ABORIGINAL PEOPLES

R. McCormick

University of British Columbia

“The earth does not belong to humans. Humans belong to the earth”. Chief Seattle spoke these words when he addressed the United States Government in 1854. It was the case even 155 years ago that many humans thought that they owned the earth. It was thought that the

natural world was something that humans were destined to conquer and control. It is not surprising that many peoples of the earth have forgotten that the natural world is a tremendous source of guidance, sustenance and healing. Aboriginal peoples of “turtle island” (North America) have never forgotten that the earth teaches us how to lead a good life, a healthy life. Examples of how nature provides us with healthy healing resources will be provided in this presentation by such teachers as the rivers, oceans, forests, mountains, the sky, trees, rocks, fire, open spaces, the wind, animals, birds, and fish. Some of the outcomes of healing that can be obtained from these teachings will be discussed such as: cleansing, perspective, connecting, grounding, empowerment, and guidance. Contact: Rod McCormick ([email protected])

THE EMERGING ISSUE OF CRYSTAL METHAMPHETAMINE USE IN FIRST NATIONS COMMUNITIES

J. Robbins

First Nations Centre of the National Aboriginal Health Organization

Crystal methamphetamine use among people in some First Nations communities (both in Canada and the United States) has evolved into an issue that is requiring more and more attention. Indicative of this, in July of 2005, the Assembly of First Nations (AFN) in Canada passed a resolution specifically directed at this emerging issue.

As a result of this resolution, the AFN has identified the need for the development of a First Nations National Task Force on Crystal Meth to develop a Strategic Action Plan to Address the Emerging issue of Crystal Meth in First Nations Communities. Generally speaking, this paper provides basic information about crystal methamphetamine as well as information that is First Nations specific.

The first part of the paper discusses: what crystal meth is; who is using it; how it used; how it is made and; how it affects the body, mind, relationships and the environment.

In Part II, interactions between governments (e.g.: health/drug strategies), large pharmaceutical companies and organized crime are examined (e.g.: production levels of amphetamines). The role that these entities play in activities surrounding the production and sale of crystal methamphetamine—with an emphasis on issues related to First Nations’ is articulated. First Nations crystal meth treatment strategies are also examined.

Part III, aspires to put a “human face” on the rising problem of crystal methamphetamine addiction in First Nations communities. Tala Tootoosis’ (Plains Cree/Nakota) story is briefly stated and the crystal meth addiction situation across the border on the Navajo Nation is commented upon. These examples aim to illustrate how crystal meth addiction has negatively affected a First Nations individual and the devastating impact the drug has had on one Native American community.

While the emergence and use of crystal meth is a relatively new phenomenon (i.e.: compared to other mind altering agents), the issue of addiction is nothing new. While it is important to focus on the specifics of how to most effectively deal with meth production and use, it is also just as important not to overly focus on it. For instance, Michael Siever of the Stonewall project in San Francisco notes that even with the introduction of crystal methamphetamine into the addiction picture, the crack cocaine problem is still as prevalent as ever. Thus, just because crystal methamphetamine is now part of the “addictions picture” does not mean addictive behaviours with regard to other substances will magically go away. Thus, especially for First Nations, effective holistic substance abuse strategies should be taken into consideration. Contact: Julian Robbins ([email protected])


HIGH RATE OF SELF-PERCEIVED HIV-RELATED STIGMA AMONG A COHORT OF INDIVIDUALS ACCESSING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY IN BRITISH COLUMBIA

D. Tzemis1, E.F. Druyts1, J.I. Forrest1,2, T.R. Orchard3, W. Zhang1, K.A. Fernandes1, E.K. Brandson1, J.S.G. Montaner1,4, R.S. Hogg1,2 1British Columbia Centre for Excellence in HIV/AIDS, 2Faculty of Health Sciences, Simon Fraser University, Burnaby BC, 3Faculty of Health Sciences, University of Western Ontario, London ON, 4Department of Medicine, University of British Columbia, Vancouver BC

Background: Research indicates that self-perceived stigma is an inhibitor to adhering to prescribed antiretroviral therapy and contributes to nondisclosure of HIV-positive status. Consequently, stigma affects prevention and treatment efforts as well as significantly impacting a person’s psychological well-being. We examine the prevalence and factors associated with self-perceived HIV-related stigma among a cohort of individuals receiving HAART in British Columbia.

Methods: Data are drawn from the Longitudinal Investigation into Supportive and Ancillary Health Services (LISA) study. LISA participants completed an interviewer-administered survey, which included questions on socio-demographics, stigma, depression, quality of life, and perception of standard of living. Clinical variables, which included CD4 count, viral load, and adherence, were obtained through the British Columbia HIV/AIDS Drug Treatment Program. Categorical variables were compared using Fisher’s Exact Test and continuous variables were assessed using the Wilcoxon Rank-Sum Test. Multivariable logistic regression was performed to determine the independent predictors of self-perceived HIV-related stigma.

Results: Forty-six percent of participants self-perceive HIV-related stigma. In the adjusted multivariate analysis depression was associated with perceiving stigma (adjusted odds ratio [AOR] 2.04, 95% CI 1.22-3.41), along with four quality of life variables: health worries, financial worries, disclosure worries and sexual function (AOR 0.72, 95% CI 0.64-0.82; AOR 0.89, 95% CI 0.80-0.99; AOR 0.61, 95% CI 0.53-0.70; and AOR 0.87, 95% CI 0.77-0.99). Participants who reported lower standards of living compared to neighbours were more likely to perceive stigma (AOR 0.40 95% CI 0.2.-0.80).

Conclusion: Further efforts are needed to support the mental and emotional well-being of those who access treatment. Our study identifies depression, poor quality of life and poor standard of living as independent variables associated with perceiving HIV-related stigma. These factors must be addressed when implementing effective and sustainable programs designed to reduce stigma and improve the lives of people living with HIV/AIDS. Contact: Eirikka Brandson ([email protected])

VENUE 2 Indigenous Research #1

JOURNEY OF AN OUTSIDER: IN SEARCH OF A RESPECTIVE RESEARCH PARADIGM

B. Walberg

Athabasca University

In January 2006, I began to contemplate the development of my final research project for the completion of my Masters of Arts in Integrated Studies at Athabasca University. I wanted to work with an Indigenous community, but knew that the past history of outsiders doing research was a contentious issue. As a result, exploring the perspective of Indigenous peoples concerning the problems with past research in Indigenous communities, and reviewing the issues and suggestions for appropriate protocols, considerations and methods for outsider research, became prerequisites for the development of my own research project. This paper reviews the findings and explores my own

process and analysis as I develop a research process that is mindful of these issues. Contact: Barbara Walberg ([email protected])

CONSTRUCTING AN INDIGENOUS-CENTERED AND DECOLONIZING RESEARCH METHODOLOGY

G. Baikie

Dalhousie University (faculty), Memorial University (student)

I wanted to investigate the traditional and contemporary Indigenous knowledge being used and created by an international group of Indigenous health professionals within their neocolonial practice settings. This resulted in a number of challenges for the creation of an appropriate qualitative research methodology:

- What constitutes an Indigenous community and can a community span international boundaries?

- Can Indigenous knowledge be both localized and globalized? - How to actually build a methodology that adheres to the

principles of Indigenous ownership, control, access, and possession within the constraints of the academy and requirements of a PhD thesis?

- How to address the inadequacy of interview methods given that cultural knowledge is typically tacit and beneath practitioner awareness?

- How to discern Indigenous knowledge from Euro-western knowledge given the domination of Euro-western knowledge particularly within professions?

- How to ensure that the research process and product did not inadvertantly contribute to the continued colonization of Indigenous peoples?

First and foremost, as both an academic and Indigenous researcher I needed to create a methodology with integrity. In other words, the research needed to adhere to the spirit and intent of the principles underlying emerging ethical standards for research involving Indigenous peoples . This lead to the construction of a research project that I termed “Indigenous-centered” as I explicitly privileged Indigenous ways-of-knowing, values, attitudes, practices, protocols, and concerns (Kovak, 2005; Smith, 1999).

Equally important was the need not to dismiss the growing critiques of both research and professional practice as colonizing endeavours. I paid considerable attention to constructing a research process which was decolonizing is both process and product. I believed this could not be achieved through traditional interviewing methods. This lead to the evolution of a Decolonizing Critical Reflection research method as the primary means for data collection. This technique, through “decolonizing the mind” (Battiste, 1998), enables the generation of decolonized data. Contact: Gail Baikie ([email protected])

“IT’S NOT AS COOL AS SHOOTING BIRDS”: BUILDING RESEARCH RELATIONSHIPS WITH ABORIGINAL COMMUNITIES

J. Bull

University of PEI

There is increasing awareness of the importance of community consultation and meaningful relationships between researchers and communities; however, very little literature provides wise practices or successful projects that employed such practices. This presentation will be facilitated by a community based member and an academic community based researcher with the goal of demystifying the complexities of working within aboriginal communities and encourage more “authentic” research relationships. We have built relationships on the principles of respect and reciprocity. Through building these relationships, we have been working together since 2006 on research in Labrador examining the use and uptake of the CIHR Guidelines for Research Involving Aboriginal Peoples (2007) and the ethics review


mechanisms in place with the Labrador Innu, Inuit, and Métis. Our experiences have been positive and rewarding and we would like to share our successes with others with the hope that we will encourage more researchers and communities to work together. Contact: Julie Bull ([email protected])

QUALITATIVE RESEARCH FOR CULTURAL GROUPS REDEFINED

C. DeCourtney

Alaska Native Tribal Health Consortium

Focus groups are a standard tool to gather information from prospective consumers when a new program/ services is being developed. Designing a program without input from consumers can lead to expensive redesign if consumer do not accept the program.

Gathering groups of consumer and conducting focus groups based on: outside interviewer, standard questions, incentives, set timeframe can provide important product/ services information. For groups such as Alaska Natives living in remote settings and adhering to a traditional lifestyle, the standard model does not work. Over a period of 10 years (1998-2008) the author conducted six focus groups with different Alaska Native cultures to gather information about traditional death and dying practices, the effect of Western medicine on these practices, and current wishes. 200 Alaska Native elders participated in seven different group meetings. How the focus groups evolved provided a significant new understanding of the importance of qualitative research based on modification of accepted tools in gathering information from indigenous cultures and other groups.

The focus groups confirmed the premise that most elders preferred to remain in their village as the end of life approaches, just as their parents did. The validity of the process was confirmed with the second set of focus groups (2005-2008). We remained flexible and adaptable, took lessons learned from the first set of focus groups (1998-2001) and applied them to the second series of focus groups. Interviewer relationships with the communities proved to be critical in creating a trusting atmosphere to allow Alaska Native elders to openly share their experiences.

The standard focus group model must be modified in order to ensure participation by indigenous elders. The importance of qualitative research can not be over emphasized when working with underserved groups such as Alaska Native elders who’s needs are not address by mainstream research tools. Contact: Christine DeCourtney ([email protected])

THE ROLE OF ETHICAL GUIDELINES IN THE DELIVERY OF FRONTLINE MENTAL HEALTH AND ADDICTIONS PROGRAMMING IN CANADIAN INDIGENOUS COMMUNITIES

C. Tait

University of Saskatchewan

This paper seeks to explore the question, “If ethical standards similar to those that shape university-based research practices were applied to the delivery of health prevention programming in Aboriginal communities, how would this change health care policy and program delivery?” In this paper, I will outline my argument for ethically based health care policy and programming in areas of front-line health prevention services. In doing so I will draw upon a case example from northern Saskatchewan of a government funded application of a “best practice” fetal alcohol syndrome prevention project. The importance of this case study is that it clearly illustrates that the moral foundation upon which university research involving human subjects is based, does not exist within front-line prevention programming targeting the exact same populations. This paper questions why the ethical guidelines that frame research involving human subjects, or those that are adopted by professional bodies such as Colleges of Physician and Surgeons, are not similarly applied to the application of best practices in the context of community prevention programming? As will be

illustrated, a lack of ethical guidelines to direct the application of prevention programming makes vulnerable both individuals targeted by the these programs, in this example impoverished First Nations women struggling with addictions, as well as the front-line workers and communities responsible for delivering the prevention programs. I argue that with the introduction of ethical guidelines in health care prevention programming, rates of prevention would increase, potential harm to vulnerable populations would decrease, and higher levels of trust between government health ministries and Aboriginal peoples at all level of program delivery would be achieved. Contact: Caroline Tait ([email protected])

VENUE 3 Indigenous Health & Wellness #1

INCORPORATING TRADITIONAL KNOWLEDGE, TEACHINGS, AND PRACTICES TO REVIVE HEALTH AND WELLNESS IN A DENE COMMUNITY NORTH OF 60

J.C. Catholique

Łutsel K’e First Nation

This project will look at traditional knowledge, teachings and practices to address health and wellness in the Dene communities. With the introduction of Western values and lifestyles, the Dene people of the North have slowly been integrated into mainstream society. The challenge faced by Dene people is to retain and to pass on the traditional knowledge of our ancestors in order to maintain our health and wellness in this ever changing world. Managing this challenge and living in balance in today’s Northern communities where Dene people are grounded in their traditions and successful in modern communities are the focus of this project. Contact: JC Catholique ([email protected])

A LABRADOR COMMUNITY GRAMMAR: LANGUAGE HEALING

A. Johns

University of Toronto

The Inuttitut language in northern Labrador is in decline, as more and more young Labrador Inuit grow up with English as their language. Communities across Labrador are well aware of this situation and are taking steps to reverse this language shift through a language nest (via the Head Start program) and publications of language materials (Andersen and Johns 2005).

This paper reports on a project undertaken during IPY, which is one component within a set of community responses to this loss. The project involves a university linguist working with the Nunatsiavut Government through the Torngâsok Cultural Centre to create a body of information (a grammar) for use by language professionals (language teacher, translators, etc.) across Labrador in their efforts to maintain and promote Inuttitut. One novel aspect of the assembly of this knowledge is that there is continual interaction through email and webpages with key members of the community. The major goal of this interaction is to determine whether the written form of the information is comprehensible to local language professionals. If the materials are not immediately readable by language professionals without specialized training, their value will be considerably lessened. At the same time, Labrador language professionals are participating in the production of the materials by passing on difficult language questions from their high school students. This allows the linguist to address particular issues that are of immediate concern and interest within an important population - young Labrador Inuit.

The efforts to revitalize the Inuttitut language in Labrador form part of a general effort to regain local control of governance, resources and also to establish broad and public priorities regarding culture. Regaining the language will strengthen intergenerational bonds and


aid the youth as they find their place within the Canadian and global context. Contact: Alana Johns ([email protected])

THE MEDICAL-SOCIAL AID TO THE ABORIGINES OF THE RUSSIAN NORTHERN TERRITORIES CONDUCTING TRADITIONAL VITAL ACTIVITY

L. Zubov1, A. Apicyn2, V. Peskov3, L. Abryutina4 1Northern State Medical University, 2Administration of the Nenets autonomous area, Russian Federation, 3Association of Nenetz people, Russian Federation, 4Russian Association of Indigenous Peoples of the North, Russian Federation

The following regional features of the Nenets autonomous area influence the population health and organization of medical care: severe climatic conditions, vast territories; nomadic indigenous population; irregular development of healthcare network. In 2002-2008 we study peculiarities of health state and carry out social-hygienic and medical examinations of the indigenous population of the Russian northern territories. All the families of roaming reindeer breeders in the tundra of the peninsula Kanin have been examined. 356 persons are observed, 176 of them children. In 42,7% of children the pathology is revealed. Pecularities of work, life and diet of families of wandering reindeer breeders were studied. The main medico-social problems are: small availability of medical aid to the wandering population; absence of the adapted criteria of a complex estimation of health of children of wandering reindeer breeders; preparation and adaptation of children to school are not solved; partial or full isolation of children from parents in boarding schools; education in the conditions which are not taking into account features of culture, physiology and psychology; change of a meal; destruction of the ecological environment; the state cease the most necessary forms of rendering of medical aid. The peculiarities of the indigenous people public health state revealed by the doctors during the expedition studies, the worked out, approved and introduced new forms of the roaming population’s medical service organization allow to solve many medical-social problems of the northern indigenous peoples. The results of the carried out long-term scientific and practical work for studying and preservation of health of the northern indigenous peoples ground the necessity of organization of a new direction in medicine – ethnic medicine. Contact: Leonid Zubov ([email protected])

PAN-ARCTIC TV SERIES ON INUIT WELLNESS: PRELIMINARY EVALUATION FINDINGS AND LESSONS LEARNED

R. Johnson, D. Leavitt, R. Morales

University of Alaska Anchorage

This session will provide preliminary findings and lessons learned to date from the ongoing evaluation of Qanuqtuurniq - Finding the Balance TV series, an International Polar Year outreach project on Inuit wellness broadcast in May 2009 in the Inuit language with English subtitles and simultaneously Web cast . A main objective of this series was to adapt and test a “communications for change” model for exchanging knowledge from different perspectives on several wellness issues of concern to Inuit. . A project team supporting healthy northern communities worked together to create the 3 day, interactive circumpolar health series using multiple communication channels to explore the issues and the success stories around youth coping and endurance/ resiliency, healthy men, and maternity care. The interactive program included live broadcasts from Iqaluit, Nunavut with panels of guests from the health and research communities discussing the issues and then opening the phone lines to answer questions from the communities across the north. In addition anyone could watch the program on a special webcast site and interact via telephone or email. Supporting the program were several “community focus groups” including a youth focus group, representative of the Inuit regions of Canada, who watched the program live on television and

provided feed back into the discussions of the issues and success stories. Data from key informant interviews, surveys and site visits will be used to describe and illustrate key results from the formative evaluation of this innovative multi-media health communication project. Focus will be on adaptation and achievement of planned objectives, development and delivery of key messages, and lessons learned to date from both project developers and program participants. Contact: Rhonda Johnson ([email protected])

CULTURAL CONTINUITY AND RESILIENCE: INVESTIGATING THE WAYS THAT THREE GENERATIONS OF INUPIAQ OVERCOME HARDSHIPS

L. Wexler

University of Massachusetts Amherst

Although there have been many studies linking acculturation stress and identity struggles to youth health disparities in Indigenous communities 1-15, there has been little research exploring the ways that Native young people are creatively responding to the tensions of growing up in a world that is markedly different from that of their parents and grandparents. In the study region, the disparate growing up experiences of the last three generations has consequences for both youth and their elders. The widening gaps between generations leaves many Indigenous Elders and adults, who traditionally helped young people correctly enter adulthood, with pervasive feelings of disempowerment and uncertainty. In this paper, I will discuss a pilot research project that created a platform for listening across age groups. The multi-phased project partnered with several Indigenous organizations and created opportunities for Elders and adults to talk to youth, and for youth to highlight what they learned by producing digital stories. Digital stories are three to five-minute visual narratives that synthesize images, video, audio recordings of voice and music, and text to create personal stories. These productions encourage young people to (re)present themselves, their priorities and interests to their family and community. A few of these stories will be shared with the audience as will the preliminary findings (and future directions) of the project. Contact: Lisa Wexler ([email protected])

ABORIGINAL SELF-GOVERNMENT AND SOCIAL SUFFERING

S. Irlbacher-Fox

Fox Consulting

This paper examines the implications of social suffering for Aboriginal self government, drawing from case studies in the Northwest Territories, Canada. Based on the author’s work over the last decade working on self government negotiations in the employ of indigenous peoples (Irlbacher-Fox, 2009), the analysis draws on a social suffering framework (Farmer, 1999; Das 1995) to understand how Canadian Aboriginal policy silences suffering as a rationale for greater indigenous autonomy, while simultaneously invoking suffering (in the form of capacity deficits, social pathologies) as the basis for ongoing government control of, and intervention into, indigenous collective and individual lives. This paper provides an account of how national policies determine both the approach to and in large part the outcomes of negotiations, which the author contends will result in agreements whose structure will ultimately perpetuate rather than alleviate social suffering. Contact: Stephanie Irlbacher-Fox ([email protected])

VENUE 4 Population Genetics - CPT1A P479L in the North: Risk

Factor, Protective Factor, or Both?

L. Arbour1, B. Boyer2, W. Burke3, S. Collins1, C.R. Greenberg4, R. Hegele5, D. Koeller3, T. Mala6, G. Sinclair1, H. Vallance1


1University of British Columbia, 2University of Alaska Fairbanks, 3University of Washington, 4University of Manitoba, 5University of Western Ontario, 6Anchorage Native Primary Care Centre.

CPT1 is a mitochondrial enzyme necessary in the transport of fatty acids for the production of energy from fat when carbohydrate is not readily available. “Mild” CPT1A deficiency first came to clinical attention after the infant of an Inuit woman presenting with acute fatty liver of pregnancy was confirmed to be affected. The responsible genetic variant, which alters the release and the activity of the enzyme, was delineated after a 44 year old First Nation man from Vancouver Island, BC presented with muscle cramps and rhabdomyolysis, now thought to be a coincidental association. Current research has revealed the presence of the genetic variant in northern and coastal Aboriginal populations of Alaska, BC, NWT, Nunavut and Greenland. It is suspected that intercurrent illness may increase risk for hypoglycemia in infants and young children homozygous for the variant, but paradoxically, there is also some evidence the variant may confer a protective effect for adult onset cardiovascular disease. This workshop will provide a forum to present what is known, contemplate what is unknown, consider ethical concerns related to research and clinical screening, and hear the opinions of those in the populations affected.

INTRODUCTION AND OVERVIEW

L. Arbour, T. Mala

CPT1 P479L IN NEWBORNS OF THE KIVALLIQ REGION OF NUNAVUT

C. Greenberg

THE EXPERIENCE WITH CPT1 NEWBORN SCREENING IN ALASKA

D. Koeller

ESTIMATE OF BRITISH COLUMBIA CPT1P479L PREVALENCE AND REVIEW OF MEDICALLY ASCERTAINED PEDIATRIC AND SUDDEN DEATH CASES FROM BC

H. Vallance

CPT1 P479L PREVALENCE IN LIVE NEWBORNS AND SUDDEN DEATH CASES IN YUKON, NORTHWEST TERRITORIES, AND NUNAVUT

S. Collins

CARNITINE PALYMITOYLTRANSFERASE IA POLYMORPHISM P479L IS COMMON IN GREENLAND INUIT AND IS ASSOCIATED WITH ELEVATED PLASMA APOLIPOPROTEIN AI

R. Hegele

COULD CPT1P479L INFLUENCE OBESITY IN ADULTS IN ALASKA?

B. Boyer

MANAGING UNCERTAINTY: IMPLICATIONS OF CPT1A P479L FOR ETHICS AND POLICY

W. Burke

DISCUSSANT PANEL: (DISCUSSANTS FROM ALASKA, YUKON, NWT, NUNAVUT AND GREENLAND TBA) Contact: Laura Arbour ([email protected])

VENUE 5 Community Participatory Research Methods #1

UNDERSTANDING ABORIGINAL COMMUNITY-BASED RESEARCH IN CANADA

D. Allman, T. Myers

Dalla Lana School of Public Health, University of Toronto

The year, 2009, marks a decade since the establishment of a dual Aboriginal/non-Aboriginal Community-Based Research (CBR) program within Canada’s federal government. In this time period, this approach to research has come to be positioned within Canada as a form of knowledge creation and inquiry able to facilitate genuine participation and collaboration, and by extension, individual and community-level commitment to the research enterprise. It does this through the establishment of socially-just and methodologically-sound research tools and strategies which are understood as meaningful and ethical by communities and individual stakeholders alike.

Aboriginal CBR specifically is defined as culturally-appropriate processes for research, analysis, and dissemination which empower and benefit the common collective. In Canada, processes for Aboriginal CBR aim to develop research capacity among underdeveloped communities in order to help prepare effective strategies for health promotion and maintenance. As a philosophy and paradigm for the development of meaningful knowledge discovery and dissemination, Canada’s Aboriginal CBR promotes principles of ownership, control, access and possession (OCAP). When applied to research, and when understood within a post colonial framework, these principles reflect the evolving importance of self-determination.

Analytically, a case story approach to the analysis of Aboriginal CBR, when juxtaposed with other forms of community research, allows for an understanding of the similarities and differences in how these models of community-centred knowledge production have evolved in Canada, as well as how colonization and Western-style democracy have shaped a Canadian narrative of participation which has evolved from a history of structural exclusion towards one of greater social inclusion.

By contributing to a growing understanding of Aboriginal CBR within the Canadian context, this paper reflects on the ways cultural self determination, particularly when combined with best practices in research ethics and scientific rigour, can contribute to the success of public health sciences across the Circumpolar North. Contact: Dan Allman ([email protected])

THE REALITIES ENCOUNTERED WHILE INTRODUCING THE COMMUNITY-BASED PARTICIPATORY RESEARCH APPROACH IN GREENLAND

E. Rink, D. Gesink-Law, R. Montgomery-Andersen, U. Poppel, A. Binzer, S. Montgomery-Andersen, A. Koch, G. Mulvad

Montana State University

Community consultation has been used to improve health studies conducted in Greenland in the past. However, community based participatory research (CBPR), where community members are involved in the development, design, implementation, analysis, interpretation, dissemination, and knowledge translation of study results, has not been practiced in Greenland. In Canada and the United States, CBPR has been identified as an effective method for conducting research with Inuit, American Indian, First Nations and Métis communities, especially in the North, because of its emphasis on community-academic partnerships to build mutual ownership of a research project and because of its ability to empower communities or groups to address their health disparities in a socially, culturally, and environmentally appropriate manner. However, the CBPR approach is not without its challenges in Arctic countries, such as Greenland, where research capacity, language, distance, time and cost become barriers


to remaining true to the purest form of CBPR. We will describe the practical application of CBPR principles and methodologies to a sexual health project investigating sexually transmitted infections in Greenland. We will present initial challenges encountered in the beginning phases of the project and solutions to these challenges. We also suggest recommendations for building capacity in Greenland to conduct CBPR projects. Contact: Elizabeth Rink ([email protected])

STRATEGIES FOR COMMUNICATING HEALTH RESEARCH FINDINGS TO MEMBERS OF AN ARCTIC ABORIGINAL COMMUNITY

J. Huntington, K.J. Goodman, R. Munday, C. Fletcher, G. Gordon

University of Alberta

In the predominantly Aboriginal hamlet of Aklavik, NWT, Canada, residents have expressed concern about health risks from Helicobacter pylori infection. The Aklavik H. pylori Project, launched in 2007, aims to describe the burden of disease, identify risk factors, evaluate clinical management approaches, and effectively communicate research findings to address community concerns. Community members were included in the research process by means of a local committee. This report describes how community consultation provided ways to maximize the value of the research findings to the community.

Community consultation was used to determine which methods of disseminating project information would be most effective. A qualitative research approach was used, including group discussion and key informant interviews, to identify local understanding of the research project, expectations, and preferred methods of knowledge transfer.

Community members’ expectations centered on learning about behaviors that could protect against ill health. Most informants expressed satisfaction with the communication methods employed by the project, including radio shows, announcements and regular flyers, but still expressed skepticism about the potential value of the research. Radio was frequently mentioned as the best way to inform people, but most informants supported a proposal to create a video aimed at revealing the process of conducting research and understanding the results; overall, informants thought the best approach would be collaboration on visual media development between the research team and community members, youth and elders in particular.

Community-driven research should aim to provide community members recognizable benefits from participation. Community consultation in this Arctic hamlet suggested that efforts aimed at increased understanding of the process of conducting the research and what the results mean would maximize the benefit of the research to the community. This component of the project identified a promising knowledge transfer strategy, the creation of a video to document the research process. Contact: Janis Huntington ([email protected])

AN ABORIGINAL COMMUNITY INITIATIVE TO PARTNER WITH ACADEMICS: DEVELOPING EVIDENCE-BASED STRATEGIES TO IMPROVE THE HEALTH & WELL-BEING

A. George, W. Martin

University of British Columbia, Department of Pediatrics

The Chief and Council of the Laxgalts’ap Village Government (LVG) have been concerned for a number of years about improving the health of its community with a on-reserve population of approximately 600. During the past 3 years, the LVG intitiated three projects aimed at improving the health and well-being of the community: gather data on access to health care, and on health problems and possible sources of community members; host an addictions forum with local, provincial and federal leaders to find a workable model for families faced with addiction; and gather data on children’s educational capacities. These projects originated with the LVG who sought academic partnerships to

assist with accomplishing the short-term aims of gathering data and the long-term aims of developing evidence-based policy and practice to address the issues. This presentation will include data from the health survey and a description of the advantages of the community-initiated academic-community partnerships.

This is one of four communities who make up the Nisga’a Nation, the first in the province of British Columbia to sign a modern-day lands claim agreement with the Canadian government. Contact: Anne George ([email protected])

HOW GREENLAND ORGANIZED PREVENTATIVE AND HEALTH PROMOTION WORK

B.K. Poulsen

PAARISA, Public Health Center

Objective: Greenland has built up a unique organization. Central and local preventive work is linked trough a preventive board and a consultant in every town. PAARISA, the Public Health Center, is in the lead and has created an education for the local consultants. A new research is presented.

Aim: to describe and evaluate the local preventive work in Greenland in the period from 1996 to 2007. Main focus is on organization, leadership and the new education for local consultants.

Methods: Retrospective, descriptive and explorative casestudy supplemented with interviews.

Official documents as well as reports from municipalities and informal letters were analyzed. Semi structured qualitative interviews with key-persons, who have worked with or close to the local preventive consultants. A seminar held in 2007. The consultants made their recommendations to the future preventive and health promotion work in the coming larger communities

Findings: The 57.000 inhabitants of Greenland lived in 17 municipalities with just as many cities and approximately 60 villages. Despite this, PAARISA has succeeded reaching public health out to the local level. In every municipality a skilled prevention counselor is placed and an intersectorial preventive board is established. The education provided the counselors with tools to manage the superior coordination of preventive and public health projects in the municipality.

Conclusions: The results shows, that to promote public health locally, you have to work cross-sectorial and be ready to coordinate and cooperate. This can be in form of networking, but formal partnerships are recommended. To achieve success, you have to make connection between central and local level. The results will now be used to optimize the health promotion work in Greenland. The researcher hopes to inspire Nunavut and Nunavik, who have similar health problems and geography. Contact: Bodil Karlshøj Poulsen ([email protected])

A DAY IN THE LIFE OF THE IPY INUIT HEALTH SURVEY LAND TEAM: PREPARING COMMUNITIES

I. Tensen, H. Nakimayak, L. Okalik, H. Saudny-Unterberger, G.M. Egeland, Qanuippitali Steering Committee (Inuvialuit), Qanuippitali Steering Committee (Nunatsiavut), Qanuippitali Steering Committee (Nunavut)

Centre for Indigenous Peoples’ Nutrition and Enviroment, McGill University

The International Polar Year (IPY) Inuit Health Survey involved extensive consultations and logistical planning to prepare communities and to coordinate activities. The survey is a multifaceted participatory health research project for those 18 years of age and above residing in 3 Canadian Inuit jurisdictions and involving 3 steering committees.

Three separate land teams were trained and traveled to all coastal communities prior to the ship’s arrival, and in each community worked closely with health centers, local research assistants and drivers. Additional community liaisons traveled ahead of the land teams to


communities in which additional time was required for preparations. Nearly 100 temporary staff was engaged each field season in communities, traveling land teams or on board the CCGS Amundsen during data collection activities in 2007 and 2008. Community research assistants were trained and helped to recruit participants from randomly selected households from which adults over 18 years of age could participate. Because of the large number of communities and community assistants, an informed consent DVD was developed to ensure that a consistent and understandable informed consent was administered. A member of the household completed a home-based questionnaire, nurses collected information on medicine and vitamins, and clinic appointments were scheduled onboard the Amundsen. Home visits were arranged for participants unable to board the ship.

The field work proceeded with invitations and collaboration in all 36 communities in the Inuvialuit Settlement Region, Nunastsiavut, and Nunavut. Three non-coastal communities were included in the survey. A total of 2796 randomly selected households were contacted of which 1955 households (72%) accepted the invitation to participate. The survey was a success in large part due to the motivation and commitment of members of the land teams, of the local research assistants and drivers and the dedication of the 3 steering committees for their oversight and planning. Contact: Grace Egeland ([email protected])

PARTICIPATORY APPROACHES FOR A COMMUNITY-BASED CHRONIC DISEASE PREVENTION PROGRAM IN TWO CANADIAN INUIT COMMUNITIES: DEVELOPMENT OF HEALTHY FOODS NORTH

J. Gittelsohn, M. Kratsmann, C. Roache, E. Mead, J. Ogina, R. Reid, S. Sharma

Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

Objective: To present a model for using formative research and stakeholder participation to develop a community-based dietary intervention program (Healthy Foods North) targeting Inuit in Nunavut, Canada.

Setting: Two remote Inuit communities in Nunavut, Canada.

Methods: Formative research included in-depth interviews (n=45) and dietary recalls (n=42). Stakeholders, including community leaders, health staff and store managers, contributed to intervention development through formative research, systematic community workshops, group feedback and implementation training.

Results: Community members used multiple methods to access foods, including harvesting, purchasing in stores, and shipping via barge or air. Key cultural themes included the perceived healthiness of country foods, food sharing, and importance of family. During community workshops, six key problem foods for intervention were identified, including soda (22 votes), chips (22), sweetened drinks (17), white bread (17), candy (16), and sugary snacks (8). Healthier as well as culturally and economically acceptable alternatives were identified for these foods by workshop participants. Behaviors for promotion were identified and prioritized, including: Healthier cooking methods at home (30 votes), Eating and cooking together as a family (23), Using a shopping list/plan menus (21), and Eating country foods (15). Labeling healthy foods on shelves (20) and reducing prices of healthy foods (18) were identified as ways to help community members achieve these goals. Stakeholder participation contributed to the development of a culturally appropriate intervention in stores, worksites, and other community venues.

Conclusions: This approach resulted in project acceptance, stakeholder collaboration, and a culturally appropriate program for an Inuit population.

Acknowledgements: The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57. Contact: Joel Gittelsohn ([email protected])

COMMUNITY-DRIVEN RESEARCH ON HELICOBACTER PYLORI INFECTION IN A CANADIAN ARCTIC HAMLET

K.J. Goodman, R. Munday, J. Huntington, J. Cheung, S. van Zanten, A. Corriveau

CANHelp Working Group. University of Alberta, Northwest Territories Health and Social Services

In recent years, the health committee of the predominantly aboriginal hamlet of Aklavik, Northwest Territories (population ~600) identified H.pylori infection and its link to gastric cancer as a priority concern and advocated for research to address solutions. The resulting Aklavik H.pylori Project is the start of a broader collaboration to investigate H.pylori infection in northern Canadian populations where gastric cancer rates are elevated and H.pylori infection is difficult to treat. This research involves community members in planning and aims to describe sociodemographic patterns of H.pylori infection and the associated burden of disease, identify effective treatment regimens, generate evidence to inform local health care policy, and address community concerns regarding health risks. The present results pertain to community participation and initial screening by the 13C-urea breath test. Between November 2007 and December 2008, informed consent and clinical survey data were obtained from 314 Aklavik residents; 308 had a breath test; 205 consented to upper gastrointestinal endoscopy and 197 attempted the procedure, with biopsies for culture and histopathology obtained from 193. Breath-test positivity was 58% and the reporting of this finding to the community served as a strong catalyst for further participation. The high level of community participation in this project coupled with the interest of health authorities has generated media attention which has led to other communities asking to be included. This ongoing community-driven project will seek effective strategies for addressing emerging community concerns in populations where H.pylori infection is difficult to treat. Contact: Karen Goodman ([email protected])

VENUE 6 Human Biology #1

IODINE DEFICIENCY IN THE NORTH OF KRASNOYARSK TERRITORY

I.V. Osokina, V.T. Manchuk

State Research Institute for Medical Studies of the North, Krasnoyarsk, Russia

State Scientific Research Institute for Medical Studies of the North

Introduction: Siberia traditionally belonged to iodine-deficient regions. Cessation of iodine prevention in the 1990’s, worsening of social and economic situation promoted the increase of iodine deficiency disorders (IDD) in Siberia.

Aim: to carry out a complex investigation of IDD in the North of Krasnoyarsk territory.

Methods: We performed 8 expeditions in polar and northern regions of the Krasnoyarsk territory: in the Igarsky, Turukhansky, Yenisseisky regions. The assessment included clinical examination, measurement of weight and height; thyroid palpation and ultrasound scan; ; plasma TSH, T4 and thyroglobulin (TG); urine samples collected in the field and processed for iodine using conventional technique; the analysis of the results of neonatal TSH- screening.

Results: The carried out investigations showed moderate iodine deficiency - the median urinary iodine in prepubertal children varied from 30 to 42 mcg/l. According to thyroid palpation and ultrasound scan the goiter prevalence in children varied from 42.5% to 58.4%. The median serum TG varied from 14.7 to 31 mcg/1 and also corresponded to moderate iodine deficiency.


IDD control programs: in all the examined regions iodized salt began to be used for mass iodine prophylaxis. In addition to it in Igarka we introduced the method of bread iodization with potassium iodide. We used the iodized oil (Lipiodol-200) in the remote settlements in Igarsky and Turukhansky regions. The IDD monitoring showed that median urinary iodine in prepubertal children increased up to 115 mcg/1 vs 31 mcg/1. Thus, IDD prevention in these regions was effective.

Conclusions: Our investigations show that in the North of Siberia there is a serious natural iodine deficiency influencing the health of the population and demanding continuous adequate iodine prevention. Contact: Irina Osokina ([email protected])

FACTORS THAT INFLUENCE THE BIOCHEMICAL CHARACTERISTICS AND HORMONES OF HYPOPHYSEAL-THYROID-ADRENAL SYSTEM OF MEN

R. Fedina

State Educational Institution of Higher Professional Education, Novosibirsk State Medical University

The purpose of the investigation: to determine the most significant factors that influence the biochemical and hormone characteristics of hypophyseal-thyroid-adrenal system of men (HTAS).

The biochemical and hormone characteristics of HTAS in the population sample from 1058 almost healthy donor men at the age of 18-60 in the Novosibirsk megapolis were studied comprehensively. The hormone status was determined using a radioimmunoassay technique; protein, carbohydrate and lipid metabolisms, by biochemical methods. The parametric Student t-criterion and nonparametric Wilkinson-Mann-Whitney testing were applied. A multifactor variance analysis revealed 15 factors that influence the biochemical characteristics and hormones of HTAS. The comparison of biochemical characteristics (crude protein, common lipids, total cholesterol, triglycerides, glucose, unesterified fatty acid, and lipid peroxidation) and hormones (adrenocorticotropin, somatotrophic hormone, adrenocortical hormone, triiodothyronine, thyroxine, and thyrotropic hormone) makes it possible to find the significant differences among the donors (p > 0.003) who live in “clean” and “dirty” districts. Insufficient stability to the urbanization factors starts to manifest at the age of 18-19.

The social-economic conditions in combination with ecological factors require the extreme tension of adaptive biological and psychoemotional mechanisms. The combination and summation of different stress vectors under present conditions of life activity make regulatory components of men adaptation vulnerable. This leads to the fast waste of reserves and dysaptation, first of all, of functionally deficient components in the organism, as well as the rapid progress of diseases, and the lower lifetime of Russia men. The main factors that influence the biochemical characteristics and hormones of HTAS are as follows: age, ecological conditions, and duration of living under such conditions, year season, tobacco smoking, and alcohol drinking.

Therefore, the obtained data can be used to examine men, to make prognosis as well as to reveal persons with risk factors, as well as a regional norm for men in Novosibirsk. Contact: Roza Fedina ([email protected])

RESULTS OF RESEARCH OF FREE RADICAL OXIDATION IN POPULATION OF YAMALO-NENETS AUTONOMOUS OKRUG (RUSSIA)

M.A. Buyack, E.R. Mirdaleeva, E.G. Samsonova, Y.V. Vorobyova, E.B. Kudryashova

State Scientific Research Institute on Medical Problems of the Far North of RAMS

Aim of the survey was to analyze mean values of free radical oxidation in inhabitants of Yamalo-Nenets Autonomous Okrug. 1333 (582 native and 751 non-native) residents (aged 20-59 years) of villages Krasnoselkup, Samburg, Yar-Sale and Se-Yakha were examined. Free radical oxidation (FRO) was evaluated in blood serum by Fe-dependent

induced chemiluminescence. All measurements were done by chemiluminometer BCHL-07 (Russia). The following, most important indices were assessed: 1) Imax - maximal intensity - shows FRO potential in a biological object, 2) S light-sum - shows content of oxygen radicals (RO2), which correspond to break of FRO chain. This index makes it possible to assess the system of lipid peroxide oxidation and antioxidative activity and other compensatory mechanisms of FRO in an organism, 3) Tg2 - antioxidative potential of the given sample. Analysis of FRO was done on the basis of comparison of the indices in native and non-native residents. Imax did not appear to be significantly different in these groups. At the same time, in natives light-sum (S) was lower by 4,7% (p<0,05) and antioxidative response (Tg2) was higher by 8,1% (p<0,05) when compared to non-natives. It is known that ratio coefficient of these indices is used for evaluation of prooxidative-antioxidative balance. Any shift characterizes predominance of oxidative or antioxidative system activity. Antioxidative potential can be expressed as Imax/S coefficient. S/Tg2a coefficient, showing the proportion of peroxide oxidation and antioxidative activity revealed that in natives this index was lower by 8,9% (p<0,001) and antioxidative coefficient Imax/S was higher by 8,7% (p<0,001) when compared to those of non-native inhabitants. It is apparent from the present analysis, that in natives’ blood serum processes of antioxidative defense prevail over oxidative ones unlike in non-native residents of the Far North. Contact: M.A. Buyack ([email protected])

SYSTEM OF XENOBIOTYCS METABOLISM AMONG NATIVE PEOPLE ON FAR EAST. ROLE OF THIS SYSTEM IN THE DEVELOPMENT OF DISEASES

S. Suleymanov

We have results researching acethyl-reduction system among different group of native people, who living on Far East. And we can fixed frequency and course some diseases on patients from this contingent with different type of acethyl-reduction system.

As known, acethyl-reduction system is one representative from another xenobiotic biotransformation system, participant in earlier adaptation, necessary for oil acid synthesis, steroid synthesis, Krebs cycle – what’s why we choose her for researching.

The acethyl-reduction system play impotent role in biotransformation of xenobiotics (medicines, industrial and home toxins). The acethylization to realize by enzyme N-acethyltransferase. The activity of N-acethyltransferase depends from genotype, B2-adrenoreceptors and metabolic reserve (pantothenic acid, pyridoxine, thyamine, lipoid acid).

We need research activity of N-acethyltransferase for rational using medicines, because many of them metabolisating by acethyl-reduction system. Especially it is important for izoniazid, because tuberculosis very wide-spread among minority nationality of Far East.

The distribution “faster” and “slower” acethyl-reducers is very variable in different ethnic groups. This variation is especially strong between asian and europeoid race.

Our research of acethylasation velocity among native and migration population on Far East reveal, what people from this group have difference acethyl-reduction system. So, quantity “faster” acethyl-reducers among aboriginals North territory - 85%, among Europeans- around 50%.

In science literature we see information about different frequency of morbidity between “faster” and “slower”acethyl-reducers.

For example, cancer of vesicle uterine meet in 2-3 time more often for “slower”acethyl-reducers; colorectal cancer meet in 2 time more often for “faster” acethyl-reducers. We are define, what among children, suffering from pneumonia (in Khabarovsk): 2/3 - “faster” and only 1/3 “slower”acethyl-reducers. “slower”acethyl-reducers have true more severity of disease and more duration of treatment.

Among children, suffering from acute dysentery, more rarely meet “faster” acethyl-reducers (around 60%).


Contact: Salavat Suleymanov ([email protected])

THE IMPACT OF ARTIFICIAL AND NATURAL RADIOACTIVITY IN THE LICHEN -> CARIBOU -> HUMAN FOOD CHAIN

T. Bliss

Radiation Protection Bureau 6302D1, Health Canada

The radionuclides showing the greatest impact on northern ecosystems are radiocesium, a fallout product from past nuclear weapons testing, and lead-210 & polonium-210, decay products of natural radon gas emanating from soil. All these radionuclides deposit on slowly growing lichens which serve as food for caribou during the long winter months. Caribou meat is the main source of protein in the diets of many northerners. The transfer of this radioactivity through the lichen –> caribou –> human food chain constitute the largest single source of radiation exposure to northern peoples.

Between the years 1960-2000, over 1200 caribou, representing 20 herds from across the Arctic, were sampled for radiocesium by Health Canada and other agencies. The levels were highest in the early 1960s when atmospheric nuclear weapons testing was at its peak, but measurable concentrations have persisted up to the present time. An ecological half-time of 6 years for cesium-137 was derived from these results, which demonstrates the vulnerability and slow recovery time of Arctic ecosystems to fallout contamination.

From 1963-1969, radiocesium body-burdens were measured by Health Canada for more than 3000 people representing almost every Arctic community. This was carried out by a combination of urine collections and portable whole-body counting. At this time some northern residents were receiving radiation doses of up to 5 millisieverts per year, five times the current public dose limit. In 1989-1990, five of these communities – Baker Lake, Rae-Edzo, Old Crow, Aklavik, and Fort McPherson were re-visited and whole-body counts completed on over 1100 people. The radiocesium levels in these people had declined significantly, by an amount greater than what would be predicted based on the levels in caribou meat. This difference is attributable to the substitution of many traditional foods by store-bought foods over this period.

On the other hand, the naturally occurring radionuclides, lead-210 and polonium-210, have remained at constant levels in the Arctic environment and now dominate the radiation exposure from consumption of traditional foods. With climate change and melting permafrost, we are likely to see increased radon emanation from Arctic soils and consequent increases of these natural radionuclides in the environment. Contact: Tracey Bliss ([email protected])

AN ESTIMATION OF COSMIC RAY BACKGROUND EXPOSURE IN NORTHERN TERRITORIES

J. Chen1, R. Timmins1, K. Verdecchia1, T. Sato2 1Healthy Environments and Consumer Safety Branch, Health Canada, 2Japan Atomic Energy Agency

The worldwide average exposure to cosmic rays contributes to about 16% of the annual effective dose from natural radiation sources. At ground level, doses from cosmic ray exposure depend strongly on the elevation above sea level, and weakly on geographical locations and solar activities. PARMA is a simulation software to calculate the cosmic-ray spectra anywhere below the altitude of 20 km and anytime after A.D. 1700. The accuracy of the simulation was well verified by several experimental data of the terrestrial cosmic-ray spectra taken under various conditions. In this study, the analytical model PARMA was used to calculate annual effective doses due to cosmic ray exposure at ground level were calculated for more than 1500 communities across Canada which cover more than 85% of the Canadian population. Generally speaking, Canadian population weighted average annual effective dose from cosmic ray exposure at ground level is 0.31 mSv. At different geographic locations and during different solar activity periods, the annual effective dose could vary

from 0.27 to 0.84 mSv. In the three territories of northern Canada, the population weighted average annual effective doses due to cosmic ray exposure are 0.29 mSv for Nunavut, 0.31 mSv for Northwest Territories, and 0.40 mSv for Yukon. The population weighted average dose for the three northern territories is 0.33 mSv, slightly higher than the Canadian wide average, however within natural variation range due to varying solar activities. Contact: Jing Chen ([email protected])

POSTNATAL EXPOSURE, BUT NOT IN-UTERO EXPOSURE, TO MIXTURES OF NORTHERN CONTAMINANTS ALTERS THE ADULTHOOD GLUCOCORTICOID STRESS RESPONSE IN MALE RATS

D. Desaulniers, G. Hua-Xio

Healthy Environments and Consumer Safety Branch, Health Canada

Perinatal events can reprogram the expression of the glucocorticoid receptor (GR) for the entire lifespan, creating abnormal hormone levels and suspected predispositions to metabolic and psychological diseases. We tested the hypothesis of a link between perinatal exposure to Northern contaminants and abnormal adulthood glucocorticoid (corticosterone: CS) stress response (GSR) in rats. The experiment included 9 treatment groups. From gestation-day 0 (day of vaginal plug) and until postnatal day (PND) 20, dams were fed daily cookies laced with corn oil (control) or a chemical Mixture (M: polychlorinated biphenyls, organochlorine pesticides, and methylmercury) at 0.5 or 1.0 mg/kg/day (0.5M, and M). At birth, some control (C) and M litters were crossfostered to create 4 groups of pups with the following in utero/postnatal exposure: C/C, C/M, M/C, M/M. Other dams received cookies with a dose of 1.7 ng/kg/day of a mixture of aryl hydrocarbon receptor agonists (AhR: non-ortho PCBs, dibenzodioxins and furans) without or with 0.5M. Mixture effects on CS was assessed in male offspring at PND85 through a GSR induced by the collection of blood from the tail vein (Time 0) and monitoring the CS decay from the trunk blood collected at decapitation 30 min later (T30). The concentrations of CS returned to normal at T30 in the group C, 0.5M, M, C/C and M/C, but it remained abnormally elevated in the group AhR, AhR+0.5M, C/M, and M/M. Interestingly, M had no effect on its own but it prevented the CS drop in adulthood in the M/M group in which exposure is associated with the postnatal stress created by the crossfostering procedure, suggesting that rats can tolerate exposure to M with no consequences unless they are subjected to early postnatal stress. The liver is a metabolic target organ and the abundance of GR mRNA was significantly reduced by the C/M and MM treatments. Globally, the crossfostering procedure permitted us to demonstrate that both the CSR and the abundance of the hepatic GR mRNA are modified by the postnatal period of exposure to M and not by in utero exposure, and that “postnatal stress” modified the effects of exposure to chemicals. These results are important in our understanding of the perinatal influence of contaminant exposure on stress-induced diseases. Contact: Daniel Desaulniers ([email protected])

SOME FEATURES OF HEALTH STATE OF INDIGENOUS POPULATION’S CHILDREN IN THE NORTH OF RUSSIA

P.I. Sidorov, N. Sibileva, L. Zubov

Northern State Medical University, Russia, Arkhangelsk

We carry out social-hygienic and medical examinations of the indigenous population of the Nenets autonomous area. The long-term monitoring among the native population shows that infant mortality of the Nenets children exceeds 1,5-2 times the average total indices in the region.

The health state of 176 children and adolescents in the reindeer brigades has been studied. In the structure of the pathology in the nomadic children diseases of the locomotor system, diseases of the respiratory system, diseases of respiratory organs, functional diseases


of the cardiovascular system and the vegetative nervous system prevailed.

A study has been carried out of the degree of iodine deficiency pronouncedness, prevalence of endemic goiter and neonatal hyperthyrotrophinemia in the area (clinical, instrumental and laboratory examinations of 132 Nenets and Russian children at the antepubertal age). The degree of iodine deficiency pronouncedness in the Russian children was described by the index of ioduria mediana 60,8 mkg/l what points at slight iodine deficiency, and in the Nenets children - 44,9 mkg/l (moderate iodine deficiency). Despite the differences in iodine provision, in the children of both nationalities, thyromegalia was absent and goiter was registered poradically. According to the indicator of neonatal hyperthyrotrophinemia, strumous endemia corresponds to the moderate degree of seriousness.

During complex evaluation of health of the native population children in the far North, it is necessary to take into account regional and ethnic features. Contact: Pavel Sidorov ([email protected])

NEW SERUM MARKERS OF AGING AND ATHEROSCLEROSIS: CHITOTRIOSIDASE, MATRIX METALLOPROTEASE ACTIVITY, AND CYSTATIN C CONCENTRATION

T. Korolenko, M.S. Cheranova

Institute of Physiology RAMS

The search of new serum markers of aging, atherosclerosis and predictors of cardio-vascular catastrophes is important in contemporary society, especially in regions and cities with high mortality from cardio-vascular pathology ( Novosibirsk and Novosibirsk Region). Activity of matrix metalloproteases (MMPs), chitotriosidase and cystatin C concentration were investigated in serum of 25 practically healthy persons aged 20-45 and elder group (25 persons, aged 50 - 65 years old, with arterial hypertension) and 25 patients with atherosclerosis before the cardiosurgical operation (Novosibirsk Regional Cardiovascular Unit). Cystatin C concentration was determined with help of commercial ELISA kits for quantitative determination of human cystatin C (BioVendor, Czechia), activity of MMP and chitotriosidase by fluorescent methods – against MCA-Pro-Leu-Gly-Leu-DpA-Ala-Arg-NH2 (American Peptide Co., USA) and 4-methylumbelliferyl-β-D-N,N’,N”-triacetylchitotrioside (Guo et al., 1995) as substrates correspondingly. Increased serum chitotriosidase and MMP activity, cystatin C concentration in aged persons as well as increased “basic” CRP-hs concentration (correlated with elevated serum cholesterol and triglycerides level) was shown. Similar results were obtained in patients with atherosclerosis before the coronary shunting operation, in this group serum MMP activity was elevated more significantly comparatively to the persons of the same age with arterial hypertension. Statins treatment improved all indexes studied in elder group (not to the normal data). One can conclude that increased chitotriosidase, MMP activity and cystatin C concentration are early markers of aging and atherosclerosis development. Contact: Tatyana Korolenko ([email protected])

SESSION 2 Sunday, July 12, 4-5:30 PM

VENUE 1 Mental Health & Wellness #2 – Holistic & Healing

Community Programs

CANADIAN INUIT COMMUNITY ENGAGEMENT IN SUICIDE PREVENTION

M.J. Kral1, P.K. Wiebe2, K. Nisbet1, C. Dallas3, L. Okalik3, N. Enuaraq1 1University of Illinois at Urbana-Champaign & University of Toronto, 2Health Canada, 3Inuit Tapiriit Kanatami

Objectives: To review suicide patterns among Inuit in Canada and highlight new developments in Inuit-driven and community-based suicide prevention.

Study Design: Narrative review of suicide among Inuit in Canada, strides toward Inuit autonomy, and community and government action toward suicide prevention.

Methods: Review of Inuit meanings of mental health, movements toward Inuit control across Inuit Nunaat (the four Inuit regions) of Canada, and of community and government action toward suicide prevention.

Results: Economic advancement is occurring in Inuit Nunaat following land claims settlements, and territorial and provincial governments are overseeing Inuit well-being. Inuit community engagement in suicide prevention is taking place, and studies are being planned to evaluate the efficacy of such action for suicide prevention and community mental health. Initial evidence demonstrates that community control over suicide prevention itself can be effective toward preventing suicide.

Conclusions: A new orientation is taking place in Canada in the name of Aboriginal community empowerment. There is a new hope for the model of meaningful community engagement and partnership with the Canadian government in suicide prevention and well-being. Contact: Patricia Wiebe ([email protected])

POSTPSYCHIATRY IN THE REGIONS OF RUSSIAN NORTH

T. Korolenko

Novosibirsk Medical University

The term of “postpsychiatry” is invented for the assessment and treatment of the mental disorders of the postmodern culture. In the up-to date Russia the postmodern culture is present mostly in the urban areas of the big towns and cities. It coexists with the big zones of the traditional and modern culture. The impact of postmodern culture on the population of North increases in the condition of the intensive migration processes. The traits of the postmodern culture include : rapid changes in the areas of personal, social and professional life, the weakening of the interpersonal links, the decrease of the intimacy, callousness, moral numbing, indifference, hardness, “no time” phenomenon, narrowing the scope of one’s moral universe. The structure and functions of the postmodern society form the predisposition for the development of the shadow forms of the previously known mental disorders, and the appearance of the new ones syndromes. The variants of the shadow syndromes of antisocial and borderline personality disorders, the cases of as yet practically unknown dissociation identity disorder, attention deficit disorder in adults, Munchausen syndrome by proxy were assessed and described. New situation in the field of the mental health that can not be treated in the frame of the traditional biological approaches. The challenges of the postmodernity demand the development of the new branch of psychiatry which will utilize mainly psychological, social, and object relation psychodynamic tools.


Contact: Tsezar Korolenko ([email protected])

“THE WAY I SEE IT”: HOW STIGMA AND DEPRESSION AFFECT SELF-PERCEIVED BODY IMAGE AMONG HIV-POSITIVE INDIVIDUALS ON HAART

A.K. Palmer1, A. Tzemis1, W. Zhang1, E.K. Brandson1, J.S.G. Montaner1,2, R.S. Hogg1,3 1British Columbia Centre for Excellence in HIV/AIDS, 2Department of Medicine, University of British Columbia, Vancouver BC, 3Faculty of Health Sciences, Simon Fraser University, Burnaby BC

Background: With significant reductions in AIDS-related morbidity and mortality, HIV is increasingly viewed as a chronic condition. However, people on HAART are experiencing new challenges such as metabolic and morphological body changes, which may affect self-perceived body image. The concept of body image is complex and encompasses an individual’s perception of their existential self, physical self and the social interpretation of their body by others.

Methods: The LISA cohort is a prospective study of HIV+ persons on HAART. An interview-administered survey collects information regarding body image, stigma, depression (CES-D 10), food insecurity, and quality of life among other information. In univariate analysis, chi-squared tests and the Wilcoxon rank sum test were used to compare individuals reporting positive body image with those reporting negative body image. In multivariate analysis, logistic regression was used with odds ratio being the measure of the association between positive body image and the covariates.

Results: Of 472 LISA participants, 57% reported positive body image. The adjusted multivariate analysis showed that being male (AOR= 2.09), employed (AOR=2.44), and having a suppressed viral load (AOR=1.84) are associated with positive body image. Alternately, stigma (AOR=0.37) and depression (AOR=0.27) are associated with negative body image. The estimated probability of a person having positive body image without stigma or depression is 80%. When stigma is included alone, probability drops to 66%, and when depression is included alone probability drops to 53%. Depression and stigma combined result in a probability of 37%.

Conclusion: Further efforts are needed to address body image issues among people living with HIV. In order to lessen the impacts of depression on body image, such issues must be addressed in healthcare settings. Community interventions are also needed to address stigma and reduce negative body image in an effort to improve the lives of people living with HIV. Contact: Eirikka Brandson ([email protected])

MENTAL HEALTH PROMOTION AND PREVENTION IN 12-18 YEAR OLD INUIT YOUTH IN NUNAVIK

G. Vrakas1, L. Fournier2, S. Moller3, R. Levy-Powell3, J. Mesher4 1Transdisciplinary Training Program in Public and Population Health Research CIHR/RRSPQ; University of Montreal Health Center’s Research Center; Institut national de santé publique; Center for Research and Intervention on Suicide and Euthanasia (CRISE; UQAM), 2University of Montreal Health Center’s Research Center; Institut national de santé publique du Québec, 3Kativik School Board, Nunavik, 4Saputiit Youth Association, Nunavik

The population of Nunavik is very young (42 % is under 18 years of age versus 21 % for the province of Quebec) and presents certain mental health issues. For example, the suicide rate of 15 to 19 year-olds is 40 times higher than that of Quebec youth of the same age group. Research on health promotion has shown that initiatives promoting community engagement are empowering and lead to better health outcomes than “top down” ones. The authors are partners in a community-based participatory research project addressing the following question: what mental health promotion and prevention initiatives are put into place by the Nunavimmiut to meet the mental health needs of their 12-18 year-old youth? Specifically, we propose to:

examine the mental health promotion and prevention programs and services aimed at 12 to 18 year-old Nunavimmiut presently implemented in Nunavik by government and community organizations and the Nunavimmiut themselves; evaluate the mental health needs of 12 to 18 year-old Nunavik youth in order to analyse how these services and programs meet their needs and how to better adapt them; suggest recommendations based on the analysis of programs/services and needs regarding youth mental health promotion and prevention programs and services in an empowerment perspective.

The study’s context, objectives, methodology and its participatory approach will be presented and discussed in this talk. This project employs an interactive or deliberative approach, which involves critical thinking and a co-construction of the research process, the production and the analysis of the results by the study partners and the involved community members, practitioners and decision-makers. A case study methodology will be adopted, where a village represents one case. Various methods will be used such as: documentary analysis, individual interviews and a focus group with key decision-makers and practitioners and photovoice with community youth, parents and elders. Contact: Georgia Vrakas ([email protected])

VENUE 2 Clinical Care #1

TRANSITION TO END OF LIFE CARE: THE INUIT EXPERIENCE IN MONTREAL

A. Robitaille1, M.L. Kelly2, B. Young1 1Nunavik Centre, Innulitsivik Health Centre, McGill University Health Centre, 2Ungava Tullatavik Health Centre

The Nunavik region situated north of the 55th parallel in Quebec has a population of 10,000 Inuit. Persons of Inuit origin are provided medical care in Montreal, situated at more than 2,000 km. A minority of these patients are found to have an advanced terminal condition, such as metastatic cancer for which treatment cannot be offered.

Decisions about end of life care are always difficult to undertake. They elicit fears of one’s imminent mortality, loss of hope, separation from loved ones and abandonment by health professionals.

The Inuit patient, though needing acute medical services, must also face the stress of being alone, immersed in a hospital environment, using a second language, isolated from family and community. These particular circumstances potentiate the chance of the Inuit having a different understanding of the decision making process, withdrawing his participation and experiencing traumatic psychological distress.

Little research has focused on the needs of the Inuit admitted to an urban hospital during the transition from curative to palliative care.

This is a multiphase nursing project having as goal to increase the quality of life of the Inuit patient in transition to palliative care in an urban medical center. It includes a review of the literature exploring the Inuit’s perception of life threatening illness, their experience in discussing end of life care and the cultural context in which such discussions are sanctioned.

A systematic chart review of adult Inuit from Nunavik who have died or who have been transferred to their northern community for end of life care between January 2007 and June 2009 will be done. The literature and chart review will provide an overall perspective of the subject and the complex concerns that are involved in providing culturally relevant care to the Inuit patient at this most difficult stage of life. Contact: Andréanne Robitaille ([email protected])

MY 11 YEARS TREATING SKIN DISEASES ON BAFFIN ISLAND, NU, CANADA. WHAT I SAW, WHAT I DID

R. Jackson


University of Ottawa

Like Julius Caesar’s description of Gaul, this presentation is divided into three parts.

The first deals with procedural items including the setting up of on-site dermatological clinics and how I use “store and forward” for consultations. Also, how I arrange for consultations in Ottawa.

The second tells of the medical aspects such as the diseases seen, their numbers, interesting aspects, treatment, and a few comments on the use of punch biopsies. Details will be given on the methods used to control the frequently seen atopic dermatitis.

The third will outline the public relations effort to “spread the gospel” on the “life and times” on Baffin Island, including mention of the first clinical medical meeting in Iqaluit., the capital of Nunavut. Contact: Robert Jackson ([email protected])

THE QUALITY AND COST OF WOUND DRESSING PROCEDURES BEFORE AND AFTER INSTITUTION OF A STANDARADIZED STERILE NO TOUCH PROTOCOL

T. Wuerz, G. Dow

Dalhousie University

Background: Current infection control practice for wound care, a daily activity both in the hospital and in the community, is widely inconsistent. Current literature surrounding various wound care procedures is extremely sparse, and there is ongoing debate as to which techniques should best be employed. Partly due to the extreme paucity of evidence, there exists a wide variation in the current practice of wound care. Dressings change technique is performed under clean or sterile conditions; sterile technique can be done using sterile gloves, or alternatively a “no touch” procedure whereby sterile dressings are manipulated using forceps. We developed a protocol for using a no touch sterile technique, and will perform an audit of dressing change technique before and after implementation of this technique. Given the high incidence or trauma and diabetes in the North in general, the results of this study will be highly applicable to practice in these areas.

Study Population: Forty patients will be randomly audited during the time of their dressing changes before and after implementation of our protocol. In each case, twenty of the patients included will have acute surgical wounds and twenty will have chronic nonsurgical wounds. Inclusion criteria include patients 18 years or older with an acute or chronic wound, as well as admission to a family practice, surgical and internal medicine ward. Burn patients as well as patients with VAC dressings will be excluded.

Intervention: No specific treatment will be carried out during the study period. The standardized no-touch wound dressing protocol will be introduced. All of the features of this protocol are contained in current nursing wound procedures.

Procedures: The research study nurse performing the audit will visit participating medical and surgical floors each morning to identify enrolled patients who will be undergoing dressing changes. These dressing changes will be audited for hand-washing before and after, as well as contact of the wound and wound field with sterile, clean, and contaminated objects.

Outcomes: Primary outcomes prespecified for this study include the number of breaks in dressing protocol, handwashing before and after dressing change, dressing time, and dressing cost. Breaks in dressing protocol is defined as any point in time during the dressing change where a nonsterile or contaminated object comes into contact with the wound. These variables will be compared before and after the dressing protocol implementation.

Statistical Analysis: Continuous variables will be compared using student’s t-test. Means will be computed with standard deviation. Categorical variables will be measured using chi-square testing with Fisher’s exact test as indicated. Statistical analysis will be carried out using SPSS statistical software. Contact: Terence Wuerz ([email protected])

IN-PATIENT CARE UTILIZATION AMONG SÁMI IN SWEDEN

S. Hassler1,2, P. Sj’lander2,3 1University West, Trollhättan, Sweden, 2Southern Lapland Research Department, Vilhelmina, Sweden, 3Centre for Musculoskeletal Research, University of Gävle, Umeå, Sweden

Objectives: The health care needed in different populations does not allways correspond directly to the rate of health care utilization. Geography, socioeconomy, gender and culturally related factors also influence the rate of utilization. Among the reindeer herding Sámi in Sweden it has been shown that the confidence in primary health care and psychiatry is significantly lower compared to non-Sámi controls. The objective of this study is to increase the knowledge on the utilization of health care among Sámi by presenting and analyzing data on in-patient health care with a special focus on gender.

Study Design: Register based epidemiological cohort study.

Methods: A study cohort of 37 039 Sámi (6 474 reindeer herders) was followed regarding all in-patient care discharges registered in the Hospital discharge register between 1999 and 2003. Hospital discharge rates and average length of stay were calculated and comparison made with a demographically matched control population of non-Sami.

Results: In all populations the discharge rates of in-patient care was lower among men than women but the gender difference was smaller among reindeer herders than non-herders and controls. Among women, reindeer herders have lower discharge rates (181/1000 persons) than non-herders (203/1000 persons) and non-Sámi controls (199/1000 persons) while the rates for men were similar for all groups. Non-Sámi men have the longest average length of stay (6.5 days) while non-herding women have the shortest (5.6 days). Among the different patient groups reindeer herding women have the lowest number of admissions to in-patient care (2.2) while reindeer herding men have the highest per patient admissions (3.0).

Conclusions: A lower than expected health care utilization among reindeer herding women may partly reflect a lower confidence in health care observed among reindeer herders. But other gender specific aspects that influence the behaviour related to health care among Sámi should also be considered. Contact: Sven Hassler ([email protected])

FREQUENCY OF ATOPY IN THE ARCTIC STILL INCREASING

V. Kamper, M. Andersson, B. Kristensen, A. Koch

Department of Epidemiology Research, Statens Serum Institut

Introduction: Allergic diseases have previously appeared to be relatively less frequent in Greenland compared with western countries. However, over a 10-year period the prevalence of atopy (defined as specific IgE in serum as a marker for allergy) in unselected persons from western Greenland increased from 10% to 19%, an increase higher than seen elsewhere in the world. Using the same methodology we determined the prevalence of atopy in 2008 in a cohort of school children in Sisimiut, west Greenland.

Methods: A cohort of 169 children aged 9-15 years previously followed in young childhood for respiratory tract infections had blood samples drawn. Samples were tested for specific IgE towards inhalant and food allergens using the Phadiatop and Fx5 assays. Information of risk factors was obtained from questionnaires from 1996-98 and at present.

Results: An overall prevalence of atopy of 30.6% was found among the children. Compared with a prevalence of atopy in 1998 of 20.6% among a similar and age-matched group of children, the prevalence increased almost 50% from 1998 to 2008. The distribution of individual allergens was the same in 1998 and 2008. Significant risk factors in early childhood for later development of atopy was having furry pets, having atopic parents, and suffering from many respiratory tract infections in early childhood.

Conclusions: The marked increase in atopy in Greenland observed from 1987 to 1998 continues. The unchanged distribution in prevalence of


allergens from 1998 to 2008 indicates that the increase cannot be ascribed to particular allergens, but rather to a generally increased atopic tendency among the children. Respiratory tract infections that are highly prevalent in young Greenlandic children are associated with development of atopy, but may only explain a minor part. These results suggest that the Greenlandic health system ought to be more aware of atopic diseases in the future. Contact: Vibe Kamper ([email protected])

THE PARADOX OF ANEMIA WITH HIGH MEAT INTAKE: IS THERE MULTIFACTORIAL ETIOLOGY OF ANEMIA AMONG THE INUIT?

J.A. Jamieson1, H.V. Kuhnlein1, Qanuippitali Steering Committee (Nunavut)2, G.M. Egeland1 1Centre for Indigenous Peoples’ Nutrition & Environment; School of Dietetics & Human Nutrition, McGill University, 2L. Gunn, Nunavut Association of Municipalities; L. Williamson, Nunavut Tunngavik Incorporated; I. Sobol and G. Osborne, Government of Nunavut Department of Health and Social Services; K. Young, University of Toronto

Dietary iron intake is insufficient to explain the prevalence of anemia among Inuit.

Primary Objective: To document the dietary intake and prevalence of anemia, H. pylori infection and parasitosis among Inuit adults.

Secondary Objectives: To characterize the type of anemia present and identify the relative contribution of each potential contributing factor. Methodology: Using good participatory research techniques, a cross-sectional study of dietary intake, nutritional assessment and screening for anemia, parasitosis and H. pylori infection in adults over 18 years of age (n=2200) was carried out with a representative sample of Canadian Inuit as part of Qanuippitali? The Inuit Health Survey. Venous blood samples were collected for analysis of iron status (serum ferritin), parasites and H. pylori infection by standard methods. Anemia was characterized by hemoglobin (Hgb) concentration (portable Hemocue). Inflammation (C-reactive protein) was assessed to account for potential effects on nutritional status. In Nunavut, 25% of females (n=700) and 21% of males (n=472) were classified as anemic (Hgb < 120 g/L and 130 g/L, respectively). Preliminary analyses will be presented. Contact: Jennifer Jamieson ([email protected])

VENUE 3 Social Determinants of Health #1 – Men’s Health

SOCIAL DETERMINANTS OF INUIT HEALTH

C. Penney

Indian and Northern Affairs Canada

Information on Inuit in Canada indicates disparities in a variety of health measures, as well as in a wide range of socio-economic factors. Using the 2001 and 2006 Aboriginal Peoples Survey, we look at which social, cultural and economic factors are most closely linked with differences in self-reported health. Regression modelling allows us to study the effect of cultural and social factors while taking such things as age, sex and other physical indicators into account. These socio-cultural factors include Inuit-specific indicators taken from the APS Arctic Supplement, as well as “standard” socio-economic factors such as education, employment and income. The results of our study indicated that social and cultural factors contribute to the self-reported health of Inuit in Canada, including such things as social ties to people in the community, and past attendance at a Residential School. Contact: Chris Penney ([email protected])

DYNAMIC ATTITUDE TO HEALTH PROBLEMS IN THE MALE POPULATION DURING SOCIAL AND ECONOMIC CRISIS IN RUSSIA (WHO-MONICA-PSYCHOSOCIAL PROGRAM)

V. Gafarov, E. Gromova, I. Gagulin, A. Gafarova, D. Santrapinsky, Y. Kabanov

Collaborative laboratory of Epidemiology Cardiovascular Diseases SB RAMS

Aim: To evaluate changes for a decade in the attitude of men to health problems during social and economic crisis in Russia.

Methods: A random representative sample of males (2149) aged 25 to 64 years from one district of Novosibirsk was examined within the framework of the screening (1984,1988,1994) of the WHO “MONICA-psychosocial” program. Health self-assessment and attitude were studied by means of the questionnaire “Awareness and Attitude towards Health” the studied population.

Results: Constant deterioration of a self-estimation of health in age group of 25-34 years is revealed (p<0,001) of 10-years research. In the age of 35-44 years the same tendencies, as in younger age group were observed, but less expressed (p<0,05). In too time, in the age of 45-54 in 1,9 times the number of answers “ health good “ has increased (p<0,05). In age group of 55-64 years the increase of number of the men estimating the health is revealed “is positive” (p<0,001). Persons of young age groups are dependent on civil functions of a society, such as necessity of earning money for themselves and for maintenance of family. And, accordingly, during economic instability (it is especial 1994) They are more vulnerable concerning health. Significant reduction of frequency of smoking is probably connected to deterioration of a self-estimation of health at this age also. But it is necessary to tell, that in the senior age groups in 1994 consumption of alcohol in reply to social and economic crisis has sharply increased.

Conclusion: Estimation of the health the population is objectively - subjective criterion of the general level of health a population. Dynamics of this criterion during social and economic crisis in Russia has shown significant deterioration of a state of health among men young, middle-aged and growth of consumption of alcohol, smoking in advanced age. Contact: Valery Gafarov ([email protected])

MEN’S ATTITUDE TO OWN HEALTH UNDER THE MICROSCOPE

G. Thunem

KUN center for gender equality

Public health and mortality in Norway has strong gendered aspects, with men on the negative side of the spectrum. Women have a life expectancy 5 years longer than that of men; there are differences in health and mortality that are not biological but rather products of social relations, lifestyle and cultural expressions of masculinity and femininity.

Focusing on men, more men than Women see their own health as good or very good, but this is at odds with reality. Traditional expressions of masculinity emphasise agency and stoic disregard for physical and mental pain. Lifestyle habits, diet, physical activity, tobacco and drug use, sexual health and accident-prone behaviour all contribute. Single men in particular seem to have difficulties reading their own bodies and health indicators, and do not seek medical attention.

Tysfjord in Nordland county in Norway has a population of about 2000, mainly of Norwegian and Lule Saami origin. This presentation describes an attempt to focus on male health in public health discourse and efforts organised, by the Árran Lulesami centre and the KUN centre for gender equality. The project has worked to organise public information meetings, specialised information and awareness campaigns focusing on men. Awareness of the impact of ethnicity and gender relations and the specific challenges of public health work in a rural setting has circumpolar parallels.


Contact: Gunhild Thunem ([email protected])

THE SOCIAL ECONOMY AND HEALTH IN NORTHERN CANADA

C. Southcott

Lakehead University

Northern communities are currently facing many social and economic challenges. The non-profit, voluntary, and co-operative organizations involved in the social economy sector are working to assist communities deal with these challenges by empowering communities through the development of social and human capital capacity. This is especially seen in the healthcare sector of Northern Canada. This paper is part of an initial evaluation of the relationship between the social economy and healthcare in the North. It seeks to offer an initial description of this relationship through an examination of the results of a census of these organizations and a subsequent survey. The analysis show that social economy organizations are particularly important to healthcare in Northern communities. At the same time these organizations are facing several important challenges that affect their ability to assist these communities. Contact: Chris Southcott ([email protected])

USING KNOWLEDGE SYNTHESIS, TRANSLATION, AND EXCHANGE TO PUT THE DETERMINANTS OF HEALTH INTO ACTION IN NORTHERN COMMUNITIES

H. Beanlands, C. Betker, A. MacLeod

National Collaborating Centre for Determinants of Health

The determinants of health are the factors that influence our health and well-being. Health is impacted by many factors: our environment, our genes, our relationships, what we eat, how active we are, and the healthy personal behaviours we adopt. Moreover, our environment reaches far beyond the natural world around us to include social, gender, economic, political, and work factors. Directly or indirectly it is these factors that determine the health of our citizens, their communities and Canada’s population as a whole (NCCPH, 2008). The World Health Organization Commission on Social Determinants of Health (2007) noted that “the conditions in which people grow, live, work and age have a powerful influence on health. Inequalities in these conditions lead to inequalities in health.” Evidence indicates that social and economic circumstances are equally, and in some cases, more important to health status than medical care, health services and our personal health behaviours.

In light of this evidence, the National Collaborating Centre for Determinants of Health recognizes that working toward improved health and reduced disparities requires a serious focus on the determinants of health. Therefore, this presentation will explore the determinants of health with a specific focus on how we can effectively take action in an intersectoral, evidence-informed and comprehensive manner. The goal of the presentation is to enhance the working understanding and the application of the determinants of health in public health policy and practice across Canada, with a particular focus on northern communities, to address health inequity. It will provide an opportunity to hear and respond to examples of where the determinants of health have been addressed, including the identification of opportunities and response to challenges. Contact: Hope Beanlands ([email protected])

INUIT MEN TALK ABOUT HEALTH

D. Kinnon

National Aboriginal Health Organization

In 2002, the Inuit Tuttarvingat (formerly the Ajunnginiq Centre) of the National Aboriginal Health Organization held a series of community workshops in Inuit regions to gather ideas about health and health-related needs. At every workshop, participants stated their concern

that Inuit men were not getting the help they needed. Those concerns sparked a research project in which 19 Inuit men across the country were interviewed about their needs and views on health. The resulting report, entitled Inuit Men Talking About Health, was released in 2009. The study provides a first in-depth look at health issues from an Inuk male perspective. We hope that this study will give a stronger voice to Inuit men, and will contribute to discussions about how health and social programs can be adapted to better serve them.

The study reveals that the huge cultural transitions in the space of just two generations have left Inuit men feeling powerless, lost, and unsure of their place in the family and community. Their level of distress is reflected in low school completion rates, high rates of incarceration and suicide. Yet services specifically oriented to male needs have lagged behind those for women. In the study Inuit men discuss some of the major factors that underlie health — like education, income, and use of health care — and also describe their experience and perceptions of personal and family problems.

This presentation will provide highlights of the men’s perspectives and solicit reactions and comments from the audience concerning priority needs among Inuit men, Inuit knowledge related to healing and promising practices to better reach and support men. Contact: Dianne Kinnon ([email protected])

VENUE 4 Database & Surveillance #1

POPULATION HEALTH INDICATORS FOR FIRST NATIONS IN ALBERTA

N. Lachance

Health Canada

The presentation has been prepared using a population health approach and is expected to guide joint efforts in terms of health planning. As such, it has been widely presented to decision-makers in First Nations organizations and governments in Alberta. The presentation of the Population Health Indicators for First Nations in Alberta provides a profile of the First Nations in Alberta by compiling information on demographics, socio-economic determinants of health (education, income, employment and housing) as well as a number of health indicators. The presentation has been developed by gathering information from a number of different sources including Statistics Canada, Health Canada, Indian and Northern Affairs Canada, Assembly of First Nations, Alberta Health & Wellness and the National Aboriginal Health Organization. The presentation emphasizes the close relationship between education, employment and income and their impact on health status. It also shows how injuries, addictions, healthy weight and the impact of young parenthood affect the socio-economic determinants of health. Contact: Nathalie Lachance ([email protected])

MÉTIS HEALTH/WELL-BEING DATA COLLECTION: CONCEPTUAL SNAPSHOT OF FACTORS BEHIND DATA-PAUCITY AND ACTION STEPS

M. Kumar

Métis Centre of the National Aboriginal Health Organization

Numerous reports, environmental scans and discussion papers allude to the dearth of Métis health/well-being data. The shortcomings of the current sources of data range from poor data quality, insufficient/inadequate data to a complete lack of data. These deficiencies have serious consequences including an inadequate understanding of the true state of Métis health, the disparities and determinants, and insufficient funding for programs, all of which collectively perpetuate health/wellbeing disparities. In this paper we present some of the limitations of current sources of Métis data, including surveys and peer-reviewed publications. Further, we


elucidate a conceptual snapshot of the factors behind the scarcity of data, with some emphasis on jurisdiction/exclusion issues. Following this, some recommendations including potential approaches to achieving a wide-ranging set of Métis health/well-being data are discussed. A comprehensive collaborative strategy which may incorporate many of the outlined approaches is explored. Contact: Mohan Kumar ([email protected])

COMMON DISEASES IN SIBERIAN NATIVES

M.I. Voevoda1, A.N. Romanova2, T.A. Romanova2, N.V. Makcharova2, M.I. Tomskii2, O.V. Yanchenko1, M.Yu. Ogarkov1, L.A. Gyrgolkau1, Yu.I. Ragino1, E.V. Shakhtshneider1 1Institute of Internal Medicine, Russia Academy of Medical Science, Siberian Branch, Novosibirsk, Russia, 2Yakut Scientific Center, Russia Academy of Medical Science, Siberian Branch, Russia - Yakutsk

At present common diseases become one of the leading causes of the death in native populations of Siberia and there are indications that their prevalence will further grow. A rapid increase of diabetes mellitus incidence also has been observed in some native populations.

The goal of this work was to study the prevalence of common diseases risk factors in various ethnic groups of indigenous peoples of Siberia and their relationship with coronary atherosclerosis.

Materials: We examined the native population of Yakutia, Khakasia, Mountain Shoria and Mountain Altai. In Yakutia and Khakasia patients of native origin and newcomers with angiographically verified coronary atherosclerosis or myocardial infarction were also examined. Traditional risk factors, including blood lipids, blood pressure, body mass, family history, glucose level, apolipoprotein E genotypes and some other genetic markers were evaluated.

Results: The level of risk factors varies in different native populations. Its prevalence gradually increases in all populations proportionally to westernization of life style. In all studied areas the frequency of risk factors in the populations of indigenous people is still lower than that of newcomers. Universal increase in prevalence of risk factors associated with metabolic syndrome is observed in patients with coronary atherosclerosis in all studied native and nonnative ethnic groups. Peculiarities of risk factor prevalence and expression is partly determined by the ethnic specificity of the genetic factors.

Conclusion: The prevalence of common diseases in native populations of Siberia is rapidly increased. An important role in this process belongs to metabolic syndrome. Contact: Mikhail Voevoda ([email protected])

USING HEALTH NEEDS ASSESSMENT TO INFORM PRIMARY HEALTH CARE PLANNING

J. Gordon, F. Tarrant

Sioux Lookout First Nations Health Authority

The project conducted the needs assessment process that undertook the collection of information in five major areas relevant to health planning for the First Nations communities in Northwestern Ontario. Data was collected on population and health status, health determinants, community strengths, existing health care services, and the vision for the future health care system.

The primary intention of the needs assessment was to inform the development of a comprehensive primary health care system for the region. While much research already exists on the health status of the aboriginal population within the area, it was dated and did not necessarily reflect current health issues. This project was undertaken to establish an up-to-date and/or current research base on the health status, issues and priorities for the First Nation communities. It also identified the gaps in primary health care service delivery and provide the foundation for the development of an action plan to address those gaps.

The research methods used were a literature review, collection, review and analysis of official statistical information, key informant interviews, focus group sessions, self-administered questionnaires and development of community profiles.

A total of twenty-six (26) communities participated in the process. Of those, only four (4) are considered non-isolated (meaning they have road accessibility) and are within three (3) hours of Sioux Lookout. The remaining twenty-two (22) participating communities are accessible by air only.

Across the twenty-six (26) communities a total of two hundred ninety-eight (298) key informant interviews and twenty (20) focus group sessions comprising an additional seventy-seven (77) informants were conducted. In total three hundred eighty-five (385) informants participated in the consultation process.

A high-level content analysis was carried out to identify similar themes and concepts across the whole data set. This helped identify community perceptions of the major health problems, causes of poor health and gaps in current service delivery. Contact: Janet Gordon ([email protected])

ESTABLISHING AN INTERNATIONAL CIRCUMPOLAR COLLABORATIVE TUBERCULOSIS WORKING GROUP

T. Zulz1, D. Scholten2 1Centers for Disease Control/Arctic Investigations Program, 2Public Health Agency of Canada

Background: The International Circumpolar Surveillance (ICS) project was established in 1998 to create an infectious disease surveillance network throughout Arctic regions. ICS allows for the collection, comparison and sharing of uniform laboratory and epidemiological data on infectious diseases and assists in developing prevention and control strategies. Collaborative surveillance initially focused on invasive pneumococcal disease. In 2006, due to concerns about high rates of tuberculosis (TB) in the Arctic, the ICS Steering Committee approved creation of a TB Working Group.

Methods: An organizational meeting in 2006 with representatives from interested circumpolar regions was held in Yellowknife, NWT, Canada. A formative evaluation was conducted in 2007 which included a literature review and questionnaire. The questionnaire was sent to all ICS representatives. The literature review focused on TB surveillance and epidemiology in circumpolar countries. Results were compared to questionnaire answers to identify critical gaps to be addressed by the program. Evaluation results were presented to working group members. Further conference calls focused on procedural issues.

Results: Greenland, Canada and the U.S. Arctic (Alaska) were represented at the organizational meeting in Yellowknife. During the evaluation, representatives from Sweden and the Russian Federation indicated interest. The evaluation identified five goals for the group (1) improve surveillance of TB, (2) identify trends in TB epidemiology, (3) assess the incidence of TB, (4) increase awareness of TB, and (5) collaborate on TB research. The group developed draft Terms of Reference, core data elements, case definition and a data sharing agreement. A work group meeting is planned for July, 2009, in conjunction with the International Congress on Circumpolar Health.

Conclusions: The ICS TB Working Group has great potential to influence public health in circumpolar countries. Continued collaboration will provide shared data that may identify common issues and assist in developing strategies for TB detection and control. Contact: Tammy Zulz ([email protected])

THE GREENLANDIC NATIONAL INPATIENT REGISTER AS A TOOL FOR HEALTH MONITORING AND RESEARCH IN GREENLAND

M. Andersson1, N. Nielsen1, M. Melbye1, K. Ladefoged2, A. Koch1


1Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark, 2Department of Internal Medicine, Queen Ingrids Hospital, Nuuk, Greenland

Like in Denmark, all individuals in Greenland are assigned a personal and unique identification number (CPR-number) at birth. This number follows the person from cradle to grave and identifies the individual in a large number of nation-wide registers concerning health, social factors, etc. Using the number as linkage these registers may be linked which has resulted in a large number of scientific health studies in Denmark. In 1987 Greenland established the Greenlandic National Inpatient Register which until now contains information about all (more than 240.000) hospitalizations in Greenland. Thus, the Register has a unique potential for insight in the health situation in Greenland during the past 20 years and contains a large potential for comprehensive register-based research studies in Greenland. However, the Register has never been used as a tool for neither administrative nor scientific purposes, and has not undergone scientific validation. As part of an agreement between the Greenland Directorate for Health and the Department of Epidemiology Research (DER) at Statens Serum Institut, Copenhagen, Denmark, the DER got access to the Register with the aim of performing a scientific validation of the register to assess its quality, which is crucial before it can be used for health monitoring and research. A first look at the register using selected diagnoses that could be validated elsewhere (i.e. births and birth related hospitalizations) disclosed that there has been a relatively stable rate of reporting of hospitalizations from the district hospitals over the period and that the rate off falsely registered diagnose codes has been low, but that there is a certain amount of underreporting. Thus, the Register appears to be a promising resource for health research in Greenland, but a more thorough validation process is needed. In the presentation the register and possible impact for health monitoring and research will be described. Contact: Mikael Andersson ([email protected])

NORTHERN RSV SURVEILLANCE: OBJECTIVES, METHODS, AND PRELIMINARY RESULTS

A. Banerji, M. Young, Northern RSV Surveillance Study Team

University of Toronto, Departments of Pediatrics & Dalla School of Public Health

Objective: Inuit infants have the highest rates of admission for lower respiratory tract infections (LRTI) in the world. The objective is to present the rationale, objectives, methodology and initial results for the Northern RSV Surveillance. This study is a multi-site prospective surveillance across most of Arctic Canada and Greenland, which documents the rates of admission for LRTI, identifies Respiratory Syncytial Virus (RSV) and other traditional and emerging viruses, and calculates the costs associated with admissions.

Methods: We describe a surveillance for admissions for LRTI in infants less than 1 year of age from Arctic Canada and Greenland who were admitted to regional and tertiary centres. RSV is identified by rapid RSV testing usually on site, while the remaining specimen will be tested for a multiplex PCR panel assessing for 22 viruses. The rates of LRTI and RSV admission per region will be calculated, as well as the costs associated with the admission to hospital. The rationale, challenges and preliminary data will be discussed. The potential policy implications of this research will be discussed.

Results: Infants were enrolled from 9 hospitals in Canada and throughout most of Greenland. We will describe the demographics of all enrolled infants up to June 2009, as well as the RSV rates in each region. The RSV season started later than the typical season in the south. Most infants were born at term without underlying risk factors for admission. We will present some of the more challenging aspects of initiating Arctic-wide RSV surveillance, the importance of ongoing surveillance and some lessons learned from our experience.

Conclusion: This study will collect valuable data on the epidemiology and costs of RSV in the Canadian Arctic and Greenland, which is a population that has been poorly studied up to this point.

Contact: Anna Banerji ([email protected])

ESTABLISHING A SENTINEL SURVEILLANCE SYSTEM FOR HIV-ASSOCIATED RISK BEHAVIOURS AMONG ABORIGINAL POPULATIONS IN CANADA

M. Aslam, S. Ogunnaike-Cooke, D. Boulos, C.P. Archibald, A-Track Working Group*

Surveillance and Risk Assessment Division, Public Health Agency of Canada

Background: Aboriginal peoples comprise 3.8% of the Canadian population, but in 2005 represented an estimated 7.5% of all prevalent HIV infections and 9% of all new HIV infections. The overall estimated HIV infection rate among Aboriginal persons in 2005 was about 2.8 times higher than among non-Aboriginal persons. Available data from routine surveillance are unable to adequately explain the current status and trends of HIV infection and related risk behaviours among Aboriginal persons, and, therefore, additional data sources are required. This paper outlines the framework to establish a sentinel HIV surveillance system among Aboriginal (First Nations, Métis, Inuit) Canadians.

Methods: Public Health Agency of Canada is working with Aboriginal representatives to develop A-Track, a second-generation HIV/AIDS surveillance system. Work is underway to finalize the surveillance instruments and identify pilot site(s) in consultation with the ATrack Working Group.

Results: A national enhanced HIV surveillance system among Aboriginal populations envisages biological and behavioural surveillance via repeated cross-sectional surveys with consistent sampling strategy, data collection methods, and indicators to monitor trends in HIV, related risk behaviours, HIV-testing history, access to healthcare services and knowledge and attitudes around HIV/AIDS among Aboriginal Canadians over time. HIV testing is expected to be optional whereas testing for other pathogens will be subject to validity of specimen collection and testing methods. The system underscores Aboriginal involvement at all stages, will recognize Aboriginal people’s shared control over jurisdictional data, respect Aboriginal customs and practices, and is expected to yield information on prevalence of HIV infections and related risk behaviours among Aboriginal persons at the participating sentinel sites. The pilot survey is expected to go in field in 2009.

Conclusions: Successful design and implementation of a sentinel HIV surveillance system among Aboriginal peoples requires community engagement, utilization of existing infrastructure, and enhanced Aboriginal capacity-building. A better understanding of HIV-related risk behaviours and HIV prevalence over time will facilitate improved policy and program interventions, at the local, provincial/territorial and federal levels, to prevent and control HIV infection among Aboriginal populations.

* A-Track Working Group (includes past members of Working Group): Chris P Archibald (Federal Co-Chair, Public Health Agency of Canada); Ken Clement (Community Co-Chair, National Aboriginal Council on HIV/AIDS); Margaret Akan, Fran Hyndman, Fred Andersen, Jeanette Doucet, and Joyce Seto (National Aboriginal Council on HIV/AIDS); Dawn Marsden (National Aboriginal Health Organization); Michelle George (Healing Our Spirit); Neil Andersson (Centro de Investigación de Enfermedades Tropicales – Tropical Disease Research Centre); Ulrick Auguste (First Nations and Inuit Health Branch, Health Canada); Kevin Barlow (Canadian Aboriginal AIDS Network). Contact: Aslam Mubeen ([email protected])


VENUE 5 Community Participatory Research Methods #2

CLIMATE CHANGE AND HEALTH ADAPTATION IN NORTHERN FIRST NATION AND INUIT COMMUNITIES PROGRAM

D. McClymont Peace, E. Myers

First Nation and Inuit Health Branch, Environmental Health Research Division, Health Canada

This program is designed for Northern First Nations and Inuit communities. It will support community-based research activities which are aimed at developing scientific expertise and relevant communication material to increase capacity/ improve decision-making at the community, regional, and national levels with respect to human health in a changing climate.

Much of the existing climate change research and program development in Canada has focused on impacts to natural and built physical environments and on ways of mitigating or reducing green-house gases which contribute to climate change. Very little research has been done on its implications to human health. To fill the gap, Health Canada – First Nations and Inuit Health Branch has developed a community-based research program, which aims to integrate both scientific studies and traditional knowledge, to help northern First Nations and Inuit increase their knowledge and capacity to develop health-adaptation strategies.

The research examined the following issues across the North: ice monitoring and safety, food security and gender analysis, landslides and their effects on water safety, and creating the link between climate change and health issues from Elder’s traditional knowledge systems and connecting them with scientists and youth through outreach. This will be described in further detail at the Congress.

The main outcome of this program is to build capacity in the North; this program is an opportunity to allow Northern community-based researchers to develop their own research and find ideal solutions to deal with their particular climate change and health issues. And by health we mean that projects can explore how the physical, mental, and/or spiritual aspects of certain people or of the entire community is being affected.

The ultimate aim of this program is to develop scientific expertise and relevant messaging that will help in decision-making with respect to human health and a changing environment in Canada’s North. Contact: Erin Myers ([email protected])

YOUTH DRIVEN PARTICIPATORY RESEARCH IN AKLAVIK, NWT

S. Chatwood1, V. Illisiak2, D. Kurszewski1 1Institute for Circumpolar Health Research, 2Moose Kerr School, Aklavik, NT

The Moose Kerr School in partnership with the Aklavik Health Committee and the Arctic Health Research Network NT have lead a research initiative to engage youth and elders via participatory methodologies to study issues related to food security and climate change in the Beaufort Delta region of the Northwest Territories. The research projects have been integrated into the school curriculum. Students complied information on the topic area of interest, designed questionnaires and gathered information using video methods. Key findings from the dietary and climate change projects will be presented. Contact: Susan Chatwood ([email protected])

COMMUNITY-BASED APPROACH TO HEALTH RESEARCH IN THE ARCTIC: A CASE STUDY FROM NUNAVUT, CANADA

D.P. Charette, S.G. Donaldson, N.C. Doubleday, T. Nancarrow, C.N. Da Silva, T. Leech, A. Manning, B. Grimwood, M. Ip, E. Pootoogook, G. Pootoogook, J. Van Oostdam


Introduction: Community-based health research (CBHR) is considered to be one of the frameworks that can be used to engage researchers and community organizations and members in research. This approach is important to ensure that the research responds to community-level health needs and concerns.

Objective: The objective of this paper is to outline a community-based methodological approach that was applied to a human health research project in Nunavut, Canada.

Research Methodology: The research study relied on semi-directed and open-ended interviews and documentation of the entire research process.

Results: The research showed the importance of community research partnerships, the involvement of community members in all phases of research, the process that was employed to collect, analyze and interpret the findings, and the mediums used to communicate the research results.

Conclusion: The results of this paper provide a new foundation that could be used to build future community-based health research projects in the circumpolar region. Contact: Shawn Donaldson ([email protected])

WATCHING OUR YOUTH LISTEN TO OUR ELDERS: BUILDING YOUTH CAPACITY TO INVESTIGATE HEALTH IMPACTS OF CLIMATE CHANGE AND OIL AND GAS DEVELOPMENT IN THE NWT

E. Freeland-Ballantyne

University of Oxford

Canada’s Mackenzie Valley Delta is the fastest warming region in the circumpolar north. While communities experience day-to-day impacts of climate change, the region is in the midst of an oil and gas boom precipitated by the proposed Mackenzie Gas Pipeline. With a focus on community health and wellness, a two-year youth-directed participatory video research investigation offers timely insights into how a community research focus on health can lead to important insights in the quest of building sustainable, healthy northern futures.

The paper details how participatory geography methods can support community research goals while simultaneously building research capacity, awareness, and monitoring action in communities affected by both climate change and oil and gas development. Presenting the significance of a participatory youth-led methodology that fosters youth-Elder and community-university cooperation, the paper details the possibility that participatory research in health can serve as a catalyst to inter-regional and intergenerational communication as well as action to address the health and wellness impacts of climate change and oil and gas development. The paper discusses the importance of sustainable community research in reaching this goal, the spaces for academic-community partnerships, and the importance of community-driven health research. I will then present the results of the research, which indicate an alternative northern conception of health, wellness and human security than those models currently represented in environmental impact assessment and economic development decisions in northern development. Offering an alternative approach to the current challenges of rapid change from a community health orientation, this work details the possible courses of action detailed in the research to support community health and sustainable development. Contact: Erin Freeland Ballantyne ([email protected])


VENUE 6 Food Security #1 – Politics of Food

ASSESSMENT OF CONTAMINANT AND DIETARY NUTRIENT INTERACTIONS IN THE INUIT HEALTH SURVEY

L.H.M. Chan, L. Van Pelt, G.M. Egeland, Qanuippitali Steering Committee (Inuvialuit), Qanuippitali Steering Committee (Nunatsiavut), Qanuippitali Steering Committee (Nunavut)

UNBC Community Health Sciences Program

The Inuit Health Survey (IHS) provides a snapshot and baseline data on the health status of Inuit People across the North in Nunavut, Inuvialuit and Nunatsiavut. This project was developed as a component of HIS that would incorporate contaminants research within broader health research studies. We obtained funding support from the Northern Contaminant Program to measure the amount of environmental contaminants in the bodies of the participants, and to access the risks and benefits associated with the traditional food diet and the relationship between contaminants and health outcomes of the participants. Survey and sample collection was conducted in Nunavut on board of the Coast Guard research vessel Amundsen in 2007 and 2008. This is a participatory research with full partnership with the Inuit organizations and the regional health departments. All necessary measures will be undertaken to increase the capacity of the communities and local health professionals. The key research question is “How do the diets and contaminants affect the health of the Inuit?” Results of the study will provide useful information to assist health professionals and policy makers at the Territorial, national and international levels in developing environmental health policies and aid Inuit in making informed dietary choices. We will present an overview of the project and discuss the significance of the expected results in determining the well being of the Inuit in the Canadian Arctic. Contact: Laurie Chan ([email protected])

MERCURY IN FISH AS A RESULT OF THE JAMES BAY HYDROELECTRIC DEVELOPMENT: PERCEPTIONS AND REALITIES

B.D. Roebuck1, E.J. Virginia2 1Department of Pharmacology and Toxicology, Dartmouth Medical School, Hanover, NH, 2Dartmouth College, Hanover, NH

The hydroelectric development scheme known as the La Grande Complex began in the1970s in the James Bay region of QuÈbec, Canada. With flooding, pre-existing mercury associated with vegetation and soils was mobilized, biologically methylated, and migrated through the aquatic food web. Mercury in some fish was above the existing Canadian and World Health Organization (WHO) fish consumption guidelines. Considerable debate, rancor, and fear within and between the several stakeholders resulted in much publicity and several measures to monitor and mitigate the potential health risk of fish consumption.

Unlike many contaminants (e.g., DDT and PCBs), mercury is also naturally present in both the environment and the fish therein. Furthermore, mercury has a long and well publicized history with several catastrophic episodes of human poisoning from contaminated foods.

This case examines three important issues. First, knowledge of an elevated presence of mercury in fish in the James Bay Region, particularly in the reservoirs and diverted water courses of the La Grande Complex, may or may not have been the direct cause of the decreased use of the fisheries by the Cree, as other societal changes were occurring simultaneously. Second, irrespective of the cause for the decline in fish consumption, the avoidance of fish and thus mercury is attended with increased consumption of nutritionally inferior foods and decreased intakes of n-3 polyunsaturated fatty acids. Third, many of the traditional foods in the Arctic contain multiple potential

toxicants; however, the fish in the James Bay Region predominately contain only mercury and fish is virtually the only source of the mercury for humans; thus, this case is much simpler than multiple contaminants in multiple foods as occurs in much of the circumpolar North. This case emphasizes a holistic view of the potential risk of mercury exposure versus the real risks in avoidance of fish. Contact: Bill Roebuck ([email protected])

CONTAMINANTS, HEALTH, AND EFFECTIVE RISK ASSESSMENT & COMMUNICATION IN THE CIRCUMPOLAR NORTH

K. Friendship1, C. Furgal2, Council of Yukon First Nations, Yukon Contaminants Committee 1Canadian Studies Indigenous Studies Graduate Program, Trent University, 2Indigenous Environmental Studies Program, Trent University

There is growing recognition of the importance of Indigenous knowledge and the incorporation of Indigenous perspectives and perceptions in environment and health research today. There have been certain challenges when assessing and communicating environmental health risk information with northern communities in the past due to an incomplete understanding of how the information would be viewed by Indigenous communities. Differences in culture, language, the politicization of information, and cross-cultural misunderstandings can all act to undermine the best intentions of health and environment professionals. While there has been an increasing awareness of these difficulties, this has not necessarily translated into more effective action taken to address these challenges. There is little research showing how environment and health benefit-risk assessment and communication has been developed at the local level in communities, what things have been affecting this process, or evaluation of the success of such efforts to date. A CIHR funded Circumpolar review will conduct case study reviews on the topics of Indigenous environmental health benefit-risk assessment and communication associated with contaminant exposure through traditional food consumption in one community of each of the following regions: Yukon, Alaska, Greenland, and the Russia North. It is hypothesized that common key factors at the individual and community scale influence the success (as measured by community reception, retention, comprehension, compliance to messages and perception of issues) of risk assessment and communication events related to contaminants, country foods, and health in circumpolar Inuit communities. As well, identifying and understanding these common factors can improve the assessment and communication of health risks and benefits for environmental health issues in Arctic regions.

This project also includes a Masters thesis subproject exploring: what are the current and possible contributions of Indigenous knowledge to environmental health benefit-risk management processes in Northern Indigenous communities? The thesis research will focus on understanding how perceptions, assessment and communication of benefits and risks associated with food safety issues are and can be enriched by the involvement of Indigenous knowledge and perspectives (e.g. exposure to long-range transport contaminants through traditional diet). Contact: Katelyn Friendship ([email protected])

FOOD SECURITY REFERENCE GROUP: BUILDING THE EVIDENCE TO SUPPORT DECISION-MAKING AT POLICY AND COMMUNITY PLANNING LEVELS AND IMPROVE FOOD SECURITY FOR FIRST NATIONS AND INUIT

A. Nahwegahbow, J. Cheechoo, M. Guyot

First Nations and Inuit Health Branch, Health Canada

Available data demonstrate that food insecurity is much higher among Aboriginal populations than non-Aboriginal populations in Canada, and is of particular concern in northern and isolated communities. To date,


there has been little conceptualization of what food security might mean for First Nations and Inuit, and little consideration of what policies or practices might enable the achievement of this important social determinant of health.

To help address these needs, the Food Security Reference Group (FSRG) was established in 2005. The FSRG brings together Inuit Tapiriit Kanatami, the Assembly of First Nations, the federal government, academics, and others for the purposes of sharing information, discussing strategies and opportunities, and setting priorities for collective action to improve food security in First Nations and Inuit communities.

Achievements of the FSRG include a comprehensive literature review and an evidence-based interventions framework, and review and documentation of community-based initiatives. These outputs have helped better define food security issues for First Nations and Inuit; highlight policy and research gaps; and conceptualize how food security can be promoted in First Nations and Inuit communities.

Future directions of the FSRG include identifying opportunities for advancing food security at both policy and community planning levels through positioning and building on the tools developed and information gathered by the FSRG, and continuing to build the evidence to support decision making at these levels. Contact: Melissa Guyot ([email protected])

COMMUNICATION PATHWAYS: HOW YOUNG INUIT WOMEN IN NUNATSIAVUT GET INFORMATION ON NUTRITION, HEALTH, AND ENVIRONMENTAL CONTAMINANTS

L. Dean

Dalhousie University, School for Resource & Environmental Studies

Inuit are sustained by the animals, birds, plants and fish of their region. Research has shown that Inuit are exposed to contaminants via their traditional diet of these wildfoods. Contaminants (chemicals / compounds related to global industrial and agricultural activities) are present in the local ecosystem and food web, eventually being consumed by humans. Based on our current understanding, humans in developmental phases (prenatal and neonatal) are at greatest risk from this exposure; any developmental anomalies may have significant long-term impacts on health. This means that women who are in their child-bearing years are vulnerable to contaminants.

The levels of contaminants in wildfood and the potential health effects they may have are of concern to Inuit. These concerns threaten confidence in the safety and value of wildfood and affects food security. Meanwhile, social and cultural benefits associated with a traditional diet and related activities are important to the fabric of community life. Therefore it is vital that communication about the risks of contaminant exposure be accurate, while recognizing the possibility of unnecessarily raising fears. Poor risk communication has been linked to confusion, mistrust, and in some cases negative changes in diet behaviour.

This study reviewed risk communication networks in Nunatsiavut for the dissemination of information related to contaminants exposure through traditional food consumption. Key informant interviews, focus groups and document review were used to identify existing communication pathways (formal and informal) delivering this information. Focus groups were carried out with young women to learn about their experience of the communication process around health and nutrition.

This research will inform new strategies for communicating about health priorities with Inuit communities, so that Inuit can make informed and balanced decisions that can positively influence their health. The results are of interest to other circumpolar communities who are facing similar health communication challenges. Contact: Libby Dean ([email protected])

LEVELS OF ARSENIC, CADMIUM, LEAD, MERCURY, SELENIUM, AND ZINC IN VARIOUS TISSUES OF MOOSE HARVESTED IN THE DEHCHO, NORTHWEST TERRITORIES

N.C. Larter1, K. Kandola2 1Department of Environment and Natural Resources, Government of the Northwest Territories, 2Department of Health and Social Services, Government of Northwest Territories

Moose is an important traditional food for residents of the Dehcho who want to know what the contaminant levels are in the country foods they consume. As part of moose monitoring program involving local First Nations, between 1 September 2004 and 31 March 2007 we collected a tooth, one kidney and a sample of liver from moose (n=46) harvested by local residents and teeth (n=17), kidney (n=18), liver (n=13) and muscle (n=7) samples from moose taken by sport hunters in the southern Mackenzie Mountains. We measured the levels of arsenic, cadmium, lead, mercury, selenium, and zinc in the tissue samples; teeth were used to determine animal age. Levels of cadmium, mercury, and zinc were higher in moose harvested from the southern Mackenzie Mountains. In contrast, levels of arsenic were lower in moose harvested from the southern Mackenzie Mountains. For moose harvested in the southern Mackenzie Mountains the mean level of cadmium in kidneys was 222.5 mg/g (wet wt) and for livers 30.9 mg/g (wet wt). Contrastingly, for moose harvested in Mackenzie and Liard River drainages the mean level of cadmium in the kidneys and livers was 26.8 and 2.7 ug/g (wet wt), respectively. These findings resulted in a public health advisory for the consumption of moose organs. Levels of cadmium in the muscle (0.1 mg/g, wet wt) and levels for all other elements were similar to those reported elsewhere and were not of a human health concern. There was a positive relationship of cadmium and zinc levels in moose organs with moose age. Bioaccumulation of cadmium by willows in areas with high naturally occurring geologic sources of cadmium is a likely hypothesis for the high renal cadmium levels reported in moose harvested in the southern Mackenzie Mountains. Contact: Kami Kandola ([email protected])

THE INFLUENCE OF PSYCHOSOCIAL FACTORS ON FOOD RELATED BEHAVIOURS AMONG INUIT COMMUNITIES IN NUNAVUT: RESULTS FROM HEALTHY FOODS NORTH

E. Mead, J. Gittelsohn, C. Roache, R. Reid, S. Sharma

University of North Carolina at Chapel Hill, Nutrition Research Institute

Objective: To describe the food acquisition and preparation behaviors of the Inuit, and to address the gap in research on the psychosocial factors affecting these behaviors.

Setting: Three remote communities in the Arctic region of Nunavut, which vary in terms of size, isolation, and access to traditional foods.

Methods: Cross sectional random household surveys were conducted among Inuit adults. Descriptive statistics were generated for sociodemographic, psychosocial (i.e., food knowledge, self-efficacy, and intentions), and behavioral (i.e., healthy food getting, unhealthy food getting, and healthiness of food preparation) dependent and independent variables. Their associations were analyzed using multivariate linear regression in Stata.

Results: The response rate was approximately 70-90%. Among the 261 participants (aged 19-89 years), unhealthy foods (e.g., potato chips, pop) were obtained 2-3 times more frequently than healthier foods. Neutral cooking methods and those adding fat were more frequently used than healthier methods that reduced fat content. Food intention was the psychosocial factor most significantly associated with the food behaviors. Intention was negatively correlated with healthiness of food preparation methods (-0.95, p<0.05) and unhealthy food getting (-0.25, p<0.001), and positively associated with healthy food getting (0.23, p<0.001). Higher levels of food knowledge and self-efficacy were associated with greater intentions (0.24, p<0.001, and 0.5, p<0.001), respectively).

40 SESSION 3: VENUE VIEWING ROOM

Conclusions: These results fill the research gap on the impact of psychosocial factors on food acquisition and preparation among Nunavut Inuit. By incorporating food knowledge, self-efficacy, and intentions into its nutrition educational activities, the community-based Healthy Foods North (HFN) program will positively impact the food acquisition and preparation behaviors of Inuit.

Acknowledgements: We would like to thank Ms. Annie Buchan and Rahabi Kamookak for their incredible work on the program. The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57. Contact: Erin Mead ([email protected])

VENUE VIEWING ROOM Video Session #1

“MAKKUKTUVUNGA, UPIMMAVUNGA” - I AM YOUNG AND I AM PROUD: A SCREENING OF A LIVE-TO-TAPE 2 HOUR CALL-IN PROGRAM ABOUT INUIT YOUTH, COPING SKILLS, AND ENDURANCE

C. Carry

Inuit Tuttarvingat of the National Aboriginal Health Organization

One of the greatest challenges to the well-being of Inuit across Inuit Nunaat is the spirit of despair that has been manifested particularly by Inuit youth. Inuit Tuttarvingat of the National Aboriginal Health Organization, with the National Inuit Youth Council and many other participants, highlights a corresponding and uplifting reality. Through the live interactive broadcast, with the assistance of a youth working group, we share positive examples that are helping youth move forward in their personal development.

The program:

- discusses the challenges Inuit youth face within a historical and development context.

- shows some types of information the Qanuippitali Inuit Health Survey collected from youth 18+ as well as results from other research.

- explores opinions and ideas shared by youth and other panelists, community focus groups and callers.

- looks at community-based youth programs that promote self-esteem, cultural pride and useful skills in Inuit Nunaat, Canada and Alaska.

- offers suggestions for youth empowerment and for parents. - points to Web-based resources for follow-up.

This 2.5 hour session will open with an introduction to the overall Qanuqtuurniq - Finding the Balance TV series, an International Polar Year outreach project on Inuit wellness broadcast on the Aboriginal Peoples Television Network - North in May 2009 in the Inuit language with English subtitles and simultaneously Web cast . A main objective of this series was to adapt and test a “communications for change” model for exchanging knowledge from different perspectives on several wellness issues of concern to Inuit. Following the screening of the youth program, evaluation highlights will be shared along with a question and answer period and an opportunity to give feedback into the model’s evaluation process. Contact: Catherine Carry ([email protected])

SESSION 3 Monday, July 13, 8:30-10:00 AM

VENUE 1 Cancer #1

THE ROLE OF INTERLEUKIN-1 AND INTERLEUKIN RECEPTOR ANTAGONIST IN HEAD AND NECK SQUAMOUS CELL STUDIES: INITIAL STUDIES

L. Nicholas-Figueroa1, Z. Chen2, C. Van Waes2, L. Duffy1 1Department of Chemistry and Biochemistry, University of Alaska Fairbanks, 2National Institute of Deafness and Communication Disorders, Bethesda, MD

Head and neck squamous cell carcinoma (HNSCC) is the most prevalent malignancy in humans involving the upper aerodigestive tract which affects, voice, speech, taste, smell, hearing, balance, and survival. HNSCC constitutively express cytokines and growth factors including interleukin-1 (IL-1), IL-6, IL-8, granulocyte macrophage colony-stimulating factor (GM-CSF) and vascular endothelial growth factor (VEGF) which promotes proliferation, inflammation, and angiogenesis. These inflammatory responses are likely regulated by a signal transduction pathway, involving activation of nuclear factor-kappa B (NF-кB) by IL-1. The expression and functions of IL-1, IL-1 receptor (IL-1R) and IL-1 receptor antagonist (IL-1RA) in HNSCC are not well understood. In this study, the expression profiles of IL-1 and related molecules provide the scientific basis for study of their functions in mediating intracellular signals regulating HNSCC tumor progression. The IL-1 family protein productions were measured in a panel of squamous cell carcinoma developed by the University of Michigan (UMSCC) 1, 5, 9, 11A, 11B, and 38 and in normal keratinocytes by enzyme linked immunosorbant analysis (ELISA). UMSCC 11B is the highest producer of IL-1α in the culture supernatant (>150 pg/ml), compared with IL-1α production by other cell lines (<50pg/ml). Adding recombinant tumor necrosis factor-alpha (TNF-α) to cell supernatants induced IL-1α production. In contrast, all cell lines produced IL-1β at the minimum level (1-14pg/ml) in their supernatants. Both IL-1α and IL-1β were found in the cytoplasm of all cell lines, and UMSCC 1, 11A, and 11B cells retained higher levels. Detectable IL-1RA was measured in all cell line cytoplasms but not in their supernatants. Significantly higher levels of intracellular IL-RA were found in normal keratinocytes. The ratio of total IL-1 to IL-1RA is increased in 4 of 6 UMSCC cell lines. These observations suggest that an imbalance in the L-1 to IL-1RA may promote tumorigenesis in HNSCC. (Funding: NIH 2U54-NS041069-06A1 and UAF/NIDCD partnership) Contact: Linda Nicholas-Figueroa ([email protected])

SURVIVAL OF HEAD AND NECK CANCER IN GREENLAND

R.G. Jensen1, J. Friborg2, J. Rosborg3, L. Specht4, S. Brofeldt3, M.H. Therkildsen5, P. Homøe1 1Department of Otolaryngology, Head & Neck Surgery, Rigshospitalet, University of Copenhagen, Denmark, 2The State Serum Institute, Copenhagen, 3Dronning Ingrids Hospital, Nuuk, Greenland, 4Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark, 5Department of Pathology, Rigshospitalet, University of Copenhagen, Denmark

Introduction: Head and neck cancer is frequent in the Inuit population of Greenland and characterized by a very high incidence of Epstein-Barr virus associated nasopharyngeal carcinoma (NPC). However, information on the treatment and survival of Inuit head and neck cancer patients is virtually non-existing. The aim of this study was therefore to analyze the epidemiological pattern, time course and survival of head and neck cancer patients in Greenland.


Material and Methods: Greenland is part of the kingdom of Denmark, and population statistics from the Danish Civil Registration System and The Danish Cancer Registry also cover Greenland. Using these registries, supplemented with hospital-based registries, all patients resident in Greenland and diagnosed with head and neck cancer during the period 1994-2003 were identified and analyzed with regard to clinical characteristics, treatment delay, and survival.

Results: A total of 125 patients were identified. The age standardized incidence rate for all head and neck cancers was 28/100,000 for males and 19/100,000 for females. High incidence rates were found for NPC (males 9/100,000 and females 7/100,000) and oral cancers (males 6/100,000 and females 7/100,000). Of all cancers 47% were stage IV at the time of diagnosis, while 61% of all NPC’s were stage IV. The median delay from date of first symptom to treatment was 248 days for all cancers. The overall crude 5-year survival for all sites together was 35% and for NPC 20%.

Conclusion: The Inuit pattern of head and neck cancers is characterized by a high incidence of NPC. Survival of head and neck cancer in Greenland is very low due to delays in treatment and inadequate follow-up on treatment complications. The improvements in treating NPC and other head and neck cancers over the last decades are yet to be seen in this Inuit population. Contact: Ramon Gordon Jensen ([email protected])

DEVELOPING A TRADITIONAL FOOD GUIDE FOR ALASKA NATIVE CANCER PATIENTS

C. DeCourtney, K. Mitchell, D. Simeon


Background: Maintaining a healthy diet is critical for cancer patients. However, during and after treatment, standard food recommendations can be foreign and unfamiliar to Alaska Natives who rely on traditional foods obtained through subsistence activities. Subsistence foods are a source of nutritional and spiritual strength for Alaska Natives battling cancer. When comfort foods are most needed, there are no tools that discuss using traditional plants and animals to substitute for recommended foods which may be unfamiliar, unavailable or unaffordable in geographically isolated Alaska communities. There are no easy-to-understand nutrition guidelines which emphasize Alaska Native wild foods to help cancer survivors maintain a nutritious diet.

Methods: A literature search was conducted and resources gathered that addressed nutritional needs of cancer patients and the nutrient content of Alaska wild foods. Nutritional data was compiled into a user-friendly 143 page guide. Information was gathered from Alaska Native elders and previously conducted nutritional analyses. The guide provides three innovative ways to understand a food’s nutritional value (food label, narrative, and icon).

Results: The food guide has been well received by both providers and patients. Extensive media coverage resulted in wide spread interest. It is accepted as an important tool for diabetes, obesity and a healthy diet. Additional printings are anticipated.

Conclusions: The availability of an easy-to-understand nutritional guide focusing on traditional foods is an important resource for Alaska Native cancer patients. It can be used as a model for underserved cultures to integrate healthy traditional foods into cancer survivorship nutrition programs and other healthy nutrition programs. Contact: Christine DeCourtney ([email protected])

THE PREVALENCE OF PROGNOSTIC AND TREATMENT FEATURES FOR BREAST CANCER SURVIVAL: ARE THEY DIFFERENT FOR FIRST NATIONS WOMEN COMPARED TO OTHER WOMEN IN ONTARIO, CANADA?

A. Ritchie


Background: Previous work has demonstrated that survival after a breast cancer diagnosis is poorer among First Nations women compared to other women. The purpose of this study was to identify the distribution of prognostic features and treatment received among First Nations and non-First Nations women with breast cancer.

Methods: This study employed a case-case design using the cohort of First Nations people in Ontario to identify 287 women diagnosed with invasive breast cancer between 1995 and 2004. Concurrently, a random sample of 671 non-First Nations women were selected through the population-based cancer registry and matched 2 to 1 on five-year date of diagnosis, age at diagnosis, and Integrated Cancer Program (ICP) first attended. Data on prognostic and treatment features were collected from medical charts. Descriptive analyses of the prognostic and treatment variables were calculated and stratified by First Nations status.

Findings: The methods of detection were significantly different between the two groups, as fewer First Nations women had their cancer detected with routine mammography or another screening program. The distributions of most of the tumour characteristics were similar between the two populations. There were significant differences for TNM stage at diagnosis, with First Nations women being diagnosed at a higher stage compared to other Ontario women. More non-First Nations women were disease free at their last contact point with the ICP compared to the First Nations women. The proportion of women who received any chemotherapy and/or any hormonal treatment was similar however; fewer First Nations women received any radiotherapy upon their breast cancer diagnosis compared to non-First Nations women.

Conclusions: These preliminary findings will be further explored and controlled for variables such as socioeconomic status and distance to the ICP. Once better understood, actions can be taken to improve the prognosis and treatment of First Nations women with breast cancer. Contact: Amanda Ritchie ([email protected])

VENUE 2 Indigenous Research #2

THE NATIONAL INUIT COMMITTEE ON ETHICS AND RESEARCH (NICER)

C. Knotsch, S. Nickels

Inuit Tuttarvingat of NAHO

During the past decade, the volume of research conducted in the Inuit regions of Canada has increased considerably. At the same time, efforts to create research guidelines for research involving Aboriginal Peoples have grown to respond to the pressing needs of Inuit, First Nations, and Métis communities. Ethical guidelines have been discussed by many research networks and in particular by those researchers working with small communities. Within the past ten years, we have seen efforts to provide guidelines and policy statements to guide research involving Inuit, First Nations and Métis in Canada.

The recently created National Inuit Committee on Ethics and Research (NICER) plays an active role in helping provide Inuit involvement and positions on research and research ethics at the community, regional, national, and international levels. In recognition of Inuit interests in improving and maintaining appropriate research conduct and processes, the National Inuit Committee on Ethics and Research will develop effective responses to identified Canadian policy statements and guidelines and prepare Inuit positions as necessary.

NICER is coordinated jointly by Inuit Tapiriit Kanatami (ITK) and Inuit Tuttarvingat (formerly known as the Ajunnginiq Centre) of the National Aboriginal Health Organization (NAHO). Both organizations are committed to facilitating the participation of Inuit in discussions about health and environment research in the Canadian Arctic, to identifying emerging research priorities, to improving and enhancing networking, and to facilitating knowledge translation.


This presentation will describe the recent development of NICER and place it into the context of research in the Canadian Arctic. Contact: Cathleen Knotsch ([email protected])

TOWARDS DEVELOPING PRINCIPLES OF ETHICAL RESEARCH IN MÉTIS COMMUNITIES

C. Graham


The concept of Métis-specific population health research, practiced in a way where Métis people are consulted and involved in the research, has really only emerged in the last two decades. There has been little documentation on research ethics and guidelines specific to Métis. As a Métis-controlled, knowledge-based organization, the Métis Centre at the National Aboriginal Health Organization (NAHO) is uniquely situated to contribute to the ongoing dialogue, nationally and internationally, on indigenous research ethics. In particular, the Métis Centre’s activities have focused on qualitative, community-based approaches to research, recognizing that mainstream or academic research methodologies and ethics may not always address the distinct perspectives, concerns and rights held by Métis, Inuit and First Nations peoples. Working with a broad range of partners, from the grassroots level to academe, the Métis Centre encourages research that honours traditional perspectives yet accounts for contemporary circumstances and needs. A guiding principle of the Métis Centre’s approach is that the results are intended to be of use to the community where the research is taking place and, on some level, to Métis generally. This presentation will outline challenges in and opportunities for undertaking collaborative research with Métis individuals, communities and organizations. It will include a detailed discussion on the current process being undertaken by the Métis Centre to develope culturally appropriate research methods, sensitive to Aboriginal languages and cultural information, for the gathering, analysis and dissemination of information arising from qualitative research. Contact: Catherine Graham ([email protected])

WHEN SCIENCE OUTPACES NATIVE POLITICAL WILL

T.A. Mala, M.K. Mau

Southcentral Foundation

Objective: To provide the reader with some considerations for designing research around Native communities from the viewpoint of two Alaska Native and a Native Hawaiian physicians.

Rationale: In the process of reviewing and writing many grants, the perennial question arises of “how to do research in Native communities?” How have the rules changed? What are the expectations that Native people have and how might they influence the nature of designing projects and implementing them once they are funded? A significant number of principal investigators have taken their proposals to Institutional Research Boards and community groups only to find their methodologies being rejected or questioned from the start. This has resulted in much frustration and elicited comments such as “where can we find the guidelines for research with Native peoples and how can we best address them?”

There is no one answer that covers all situations. Tribes are sovereign entities with the right to govern their own destinies. The authors here present their observations on the process with the hope that this paper will result in mutually beneficial discussions that will create partnerships and better understanding of one another’s needs.

This paper explores the design process based on community based participatory research and its outcomes resulting in benefit to the populations being examined. Questions include who owns the data? How will it be used? How will the results be reported back to the community? How are ethical standards being applied? What is the role of the community? What is the training and backgrounds of the principal investigators? How will the outcomes affect the community in the future? How to plan for future collaboration?

Conclusion: Research is possible with Native communities and even welcomed once basic ethical considerations are addressed and partnerships are developed based on consensus and respect. Contact: Ted Mala ([email protected])

EXPLORING PROCESSES IN HEALTH RESEARCH ETHICS IN CANADA’S NORTH

G.K. Healey1, J. Butler Walker2, S. Chatwood3 1Qaujigartiit/Arctic Health Research Network – NU, 2Arctic Health Research Network – YU, 3Institute for Circumpolar Health Research

There exists a need throughout the North to increase capacity to address issues of health research ethics, and in each territory, the needs are diverse.

The goals of this project were to:

- Develop a tri-territorial strategy for ethical review of health research involving Indigenous peoples

- Conduct a survey of existing ethical guidelines and literature that are relevant to northern populations.

- Evaluate community capacity to provide input on ethical review of health research projects by

- To develop a draft of a Health Research Ethics Checklist for community proposal reviewers.

A review of literature and community ethical guidelines for health research was conducted in 2007-08. Common themes in community ethics across the territories revealed in the review were related to: licensing; principles of respect – for communities and for researchers; meaningful community engagement; the use of appropriate research methods; use of data and ownership, control, access and protection/possession (OCAP) of data; sharing knowledge obtained from research.

In January, 2009, a meeting of stakeholders from Yukon, NWT, Nunavut, Nunavik and Labrador met in Iqaluit, NU to discuss opportunities to collaborate on health research ethics review for northern communities. The result of this meeting was a commitment to work across jurisdictions to meet the health research ethics needs of communities and northern regions by working to build capacity for ethical review; to collaborate to share tools and resources; to provide education opportunities when possible; and to form a working group to explore the possibility of developing a Northern Health Research Ethics Council. Contact: Gwen Healey ([email protected])

IN PURSUIT OF AN ‘INDIGENOUS’ EDUCATION: STUDENT REFLECTIONS IN ABORIGINAL HEALTH RESEARCH IN CANADA

A. Reeves


The environment typically modelled for most graduate students in Canada is one based on a few simple tenants, including the infamous law of ‘publish or perish’, as well as academic competition among colleagues. With the advent of the Institute of Aboriginal People’s Health (IAPH) initiative through the Canadian Institutes of Health Research (CIHR), graduate students researching Aboriginal health in Canada have been offered an opportunity to work in a new academic model. Coordinating centres across Canada, the Network Environments for Aboriginal Health Research (NEAHR), offer regional conferences and other graduate student gatherings, fostering a sense of partnership, mutual benefit and support among students. This presentation focuses on the experiences of four graduate students, both Aboriginal and non-Aboriginal, who are currently part of this programme. These four stories describe student and community engagement in an Aboriginal context, in both urban and rural areas, from the East Coast to the West Coast of Canada. The only programme of it’s kind in the world, this federal research agenda strengthens Aboriginal research by investing in students, not only through grants,


but through mentorship, student collaboration, and a strong exposure to Indigenous cultural events. This presentation highlights the impact of this programme on graduate student development: from an initially diverse group evolves a team of researchers with a shared vision to address health disparities in Aboriginal communities. Contact: Allison Reeves ([email protected])


BUILDING COMMUNITY CAPACITY - YUKON FIRST NATIONS’ HEALTH PROMOTION PLANNING SCHOOLS

J. Butler Walker1, N. Kassi1, L. Duncan2 1Arctic Health Research Network – Yukon, 2Council of Yukon First Nation

The Arctic Health Research Network-Yukon, in collaboration with the Council of Yukon First Nations, Yukon College and the Health Promotion Centre, University of Toronto, hosted capacity building training programs in 2007 and 2008 with Yukon First Nations. A total of 54 Yukon First Nations front-line health resource workers from across the Yukon worked together on issues of importance in their communities. These priority issues included diabetes, food security, residential school trauma, depression, substance use and injury prevention. Participants worked through a facilitated comprehensive planning process to identify and develop actions to address these issues in their communities, which will be described. Ethical considerations in relation to CB processes and OCAP (Ownership, Control, Access and Possession), partnership development and recommendations for further community capacity building will be highlighted. Contact: Jody Butler Walker ([email protected])

TLICHO COMMUNITY-BASED RESEARCH AND EVIDENCE-BASED INTERVENTIONS FOR STI PREVENTION

A. Daniels, R. Drybones, L. Lafferty, T. Moore, J. Naedzo, K. Edwards, S. Mitchell

Tlicho Community Services Agency

This presentation will describe the community-led process of developing and implementing a research-based action plan within the four Tlicho communities around resilience and sexual health. The community leader is the Tlicho Community Services Agency (TCSA) whose goal is to develop and provide health, education and social programs that integrate traditional values. The sexual health research project began in response to the leadership of the Tlicho Healing Wind Grassroots Advisory Committee (HWGAC), which ensures ethical and cultural appropriateness of programs around sexual health. Sixteen community-based researchers were trained in research methods by CIET, an international non-government organization. The baseline survey revealed the strengths of the Tlicho communities’ resources to combat sexually transmitted infections (STIs). An outcome of the survey was an evidence-based community action plan for addressing knowledge gaps while continuing to support successful strategies. Community-based researchers (CBRs) both advise and implement the research/communication program and action plan. Actions include youth focus groups to assess and adapt existing resource materials to be culturally appropriate, and a pan-community youth conference to communicate information based on traditional values. The presentation will describe the research outcomes, resulting action plan, including outcomes and challenges. Contact: Nancy Gibson ([email protected])

HEALTH CARE DECISION-MAKING IN AN INUIT COMMUNITY

N. Edgecombe

Dalhousie University, School of Nursing

The purpose of this study was to identify and describe the health care decision-making of the Inuit of a small Inuit community, in Nunavut, Canada. An ethnographic research design was used which included participant observation, formal and informal interviews and available data. Field notes, documents and informal interviews were analysis to identify behaviours, values and beliefs relating to health care decisions within the sociocultural environment of the community and formal taped interviews with key informants were used to clarify and verify findings.

The findings suggested two health decision-making processes: an illness orientated process and a health promotion/prevention process. The illness-oriented decision-making process was similar to that identified by others with two exceptions: the Inuit have no choice as to where to seek treatment and time is a major factor in their decision-making. The Inuit have become reliant on the biomedical health care system, which has replaced traditional healing practices. The health promotion/prevention decision-making process was consistent with several of the health promotion and behaviour models. Health and wellness are closely associated with traditional values and activities and many of the health issues and concerns are linked, at least to some degree to a loss of traditional life skills and values. Contact: nancy Edgecombe ([email protected])

THE DEVELOPMENT OF A HEALTH ACTION PLAN FOR CIRCUMPOLAR INUIT

M. Grey

Makivik Corporation

Although the last 100 years have seen some major improvements in health and survival for circumpolar Inuit, advances in some areas have been overshadowed by emerging problems. Major health concerns that are shared by all Inuit include mental health, suicide, substance abuse and diseases such as cancer, diabetes, heart disease and tuberculosis (TB). There is only limited Inuit-specific health data available within national statistics, but for the data that is available, stark differences are visible between Inuit and national populations in the circumpolar countries. For example, Inuit life expectancy is around 10 years less compared to that of national populations. Infant mortality was between 1.5 and 2.9 times higher among Inuit in 2000-2004. Given the prevailing differences and stark health issues confronting Inuit across the circumpolar region, when the Inuit Circumpolar Council (ICC) held its General Assembly in Barrow in 2004, Inuit health and wellness was identified as a priority for ICC action.

Since 1977, the ICC has flourished and grown into a major international non-government organization representing approximately 155 000 Inuit of Alaska, Canada, Greenland and Chukotka (Russia). ICC has offices in each of the four countries. ICC works on issues affecting pan-circumpolar Inuit, such as environment, human rights, and health. At the General Assembly in Barrow in 2004, the importance of health was expressed in the Utqiagvik Declaration. In response to it, ICC is working on the development of a Circumpolar Inuit Health Action Plan, which will identify the health issues and mechanisms in which Inuit health priorities can be advanced. To guide this work, a steering committee with representatives from each of the four country ICC offices was created. Their role is to help shape the Circumpolar Inuit Health Plan by identifying ways for ICC to act as an advocate on behalf of the Circumpolar Inuit.

This presentation will introduce some information on the health concerns, and how the Health Action Plan can move forward to address the associated challenges. Contact: Minnie Grey ([email protected])

WORKING ON THE LAND, WORKING OFF THE LAND

Z. Todd



During the environmental assessment of the proposed Mackenzie Gas Project, Joint Review Panel members and others highlighted a lack of contemporary evidence-based research about the effect of the wage economy on Inuvialuit land-based activities including hunting, trapping, and fishing. This research aims to address this gap by studying how employment impacts harvesting activity (time spent on the land), as well as qualitative changes in the structure and use of time and the social networks and sharing arrangements associated with time on the land. The study aims to identify implications for managing the impacts of the proposed Mackenzie Gas Project and potential mineral extraction near Paulatuk, and suggest variables for consideration in a related health study. The study results will be useful for addressing gaps in knowledge about the impact of the wage economy on land-based livelihood activities in the region. There is no clear-cut answer to how participation in the wage economy impacts traditional harvesting activities in Arctic communities. However, previous studies seem to indicate that the type work, the flexibility of employment opportunities to accommodate harvesting activities and the time of year during which employment opportunities will occur are all important when considering the impacts of participation in the wage economy on traditional harvesting activities. Furthermore, examination of household economic strategies and Women’s roles in harvesting can inform future decisions regarding resource extraction projects—and their related employment opportunities—that may impact traditional harvesting activities in the Inuvialuit Settlement Region. This becomes even more important when other pressures, such as the impacts of resource extraction on wildlife and the effects of climate change on traditional harvesting activities in the Arctic are considered. Contact: Zoe Todd ([email protected])

VENUE 4 Infectious Diseases #1 – HPV

THE PREVALENCE OF HUMAN PAPILLOMAVIRUS AND ITS IMPACT ON CERVICAL DYSPLASIA IN NORTHERN CANADA

Y.A. Li, P. Brassard, T. Wong, A. Severini, A. Corriveau, S. Chatwood, G. Johnson, I. Sobol, B. Hanley, Y. Mao

Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, McGill University, GNWT Health and Social Services, Institute for Circumpolar Health Research

Cervical cancer rates are higher among aboriginal populations than among the general population in Canada. Human Papillomavirus (HPV) are highly associated with cervical cancer.

The objective of this project is to determine the prevalence, distribution, and risk factors of type-specific HPV infections among women in northern Canada, Women living in the Northwest Territories (NT), Nunavut, and Yukon, at cervical cancer screening ages, and with no cancer history are included in the study. Cervical sample collection is incorporated into the routine sample collection for Pap testing. A questionnaire will collect socio-economic, demographic, and behaviour information of participants. HPV types are detected by using Luminex assay at the National Microbiology Laboratory of Canada. Pap test results, HPV types, and questionnaire data will be linked for analyses.

The prevalence and distribution of HPV type-specific infections and cervical dysplasia will be calculated with 95% confidence intervals. Multivariate regression will be used to explore the associations between type-specific HPV infections and cervical dysplasia as well as the associations between risk factors and type-specific HPV infections.

So far more than 7,000 samples from the NT and Nunavut have been tested for HPV types. The crude HPV positive rates are 26.9% and 33.9% of the NT and Nunavut, respectively. There are over 70% of the HPV positive samples from both regions are positive with high-risk types. The prevalence analyses will be completed in April 2009. More results will be available at the conference.

Contact: Y. Anita Li ([email protected])

EVALUATING THE INTRODUCTION AND IMPACT OF THE HUMAN PAPILLOMAVIRUS VACCINE AMONG ALASKA NATIVE WOMEN

T. Hennessy1, N. Murphy2 1US Centers for Disease Control and Prevention (CDC) Arctic Investigations Program, 2Southcentral Foundation

The human papillomavirus (HPV) is one of the most common causes of sexually transmitted diseases. Infection with some HPV genotypes can lead to genital warts or cancer. In 2006, a HPV vaccine was licensed and introduced into the routine vaccine schedule for young women in the U.S. For Alaska Native women, HPV infection is common and cervical cancer is of high concern. We developed a comprehensive plan to enhance HPV vaccine use and collect data necessary to understand the health and economic impact over time. This plan includes: 1) an electronic vaccine registry to track vaccine uptake, 2) qualitative research methods to identify knowledge and attitudes about the vaccine to aid development of education materials, 3) combining data from across Alaska to track the incidence of precancerous cervical lesions and cancer, 4) establishing surveillance for the HPV genotypes causing precancerous cervical lesions, 5) evaluating the safety, immunogenicity and duration of protection of HPV vaccine among Alaska Native women, 6) determining the HPV genotypes in archived cervical cancer specimens from 1980 - 2008, 6) modeling the economic impact of HPV vaccine on direct medical costs. We will report on progress implementing this plan and data from vaccine uptake, public perception of the vaccine and HPV genotypes in cervical cancer specimens. Contact: Thomas Hennessy ([email protected])

IMPROVING HPV PREVENTION AMONG ABORIGINAL PEOPLES

G. Wurtak1, B. Elias2 1International Centre for Infectious Diseases, 2University of Manitoba

Cervical cancer rates are two to six times higher in Aboriginal women than the general population. The Human Papillomavirus (HPV) is the leading cause of cervical cancer and anogenital warts, and is implicated in numerous other cancers. On December 9, 2008 a consultative workshop was arranged to discuss HPV issues affecting Canadian Aboriginal populations. This workshop, involving approximately 50 key stakeholders representing 24 different organizations from across Canada, was hosted by the International Centre for Infectious Diseases in Winnipeg, Manitoba, and supported by PHAC and the MacArthur Foundation. The workshop objectives were to 1) Share current information on HPV and related Aboriginal health issues; 2) Identify HPV research gaps and priorities; and 3) Identify implementation challenges and strategies for program improvement The presentation will a) highlight the process involved in bringing together a diverse group of stakeholders from different sectors; b) share information on HPV and cervical cancer prevention activities and research in different regions of Canada; c) outline the major HPV related issues that arose through this consultation; and d) present participants’ suggestions for addressing HPV/cervical cancer. Information covering a range of Aboriginal health and cultural issues will be presented. The issues, needs, gaps, and activities that were suggested by different breakout theme groups will be shared. Three broad themes will be discussed: 1) Understanding HPV; 2) Developing a Population Level Understanding of HPV; and 3) Developing Community Understanding and Program Implementation. The issues that arose will be highlighted: Improve awareness of HPV, consequences; HPV issues within the context of Women’s health; Capacity development, community & professional education ; Cultural and gender competency; Funding; Access to services; Sexual health awareness; Technology and infrastructure improvements; Data to inform decision-making; Protocol and algorithm standardization; and Potential demonstration projects.


Contact: George Wurtak ([email protected])

INCIDENCE OF TYPE-SPECIFIC HPV IN A POPULATION OF INUIT WOMEN IN NUNAVIK, QUEBEC

R. Bennett2, E. Coutle3,4, M. Roger4, E.L. Franco2,3, P. Brassard1,2 1Departments of Medicine, 2Epidemiology, Biostatistics & Occupational Health, and 3Oncology, McGill University; and of 4Microbiology, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada

Background: There is little information on incidence of human papillomavirus(HPV) in Canadian populations, particularly regarding rural, remote, and northern communities. These communities may have different patterns of HPV acquisition, and since Inuit women have higher rates of cervical cancer than non-Inuit women in Canada, understanding the burden of HPV infection within this population is important, especially before the implementation of prevention strategies (e.g. vaccination).

Objective: We sought to study the incidence of infection by HPV type, phylogenetic Alpha-papillomavirus species, and oncogenic risk grouping among Inuit women in Nunavik, Quebec.

Results: A cohort of 629 Women aged 15-69 was assembled between January 2002 and December 2007 from four communities in Nunavik, Quebec. Cervical specimens were collected both at enrolment and during all subsequent visits. The median interval between visits was 11.8 (range: 1- 49.7) months. A total of 36 genital HPV genotypes were detected by PCR amplification using PGMY09-PGMY11 primers. 33.9% (125/369) of women with more than one visit had an incident infection by at least one type during follow-up, resulting in 162 incident infections of any HPV type in total (overall incidence rate: 19.7 per 1000 women-months (WM)). Incidence was based on the number of months from baseline to either the first positive test result for the infection of interest or the end of follow-up if the woman remained negative. The incidence of HPV-16, HPV-18, and high-risk (HR) infections were 2.21, 1.18, and 6.54 per 1000 WM, respectively. Incidence for species α7 and α9 were similar (4.79 and 4.61 per 1000 WM, respectively).

Conclusions: Overall, HR-HPV, and HPV-16 incidence were lower in this population as compared with a population of Canadian university students though HPV-18 infections were acquired at a comparable rate. A greater proportion of this cohort acquired infection than in a cohort of randomly selected women in Ontario. Contact: Rachel Bennett ([email protected])

HPV SURVEILLANCE: CORRELATION OF TYPE-SPECIFIC ONCOGENIC HPV WITH CERVICAL CANCER SCREENING FINDINGS IN NUNAVUT, CANADA

I. Sobol1, S. Totten2, A. Severini3, V. Goleski3, G. Johnson4, G. Jayaraman2, T. Wong2, Y. Mao5 1Nunavut Department of Health and Social Services, 2Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 3National Microbiology Laboratory, Public Health Agency of Canada, 4Cytopathology Laboratory, DynaLIFEDx, 5Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada

Background: The Nunavut Department of Health and Social Services in Canada has been gathering evidence to inform public health decision making pertaining to HPV vaccination and cervical cancer prevention. Preliminary data suggested a suboptimal match between circulating HPV types in Nunavut and types contained in the currently approved quadrivalent (6/11/16/18) HPV vaccine in Canada. Nunavut has a young, mainly Inuit population of 30,000 that is sparsely distributed across 2 million square kilometers in 28 communities.

Objectives: To determine the prevalence and distribution of HPV types in Nunavut in association with cervical Pap test cytological outcomes as part of a population-based surveillance program.

Methods: Residual cervical specimens from routine liquid based cervical cytology testing were tested for 45 HPV types using an in-house

Luminex genotyping assay. Type-specific HPV results were correlated with cervical cancer screening findings.

Results: Preliminary results from 1116 women (90% Inuit) suggest a 34.1% prevalence of any HPV type, 35.0% of whom had multiple HPV types. The prevalence of any oncogenic HPV type was 24.4%, with higher prevalence in younger females (37.5% in 15-24 year olds vs 26.4% in 25-34 year olds vs 9.9% in 35+ year olds). Prevalence of the oncogenic vaccine types 16, 18 were 7.3%, 2.1% respectively. The non-vaccine oncogenic HPV types 31 (4.3%) and 45 (2.3%) were more prevalent than type 18. 100% of women with high-grade squamous intraepithelial lesions (HSIL) were infected with one or more oncogenic HPV types. In 12 women with HSIL, HPV16 was detected in 7 (58.3%), HPV18 in 1 (8.3%), HPV45 in 2 (16.7%), HPV31, 35, 39, 52, 56, 58 and 66 in one each (8.3% each).

Conclusions: HPV infection is highly prevalent among women in Nunavut. HPV16 is the most common type, followed by HPV31. HPV16 was detected in over half of the high-grade cervical lesions. Results to date have informed evidence-based decision making regarding HPV immunization in Nunavut. Contact: Thomas Wong ([email protected])

VENUE 5 Food Security #2 – Politics of Food

A COMMUNITY BASED INITIATIVE TOWARDS A SUSTAINABLE FOOD SECURITY STRATEGY FOR THE COMMUNITY OF OLD CROW, YUKON

N. Kassi

Arctic Health Research Network – YU

In this presentation we will describe the challenges the community of Old Crow are facing in relation to “Our Changing Homelands, Our Changing Lives.” Old Crow is the northernmost community in the Yukon, with a population of 280, of which 90-95% are Vuntut Gwitchin First Nation citizens. It is a small village situated 130 km above the Arctic Circle, home to the Vuntut Gwitchin people, which in the Gwitchin language means “People of the Lakes”. The Gwitchin life and culture have traditionally been based on the Porcupine Caribou herd, the people’s main source of food, tools and clothing. Fish and other animals have supplemented their diet in nutritionally and traditionally important ways. This life is changing every day before their very eyes. The mainstay of their traditional diet - the caribou and the salmon, are rapidly declining in numbers. The cost of living is extremely high as there are no roads to Old Crow, so all supplies must be flown in year round. Changes to the land and water are taking their toll on the very existence of the Gwitchin people. The environment that the people traveled on, the waterways and the land have changed quite drastically in a very few years. This research is linked to health in the most fundamental way – without sustainable and adequate nutrition, the Vuntut Gwitchin will not survive. The primary research question is: How will the Vuntut Gwitchin people of Old Crow adapt their food security strategies to maintain their health in the face of declining traditional food species resulting from climate change? Contact: Norma Kassi ([email protected])

WHAT DOES ‘FOOD SECURITY’ MEAN TO INUIT? INPUT INTO AN INUIT STRATEGY FOR INUIT OF NUNAAT

J. Cheechoo

Inuit Tapiriit Kanatami

It is generally accepted that the term ‘food security’ means, in simplest terms “access to nutritious food.” Inuit health and well-being are directly linked to food security and in particular, their relationship to customary ‘country food’: community sharing, cultural continuity, intergenerational communication. References in the media relate food (in)security to war and mass-migration related to political unrest.


Meanwhile, many Inuit face pervasive, systemic food insecurity within Canada.

In Inuit Nunaat (“Inuit Homeland”) the increasing widespread impacts of climate change, concern over environmental contaminants, and changing socio-economic conditions have all had a tremendous effect on the ability of Inuit to access fresh and nutritious foods. Procuring country foods has become costly (money is required for vehicles, fuel, guns, ammunition) and the seasonal hunting cycle is not reflective of work schedules and schooling. Meanwhile, food purchased at stores is also increasingly costly in the Arctic and can often be of poor quality and nutritional value. The impact of climate change on country food sources (e.g. changes in migration/birthing patterns of animals; instability of ice for travel) has been identified as a priority by Inuit.

Food security encompasses many aspects of well-being in Inuit Nunaat, and therefore discussions on this topic cannot disregard the interconnectedness of environment and health, as well as culture, custom and, local economics. Under Inuit Tapiriit Kanatami (ITK), Canada’s national Inuit organization, has a unique oportunity to encourage the dialogue on food security in this broader context. The presentation will include a summary of the upcoming strategy on food security, based on input from the Inuit regions of Inuvialuit, Nunavut, Nunavik and Nunatsiavut. The Food Security Team of ITK in partnership with representatives from communities in Inuit Nunaat will share their direct experiences of how food security relates to them. Contact: John Cheechoo ([email protected])

FROM SURVIVAL TO NECESSITY: FOOD STORIES FROM THREE GENERATIONS OF LABRADOR INUIT-MÉTIS

D. Martin


Research Question: This qualitative study posed the question: How do people who live in one Labrador Inuit-Métis community experience and understand their relationships to food in the context of global change?

Objective: This presentation explores the influence of socio-economic, political and environmental changes on the transmission of generational knowledge surrounding traditional foods in one Labrador Inuit-Métis community.

Methods: Using an ethnographic approach, this study collected stories and photographs from three generations of men and women in one Labrador Inuit-Métis community. A total of ten one-on-one interviews, seven two-person interviews and one focus group session were conducted with twenty-four community members during the winter of 2008.

Findings: The means through which food is obtained has changed dramatically over the course of three generations of people who live in one Labrador Inuit-Métis community. Where once a generation relied entirely upon their natural surroundings for survival, today, the activities associated with procuring foods remain a vital part of the local culture, but the means to continue these activities are becoming reliant upon a market economy. This presentation explores the way that knowledge about foods is passed on to younger generations when they no longer have the same relationship with their natural surroundings as their parents and grandparents once did.

Conclusions: Ultimately, food has always, and will continue to be, necessary for survival. As such, the knowledge about food-related activities held by older generations of Labrador Inuit-Métis is vital for understanding local ecologies in which foods are procured. Maintaining and strengthening the transmission of generational knowledge related to food ensures that future generations remain connected to, and respectful of, their natural surroundings. The challenge is to respect and understand the different ways in which younger generations are interacting with their natural surroundings, while continuing to strengthen and build upon the understandings of older generations. Contact: Debbie Martin ([email protected])

INDIGENOUS PEOPLES’ FOOD SYSTEMS FOR HEALTH: THREE CANADIAN INUIT AND FIRST NATIONS PROJECTS

H. Kuhnlein1, B. Erasmus2, B. Tallio3, L. Okalik4

Inuit Tapiriit Kanatami 1Centre for Indigenous Peoples’ Nutrition and Environment (CINE), McGill University, Montreal, QC, 2Dene Nation, Yellowknife, NT, 3Nuxalk Nation, Bella Coola, BC, 4Inuit Tapiriit Kanatami, Ottawa, ON

Dr. Harriet Kuhnlein, Founding Director and Chief Bill Erasmus have led a project on Indigenous Peoples’ food systems for health for twelve Indigenous Peoples from as far away as Japan, Thailand, India, Pohnepei, two African locations, Peru, and Columbia to home here in Canada: Gwichin in the Northwest Territories; Nuxalk Nation in British Columbia to Inuit in Pangnirtung, Nunavut.

Research in each indigenous community area has an academic partner and a community leader partner as Principal Investigators. We have matched the scientific work and the Indigenous Peoples’ traditional knowledge on foods of our ancestors past.

We have been fortunate to have funding to bring us together once a year to present and address our respective projects, and how we can link the work to policies, and further to create templates for intervention.

With Dr. Harriet Kuhnlein introducing the background project, Chief Bill Erasmus will present on the Fort MacPherson project in the NWT with the Gwichin, Bill Tallio will present on the Nuxalk Nation project and, Looee Okalik on the Baffin Island Inuit project - all in relation to Indigenous Peoples’ food systems and health promotion. Contact: Looee Okalik ([email protected])

ORAL HISTORY CONTRIBUTIONS TO UNDERSTANDING FOOD SECURITY TRENDS AND ADAPTATIONS: VUNTUT GWITCHIN FIRST NATION, YUKON, CANADA

S. Wesche, L.H.M. Chan, M. Williams, C. Dickson

University of Northern British Columbia

Climate change has been recognized as a key driver of traditional food security for members of the Vuntut Gwitchin First Nation (VGFN) whose subsistence is largely dependent on their close relationship with the land, and in particular the Porcupine Caribou herd. Northern environmental systems have always been dynamic and Aboriginal populations have shown a consistent ability to adapt. However, the increasing rate of climate change and the projected extent of impacts both challenge these abilities and require concerted adaptation efforts to strengthen traditional food systems in times of high uncertainty. Drawing on oral history provides insight into the resilient nature of Aboriginal populations, illuminating past adaptation strategies and existing cultural assets. This study examines how the adaptability of VGFN members to changing food security has evolved over the past century in the northern Yukon by analyzing key historical relationships between land, food, climate and adaptation. Methods include a qualitative analysis of oral history transcripts recorded since the 1970s, which form part of a database maintained and updated by the VGFN Heritage Branch in Old Crow, Yukon. A subset of interviews was selected for analysis based on the density of keywords relevant to food security as identified in the database index. Results provide insight into the factors that have challenged food security for community members in the past (most specifically relating to food availability) and human adaptation strategies used to respond to food shortages. Existing cultural assets that support adaptive capacity are also identified. In combination with other IPY research results relating to food security and wildlife trends, this work provides a foundation upon which to forecast possible response strategies and identify important cultural assets for strengthening adaptive capacity in the face of future change. Contact: Sonia Wesche ([email protected])


PROMOTING HEALTHIER FOOD OPTIONS IN CONJUNCTION WITH HEALTH FOODS NORTH: A RETAIL PERSPECTIVE

S. Hatjó, C. Reeve

The North West Company, Winnipeg, MB

Objective: To measure the impact of Healthy Foods North (HFN) on consumer purchasing patterns in select North West (NWC) company stores.

Background: Increasing consumption of healthier food options is an integral part of influencing positive health outcomes for Indigenous populations in Northern Canada. The NWC, operating under the North Mart and Northern banners, is a key retailer supplying goods to remote communities in Canada. NWC’s corporate Healthy Living (HL) team, consisting of a dietitian and pharmacist, partnered with HFN to provide support of the retail-based component of the intervention. The support provided by the team included: program planning, logistical and operational support, marketing resources and program evaluation assistance.

Setting: Two Northern and North Mart Grocery stores located in the NWT and Nunavut.

Methods: Consumption of targeted food products and ease of program implementation was measured in the four HFN program communities and two delayed intervention communities. An internal database system was used to compile quantitative purchase data on the specific products offered during the seven intervention phases. Direct observation reports from HFN interventionists coupled with an online survey on program execution in the stores will be completed by NWC management and staff.

Results: It is anticipated that the presence of HFN in NWC stores will have a positive impact on the promoted items, with repeated items demonstrating greater impact. Results from the online survey will provide insight on operational execution of HFN in NWC stores.

Conclusions: Implications of these findings will be used to demonstrate the importance of cross-institutional partnerships in influencing dietary changes in the North. Holistically, these partnerships have the synergistic ability to improve the impact and execution of community-based programs such as Healthy Foods North.

Acknowledgements: We would like to thank the North West Marketing Department, North West local store managers for their cooperation and mostly the Healthy Foods North team for making this intervention a reality. Contact: Suzanne Hajto ([email protected])

BUILDING CULTURAL PRIDE WITH TRADITIONAL FOODS (VIDEO)

J. Caines, T. Heale, M. Fournier

This is a film of Dene elders from the Yellowknives Dene and the Tlicho region cooking with educators from many of the regions of the Northwest Territories in Canada. The elders are sharing their knowledge about getting wild game and preparing it for eating in the Ecole Sir John Franklin High School Foods’ lab. This was filmed during the Northwest Territories Educators’ conference held in Yellowknife, February 16-18, 2009.

One of the elders, Muriel Betsina, teaches the participants how her father cooked caribou head and we see the process from the beginning, preparing the head for the oven to carving the cooked head and eating it. Muriel also demonstrates different methods of cleaning fish: loch (freshwater cod) and whitefish, two fish that are harvested in Great Slave Lake in the Northwest Territories. She demonstrates the cleaning and gutting method for drying fish which would hang on sticks or from lines during the early summer. Joyce Caines is the nutrition educator for the event and she informs the discussion with the nutrient value of some of the game and some of the market food additions used in the cooking methods.

This was filmed by two students from École Sir John Franklin High school, Tyler Heale and Matthew Fournier.

Contact: Joyce Caines ([email protected])

VENUE 6 Health Promotion & Social Marketing

DON’T BE A BUTTHEAD CAMPAIGN- 5 YEARS EXPERIENCE WITH A SOCIAL MARKETING CAMPAIGN TARGETED TO YOUTH TOBACCO REDUCTION

M. Wideman1, E. Stewart2 1Department of Health & Social Services, GNWT, 2Department of Education, GNWT.

Tobacco use is a serious health concern in the NWT with youth smoking rates twice the national average and communities where smoking among adults reaches 65%. This presentation will describe a unique social marketing campaign aimed at strengthening the resolve of young people aged 8–14 not to start smoking. A central element of the campaign involves youth making a written commitment to be smoke free, and renewing that commitment on a yearly basis. Other elements have varied over the years but include media components, sports initiatives, a creative contest and other activities that spread the message that non-smoking is the new norm. The campaign relies strongly on involvement and promotion at the community level, particularly within the schools.

Two program evaluations and declining youth tobacco rates suggest that the program has had an impact. The presentation will address the campaign’s successes as well as some of the challenges faced in operating in the NWT’s unique cultural and geographical environment.

After five years of operation, and in light of diminishing funding, the Butthead campaign now faces the challenge of becoming better integrated into other healthy living initiatives aimed at young people in the territory. Contact: Miriam Wideman ([email protected])

CLOTH DIAPER PILOT

P. Zizman


This pilot project seeks to promote cloth diapers as an economical and environmental health alternative for families in Inuit communities. We hope that it becomes a catalyst for women and their families to create a community movement raising awareness of the damaging effects of disposable diaper use. The diapers also serve a dual purpose: a promotional tool for the Inuit midwifery network.

Inuit Tuttarvingat of the National Aboriginal Health Organization offered to supply full sets of cloth diapers to interested families, advertising in Inuit Nunaat communities via: our Governing Committee, radio, health centres and through Canada Prenatal Nutrition Program Coordinators. Of the eighteen women who responded with interest, nine were selected from several communities. Inuit Tuttarvingat partnered with Arctic Cooperatives Limited (owned and controlled by 31 community-based Co-operative business), who supplied various products to the selected families to support their efforts.

In addition to describing the methods and materials (including a fact sheet for northerners) used in this project, this presentation highlights the personal experiences and practical suggestions of the families that participated. We also review some perceived impacts from the qualitative evaluation results finalized in June 2009 that could include: contrasts concerning the use of different water delivery services in communities; garbage reduction among four families in one of the communities; issues concerning motivation, finances and convenience; support and encouragement from community members and daycares; thoughts around returning to more traditional diapering methods; and whether the diapers intrigued participants to learn more about Inuit


midwifery. The presentation will close with next steps concerning dissemination of the results to the Inuit public and beyond. Contact: Paani Zizman ([email protected])

HEALTHY SMILE HAPPY CHILD: RESEARCH AND EVALUATION OF A CAPACITY BUILDING ORAL HEALTH PROMOTION INITIATIVE

R. Schroth, L. Harms, J. Edwards, M.E. Moffatt

University of Manitoba

Introduction: Early Childhood Caries (ECC) is a growing concern among preschool children. This burden of ECC in Manitoba led to the development of an inter-sectoral partnership, Healthy Smile Happy Child (HSHC). HSHC uses community-development principles to assist communities in identifying solutions to improve early childhood oral health. Emphasis is placed on building capacity within existing programs and services to ensure sustainable oral health promotion.

Methods: Research and evaluation has been a key pillar in this initiative. HSHC has undertaken various research and evaluation projects including epidemiological studies on the prevalence of and risk factors for ECC, assessing the effectiveness of community training workshops, as well as qualitative research with service providers, community members, and different cultural groups.

Results: The prevalence of ECC was initially documented in 4 communities. Knowledge on prevalence and risk factors was then transferred back to these communities. Results following 5 years of active community engagement reveal significant improvements in parental knowledge, attitudes, and behaviours towards preschool oral health and a significant reduction in the active dental caries rate. Findings from workshop evaluations show statistically significant increases in knowledge and awareness of service providers after receiving training. Focus groups results with service providers and community members show good understandings of oral health and positive experiences with HSHC. Barriers to maintaining good oral health and preventing ECC were also identified. Focus group interviews with cultural groups identify cultural beliefs and practices pertaining to preschool oral health and ECC, which can help tailor oral health promotion.

Conclusions: The HSHC project has undertaken mixed research methods to evaluate the success of this initiative. The project has adhered to community-development and healthy living principles to empower communities to develop capacity and knowledge to sustain ongoing early childhood oral health promotion initiatives. Contact: Robert Schroth ([email protected])

YOUTH AND TOBACCO: WORKING WITH THE K’ÁLEMI DENE SCHOOL

C. Jardine1, E. Erasmus2, M. Wideman3, L. Beaulieu4, A. Brockman, A. Abel4, C. Wild1 1University of Alberta, 2K’álemì Dene School, 3GNWT Dept. of Health and Social Services, 4Yellowknives Dene First Nation

Smoking is one of the biggest health problems in many First Nations communities today. Of particular concern is the high rate of smoking in youth. Our research program was initiated to better understand why some youth choose to take up smoking and some choose not to smoke. We worked with the K’álemì Dene School in N’Dilo, training older students to conduct the research with the younger students. Training sessions covered the research process, research ethics, and specific skills needed to conduct the research (such as interviewing skills, interpretation skills, and data presentation skills). The student researchers designed a series of questions about smoking and smoking behaviours that were used as the basis for initial interviews. We also used a method called PhotoVoice, whereby students were asked to take pictures about smoking in their community and then to discuss their pictures with the researchers. The results obtained from this research process helped us to better understand the decision making

process used by youth in deciding to smoke or not to smoke. Working with students produced better research results, developed research capacity and instilled interest in the research process. Contact: Cindy Jardine ([email protected])

NORTH STARSS (START THINKING ABOUT REDUCING SECONDHAND SMOKE)

S. Duke

Healthy Moms, Healthy Babies - Victoria Faulkner Women’s Centre

This presentation will provide an overview of the STARSS (Start Thinking About Reducing Secondhand Smoke) program that aims at better understanding the role of smoking in Women’s lives and the use of a harm reduction approach in reducing secondhand smoke exposure for children.

Learning Objectives: At the end of this session, participants should be able to:

- Better understand the role of smoking in Women’s lives - Know the importance of a harm reduction approach with

reducing secondhand smoke exposure for children - Discuss available resources and support for smoking moms and

families - Use the STARSS model to work with smoking moms and families

within their own work place

Participants will be engaged in the learning process through lecture, fun interactive games, use of program resources, and case studies using the STARSS process.

Attendees will learn more about the effects of secondhand smoke, what works to reduce secondhand smoke, how to set long and short term goals to create change, strategies to reduce stress (for example: how to use deep breathing and muscle relaxation), how to use problem solving to plan ahead, and how to support smoking moms and families where they are at. Contact: Shannon Duke ([email protected])

VENUE 7 Clinical Care #2

PHYSIOTHERAPY IN NUNAVUT: OBSERVATIONS AND CHALLENGES FOR PRACTICE

C. Kehler

J.A.Hildes Northern Medical Unit, University of Manitoba

The role of a visiting physiotherapist in the Canadian arctic presents unique challenges that will be explored in this paper. Patient interaction involves the provision of consultative advice that can be implemented between visits, and which takes into account the culturally specific activities of daily living, including hunting, fishing, skinning, clothing preparation, food preparation, child care practices etc. Environmental challenges include those posed by the terrain, housing characteristcs, and transportation needs. History taking and interview techniques must be tailored to the local Inuit values regarding the expression of pain and disability. While nursing and physician services have been provided for decades in the Canadian arctic, visiting physiotherapy services have been provided on a regular basis in more recent years. Continuity of personnel and of service remains a challenge. Contact: Carol Kehler ([email protected])

DEATH & DYING: PERSPECTIVES OF A FIRST NATIONS COMMUNITY IN THE NORTHWEST TERRITORIES

R.A. Blake

University of Regina, Regina, Saskatchewan


The experience of facing death can be difficult for the terminally ill patient and their family, and friends. This qualitative research project sought to understand how the Gwich’in people of Fort McPherson, Northwest Territories (NT), historically perceived death and dying, and to document their current protocols regarding the same. This project also explored participants’ views and experiences regarding end of life care services. Preferred place of death was also explored in the study. The project took place in Fort McPherson, NT, between May 2008 and December 2008, in which ten community members, most of whom are elders were interviewed. Relying on participants’ traditional knowledge, perspectives, and experiences pertaining to death and dying, the data analysis is identified in three primary categories: 1) historical perspectives and practices, 2) contemporary perspectives and practices, and 3) end of life care services experiences and perspectives. Findings included the resilience and importance of traditional values and customs, the importance of traditional food, the value of traditional medicine. Further, culturally relevant end of life care services needs to be developed, as the Gwich’in preferred place of death is at home.

Health and Social Services professionals who work in the realm of palliative care should have appropriate cross cultural training and education, as cultures are diverse. Moreover, it is important for those in the helping field to be aware of how historical and contemporary customs impact the Gwich’in people. End of life care issues needs to be addressed accordingly. Contact: Ruth Anne Blake ([email protected])

ABORIGINAL PATIENT NAVIGATORS: FACILITATING ACCESS TO MAINSTREAM HEALTH SERVICES FOR ABORIGINAL PEOPLE

L. Day, P. Vlahos

Vancouver Coastal Health Authority

The goal of the Vancouver Coastal Health Authority (VCHA) Aboriginal Patient Navigator (APN) program is to increase access to, and Aboriginal patients’ ability to navigate the mainstream health system, fostering connections with hospitals, long term care facilities, mental health and addiction programs and services, and encouraging a holistic and culturally inclusive approach to health care delivery. Additionally, APNs have supported and advocated on behalf of their clients by forging relationships with complementary systems, like justice, child and family services, and education. The APN Program has successfully accomplished the goals outlined above by facilitating cultural requirements, networking with Aboriginal communities and external Aboriginal Health Care service providers as well as facilitating communication between Aboriginal patients and health care providers. Specific responsibilities of the VCHA Aboriginal APN’s include the following:

- Provide support services to Aboriginal clients and their families in their assigned acute care hospital and other facilities.

- Offer telephone consultation and advice to rural and/or other urban acute care sites as needed.

- Work with clients and families to support them to feel comfortable with the culture of the hospital and provides consultation and assistance to the health care team regarding service provision and appropriate accommodations of Aboriginal health practices and beliefs.

- Provide referral and advocacy support to clients, families and community service providers to facilitate continuity of care and access to appropriate health care and community services.

- Provide input, recommendations, referrals, support and guidance for discharge planning.

This presentation will briefly outline the community based development approach of the VCHA APN Program, intake and response and other APN program statistics, highlight some of the APN program successes and barriers by featuring two recent case studies, and describe the unique evaluation approach of the program.

Contact: Linda Day ([email protected])

PARTNERSHIPS IN HEALTH CARE INFRASTRUCTURE DEVELOPMENT IN NUNAVUT

J. Jaud

FSC Architects and Engineers

Health Care Projects: Arviat Health Centre, Kivalliq Health Centre, Qikiqtani General Hospital, Repulse Bay Health Centre, Arctic Bay Health Centre, Taloyoak Health Centre in Nunavut.

Project Teams: Departments of Health and Social Services and Community and Government Services, Government of Nunavut, FSC Architects and Engineers, Qikiqtaaluk Corporation.

The building industry advocates many ways to deliver health care projects. Which is the most effective for your project? What are the parameters that must be understood in order to advance your project beyond a community need?

The problem has been to understand the dynamics of project delivery systems and reaching conclusions that will eventually actualize the project in the most effective way.

Our study reviews the development of Health Infrastructure projects in Nunavut and discovers the advantages and disadvantages of different project delivery models for remote community health care projects.

Our results also indicate that input into the projects from Hamlets and staff of the health care facility result in buildings that are highly functional and appreciated by community residents and health care staff and are an effective use of project funds.

The most successful health care projects in the North are those that have had community involvement as part of the planning, construction and operational process. Contact: Jerry Jaud ([email protected])

OUTCOMES FOR TELEPHONE CONSULTATIONS IN A NORTHERN CANADIAN EMERGENCY DEPARTMENT

A. Hoechmann, B. Farrell

Background: Family / Emergency physicians working at the Stanton Regional Hospital in Yellowknife receive many calls from health care providers in remote areas regarding patients. Until recently, little was known about the volume and acuity of calls, the characteristics of the patients, and the effect on users.

In 2004, we collected records of all phone calls placed to the Stanton ER from the periphery during a 2 month time period. We then compiled data on the volume and timing of calls, the presenting complaints, and some key patient demographics. As a result of that analysis, a new record template was developed at the Stanton Regional Hospital to facilitate in the documentation of calls, with a view to ultimately improving patient care and safety.

Purpose: We wanted to know if patients who were initially managed remotely by telephone required transfer from their home to the Stanton Regional Hospital for further care. The ultimate goal of course was to provide a more effective, safer, and efficient service to the northern Canadians and health care providers in places such as Yellowknife.

Methods: This project is a descriptive study. It marks an attempt to provide a better understanding of the challenges of providing long distance medical care in the remote environments of the Northwest Territories and western Nunavut. In the fall of 2004, we extracted data from the call records into an Excel sheet. There are over 350 records in the complete data set, each representing a complete telephone consultation. In the second phase of the project, we tried linked some of the records of phone calls with their corresponding records of visits to the Stanton Regional Hospital emergency room, inpatient admissions and clinics. This was done by cross-referencing our existing data with the hospital’s computerized Medipatient record system.

Results: On average, 6 calls were made from the nursing stations to the Stanton Territorial Hospital Emergency Department each day.


Approximately 40% of calls resulted in the patient being transported, most often by medevac. Admission rates and transfer rates were carried out on a subset of the available data. From this we were able to determine that in many cases patient’s needs were met at least initially with a phone call alone.

SESSION 4 Monday, July 13, 1:30-3:30 PM

VENUE 1 Indigenous Pedagogy in Mental Health Workshop:

Healing Teachings for Mental Health Workers, Valuable Knowledge for Clients

S. Stewart

Yellowknife Dene, OISE/University of Toronto

Abstract: Indigenous pedagogy places mental health care, like education, in the context of culture, values, relationship, and historical realities. It is this understanding that provide the foundation of “Indigenous Standpoint Pedagogy” (ISP), which is the “inherently political, reformative, relational, and deeply personal approach that is located in the chaos of colonial and cultural interfaces” (Philips, Whatman, Hart, & Winslett, 2005). ISP fundamentally identifies and embeds Indigenous community participation in the development and teaching of Indigenous perspectives, or standpoints, and is a multi-faceted process. This workshop identifies and explores ISP as a valuable way to teach counsellors from diverse Native cultural perspectives, and to use this approach in mental health support work with clients. Also provided is a rationale for ISP in curriculum for Indigenous mental health workers as an integral way to promote and maintain mental health and healing.

Workshop Outline: This session details my approach to mental health worker (counsellors, psychologists, psychiatrists, social workers, child and youth care) training and client contact, which is based on an Indigenous pedagogy that places education and mental health services in the context of culture, values, relationship, and historical realities. The session will be an interactive dialogue between the presenter and audience that will invite reflexive listening and learning. Three main aspects of an Indigenous pedagogy will be discussed as they relate to Indigenous counselling and healing practices and Indigenous counsellor training: ISP theory, relationship, and empowerment.

Possible Participants: This workshop is designed for mental health trainers and mental health frontline workers (counsellors, psychologists, psychiatrists, social workers, child and youth care workers).

ISP Theory: It is this theory of understanding of teaching and learning that provides me with the foundation of what Philips, Whatman, Hart, and Winslett (2005) have termed the “Indigenous Standpoint Pedagogy” (ISP), which is described as being the “inherently political, reformative, relational, and deeply personal approach that is located in the chaos of colonial and cultural interfaces”. ISP fundamentally identifies and embeds Indigenous community participation in the development and teaching of Indigenous perspectives, or standpoints, and is a multi-faceted process. It is mainly concerned with Native perspectives in education not as an alternative to western approaches but as a legitimate form of education in and of itself. I bring this perspective to my teaching by virtue of my identity and my desire to work from an Indigenous perspective in all aspects of my teaching methods and goals. What this means in practice is that I value multiple perspectives on learning and teaching in my interaction with students and clients, such as linear and non-linear thinking, differing time orientation, holistic approaches and dualism, and community-based and individual focussed connection. However, the most important

facet to this approach is a focus on the understanding and process of healing.

Relationship: The foundation to this counselling and counsellor training approach lies in relationship, and this will be discussed as the centre of success for meaningful communication with students and clients. “Yet only through communication can human life hold meaning” (Freire, 2003, p. 61). Further, a discussion of the relationship between Indigenous peoples and colonial rule will occur in the context of mental health and healing (Gone, 2004; Mussell, Cardiff, & White, 2004; Smith, 1999; Stewart, 2007).

Empowerment: Another important principal in my philosophy of teaching and counselling is empowerment. And this has its roots in Paolo Freire’s seminal work, Pedagogy of the Oppressed. From this point, I come from a humanist perspective in which my efforts as an educator must be consistent with those of the students in order to engage in critical thinking and the quest for mutual humanization—my goals in teaching and counselling. Freire (2003) states that the educator’s efforts “must be imbued with a profound trust in people and their creative power. To achieve this, they must be partners of the students in their relations with them…The teacher's thinking is authenticated only by the authenticity of the students' thinking. The teacher cannot think for her students, nor can she impose her thought on them. Authentic thinking, thinking that is concerned about reality, does not take place in ivory tower isolation, but only in communication” (p.61). For me, education and healing through counselling is based on traditional Indigenous values of sharing, supporting, and liberating, and that teaching is a practice of freedom, not domination (Mussell, 2005; Mussell, Nichols, & Adler, 1993). For me, a teacher and a counsellor assumes a leadership role in the classroom or the session, not an expert stance, in order to be an effective educator and helper. A helper must take responsibility and leadership in pragmatic ways that reflect such traditional values of respect, incorporation of community, voice, trust, mutuality, authentic communication, and shared interest in learning (McCormick, 1996, 1997).

Objectives for workshop: Attendees will learn to understand the fundamental of Indigenous pedagogies and healing in mental health teachings and practices (such as counselling, social work, nursing, etc) and to evaluate its strengths and weakness as applicable to their own personal teaching and helping philosophies and practices. Additionally, those interested in policymaking will come away with a concrete understanding and articulation of a rationale for indigenous pedagogies for counsellor educators and counsellors engaged in professional helping (Erasmus & Ensign, 1998).

How attendees will be engaged: Participants will be invited to discuss and dialogue amongst each other and with the presenter throughout presentation of main ideas. This could include sharing of experiences, ideas, and hopes regarding the presentation topic. Contact: Suzanne Stewart ([email protected])

VENUE 2 Education & Building Resource/Research Capacity #1

DEVELOPING A PHYSICIAN SERVICES PROGRAM IN NUNAVUT 1999-2009

W.A. MacDonald

Health and Social Services, Government of Nunavut

When Nunavut was established in 1999 the new Department of Health and Social Services inherited a health care delivery system organized around 3 regional health boards corresponding to the 3 administrative regions of the new Territory: Baffin, Kivalliq and Kitikmeot.

This system was dismantled in 2000 and replaced with a more centralized Department and 3 adminstrative “regions”, each with an Executive Director reporting directly to an Assistant Deputy Minister of Operations.


The physician services aspect of the care delivery model was addressed by the appointment of a Director, Medical Affairs in 2001. This position is responsible for physician services in Nunavut, and for the quality of care in the Territory.

In 2001 there was no consistent administrative support structure for the physician services’ program. Pay and hiring practices varied across the Territory and retention rates were very low. Compared to national averages Nunavut had about one-half the number of physicians to population.

Since 2001, the number of funded physician positions has increased, the number of full time specialist positions has increased, the pay and contractual structures have been overhauled and standardized, an aggressive recruitment campaign based on unique “testimonial” ads has been initiated, and administrative support positions have been created within the Department. Finally with all the above developments in place the average length of stay of family physicians in the Territory has increased significantly over earlier years. Future plans include sponsoring medical school placements for qualified Inuit students from Nunavut.

The goal of the program is to provide consistent, competent physician services to the population of Nunavut, and to create a work environment for physicians which is conducive to long term practise. Contact: W.Alexander Macdonald ([email protected])

PROPOSAL FOR A STANDARD PRIMARY CARE PHYSICIAN COMMUNITY COVERAGE MODEL FOR THE NORTHWEST TERRITORIES

E. Affleck

Yellowknife Health & Social Services Authority

Objective: It is becoming more difficult to staff the remote communities of the Northwest Territories with physicians. There appear to be a number of causes underlying this staffing shortfall including worldwide physician shortages. This shortfall in regular physician community coverage has resulted in greater reliance on physician services in Yellowknife, and anecdotally in more medevac transfers of patients to the two territorial hospitals. Current trends in physician coverage threaten the sustainability of the remote community service.

The objective of this study is to describe in detail the current state of physician community coverage in the Northwest Territories by examining coverage statistics and the model of service. Based on the findings a new model of coordinated physician community coverage is proposed aimed at providing sustainable quality service.

Methods: Government of the Northwest Territories statistical and demographic information is used to establish physician coverage rates by population and community. Rates of physician recruitment and retention by health Authority, and rates and cost of medical evacuation by community and territorially are examined. Lastly referral and remote physician coverage patterns are detailed.

Results: There is a clear shortfall in primary care physician services in the Northwest Territories, particularly in the remote communities, bringing into question the very sustainability of remote community physician service. Combined with a lack of standardization of community coverage and a lack of coordination and clear criteria for medical transportation this results in what appear to be needless and costly transportation.

Discussion: A coordinated territorial community call coverage system is proposed that will see three primary care physicians on call for the Northwest Territories. Central to this service is standardization of care and coordination of medical transportation. A hybrid digital information system with simple store and forward Telehealth, videoconferencing services, and digital documentation templates will support this service. Contact: Ewan Affleck ([email protected])

DISTRIBUTION OF PHYSICIANS, NURSES, AND PHARMACISTS IN NORTHERN CANADA

A. Porter-Chapman

Canadian Institute for Health Information

Hypothesis: What does the geographic distribution of employed physician, registered nurse, licensed practical nurse and pharmacist working in Canada’s northern territories resemble?

In 2007, Canada’s northern territories healthcare workforce included, but is not limited to, registered nurses, licensed practical nurses, physicians (Family Medicine and Specialist) and pharmacists. Of these healthcare professionals, the majority of physicians (over 85%) and pharmacists (over 70%) are located in the capital cities. For regulated nurses the distribution varies by territory; ranging from 99% in the Yukon, 61% in the Northwest Territories and 33% in Nunavut.

Methods: This study analyzed administrative data from the Regulated Nursing Professions Database, Scott’s Medical Database and the Pharmacist Database at the Canadian Institute for Health Information (CIHI). These pan-Canadian databases contain demographic, employment, education and geographic information for all physicians, licensed practical nurses (LPNs), registered nurses and pharmacists in Canada.

A distribution analysis was developed for those professionals employed in northern Canada in 2007. Geographical indicators about the workforce were linked to current Canadian census divisions and census subdivisions. These data were then compared to information from Statistics Canada’s Census.

Results: The distribution of physicians, regulated nurses and pharmacists varies across professions in Canada’s northern territories but in each case clustering in the cities is evident to varying degrees. While the geographic distribution is informative, the demographic, education, employment and mobility trends of healthcare professionals shows us even more about the work lives of healthcare professionals employed in Canada’s northern territories.

This examination of the distribution healthcare professionals currently employed in Canada’s northern territories can assist territorial and federal health planners in their recruitment and retention policies. The information in this presentation provides one more piece of understanding as to the shape of Canada’s northern healthcare workforce. Contact: Andrea Porter-Chapman ([email protected])

COMMUNITY-BASED HEALTH CARE IN ACTION

A. Hache

Centre for Northern Families

This panel presentation explores the successes, challenges and outcomes of establishing a multi-disciplinary team in a community-based health care clinic situated in a northern family resource drop-in centre with an onsite emergency shelter that serves women who are homeless. The clinic that partners several agencies including the Yellowknife Health and Social Services Authority, the Great Slave Community Health Care Clinic, Aurora College and the Centre for Northern Families provides a concrete example of primary health care in action, delivering services to marginalized populations in a way that meets their specific needs in an environment they feel comfortable being in.

The clinic established 5 years ago approached health care from a social determinants perspective. It piloted the Family Physician and Nurse Practitioner dyad in a collaborative practice and was used as a base of operation to develop the electronic medical record system giving patients and doctors easier and faster access to medical information they need for diagnosis and treatment.

The clinic operates one day a week and is open to the general public. Women living in the emergency shelter attend regularly receiving the first consistent health care service in their lives. On average 35 people attend each session. In its first three months of operation there were a


total of 108 visits. The majority of patients were 19-29 years of age, followed by those 40-59 years of age. Most were Inuit, closely followed by Dene.

The partnership worked because everyone focused on “the people we were helping rather than our own fears, misperceptions and biases”. The Women say:

- I feel comfortable here. I don’t have to make an appointment; I can just drop in.

- I feel judged when I go to the doctor’s office – here I don’t. Contact: Arlene Hache ([email protected])

HEADING A SÁMI HEALTH INSTITUTION: EXPERIENCE AND CHALLENGES

G.K. Heatha

The Sámi National Centre for Mental Health - SANKS

In this paper I will focus on the particular challenges a head of a Sámi health institution in Norway may face when he or she is responsible for developing an equal health service to the Sámi population.

The paper builds on my Master degree in Business Administration. The thesis, which takes an ethnographic approach, is based on my own experiences, participatory observation, interviews and various health policy documents.

My study shows that those who head Sámi health institutions may experience particular challenges. The challenges can be understood as a consequence of the fact that majority or minority background has an influence on the understanding and interpretation of concepts such as equal service, the ability to provide concrete examples of measures and the willingness or ability to instigate concrete measures. In other words, the idea of actually instigating measures that can result in an equal service for the Sámi population can lead to difficult dilemmas for persons from majority backgrounds. Among other things, the dilemmas may be related to concerns that measures specifically targeting the Sámi population may be perceived as being unjust by other minorities and by the Norwegian population. It appears, on the other hand, that the place one grew up is significant in terms of choice of strategy in relation to a concrete case.

The responsible health authorities should consider other solutions than the present ones because the survey shows that lack of knowledge about the Sámi society can affect the ability to propose and instigate measures aimed at creating an equal service for the Sámi population. Without concrete measures, we will never achieve an equal health service for the Sámi population. All we will be left with is a large number of reports and plans emphasising how important various measures are. Contact: Gunn Kristin Heatta ([email protected])

LAND BASED EXPERIENTIAL INDIGENOUS CULTURE AND HEALTH TRAINING

M. Jong

Memorial University

There is a need for culturally safe care if we are to improve the health of indigenous peoples. We have been providing indigenous culture and health training for family medical residents, medical students and allied health personnel for about 15 years. Training has evolved into a land based experiential learning.

Learning is through story telling and living with the elders in a tradition setting in tents in the bush. It includes a walk through the country to share the experience of living on the land with the Innu and appreciate what the land means for them.

Participants gave great evaluation of the training. Contact: Michael Jong ([email protected])

IMPROVING ACCESS AND OUTCOMES IN CANADA’S NORTHERN TERRITORIES

S. Chatwood1,3, S. Law2, K. Young3, E. Affleck4, A. Cortinois5, C. Kirby2 1Institute for Circumpolar Health Research, 2Canadian Health Services Research Foundation, 3University of Toronto, Dalla Lana School of Public Health, 4Yellowknife Health and Social Services Authority, 5Centre for Global eHealth Innovation

New investments and opportunities for health and related programs in Canada’s northern territories have stimulated many training, research, and service innovations that aim to improve access to healthcare and health outcomes for northern and Aboriginal people. This presentation will provide an overview of projects underway in the Northwest Territories (NWT) and in Nunavut where different approaches to introducing evidence-informed change have been adopted – but with hopefully similar outcomes.

In the NWT, there have been major collaborative efforts (between researchers and decision makers) to promote the investment in research and research infrastructure to advance health and healthcare. Partnerships exist between the Institute for Circumpolar Health Research, University of Toronto Dalla Lana School of Public Health, the Center for Global eHealth Innovation and territorial health authorities. Infrastructure funds have been acquired from INAC to renovate existing office space within the health authority where, among other research programs, a health services research program will be nested. Health services research program development is ongoing and will include health systems analysis and the development of eHealth solutions including store and forward technologies and video enhancements for communications.

In Nunavut, the Canadian Health Services Research Foundation (CHSRF) is working with the Nunavut Department of Health and Social Services (DHSS) in a major project that brings experts in health human resources and health services organization and management together with the relevant scientific evidence to work with DHSS staff to identify improvements in access and outcomes across all communities. The project plan includes an evaluation component that will assess the effectiveness and impact of this approach as well as the longer-term results of any changes in policy and practice to implement the final recommendations (in 2010).

It is anticipated that a comparison of the two approaches, and a presentation of the progress and lessons learned to date may be of wider interest to conference attendees from other jurisdictions. Contact: Susan Chatwood ([email protected])

VENUE 3 Indigenous Wellness & Medical History #3

HISTORICAL AND SOCIAL EFFECTS OF LEGISLATION AND POLICY IN ABORIGINAL HEALTH

C. Cook, D. Ballard, A.A. Roussin, K. Gray

Winnipeg Regional Health Authority

This paper will discuss the impact historic legislation and policies have on the delivery of health services to Aboriginal Peoples and the efforts underway to amend the legislation and policies in order to provide better health care and services to Aboriginal Peoples. The present health services delivered to Aboriginal Peoples are a direct result of historic legislation and policies that directly or indirectly produced jurisdictional barriers encountered by Aboriginal Peoples and health service providers when requesting these services. Health care providers are now beginning to address these jurisdictional barriers in an effort to adequately provide Aboriginal Peoples with health services when required. In Manitoba, jurisdictional barriers to the provision of health care for Aboriginal Peoples are being addressed in the Legislative Assembly of Manitoba in the form of a child first principle to resolving jurisdictional disputes within and between federal and


provincial/territorial governments. This child first principle is presently before the Legislative Assembly of Manitoba as Bill 203 “The Jordan’s Principle Implementation Act” and came about as a result of the evolution of historic legislation and policies that impacted the provision of health services to Aboriginal Peoples. Contact: Dennis Ballard ([email protected])

A SOCIAL AND ENVIRONMENTAL HISTORY OF HEALTH CARE RELOCATIONS IN THE CANADIAN NORTH SINCE 1890

L. Piper


This paper examines the origins, evolution and impact of relocating people with infectious and chronic diseases from Canada’s northern territories to southern health care facilities. Previous researchers have focused upon Inuit relocation after 1945 (Grygier 1997; Tester and Kulchyski 1994), in particular as a result of tuberculosis infection. However, relocations for health care began before 1900, involved Aboriginal and non-Aboriginal people across the Canadian North, and temporarily or permanently removed individuals with disabilities, mental illness, and cancer as well as those with infectious diseases such as tuberculosis, syphilis, and gonorrhoea. Using federal and territorial government records from the Library and Archives Canada, the Yukon Archives, and Northwest Territories Archives, records of religious groups responsible for northern health care, and oral histories with indigenous communities in the eastern and western Arctic, this paper explores several key themes: First, how relocation policy was rooted in perceptions of northern environments as hazardous. Understandings of northern ecosystems changed over the 20th century, but nevertheless continued to reinforce the idea that the North was environmentally unsuited to the creation of local modern health facilities. Second, the role of attitudes held by state and religious officials that attached moral judgements to certain diseases, especially gonorrhoea, syphilis, and tuberculosis. These individuals saw intervention through relocation as a means of social education as well as an opportunity for treatment. Finally, this paper explores how attitudes intersecting health, morality, and environment influenced the experience of relocation for Aboriginal and non-Aboriginal northerners. This paper demonstrates that relocation policies arose not simply as a practical response to the challenges of health care provision across a large area with a small and widely dispersed population. Rather, this policy reflected complex understandings of northern communities and environments and aspired to achieve specific social objectives for people in the North. Contact: Liza Piper ([email protected])

“ARE YOU NOW A QALLUNAQ?” INUIT TUBERCULOSIS EVACUEES IN THE 1940S-1950S

E. Olofsson, T. Holton, I. Partridge

McGill University

In the mid 1940s the Canadian government implemented a medical mass-survey of Inuit and other indigenous peoples living in northern Canada and evacuated those suspected of having tuberculosis (TB) and other serious conditions. Hospital stays often lasted several years, and while many Inuit patients were eventually returned to their home communities, others never returned, some because they chose to stay in the south and others because they did not survive their illness. The current study is interested in how hospitalization in the south affected the identity of Inuit patients, and in particular examines the negotiation of identity as a form of resilience. This investigation is accomplished through life history interviews with Inuit former evacuees living in Montreal and in different communities in Nunavik. We explore Inuit individuals’ experiences of departure, travel, and of their sojourn in an unfamiliar environment, as well as their lives after the hospital stay. The life histories are also supplemented with documentary research of archival material regarding the hospitals, and interviews with some hospital personnel from the era. Oral historical

research that focuses on peoples’ experiences and their perceptions is an important key to the root of the social and health concerns that exist in Inuit communities both in the north and in the cities. The results of this study could be used to inform both governmental policy and intervention programs. Contact: Ebba Olofsson ([email protected])

HISTORICAL AND SCIENTIFIC PERSPECTIVES ON HEALTH OF CANADA’S FIRST PEOPLES

R. Obomsawin


Historical perspectives and commentary on the forgotten legacy of the outstanding health of Canada’s first peoples in the pre-contact era is examined and documented from wide ranging historical sources. Principal factors underlying pre-contact outstanding health levels and the key causes underlying its precipitous loss are addressed. Based on the historical record and an alternate bio-medical model, widely disseminated medical assumptions about imported microbes infecting “virgin soils” and causing mass infectious disease in Aboriginal populations in the early post-contact era is challenged. More basic causal factors for pandemic infectious disease patterns is presented for consideration. Patterns of traditional foods in relation to sustaining health & preventing disease among the first Nations, Inuit and Métis populations is looked at. Correlative factors behind the increasing levels of degenerative disease among Aboriginal peoples in the twentieth & twenty-first century is also explored. The historical progression of the Federal government in the field of health care for Canada’s first peoples is described, including the recent policy of transfer of public sector health services to Aboriginal control. A number of scientific issues are documented and interpreted, including:

- Adverse impacts of modern civilization-globalization on the health of Indigenous peoples

- Western medical services & Aboriginal health outcomes - The unbalanced dominance of western selective medicine & its

iatrogenic impacts versus nature-based traditional healing - Socio-economic factors & declines in infectious diseases - Issues surrounding vaccine usage among First Nations & Inuit

people - Nutrient intake levels of Canada’s first peoples when living on

traditional diets - Medical concerns on milk usage of another species beyond

weaning - Vitamin prophylaxis & remediation of infectious diseases - Bio-physical underpinnings of mental health - Recent health regenerative successes in an Aboriginal community Contact: Raymond Obomsawin ([email protected])

THE HEALTH OF FIRST NATIONS CHILDREN UPON ADMISSION TO A RESIDENTIAL SCHOOL IN A NORTHERN MANITOBA COMMUNITY

A. Woods

University of Mantioba

For over a century, First Nations children were removed from their families and communities and put into Residential schools. It is now known that thousands of children suffered physical, sexual, emotional and spiritual abuse while at the schools as well as neglect of their needs. The abuse and neglect was damaging to the children during their time in the Residential schools and has continued to inflict enduring pain and difficulty in the lives of Residential school survivors. The negative effect of the abuse and neglect also continues to effect the successive generations of Residential school survivors, and is known as the intergenerational impact of the Residential school experience. It is possible that there are connections between the experiences First Nations children had in Residential school and health problems experienced by First Nations people today. In order to better understand what happened to the children in Residential school in


terms of health, it is necessary to examine the health of the children at the time that they were admitted to Residential school. This research will examine the overall health of First Nations children at the time of their admission to, and during their stay in, a Residential School. The research design is an historical qualitative inquiry using a set of Residential school records. By compiling the information from the documents, a better understanding will be gained of the health of children when they first came to the school and if, and how, their health changed while they were at the school. As children from each of the three Aboriginal groups of Canada, First Nations, Métis, and Inuit, were forced to attend Residential schools, this information will be useful for all Residential school survivors on their paths to healing from their Residential school experiences. Contact: Amanda Woods ([email protected])

MY GRANDMOTHER’S MOCCASINS

L. Edge


This study explores multiple perspectives of Indigenous Women’s participation in traditional cultural activities, such as beadwork, to examine how participation in these activities may contribute to identity formation, teacher/learner relationships, relationships to social and cultural environments and health and well-being.

Indigenous ways of knowing and meaning are explored from an Indigenous perspective through qualitative methods; critical inquiry; ethnographic, historical and material culture; narrative and storytelling; and visual arts research and representation towards expression of a conceptual framework and related contexts that offers insight into beadwork as a traditional cultural activity.

A personal narrative reflects and interprets learning experiences through writing and digital media as a method to strengthen alternative representation in research and enhance our understanding of methodologies and outcomes.

The research draws our attention to the many contributions of First Nations and Métis women in the sub-arctic regions of northern Canada whose legacy is a rich endowment of materials created and crafted by them from which current and future generations may continue to learn about Indigenous ways of being.

Analysis and reflection upon Indigenous ways of knowing may contribute to our understanding of Indigenous Women’s identity, lifelong learning and the health and wellness of Indigenous people in North America. Contact: Lois Edge ([email protected])

CAREGIVING IN CONFINEMENT: JAPANESE IMMIGRANT MIDWIVES DURING WORLD WAR II

S. Smith

Dept. of History and Classics, University of Alberta

This paper draws on qualitative methods and historical sources, including government records, to provide an historical exploration of the social determinants of health. This case study of one immigrant midwife in wartime, it reveals how health disparities are sometimes produced by health policies. It shows that human health is a product of society, and the conditions of life, as much as biology.

This paper demonstrates the significance of caregiving labor for remote populations through the study of a Japanese immigrant midwife during the mass incarceration of Japanese Americans in U.S. government camps during World War II. It draws on the diaries of Toku Shimomura, a midwife or sanba, who faced a harrowing process of what the U.S. government called “evacuation” and “relocation” from the west coast to remote inland camps in the 1940s. Toku’s wartime diaries humanize a tragic moment and provide evidence of how people coped with harsh and unhealthy living conditions.

The forced relocation of Japanese Americans created a situation in which a health care system had to be built from scratch to care for a vast population placed in desolate locations. In each of the ten U.S. camps, the government constructed and staffed a hospital. Yet, as Toku’s story demonstrates, hospitals were not sufficient to meet the requirements of people living in places of confinement.

This paper shows how Toku’s identity as a midwife shaped her contributions to camp life. It demonstrates how she aided community survival, and her own, through informal caregiving work. It reveals that midwife practice has had public health dimensions not fully captured by research that only focuses on the midwife’s contributions to birthing babies. The history of midwifery during the wartime incarceration shows that midwives have been central, if too often invisible, figures in health care promotion. Contact: Susan Smith ([email protected])

VENUE 4 Infectious Diseases #2 – Tuberculosis

HARMONY, BALANCE, AND RESILIENCE: ENHANCING ADHERENCE TO TB TREATMENT IN CANADIAN ABORIGINAL POPULATIONS

C. Lopez, P. Orr


Adherence to tuberculosis (TB) therapy is necessary for the health of the individual patient and his/her family as well as the community. It is also a concern for all TB programs in Canada, including those that care for aboriginal patients and populations which continue to be burdened with high rates of TB infection and disease. Failure to adhere to TB treatment regimens (medication and monitoring) may result in morbidity and mortality of the patient, transmission to others, and development of resistance. Drawing on the published experience of TB in indigenous populations in Canada and other countries, we examine the personal, social, and health system factors that affect TB adherence in aboriginal populations. Program strategies that enhance adherence are explored, including those that promote self-efficacy, “permeable” health services and a patient centred approach. Community activism that challenges “dependent” thinking, use of traditional problem solving methods, integration of TB care with other health services that address patient needs are required. Holistic views of health as characterized by harmony and balance allow for the involvement of family and community in support of individuals for whom adherence is difficult, and for the molding of TB programs in a manner that promotes cultural safety and effectiveness. Contact: Carmen Lopez ([email protected])

VITAMIN D RECEPTOR GENE POLYMORPHISMS IN A CANADIAN FIRST NATIONS POPULATION WITH TB

L. Larcombe, P. Orr, B. Martin, P. Nicherson


The Dené First Nations in northern Manitoba have one of the highest tuberculosis rates in the world (600 per 100,000). Historically, exposure to UV light was used to treat patients with cutaneous tuberculosis with dramatic affect. Recently, it was proposed that sunlight catalyzes the conversion of vitamin D3 and in conjunction with the vitamin D receptors (VDR) they enhance the cathelciden peptide, which has a direct antimicrobial effect on Mycobacterium tuberculosis. Single nucleotide polymorphisms (SNPs) in the VDR gene affect transcription levels and may affect the downstream production of intrinsic antimicrobial peptides. Four vitamin D receptor restriction site polymorphisms that are associated with disease susceptibility or resistance were analyzed in a Dené, Cree and Caucasian cohorts. The Dené maintain a significantly higher frequency of the Fok1 and Taq1 alleles (87% and 98%) associated with disease as compared to a Cree


cohort (56%, 84%) and both cohorts significantly from the Caucasian (36%, 34%) cohort. The Apa1 and Bsm1 alleles associated with lower functional expression were found in higher frequency among the Dené (71%, 93%) as compared to the Caucasians (49%, 59%) and Cree (51%, 68%). Given the important role of vitamin D as an effecter of macrophage function in limiting infections like tuberculosis, the high frequency of SNPs that may limit the downstream function of vitamin D in the Dené cohort may in part explain the high rate of tuberculosis in this population. Contact: Linda Larcombe ([email protected])

REVIEW OF MANAGEMENT OF THE 2007 YELLOWKNIFE TB OUTBREAK

E. Affleck


Objective: Over the spring, summer and fall of 2007 The Yellowknife Health & Social Services Authority (YHSSA) was faced with an outbreak of Tuberculosis (TB) stemming from an index case diagnosed in March of 2007. This index case first came to the attention of health officials in September of 2006 when a CXR of the individual was read as suspicious for tuberculosis. The individual remained undiagnosed for 7 months after the initial CXR, during which time he had contact with over 500 people. As a direct consequence of this case there have been 19 active cases of Tuberculosis diagnosed.

The fallout from this TB case has proven significant, having a direct effect on the health of the community and staff workload. The objective of this study was to analyze the management of the index case in the 2007 Yellowknife TB outbreak in order to identify possible deficiencies in care and opportunities for improved TB management.

Methods: Tracer methodology was used to follow the management of the index TB case from first presentation through to ultimate diagnosis and initiation of treatment. For comparative purposes the index case from a similar but much less significant TB outbreak from 2003 was also examined with tracer methodology. Lastly the findings of these analyses were reviewed in light of a series of recommendations made in a report commissioned after a 2001 TB related death in the Northwest Territories.

Results: The cause of the TB outbreak in Yellowknife can be traced to the breakdown of health service along the continuum of care. There were multiple occasions when the index case could have been, but was not apprehended for treatment. Central to this failure of service appears to be affective communication protocols between levels of care and clearly defined and understood roles and responsibilities.

Discussion: As a result of this study a series of clear recommendations are made to address deficiencies in the TB management system. Contact: Ewan Affleck ([email protected])

TUBERCULOSIS AND VITAMIN D IN GREENLAND

N. Nielsen1, T. Skifte2, A. Koch1, M. Andersson1, K. Ladefoged3 1Department of Epidemiology Research, Statens Serum Institut, Copenhagen, 2National Board of Health in Greeenland, Nuuk, 3Medical Department, Queen Ingrids Hospital, Nuuk

Background: Tuberculosis (TB) is a major cause of illness and death worldwide. In Greenland one of the highest incidences (2300 per 100.000) was found after the Second World War. Due to significant national efforts, this incidence decreased substantially and reached in 1985 the lowest registered level of 25 per 100.000. Since then the incidence has increased again to averagely 133 per 100.000 throughout the last 10 years.

The TB pathogen Mycobacterium tuberculosis resides within macrophages. Para-doxically, macrophage activity is the first type of defence against M. tuberculosis infection. The active metabolite of vitamin D, 1,25-dihydroxyvitamin D, is a modulator of macrophage function improving the ability of macrophages to inhibit the growth of the mycobacteria. Hence, susceptibility to TB may be increased by

vitamin D deficiency. A recent meta-analysis concluded that low serum vitamin D levels are associated with higher risk of active TB.

Objective: To analyse the potential association between vitamin D and TB in Greenland with the aim of assessing whether vitamin D supplementation could have a beneficial effect on Greenlandic people in terms of bracing their immune system to respond more efficiently to TB infection.

Methods: A case-control study was designed by identifying TB patients and controls from 13 districts in Greenland. 72 patients and 72 controls donated a blood sample and their serum con-centration of vitamin D was determined. Associations between vitamin D and TB were as-sessed using multivariate regression analyses.

Results: Individuals with vitamin D concentrations < 80 nmol/L had a 7.4 times (95% CI: 2.0 - 28) higher risk of being TB infected as compared to those with 80-140 nmol/L (reference). Interestingly, individuals with vitamin D concentrations >140 nmol/L also had a higher (6.9 times, 95% CI: 1.9 - 24) risk of being TB infected (P=0.0019).

Conclusion: Both low and high serum concentrations of vitamin D appear to be strongly associated with TB in Greenland. Contact: Nina Nielsen ([email protected])

TUBERCULOSIS INFECTION AMONG INUIT CHILDREN IN GREENLAND

B. Søborg, A. Koch, M. Melbye, V.Ø. Thomsen, K. Ladefoged, M. Andersson, A.B.M. Andersen

Statens Serum Institut, Department of Epidemiology Research

Tuberculosis remains a major public health problem in Greenland. A world-record in tuberculosis incidence recorded in 1952 (2,200 per 100,000) launched a systematic effort that reduced the incidence to approximately 10 per 100,000 in the mid-1980’ies. However, the incidence increased markedly during the 1990’ies. To determine whether the reported increase represents active M. tuberculosis transmission an M.tuberculosis screening survey were performed among school children in Greenland.

Objectives: 1)Examine the prevalence of M.tuberculosis infection among children in Greenland, 2) Examine if prevalence of M.tuberculosis infection differ depending on whether the gold standard Tuberculin Skin test or the Interferon Gamma release assay QuantiFERON-TB Gold are used.

Methods: 2,231 school children aged 5-17 years (~25% of the population in the relevant age group) from five towns in west, south and east Greenland were tested for M. tuberculosis infection using tuberculin skin test and the Interferon Gamma release assay QuantiFERON-TB Gold.

Results: Overall, 11.4 % of the tested children had at least one positive test result. 8.9% of the children presented a positive QuantiFERON-TB Gold test and 9.2% a positive tuberculin skin test.

The prevalence of a positive test result increased with age from 8.1 % in the youngest to 19.9% in the oldest age groups (trend p<0.001).The positive rate varied substantially by location (~2% in west Greenland and ~20% in south Greenland). Annual risk of infection was estimated, on the basis of a concordant positive result in both tests, to 0.8% per year.

Conclusions: With an estimated annual risk of M.tuberculosis infection at 0.8% and an a overall prevalence at 11.4%, active transmission seems to occur at alarmingly high rates in present day Greenland and urge the need for public health interventions. The prevalence was high irrespectively of screening test used, and overall test concordance was good. The new IGRA test performed well in school age children, with a low rate (1%) of indeterminate results. Contact: Bolette Søborg ([email protected])


MANITOBA'S ABORIGINAL PEOPLE AND TB: HOW SOCIAL CONDITIONS AND BEHAVIOURS CONTRIBUTE TO THE ELEVATED RATES

V. Maud

University of Saskatchewan

The focus of this presentation is to explore the contemporary problem of TB in Manitoba among Aboriginal peoples. Aboriginal people have continually had elevated rates of infectious disease compared to dominant society Petrelli et al. (2004).

A more extensive examination of incidence rates within particular subgroups of the population reveals the true nature of the disease in Manitoba. The incidence rate for tuberculosis for Canadian-born treaty-status individuals was 48.4 per 100,000, a value more than ten times higher than among Canadian-born non-treaty-status {sic} individuals (3.3 per 100,000) and more than double compared to foreign-born individuals (22.0 per 100,000). Interestingly, the rate for Canadian-born treaty-status individuals in selected northern communities soars to more than 490 per 100,000. (Petrelli, D., Sharma, K., Al-Azem, A., Hershfield, E., & Kabani, A.) Strain-related virulence of the dominant Mycobacterium tuberculosis strain in the Canadian province of Manitoba (Tuberculosis (Edinb). 84, 318).

With the obvious elevate rate of disease, we must question as to why the rate persists despite the significant resources available to control this disease. Therefore, it is critical we understand how social conditions such as inadequate housing and overcrowded living conditions; as well as social behaviors such as poor nutrition and smoking increase the TB. Without understanding and addressing these conditions, it is unlikely that Aboriginal communities within Manitoba will experience a decrease in TB; in fact the rate will most likely escalate. Contact: Velvet Maud ([email protected])

VENUE 5 Food Security #3 – Factors affecting Food Security

FACTORS INFLUENCING DIET AND THE FOOD ENVIRONMENT IN TWO INUIT COMMUNITIES IN NUNAVUT: QUALITATIVE FORMATIVE RESEARCH RESULTS FROM HEALTHY FOODS NORTH

E. Mead, M. Kratzmann, C. Roache, R. Reid, J. Ogina, J. Gittelsohn, S. Sharma

University of North Carolina at Chapel Hill, Nutrition Research Institute, Kannapolis, NC

Objective: To explore multiple community perspectives on the barriers and enhancing factors affecting food procurement and food stocking in stores for Inuit populations of Nunavut, which could be targeted by Healthy Foods North, a community-based nutritional intervention program.

Setting: Two remote Inuit communities in the Arctic region of Nunavut.

Methods: Observational data were collected, and semi-structured in-depth interviews were conducted with Inuit adults representing key people in the communities. The data were analyzed using the qualitative statistical software program N6 QSR NUD*IST.

Results: Forty-five Inuit participants (29 from community A, 16 from community B) were interviewed. Traditional “country” foods acquired through harvesting were considered the healthiest by community members, but multiple factors inhibited their procurement, including high cost of gas and loss of traditional knowledge. The main barriers perceived by community members to purchasing healthy foods at the stores included expense and quality. The community leaders and health staff identified multiple barriers to eating healthy in the community, such as lack of skills to prepare store-bought foods. Store managers identified several challenges to providing fresh produce and

other foods, such as long transportation and arctic temperatures. They also cited factors influencing their decisions to stock and discontinue stocking foods, such as customer request and media promotion of foods.

Conclusions: Several factors inhibit healthy eating for Inuit populations living in remote communities as identified by multiple community stakeholders. To ensure effectiveness and sustainability, Healthy Foods North will address these factors, as well as utilize those factors that promote healthy food acquisition and consumption.

Acknowledgements: The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57. Contact: Erin Mead ([email protected])

CLIMATE CHANGE IMPACTS AND ADAPTATION: IMPLICATIONS FOR DIET AND HEALTH IN TWO FIRST NATION COMMUNITIES IN THE YUKON, CANADA

L.H.M. Chan, P. Tobin, C. Dickson


Northern Aboriginal communities are particularly vulnerable to climate change due to their reliance on traditional food. Climate change can affect food security by influencing species distribution, population abundance, morphology, behaviour, and community structure of animal and plant species. Studying the effects of climate change in the north on Aboriginal peoples’ ability to locate and procure physically, socially, spiritually, mentally and economically important food sources is critical.

This project aims to determine if there have been changes to diet and health as a result of climate change and if so, what strategies have people used to adapt to these changes. Four focus groups with 21 participants were conducted in October 2007 in the community of Old Crow and another 4 focus groups with 49 participants were conducted in May 2008.

Data collected from the focus groups included traditional food consumption, availability and access of traditional food, self reporting of changes in the traditional diet and reasons for these changes. In addition, 41 individual interviews were completed in Old Crow and information on traditional food consumption and self perceived reasons for change in diet were noted as were hunting, fishing, trapping, and gathering practices. All data from the interviews was entered into Epi-Info version 3.4.3 for statistical analysis. Preliminary results from data collection were recently presented back to the communities and are currently being finalized.

Results of this study will be useful for the planning of adaptation strategies to improve food security in the communities as well as the region. Contact: Pam Tobin ([email protected])

CLIMATE CHANGE AND FOOD SECURITY AMONG FEMALES IN AN INUIT COMMUNITY

J.D. Ford, M. Beaumier

McGill University

The territory of Nunavut has the highest incidence of food insecurity in Canada, where over 50% of Inuit households are believed to experience difficulties in obtaining sufficient food. This significantly exceeds the Canadian average of 9.2 %. Food insecurity is manifest when food systems are stressed such that adequate nutrition is not accessible, available, and/or of sufficient quality. Several studies have reported food systems to be negatively affected by economic, social and cultural transformation and climate change. Inuit women have been identified to be particularly vulnerable to food insecurity and more at risk to climate change. Food insecurity can have serious implications for women’s physical and mental health, and social well-being resulting in increased susceptibility to infection and chronic health afflictions. This paper explores ways in which a rapidly changing climate in the High


Arctic impacts the food security of Inuit females in the community of Igloolik, Nunavut. Using a community participatory research approach, various determinants of food security were identified, and the role of current and future climate change was assessed. Over 30 Inuit women from the community of Igloolik, Nunavut, were interviewed. Health professionals, Hamlet representatives, store managers and local organization members were also interviewed to get different perspectives on this complex and multi-disciplinary problematic. Preliminary results highlight multi-level interactions between biophysical and human determinants of food security, with multiple stresses interacting to create acute food insecurity among certain community members. The identification of pathways through which climate affects female food insecurity in the context of other stresses is particularly important for policy responses to strengthen Inuit food security. Contact: James D. Ford ([email protected])

INUIT WOMEN AND CLIMATE CHANGE

Pauktuutit Inuit Women of Canada

Pauktuutit Inuit Women of Canada facilitated a dialogue with Inuit women from across Inuit Nunaat about how climate change is affecting their lives. This gathering, held in Iqaluit, Nunavut, in March 2009, created an opportunity for Inuit women from all regions to share their insights and stories about how their lives have been impacted. The discussions were also intended to develop research questions on gender and climate change in the Canadian Arctic for further in-depth examination. This presentation will include major issues and research questions that were identified by the participants such as the impacts of climate change on food security, gender roles, traditional knowledge and activities such as harvesting and clothing production, as well as recommendations for future actions. Contact: Pauktuutit Inuit Women of Canada ([email protected])

PREVALENCE AND DETERMINANTS OF FOOD SECURITY AMONG INUIT HOUSEHOLDS WITH PRESCHOOL AGED CHILDREN

G. Egeland1, A. Pacey1, C. Huet1, C. Zhirong1, Qanuippitali Steering Committee (Nunavut)2 1Centre for Indigenous Peoples’ Nutrition and Environment (CINE) & School of Dietetics and Human Nutrition, McGill University, 2DHSS, Gov. Nunavut, Nunavut Tunngavik Inc, Nunavut Association of Municipalities, Iqaluit, NT

A high prevalence of food insecurity has been noted in the few Arctic communities which have participated in a food security assessment raising concerns regarding the prevalence of food security throughout the Arctic where unemployment rates and market food costs are extremely high. Therefore, the prevalence and determinants of food security was assessed using the child component of the IPY Inuit Health Survey.

The child survey was a cross-sectional survey of preschool children, aged 3-5 years, recruited through local health centre vaccination lists. A total of 383 Inuit children and their parents/guardians from 16 Nunavut communities participated in the survey between August 2007 and September 2008. Bilingual and trained interviewers conducted interviews with the child’s caregiver and completed questionnaires about the child’s diet, health history, household conditions and food security. Food security was assessed using a USDA questionnaire that had been slightly modified by Indian and Northern Affairs Canada through consultation with Inuit community members. Correlates of food insecurity evaluated included household crowding, age and gender distribution of household members, social assistance and other socioeconomic indicators, access to and consumption of traditional food, region, and measures of child growth.

Results are embargoed until presentation to communities is completed in May of 2009. Full details of results will be provided at the ICCH. The data highlight the prevalence of food insecurity for Artic households

with young children and provide meaningful information on the risk factors for food insecurity in Arctic communities. Contact: Grace Egeland ([email protected])

HEALTH BELIEFS AND DIETARY COMPOSITION AMONG INUIT LIVING IN NUNAVUT, CANADA

S.G. Donaldson, N.C. Doubleday, A. Kushwaha, M. Ip, T. Vlasova, R. Pearce, A. Manning, B. Adlard, D.P. Charette, B. Grimwood, J. Van Oostdam


Health professionals are challenged to provide culturally appropriate and relevant dietary advice in response to a number of environmental changes from climate change to environmental contaminants in traditional foods. In order to provide culturally relevant and effective dietary advice, health professionals must have the best available data. The objective of this paper is to examine the relationship between health beliefs and diet selection. In-depth semi-structured interviews (n=101) were conducted with residents of Nunavut. The results of this study show that the consumption of a traditional diet as well as the process associated with harvesting traditional food are integral to the Inuit concept of health and well-being. Access was identified as the major barrier to traditional food consumption. The results of this research complement existing studies and could be integrated to develop more effective dietary advice and health promotion activities for people living in Arctic Canada. Contact: Shawn Donaldson ([email protected])

THE IMPACT OF HELIOPHYSICAL FACTORS ON MAN LIFESPAN IN THE CIRCUMPOLAR REGIONS. PERSPECTIVES OF USAGE OF THE HELIO-GEROPROTECTORS

A. Trofimov

International Scientific Research Institute of Cosmic Anthropoecology

There investigated the author’s hypothesis for amount of the solar activity during man organism prenatal development, detecting gene expression responsible for the level of metabolism and age processes can restrict man lifespan in the circumpolar regions. The 1st stage comprised examination of the persons of different age (n= 200) using the unique computer program “Helios” in the middle latitudes. The significant age differences in the mean levels of the solar activity (according to the Wolf’s numbers) during prenatal development were shown. At the age of 51-70 years W=88,4±8,4, at the age of over 70 years W=36,7±4,5 (p<0,05). It seemed man lifespan in the Far North is associated with state of the heliophysical medium in the prenatal period. At the 2nd stage there have been examined 280 persons, residing in the high latitude settlement Dixon (in latitude 730 30’North). It was shown that maximum polar length of service and possible man health reserves are detected at minimum solar activity in the 1st (r= - 0,170), 7th (r= - 0,160) months of the intrauterine development and during the 1st year after birth (r= -0,140) (p<0,05). Some water helio-geroprotectors, patented in Russia, have been developed and tested for inhabitants of the circumpolar regions with high prenatal heliophysical activity. There observed the anti-aging trends in animals (rats) (n=30) intrauterinely developed at the high solar activity and after using the water protectors for drinking within a month. They are an increased content of stable isotope of carbon 13C in tissues (wool) (p<0,05), usually, decreased at aging, increased level of blood testosterone as well as decreased organism functional dependence on intensity of the heliophysical factors (protons, electrons) during the period of examination. Thus, helio-geroprotective effect, being important for health preservation and enhancing of man lifespan in the northern regions of the planet is possible. Contact: Alexander Trofimov ([email protected])


VENUE 6 Chronic Diseases #1

INFLAMMATORY MARKERS FOR PATIENTS ISCHEMIC HEART DISEASE (IHD) IN THE CONDITIONS OF YAKUTIA

A.S. Golderova, C.D. Efremova, E.A. Lexeeva, A.N. Romanova

Establishment of RAMS, Yakutsk Research Center of complex medical problems SB RAMS

Research of some authors are established that for Yakuts smaller frequency and the area of atherosclerotic defeats, and also “the slowed down” rate of development of an atherosclerosis in comparison with unradical inhabitants. In our day, we’d received some facts about a considerable role of an inflammation in mechanisms of development of an atherosclerosis. It is known that citokins regulate intercellular interactions, support a system and local inflammation in an atherosclerotic plaque. A research objective - the comparative characteristic of the maintenance of inflammatory markers at patients IHDin dependence about a national identity. 72 men (Yakutsk - 35, Russian - 37) with verified diagnosis IHD at the age from 45 till 67 years which were in cardiological branch of Clinical centre RB - 1 - NCM have been surveyed. In whey of blood sick by a method immunofermated analysis have been defined level of C-reactive protein (CRP), proinflammatory cytokines - TNFα, IL-6, IL-1b, γ-IFN, antibodies A, M and G (sets of firm of Joint-Stock Company “the Vector-Best” (Novosibirsk, Russia). Statistical processing has been spent with the using of package SPSS-11.5. At patients IHD depending on a nationality authentic distinctions are revealed under maintenance CRP. At 78,8 % of Yakutsk of patients IHD level CRP exceeding “base” value of 5 mg ml whereas at Russian such values meet in 91,2 % is marked. At comparison of both groups concentration CRP authentically above at Russian, than in Yakutsk (9,7 ± 0,61 and 7,76 ± 0,56, expediently, p <0,035). Level proinflammatory citokin IL-6 at Russian tends to increase in comparison with Yakutsk (8,6 ± 1,7 and 5,3 ± 0,74 pg ml). Yakutsk habitants have a high value of an antibody of M in comparison with Russian (1,94 ± 0,17 and 1, 44 ± 0,13 is revealed, expediently, at p <0,035). The obtained data of the preliminary analysis of inflammatory markers at patients IHD testifies to distinction depending on an ethnic accessory which demand the further studying. Contact: Aitalina Golderova ([email protected])

ASSOCIATION OF THE CONTENTS OF BASAL INSULIN WITH LIPIDE METABOLISM AND PREVALENCE OF CHOLELITHIASIS AND ISCHEMIC HEART DISEASE IN POPULATION OF EASTERN SIBERIA

E.V. Lukicheva, V.V. Tsukanov, K.G. Nozdrachev, Y.L. Tonkikh, E.Y. Kupershtein, E.P. Bronnikova, S.A. Dogadin

State Medical Research Institute for Northern Problems, Siberian Division of Russia Academy of Medical Sciences, Krasnoyarsk, Russia

Aim: To study the metabolic factors, protecting native inhabitants of northern regions of Siberia from cholelithiasis and ischemic heart disease (IHD).

Methods: The epidemiological research of cholelithiasis and IHD in eight settlements of Evenkia and Yakutia was done, during which was studied health status of 1154 Evens and Evenks and 1591 Europoids. The definition of insulin contents by radioimmunne method in blood serum, lipid contents of bile and spectrum of cholic acids of bile, contents of lipids, spectrum of lipoproteins, neutral lipids and phospholipids in blood serum and plasma by biochemical and chromatographic methods.

Results: The prevalence of cholelithiasis in Europoids was 8,8%, IHD - 18,8%, among Mongoloids these parameters were 1,5% (p<0,001) and 10,2% (p<0,001). The contents of basal insulin in Europoids was 64,31+3,29 pmol/l, in Mongoloids 40,61+1,24 pmol/l (p<0,001). The content of total cholesterol in blood serum in Europoids was much

higher in comparison with Evens and Evenks. In all populations hyperinsulinemia was correlated with risk factors of cholelithiasis and IHD and contents of lipids in blood and bile.

Conclusion: The lipid-hormonal interconnections play basic role in pathogenesis of cholelithiasis and IHD, substantially determining prevalence of this pathology in Eastern Siberia. Contact: Ellina Lukicheva ([email protected])

VITAL EXHAUSTION AND MYOCARDION INFARCTION (EPIDEMIOLOGICAL RESEARCH ON BASIS OF PROGRAM WHO MONICA-PSYCHOLOGICAL)

V. Gafarov, E. Gromova, I. Gagulin, Y. Kabanov, A. Gafarova

Collaborative laboratory epidemiology cardiovascular diseases SB RAMS

Purpose: We sought to examine the relationship between vital exhaustions symptoms and the risk of development myocardial infarction in 10 years among men ages 25 to 64 years old.

Methods: Within the framework of program WHO MONICA-psychosocial was examined representative sample of men 25-64 years old (1994 year). Total sample was 657 persons. Response 82.5%. Vital exhaustions symptoms were measured at baseline with the use of the MONICA - psychosocial Interview Vital Exhaustion scale. The incidence new myocardial infarction was ascertained under systematic surveillance the 10-year follow-up. Cox - proportional regression model was used for an estimation of relative risk (RR).

Results: Prevalence of vital exhaustion in cohort of men with myocardial infarction was 65.8% (21.1% men with developed myocardion infarction had high level of vital exhaustion and 44.7% - an average level of vital exhaustion). 64% men with developed myocardial infarction had high level of vital exhaustion amongmen ages 55 to 64 years; on 16 % to groups 35-44 and 45-54 years and 4 % - 25-34 years. The relative risk of development of myocardial infarction within 10 years in group of men with high level of vital exhaustion, in comparison with group of men with low level of vital exhaustion was 2 times higher. At research of a social gradient of men with MI, appeared, that men with a vital exhaustion have only initial educational level, the majority of them - pensioners. Most the high level of a vital exhaustion was found in groups dissolved, widows, and concerning a category “was never married”.

Conclusions: The received data allow to draw a conclusion, that the risk of occurrence of myocardial infarction of a myocardium is connected to presence of a vital exhaustion which directly is connected to the social and economic status. Contact: Valery Gafarov ([email protected])

DO THE OBESE GREENLANDERS CONSIDER THEMSELVES OBESE? BODY SIZE PERCEPTION AND OBESITY IN RELATION TO DEMOGRAPHIC FACTORS

A.B.S. Nielson, N.K. Larsen, P. Bjerregaard

Centre for Health Research in Greenland, National Institute of Public Health, University of Southern Denmark, Denmark

Background: A recent survey revealed 53.6% Greenlanders to be overweight. As opposed to the Westernised world overweight is well-established among well-educated Greenlanders. The ideal body image in affluent populations is generally slim (especially among women), while it is more voluptuous in populations, where periodical food scarcity has been, or is common. Obesity problems among Greenlanders should therefore also been addressed in a cultural context. This paper examines body-size perception among Greenlanders and its relation to socio-demographic factors.

Methods: Analyses included 2,247 West Greenlanders, age >18 years, from a cross-sectional study comprising para-clinical examination, an interview including socio-demographic conditions, and a question-naire including 9 silhouette drawings ranging from very thin to very obese (0-10). The participants were asked to identify their body figure,


ideal body figure, and subjective perception of own body size. We examined, split by sex, the bivariate effects of BMI on body-size perception, and analysed whether the relation depended on age, education and residence.

Results: The bivariate analyses showed that the identified body figure rose by increasing BMI levels: men classified as normal-weight, pre-obese (25<BMI<30) and obese (BMI>30) chose figures 3.4, 4.9 and 6.0 (mean), whereas women chose figures 3.5, 4.9 and 5.9. A similar association was found for ideal body figure and BMI among women: 3.6, 3.9 and 4.5. The figure best depicting the ideal body was similar for pre-obese and obese men (mean 4.3 vs. 4.5, p=0.11), whereas ideal body differed among normal-weight and obese men (mean 4.0 vs. 4.5, p<0.0001).

The multivariate analyses revealed only age to be associated with ideal body figure among men: ideal body image was larger among younger age-groups as opposed to 60+ years. No socio-demographic factors were associated with the ideal body image among women: only BMI was in-fluential.

Conclusion: A larger ideal body figure chosen by younger men was unexpected, but may reflect being over-weight is more common in Greenland than decades ago. Women’s preference of an ideal body figure reflecting their BMI may indicate that obesity is not seen as unattractive. Contact: Anni B.S. Nielsen ([email protected])

STUDY OF LEFT VENTRICULAR STRUCTURALLY-FUNCTIONAL CONDITION IN PATIENTS WITH CORONARY ARTERY DISEASE AND ACCOMPANYING ARTERIAL HYPERTENSION

T.A. Romanova, I.R. Petrova, V.V. Antipina, L.V. Tarabukina

National centre of medicine

The purpose of research was studying interrelation of structurally geometrical and functional parameters of left ventricular with a degree of atherosclerotic leisure of coronary arteries in patients with coronary artery disease (CAD) and accompanied arterial hypertension of indigenous and non-indigenous nationality of Yakutia.

Methods: 135 patients with CAD, stenocardia (from 1 to IV FC on the Canadian classification, 1972), small-locused and large-locused myocardial infarction and an arterial hypertension have been taken into research. All patients have been distributed into 2 groups. The first group included patients of a native nationality of Yakutia - Yakuts (n=55), 2 group included patients of non-indigenous nationality of Yakutia - Russia (n=80). ECHOCG was executed to all the patients by a standard technique on Acuson-128/XP-10, HDI-3000 (USA). LV hypertrophy was diagnosed at increase of IVS - thickness and LVBW - thickness in the end of diastole more than 1,1 sm. For an estimation of expressiveness of a myocardial hypertrophy, LV mass was counted under R.B. Deveroux formula. LV myocardium mass index (LVMMI) was counted on Fremingem criterion. The top border of LVMMI norm for men - 143 g/m, for women - 102 g/m. 4 LV geometrical types were allocated: I type- normal geometry of LV, II type - concentric remodelling of LV, III type-concentric LV hypertrophy, IV type - eccentric LV hypertrophy. Coronary angiography and left-ventriculography on 2 - projective angiographic system “Axiom Artis BA” Siemens (Germany) was executed to all patients. Patients of I and II groups were comparable on age, gender, CAD and AH duration, maximal systolic and diastolic AP, CAD risk factors. However, acute failure of cerebral blood circulation and burdened heredity in patients of II group (Russia) was met authentically more often, than in patients of II group (Yakuts).

Results of research: research has shown, that the greatest number of patients with CAD in combination with AH of both indigenous, and non- indigenous nationality had the IVth geometrical type of LV, i.e. eccentric LV hypertrophy, as adverse disadaptive variant of LV remodelling. In patients with CAD and accompanying AH of non-indigenous nationality, the II and III geometrical types of LV were

tapped authentically more often (p=0,004; r=0,05). During studying interrelation of LV geometrical types with a degree of CA atherosclerotic leisure heaviness authentic distinctions are revealed. So, in the patients not having critical CA stenoses or having 1-vascular CA leisure, II geometrical type of LV is tapped authentically less often, than I type (LV normal geometry). The interrelation of LV IV geometrical type with multivascular CA leisure is revealed. Therefore, in patients with CAD in a combination with AH, having two-vascular and three-vascular CA leisure, authentically less often I geometrical type of LV in comparison with IV type is determined (p=0,02; r=0,05). The comparative analysis of structurally geometrical and functional parameters of LV in patients with 2-vascular and 3 vascular CA leisure has not revealed authentic distinctions between patients of indigenous, and non- indigenous nationality of Yakutia.

Conclusions: In patients with CAD in combination with AH of both indigenous and non- indigenous nationality IV geometrical type of LV, being an adverse disadaptive remodelling variant of LV, prevails. At 2-vascular and 3 vascular CA leisure, LV IV type is tapped authentically more often, than I type (p=0,02; r=0,05). Contact: Tatiana Romanova ([email protected])

SPECTRUM OF FATTY ACIDS IN BLOOD SERUM AND PREVALENCE OF CHOLELITHIASIS IN MONGOLOIDS AND EUROPOIDS OF SIBERIA

V.V. Tsukanov, E.Y. Kupershtein, Y.L. Tonkikh, E.V. Lukicheva, E.P. Bronnikova


Aim: To analyze spectrum of fatty acids in blood serum and prevalence of chole-lithiasis in native and alien inhabitants of Eastern Siberia.

Methods: The epidemiological research was performed by ultrasonic scanning in 3648 patients (1652 Evenks and 1996 Europoids) in Evenkia and for 2191 patient (1179 Khakases and 1012 Europoids) in Khakasia. In 220 patients (124 natives, 96 aliens) in Khakasia and 184 patients in Evenkia (88 natives, 96 aliens) spectrum and contents of fatty acids in blood serum was determined by gas-liquid chromatography.

Results: The prevalence of cholelithiasis was 3,4% in Mongoloids and 7,3% in Europoids in Khakasia (p<0,001); in Evenkia these parameters were 1,5% and 8,8% accordingly (p<0,001). The ratio of saturated and non-saturated fatty acids in Euro-poids with cholelithiasis in Khakasia was 1,16; in healthy persons – 0,8 (p<0,001), in Khakases with cholelithiasis – 0,85 and in healthy Khakases – 0,56 (p=0,005). The ratio of saturated and non-saturated fatty acids in Europoids with cholelithiasis in Evenkia was 1,13; in healthy persons – 0,94 (p=0,003), in Evenks with cholelithiasis – 1,01, in healthy Evenks – 0,85 (p=0,001).

Conclusion: Despite of significant differences in prevalence of cholelithiasis in populations of Mongoloids and Europoids, among patients with cholelithiasis the ratio of saturated and non-saturated fatty acids in blood serum was increased in all popula-tions, that allows to consider this parameter as universal marker of lipid metabolism disturbance in biliary pathology. Contact: Vladislav Tsukanov ([email protected])

ADAPTATION OF CARDIOVASCULAR SYSTEM AT HIGH PHYSICAL ACTIVITY IN THE NORTH

S.G. Kriroschekov1, I.A. Pinigina2 1Institute of Physiology SB RAMS, Siberia, 2Yakuts Centre of Science, Yakutsk (SB RAMS)

In order to study structurally functional changes of cardiovascular system and metabolic indicators at going in for sports in the North, 146 men of the Yakut nationality (18-29 years) living in Yakutsk city have been surveyed. The basic group - sportsmen of high level of skill: free-style wrestling & boxing (n=108), control - not sportsmen (n=38).


Methods: Anthropometry, arterial pressure (AP), echocardiography, rheography, biochemical analysis of blood serum. The basic group has been divided into 2 subgroups depending on level of AP (group A, APsys from 110 to 130, group B, APsys more than 130 mmHg).

Results: The total cholesterol and low density lipoprotein (LDL) levels were low in the basic group (p=0,001), the index atherogeneity was above in control group (p=0,04). It is revealed the big average indexes of a thickness of heart interventricular septum, left ventricular end (LVE) systolic volume and diameter, LVE diastolic volume and diameter, mass of myocardium in the basic group vs. control. While indexing to surface of a body, all structural indicators were authentically more in the basic group. Sportsmen had lower HR, systolic, diastolic and an average AP. The shock volume of LV was more in control group (p=0,01) but after indexation to the surface of a body it was disappeared. The minute blood volume and the heart index were the greatest in control group, coinciding with the raised body weight (p=0,001). The regional vessels resistance (RVR) did not differ between investigated groups, but RVR index was bigger in the basic group (p=0,001). The comparison of structural indicators between A and B subgroups revealed increased index of LV mass (p=0,01) and RVR (p=0,05) in group B.

Conclusion: Playing sports in the North leads to specialized changes of functioning of cardiovascular system, concerned with point of view on “adaptation of function” and “sports heart”. Conditions of the North can promote occurrence of changes at separate sportsmen (risk group) who are shown by disorder of hemodynamic parameters at preservation of normal values of indicators of blood lipid profile. Contact: Sergey Krivoschekov ([email protected])

COMMUNITY DIABETES WORKERS COME TO LIFE

B. Roos

Health Canada, First Nations & Inuit Health, Atlantic Region

In September, 2006, 10 First Nations community health workers from Nova Scotia (NS) and New Brunswick (NB) gathered at Metepenagiag Lodge to start Yellowquill College’s Community Diabetes Prevention Worker (CDPW) Training. The group had four one week in class sessions between September and June. Assignments and presentations were completed within their community throughout the program. The Elder ensured a cultural focus was weaved through the training. Tests and assignments evaluated the students to confirm they met the required CDPW Core Competencies and Yellowquill College program requirements. Pre-Test/Post-Test scores showed a knowledge growth between 8% – 50% with an average of 24%. Only one student did not complete due to family commitments. Based on recommendations, the course is now completed in a six modular training program. Eight First Nations workers from NS, NB, and Prince Edward Island (PEI) graduated in June 2008. Pre-Test/Post-Test scores showed a knowledge growth between 4% - 40% with an average growth of 23%. Two students did not complete, one due to community staffing shortage, the other due to personal illness. Nine First Nations & Inuit students from NS, NB, and Nunavik are scheduled to graduate in June 2009.

Working collaboratively with the Inuit Diabetes Network and the Nunatsiavut Government, an Inuit specific CDPW training was initiated in Nunatsiavut. The Inuit community workers completed the six week modular program through Yellowquill College. Eight graduates (one from each of the Nunatsiavut Inuit communities along with the Regional Health Educator) celebrated their success in July 2008. The knowledge growth among this group ranged between 10% - 48%, with an average growth of 29%.

The presentation will provide an overview of the planning process used and course overview. The focus of the presentation will come from a student from each of the graduating classes highlighting some of their learnings, successes, and challenges throughout the training. They will describe their community diabetes work since graduation. Elder Josie Augustine will also share cultural teachings related to diabetes.

Learning curves and evaluations related to the training will be presented. Contact: Brenda Roos ([email protected])

TRADITIONAL DIET FOR OBESITY AND DIABETES IN A FIRST NATIONS COMMUNITY

J. Wortman

First Nations and Inuit Health Branch, Health Canada

Canadian Aboriginal populations have high rates of obesity and type 2 diabetes. Prior to European contact, West Coast First Nations ate a diet of game, seafood and edible wild plants. Most of their calories came from fats including a unique marine oil derived from Oolichan fish. The modern diet consists of traditional foods plus market foods of poor nutritional quality. Most calories in the modern diet are derived from refined carbohydrates in contrast to the low carbohydrate content of the traditional diet. Recent studies in generalized populations have demonstrated that low-carbohydrate diets reverse the signs and symptoms of obesity, metabolic syndrome and type 2 diabetes. A trial of a modern diet based on the traditional diet of the Namgis First Nation was done to determine if it would benefit people with obesity and type 2 diabetes.

Methods: The study diet consisted of traditional foods plus market foods of similar macronutrient value. Subjects were recruited from the Alert Bay, Canada. After providing informed consent, subjects had baseline measurements for WBC, HgA1c and lipid profile. Blood pressure, height, weight, waist and hip measurements were done at baseline and repeated over a 12-month period. Bloods tests were repeated at 3, 6 and 12 months. Subjects were instructed in the diet and compliance was encouraged through follow-up visits, support groups, community dinners and instruction sessions by the lead investigator.

Results: Analysis of 40 subjects who had followed the diet for an average of 7.6 months demonstrated mean weight loss of 10.1% of body weight. Significant improvements were achieved in waist hip ratio, HDL, triglycerides, triglyceride HDL ratio and cholesterol HDL ratio. Among diabetics, HgA1c dropped a percentage point (p < 0.047) while medications were reduced or discontinued.

Conclusion: A dietary intervention based on a traditional dietary pattern can deliver a significant improvement in weight, type 2 diabetes and metabolic syndrome over a 7.6-month period. This type of approach, which correlates a lifestyle change to the local heritage, may be useful in reducing obesity, metabolic syndrome and type 2 diabetes in affected populations. Contact: Jay Wortman ([email protected])

VENUE 7 Injury Prevention

DROWNING PREVENTION IN THE NWT & NUNAVUT: RESULTS FROM A THREE YEAR STUDY

A. Giles1, A. Baker2, D. Rousell1, G. Stadig1, M. Matt-Stotyn1 1University of Ottawa, 2University of Calgary

The Government of the Northwest Territories’ (NWT) Department of Health and Social Services has found that despite efforts at various forms of safety education, “the NWT is a risky place to maintain an active lifestyle” (Helwig, 2000, p. 5); certainly, this statement is especially true when it comes to aquatic settings. The drowning rate in the NWT and Nunavut is up to ten times the national average, with Aboriginal peoples drowning more often than non-Aboriginal peoples (NWT Health and Social Services, 2004; Waldram et al., 2006). According to the 2004 Injury Report in the NWT, drowning is the second leading cause of accidental death in the NWT and is one of the top four leading causes of death by unintentional injury in every age group from 0 to over 65 years of age. Drowning statistics are less


readily available for Nunavut after 1999; however, research in the Kivalliq region from 1987-1999 corroborates trends found in the Injury Report in the NWT, specifically that drowning was the second leading cause of accidental death during that time period (Macaulay et al., 2003). Over the past three years, our team has conducted a qualitative research study in an attempt to understand why drowning rates remain so high in the NWT and Nunavut, especially in light of the 41 year history of the NWT Above Ground Pool Program. Participant observation, archival research, semi-structured interviews, focus groups, and oral histories were all used to gather data with residents of five NWT and two Nunavut communities. Our findings suggest that in order to facilitate stronger uptake of aquatics safety, programs need to engage with a postcolonial framework. Our presentation will outline what such an approach would look like in a Northern aquatics setting, and will offer concrete, practical suggestions for both policymakers and practitioners alike. Contact: Audrey Giles ([email protected])

FIRST NATIONS AND INUIT CHILDREN AND YOUTH INJURY INDICATORS PROJECT

I. Pike

Department of Pediatrics, University of British Columbia

Introduction: First Nations and Inuit children and youth experience a significantly higher rate of injury related death and disability than other young people in Canada. An accurate determination of the factors related to injury, and the ability to monitor trends and patterns among First nations children and youth, will assist in prevention. The goal of this project is to support the development of a team that will identify and develop national injury indicators specific to children and youth in First Nations and Inuit populations.

Methods: In a previous project, 34 indicators were developed for children and youth in Canada through the use of a modified Delphi process involving Canadian and International experts in injury prevention research, policy and practice. A similar broad-based modified Delphi process was used in a parallel project to develop indicators specific to First Nations and Inuit children and youth.

Results: Representatives from the Assembly of First Nations, Inuit Tapiriit Kanatami, First Nations and Inuit Health Branch and others gathered in the spring of 2007 to identify key injury issues and key indicators for First Nations and Inuit children and youth. At that meeting, 62 indicators were suggested. Feedback was obtained by meeting with the Manitoba Community Wellness Working Group, AFN’s First Nations Regional Injury Prevention Working Group, First Nations Early Childhood Circle, Chiefs of Ontario, and National Inuit Committee on Health. Currently, 27 indicators for First Nations and Inuit children and youth have been defined and specified.

Discussion and Conclusions: Wider representation is being sought from the First Nations and Inuit communities to participate in a modified-Delphi process to ensure that the indicators that have been chosen are useful, and will prompt action to prevent injuries in First Nations and Inuit children and youth. Availability of Inuit data continues to be a challenge. Contact: Ian Pike ([email protected])

A SURVEY OF INJURIES PRESENTING TO HOSPITAL AND A COMMUNITY HEALTH CENTRE IN NUNAVUT, CANADA

C. Sikora1, C. Gregson1, T. Neily1, P. Tchouaffi1, G. Osborne2

University of Alberta, Edmonton Alberta, Canada 1Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, 2Department of Health & Social Services, Government of Nunavut, Iqaluit Nunavut, Canada

Introduction: National data has suggested that injury, both intentional and non-intentional , in the Arctic is more prevalent than elsewhere in Canada. Both suicide and non-suicide-related injury can be prevented. In order to develop effective injury prevention strategies, it is

important to have an understanding of the demographic factors, mechanism, type and body system involved with injuries presenting to hospital and community health centre in Nunavut.

Methods: Data was obtained from three sources: the discharge abstract database comprising inpatient and surgery separations from the Qikiqtani General Hospital (2000-2006), reports of death from the Chief Coroner, Nunavut (1999-2007) and injury presentations to a community health centre in Nunavut (Canadian Hospital Injury Reporting and Prevention Program, Public Health Agency of Canada).

Results: Data from Qikiqtani General Hospital revealed that approximately 68% of all injuries presenting to hospital occur in the 13-45 age group. The highest rate of injury is in the 20-29 age group with 74 and 67 injuries/1000 population for non-suicide and suicide related injuries, respectively. The type of injury was stratified by mechanism (eg. assault, use of a powered vehicle, etc…) and age. Approximately 81% of individuals who died from injury were male with 37% of all deaths due to injury being accidental. Deaths were stratified by mechanism and age. The community health centre data was analysed, with 25 injuries per 100 population presenting to the community health centre on a per year basis. Approximately 68% of all injuries in this setting occurred in males. Almost all of these injuries (97%) were treated without transfer to a hospital and most (85%) were unintentional. The nature of the injury, body system and mechanism are described.

Conclusion: There is a high rate of intentional and non-intentional injury occurring in Nunavut. Information from this report will be used to develop relevant community-oriented injury prevention strategies in Nunavut. Contact: Christopher Sikora ([email protected])

WORKER FATALITIES IN THE ALASKA TOURISM INDUSTRY: 1990-2008

P. Anderson

Centers for Disease Control/National Institute for Occupational Safety and Health

Background: Tourism is the second leading economic driver of the Alaskan economy and Alaska’s fourth largest employer. Each year, the Alaskan tourism industry employs approximately 26,000 workers, services nearly 2 million visitors, and generates over 2 billion dollars in state revenue. Despite the socioeconomic importance of tourism, fatality trends among these workers remain uncharacterized. Understanding fatality trends is a critical first step towards protecting Alaska’s tourism workers and a vital state industry.

Methods: North American Industrial Classification System codes were used to query the Alaska Occupational Injury Surveillance System for fatal events between 1990 and 2008. A case definition was then used to further isolate tourism cases. Detailed record review was conducted to code specific injury mechanisms and risk factors in order to identify areas for prevention.

Results: From 1990-2008, 124 work-related deaths occurred in Alaska’s tourism industry a fatality rate of 17/100,000 workers, just over 4 times the national average of 4.0/100,000 for all U.S. workers. The majority (78%) of deaths occurred during the high tourist season from May to September. In addition, 87 tourists were killed in these events. Most deaths occurred among Pilots (49%), Guides (27%), and Conservation and Enforcement workers (17%). The leading causes of death were aircraft crashes (54%), drowning (12%), and falls (8%). Those killed in aircraft crashes were being flown to sites in pursuit of hunting, fishing, and wilderness travel (67%), wildlife conservation and enforcement work (19%), or sightseeing (10%).

Conclusion: Recreational tourism workers in Alaska encounter a fatality rate 4 times the national average for all U.S. workers. As a result, Pilots, Guides, and Conservation workers represent high-risk occupational groups in the Alaska tourism industry. Flying for the purpose of hunting, fishing, and wilderness travel is a source of significant mortality in Alaskan tourism. Analysis of plane crashes


related to these activities is needed to identify practical strategies for prevention. Contact: Paul Anderson ([email protected])

HEALTH HAZARDS OF THE ARCTIC/SUBARCTIC MOOSE

R.A. Dieter, R. Dieter Jr., R. Dieter, D. Dieter

The Center for Surgery

Introduction: Large animals roam free over the North American countries including Canada and Northern United States. The moose is one of the largest wild animal groups seen and may pose a number of hazards to the human population.

Project: A 6 year review of the various Canadian and U.S. territories, provinces, and state populated by moose was conducted. The various health hazards to the human were studied including the highway incidents, direct charging and consumption concerns. Motor vehicle-moose accidents occur daily and thus create a significant risk to the motorist. Surveys were conducted of the regional highway, safety, and environmental departments for data in Canada and the USA.

Results: Across northern North America, in Canada, Alaska and Maine a large number of moose-vehicle accidents occur each year. The death toll, injury, and property damage as a result of this long legged animal crossing the highways is immense. For example, 600 or more such accidents occur each year in Alaska with the possibility of injury or death to the human. Automobile damage may run into the billions. The results for each province or state were tabulated to demonstrate the significant risk.

Conclusion: Health hazards of the Canadian and U.S. arctic and subarctic motor-vehicle moose accidents persist. Better monitoring and reporting systems are necessary to properly quantify this huge risk. In addition, new and improved techniques to avoid the moose-motor vehicle collisions are a requirement for the safety of the northern inhabitants. Contact: Raymond Dieter ([email protected])

HEALTH HAZARDS OF NORTH AMERICAN ANIMAL VEHICLE ACCIDENTS

R. Dieter, R.A. Dieter Jr., L. Gulliver, L. Murawski, D. Carlino, B. Dieter

The Center for Surgery

Introduction: Human transportation more and more depends on motorized vehicles traveling at high speeds with little maneuverability in short time and space periods. Thus highway and air collisions continue to escalate in number and human risk.

Study: Extensive highway records were developed to show the number of miles traveled, animal collisions and relation to time of day. Further, air incidents were monitored as to the cause and result.

Results: Each day throughout Canada and northern USA, a large number of accidents occur whether on land or in the air. Most such accidents lead to no health nor serious physical damage. However, these incidents may lead to serious health or death consequent to the trauma. Completion of these results and the billions of dollars involved show the continued high risk of large birds to airlines or animals on the highway. Data demonstrates the health concerns.

Summary: Daily human heath risks develop suddenly and unrepentantly on the road or in the air as a result of domestic wild animals and birds. New programs and techniques are necessary to reduce the incidence. Contact: Raymond Dieter ([email protected])

THE CANADIAN RED CROSS EXPERIENCE IN INJURY PREVENTION

Canadian Red Cross (Presenter TBA)

The Canadian Red Cross

Through the delivery of first aid training, water safety and drowning prevention initiatives , disaster preparedness and violence prevention education, the Canadian Red Cross has an extensive history working at a community level in injury prevention. During this session, representatives will outline the historical and current work of the Red Cross in the three Canadian Territories. Additionally, we will examine the movement forward, towards the development of sustainable, collaborative partnerships for the future enhanced capacity of communities’ injury prevention efforts. Contact: The Canadian Red Cross, Presenter TBA Western Zone ([email protected])

COMMUNITY-BASED PARTICIPATORY RESEARCH APPROACH TO UNINTENTIONAL INJURY PREVENTION IN THE YUKON

J. Butler Walker1, B. Hanley2 1Arctic Health Research Network – YU, 2Ministry of Health, Yukon

Injuries are the leading cause of death across the Canadian North, yet the populations at risk, as well as risk factors, including cross cultural influences, remain to be systematically investigated. This presentation will describe the community-based participatory research approach being implemented in the Yukon, with a focus on unintentional injuries. Contact: Jody Butler Walker ([email protected])

SESSION 5 Monday, July 13, 4:00-5:30 PM

VENUE 1 Mental Health & Wellness #3 – Trauma at the Front Line

MENTAL HEALTH AND ADDICTIONS IN THE NORTHWEST TERRITORIES: PERSPECTIVES FROM THE FRONTLINE SERVICE PROVIDERS

A. Kronstal

University of Victoria

Much attention has been paid in recent years to the impacts of rapid change in the Canadian North. Discussions on this topic often turn to how social and economic changes may be affecting the health and social wellness of communities, particularly in terms of community mental health and rates of alcohol and other drug use.

It is within this context that I have undertaken exploratory research to determine 1) the perspectives of community-based mental health and addiction professionals in the Northwest Territories (NWT),Canada on the state of mental health and wellness in communities; and, 2) how such professionals conceive of current change in the territory in relation to their professional practice.

In this presentation, I first provide an overview of the research questions and methodological approach for this research as well as an account of findings from in-depth qualitative interviews with 16 community mental health and addiction professionals from across the NWT conducted in the spring and summer of 2008. I also discuss key themes emerging from interviews in the context of current policy and health infrastructure in the Northwest Territories.

My inquiry is part of a multi-disciplinary research program for International Polar Year entitled “The impacts of oil and gas activity on peoples in the Arctic using a multiple securities perspective” (GAPS). Given that my research is undertaken as part of this larger initiative, I also discuss the collaborative measures I took to ensure local priorities are reflected in the wider multi-disciplinary, multi-country research project.


Contact: Alana Kronstal ([email protected])

BEYOND VICARIOUS TRAUMA - HELPING OURSELVES AS WE HELP OTHERS

J. De Luce

Private Practitioner

There exists unfixable suffering. Those of us who have trained and chosen the helping professions will see it. We will also at some point experience vicarious trauma as a result of exposure to unfixable suffering as a part of our chosen professional life. How can we provide care to those affected by these life tragedies and still maintain our ability to care, our zest for life and our desire to work creatively in highly challenging circumstances? How might one accomplish this? Is transcendence possible? What is transcendence when facing unfixable suffering? How do we work with those areas that are amenable to intervention knowing some may never be, without feeling demoralized or as though we have lost a part of our soul? The speaker will discuss what she has learned from her clinical practice, the research of others and her own research that helps us do more than survive in difficult times, it may be possible to thrive despite unfixable suffering. Contact: Jamie De Luce ([email protected])

SECONDARY TRAUMA AND NORTHERN HELPING PRACTITIONERS

L. O’ Neill


Secondary Trauma and Northern Helping Practitioners

This research study considered the experience of northern helping practitioners in providing trauma support in isolated communities in northern BC and Yukon. In these communities, access to specialists in the field of trauma counselling is severely restricted due to distance from main centres. Economic and cultural factors leave the support of survivors of trauma to helping practitioners in various fields with varying levels of training and supervision (Boone, Minore, Katt, & Kinch, 1997; Trippany, Kress, & Wilcoxon, 2004). Many northern communities have experienced historical trauma and continue to experience intergenerational trauma, contributed to by current psychosocial conditions linked to the legacy of colonization (Brave Heart, 2003; Duran, Duran, Brave Heart & Davis-Yellow Horse, 1998; Tafoya & Del Vecchio, 1996). In remote communities, helping practitioners may be working in their home communities, sometimes sharing similar trauma experiences to that of their clients (Morrissette & Naden, 1998). Helping practitioners in the North are also hired from “outside” to provide service to communities, arriving with limited knowledge of the specific context of the communities. These helping practitioners may be put at personal and professional risk of developing secondary traumatic symptoms from repeated exposure to clients’ trauma in the helping relationship (Baird & Jenkins, 2003).

Using a narrative inquiry process, the stories of eight helping practitioners were analyzed using a three phase analysis based developed by Lieblich, Tuval-Mashiach, and Zilber (1998). The narratives were summarized into experience portraits that were then analyzed for content and change processes. The themes that emerged from the data indicated the effects on practitioners and the strategies used by practitioners in maintaining their ability to practice under challenging conditions. Ten categories provided a structure for arranging the data. Five metathemes were interpreted from the narratives: helping takes over life, humanity, respectful engagement, invested and embedded, profoundly affected, and belief. Contact: Linda O’Neill ([email protected])

ETHNIC DISCRIMINATION AND BULLYING IN THE SÁMI AND NON-SÁMI POPULATIONS IN NORWAY: THE SAMINOR STUDY

K.L. Hansen, M. Melhus, A. Høgmo, E. Lund

Centre of Sámi Health Reserach, University of Tromseo

Objectives: To investigate the prevalence of self-reported experiences of ethnic discrimination and bullying among Sámi and non-Sámi adults.

Methods: SAMINOR is a population-based study of health and living conditions that was administered in 2003(4) in 24 different Norwegian and Sámi populated municipalities within central and northern Norway. This analysis was based on 12265 men and women aged 36-79 years. Ethnic distribution was Sámi (33 .1%), Kvens (7.8%) and the ethnic Norwegian majority (59.1%).

Results: Overall, Sámi and Kven respondents reported more ethnic discrimination and bullying in general than ethnic Norwegians (p<0.001). The reporting was highest among the younger participants (p<0.001). Men reported more ethnic discrimination than women, while women reported more bullying. Respondents with the strongest Sámi affiliation reported higher levels of ethnic discrimination outside the Administrative Area, while respondents with weak Sámi affiliation, Kvens and ethnic Norwegians, reported higher levels inside this district. Among the respondents that reported bullying previously, the most common type was discriminating remarks and the most common location was public schools. For those who reported bullying in the past year, the most common types were gossiping and discriminating remarks, and the most common locations were at work and in the local community. Two out of three of those reporting ethnic discrimination, independent of ethnicity, also reported bullying.

Conclusions: The findings from this study show that the Sámi and Kven population more often experience bullying and ethnic discrimination than ethnic Norwegians. These results are consistent with experiences from other minority and marginalized groups that experienced colonization. More research is needed to understand the role bullying and ethnic discrimination play in the wellbeing and health of the Sámi and Kven population. Contact: Ketil Lenert Hansen ([email protected])

MEASURING THE HEALTH EFFECTS OF HISTORICAL AND CONTEMPORARY CULTURAL LOSSES

L. Whitbeck

University of Nebraska-Lincoln

Measuring the Health Effects of Historical and Contemporary Cultural Losses Les B. Whitbeck University of Nebraska-Lincoln Rapid cultural changes induced by climate change and infringement on traditional circumpolar cultures by the outside are likely to have consequences on the well-being of Indigenous adults and adolescents. These consequences may include psychological and substance use problems, suicidal ideation and behaviors, and stress-related physical illnesses. Yet the measurement of cultural losses is still in its earliest stages. There is a need to develop and share measures of cultural loss across Indigenous cultures so that a cumulative body of research can be developed. Using measures we developed to assess the stress effects of historical losses among North American Indigenous people as a starting point, we propose the development of uniform measures of historical and contemporary cultural losses. This presentation will describe our measure of historical loss and provide an overview of its factor structure for adults and adolescents. Our approach has been to focus on recalled historical losses and the degree to which recurring or intrusive thoughts about these losses impinge on moods and behaviors (Whitbeck, Adams, Hoyt, & Chen, 2004). We dealt with the problem of history in terms of specific past losses identified in focus groups with Indigenous elders. Then, similar to measures of stress-related trauma, we asked how often the individual thinks about these losses: Never, yearly or only at special times, monthly, weekly, daily or several times a day. The underlying assumption is that thoughts pertaining to losses daily or several times a day may be intrusive and affect moods. The presentation will conclude with mental health, substance abuse, and health correlates of the measure among Indigenous people and the potential for use of similar methods for assessing the effects of progressive cultural losses among circumpolar Indigenous peoples.


Contact: Les Whitbeck ([email protected])

VENUE 2 Sexual Health #1

LIFE QUALITY IN HIV-INFECTED GREENLANDERS

M. Rydbacken, K. Ladefoged

Medical Department, Queen Ingrid’s Hospital, Nuuk, Greenland

Greenland is a huge country with approximately 56000 inhabitants living in small towns and settlements scattered along the coastline.

Since 1986 all HIV infected patients in Greenland have been anonymously registered in a central database at the Chief Medical Office in Nuuk. This cohort comprises 152 patients. Ninety-four % of the patients were Inuit, and 84% were infected in Greenland. Thirty-six % were women, 83% were heterosexually infected, 15% homosexually infected and 2% were infected by i.v. drug abuse. The median age at diagnosis was 52 years. Treatment with HAART was commenced in 1996 and treatment schedule follows international recommended guidelines. Compliance has been a great problem and, although improving, treatment results are still not quite as good as e.g. in Denmark. It has been an impression that the main part of HIV infected Greenlanders belongs to socially marginalized subpopulations burdened with poverty, unemployment and alcoholism, but a specific study of living conditions and life quality in these patients has never been performed. In 2008 there were 65 surviving HIV infected patients. Most patients were living in the two major cities Nuuk and Sisimiut. The survivors were included in a life quality survey. Based on interviews a questionnaire was fulfilled with registration of demographic data, housing conditions, educational background, employment status, financial situation, social life, impact of the HIV diagnosis on psychological well-being and on relation to friends and family, alcohol and tobacco consumption, sex life and sexual issues, health and treatment, contact with health services etc.

The study will be completed during the spring 2009. The result will be presented and discussed. Contact: Karin Ladefoged ([email protected])

AN ADOLESCENT FOCUS GROUP PROJECT ON SEXUALLY TRANSMITTED DISEASE, HIV/AIDS, AND UNPLANNED PREGNANCY

J. Leston


Background: The disparity in sexually transmitted disease (STD) rates between Alaska Native and non-Native populations, particularly among young adults and females, is significant and concerning. Many factors may contribute to high rates of STD, including social and cultural factors, geography, and access to care. However, there is limited published data on the contribution of these factors to sexual health and STD transmission in Alaska Native populations. To better understand the impact of different factors on sexual health and STD in this population, the Alaska Native Tribal Health Consortium (ANTHC) STD Program conducted a series of focus groups to guide the development of culturally appropriate, community driven sexual health interventions.

Methods: A convenience sample of Alaska Native adolescents (n=105) from five rural communities in Alaska, ages 15-24, participated in 21 focus groups. Focus group participants were divided by sex and age. We assessed themes related to knowledge and beliefs about STD, HIV/AIDS, and unplanned pregnancy, as well as perceptions of how adolescents prefer to learn about sexual health issues.

Results: The major themes identified were: STD/HIV and unplanned pregnancy messages are viewed within a framework of disease prevention and health protection activities; sexual health messages should be delivered via the internet and school; young adults want to

hear messages promoting STD/HIV testing and condom use; easier access to condoms is needed; there is a basic understanding of sexual health, but adolescents have a lot of unanswered questions pertaining to STD/HIV; alcohol and drug use affect sexual behavior and risk taking; and issues of confidentiality and embarrassment affect healthcare seeking behaviors for sexual health issues.

Conclusions: One of the fundamental principles of public health practice is community participation, which asserts that success in achieving change is enhanced by the active participation of the intended audience in defining their own high-priority solutions. Our findings—driven by the youth themselves—will be critical in designing and implementing future sexual health interventions and could promote greater community involvement and acceptance. Contact: Jessica Leston ([email protected])

COMING OF AGE: HOW YOUNG WOMEN IN THE NORTHWEST TERRITORIES UNDERSTAND BARRIERS AND FACILITATORS TO POSITIVE, EMPOWERED, AND SAFER SEXUAL HEALTH

C. Lys


Compared to other Canadian youth, young people in the Northwest Territories (NWT) suffer disproportionately from more negative sexual health outcomes, such as high rates of Sexually Transmitted Infections (STIs) and adolescent pregnancy. Although numerous quantitative studies measure indicators of sexual health amongst NWT youth, little qualitative research explores the barriers and facilitators that impede or support their ability to achieve positive, empowered, or safer sexual health outcomes. The purpose of this study was to explore the self-perceived barriers and facilitators that impact female youth in the NWT, as this demographic has one of the highest vulnerabilities for STIs and unintended pregnancies and represents the fastest growing population for HIV/AIDS transmission in Canada. Recruited through purposive sampling, 12 female participants aged 15-19 who live in the NWT and mostly or always have relationships with male partners participated in audio taped, semi-structured, face-to-face interviews that followed a constructivist framework. Using qualitative data analysis software, inductive coding and thematic analysis of transcribed data occurred. Results of this research increase understanding of the self-perceived barriers and facilitators to positive sexual health for young women in the NWT, thus potentially aiding in the development of appropriate and effective health promotion initiatives and programs for this population. Contact: Candice Lys ([email protected])

HIV/AIDS AND THE LIFESAVERS CAMPAIGN: PREVENTION AND EDUCATION ACROSS INUIT NUNAAT

Pauktuutit Inuit Women of Canada.

Pauktuutit has been a leader in innovative and creative approaches to raising awareness and addressing these issues in an Inuit-specific context, and has become a credible and valued partner to many Inuit communities, organizations and governments. One notable and very successful initiative is the multi-faceted ‘Livesavers” project, which continues to raise awareness about HIV and AIDS in Inuit communities. Products since the mid-1990s have included school-based HIV/AIDS Fairs, posters and ‘country food’ flavours of condom covers. Policy and substantive direction is provided by the Canadian Inuit HIV/AIDS Network (CIHAN), a nationally representative community and regionally-based advisory committee comprised of Inuit policy and program experts, community activists and Inuit living with HIV and AIDS. The focus to date has been on individuals and communities, front line workers and health service providers, as well as provincial, territorial and federal policy and decision makers. Emerging issues include sexual health in relation to resource extraction and economic development initiatives across the Arctic, and urban issues such as the need for interventions targeted to Inuit in the sex trade, and


intravenous drug use. Pauktuutit will provide an overview of more than a decade of advocacy and prevention and education strategies, as well as challenges and future opportunities to prevent the spread of HIV in Inuit communities, including urban communities, in Canada. Contact: Pauktuutit Inuit Women of Canada ([email protected])

SOCIAL AND CULTURAL FACTORS INFLUENCING SEXUAL HEALTH IN GREENLAND

D. Gesink-Law, E. Rink, R. Montgomery-Andersen, S. Montgomery-Andersen, U. Poppel, A. Binzer, A. Koch, S. Skov-Jensen, G. Mulvad


Background: Our objective was to identify the social, cultural, and behavioural factors influencing sexual health and sexually transmitted infections (STIs) in Greenland.

Methods: 149 Nuuk residents between 15 and 65 years of age were recruited to answer an interviewer-administered sexual health survey and be tested for chlamydial infection, gonorrhea, and mycoplasm genitalium. Descriptive statistics were used to summarize sexual health responses and STI Results: Regression modeling was used to determine which factors were associated with infection.

Results: 18% of participants tested positive for an STI at the time of interview (8% Chlamydia, 7% mycoplasm, 3% gonorrhea). 75% of the male cases were Greenlandic although only 45% of all male participants were Greenlandic. This imbalance did not exist for Greenlandic women. 70% of women and 58% of men had an STI previously. 60% of women and men totally trusted their partners and the primary reason why participants had not used a condom in the past was because they “felt connected to that partner and trusted partner was safe”. Men were more likely to drink and have sex than women. Men were also more likely to report that their decision to have sex was influenced by being drunk. Women more frequently reported that alcohol affected their ability to make good sexual decisions. The majority of both men and women were 15 to 16 years old when they first had sex. 30% of women and 17% of men had experienced forced sex in their lifetime. When Nuuk adolescents and adults were asked where they learned about contraception, HIV and other STIs, home ranked third, after school or work (1st) and out in the community (2nd).

Conclusions: Social and cultural norms around sexual health communication, trust, drinking and sex appear to influence individual sexual behaviours and risk for STIs. Contact: Dionne Gesink Law ([email protected])

THE IMPORTANCE OF COMMUNITY INVOLVEMENT IN IDENTIFYING BARRIERS TO CONTRACEPTIVE USE AMONG ADOLESCENTS IN RURAL AND REMOTE SETTINGS

J. Soon1, J. Shoveller2, J. Reade1, M.E. Kelm3, N. Hanlon4, J. Johnson5 1University of British Columbia Faculty of Pharmaceutical Sciences, 2University of British Columbia School of Population and Public Health, 3Simon Fraser University History Department, 4University of Northern British Columbia Geography Department, 5University of British Columbia School of Nursing

Across Canada, many adolescents experience serious health and social problems related to early unintended pregnancy and sexually transmitted infections. Despite public health initiatives, pregnancy rates among teens in northern British Columbia are 60% higher than the provincial average. Determining the barriers to the use of contraception among teens at risk of unwanted pregnancy has important health policy implications. Barriers such as social attitudes, beliefs about risk-taking, and where adolescents live can affect their experiences accessing contraception. Our project involves addressing and removing these barriers by working with community members to create sustainable and relevant interventions. Thus, this study utilized qualitative research methods grounded in participatory action, with ongoing meetings with the community-based advisory group. Ethnographic fieldwork was employed in a northern rural community

(population 2,000). During 8 weeks of participant observation, in-depth interviews were conducted with 20 female and 20 male English-speaking adolescents (aged 15 – 19 years) with varied socio-cultural and economic backgrounds and diverse contraceptive experiences. Interviews were also conducted with 9 health care and social service providers. Findings suggest the presence of barriers that are related to both individual knowledge, attitudes and decision-making as well as to social interactions and constraints within the healthcare setting. These barriers include lack of timely and appropriate information on contraception, myths regarding side effects of contraception, lack of convenient clinic appointment times, scarcity of physicians for prescribing contraception, lack of interpersonal skills related to negotiating contraception use, high cost of contraception and geographic barriers to health service access are negatively impacting contraception use among northern adolescents. In conjunction with the local health authority, city council, Aboriginal leaders, the non-profit agency OPTions for Sexual Health and local community members, we are facilitating the identification and implementation of creative adolescent-oriented contraception-related interventions that are sustainable, realistic and most importantly, community driven. Contact: Judith Soon ([email protected])

VENUE 3 Genetics

ASSOCIATION BETWEEN PERIODONTITIS AND RHEUMATOID ARTHRITIS IN CREE AND OJIBWAY POPULATIONS: A STUDY OF GENE-ENVIRONMENT EFFECTS

H. El-Gabalawy


Background: Indigenous North American native populations have amongst the highest prevalence rates of rheumatoid arthritis (RA) in the world. In populations such as the Cree and Ojibway tribes, RA is familial, starts at a young age, and is clinically severe and progressive. Anti-citrullinated protein antibodies (ACPA) are specific for rheumatoid arthritis (RA), and precede the onset of clinically detectable disease. Periodontitis is a prevalent oral chronic disease that has long been associated with RA. The pathogen porphyromonas gingivalis (PG), a common etiologic agent of periodontitis, has been proposed to be involved in breaking tolerance to citrullinated antigens. To address this hypothesis, we studied a cohort of Cree and Ojibway First Nations RA patients and their first degree relatives (FDR) in Central Canada, looking for associations between anti-PG antibodies, RA antibodies, predisposing HLA-DRB1 alleles, and symptoms of oral and articular pathology.

Methods: Cree and Ojibway RA patients (n=82) from Central Canada and their FDR (n=205) were evaluated with questionnaires and joint examination. Questions regarding oral hygiene and joint symptoms were included. Serum samples were tested for anti-CCP2 antibodies (IgM, IgA, IgG1-4 isotypes) by ELISA, IgM and IgA RF by nephlometry and ELISA, respectively. IgG antibodies to PG lipopolysaccharide (anti-PG) were tested by ELISA. HLA-DRB1 testing was performed by sequencing.

Results: Demographics of RA vs. FDR: age=47 vs. 37, p<0.001; females=90% vs. 72% p<0.01. Autoantibodies in RA vs. FDR: ACPA (any isotype)=91% vs. 19%; IgM RF=82% vs. 17%; IgA RF=48% vs. 22%, all comparison p<0.001. Of the individuals who were seropositive for ACPA and/or RF, the mean titers of the autoantibodies were significantly higher in RA compared to FDR. Titers of anti-PG antibodies were also higher in RA vs. FDR (p=0.002), and were higher in ACPA + vs. ACPA- RA (p=0.02) and FDR (p=0.002). In contrast, anti=PG titers were comparable in RF+ and RF- patients and FDR. Analysis of self-reported symptoms of poor oral hygiene did not demonstrate an association between these symptoms and ACPA, RF, or anti-PG.


ACPA+ FDR tended to see a dentist less frequently than those without this autoantibody. Hand symptoms potentially suggestive of early RA were present in 54% of FDR, although these symptoms did not correlate with autoantibodies or oral hygiene symptoms. Analysis of HLA-DRB1 allele status indicated that 81% and 73% of RA and FDR respectively, were shared epitope (SE) positive (p=NS). FDR with 2 alleles were much more likely to have ACPA (OR 10.6 p=0.001), although there was no association between SE status and anti-PG immune response.

Conclusions: In a high risk population of the relatives of First Nations RA patients with a predisposing genetic background, anti-PG antibodies were associated with ACPA, although not with RF or SE alleles. These findings suggest that ACPA and immune responses to PG antigens may develop in parallel, although the role of PG in breaking tolerance to citrullinated antigens needs further study. Contact: Hani El-Gabalawy ([email protected])

EXPLORING THE IMPACT OF LONG QT SYNDROME IN A BRITISH COLUMBIA FIRST NATIONS COMMUNITY

L.A. Huisman1, L. Arbour1, R. McCormick2 1Department of Medical Genetics and 2Department of Counseling Psychology, University of British Columbia

Background: Some First Nations families in Northwest, BC are affected by the same novel genetic mutation that predisposes them to Long QT syndrome (LQTS) - a genetic heart disease putting individuals at increased risks for irregular heart rhythms and sudden death.

Previous studies on LQTS in this community focused on biological aspects. This study explores the personal impact of LQTS, with the understanding that results will inform genetic counseling. Western counseling techniques may not be entirely appropriate for First Nations patients, who have significantly different notions of healing and unique worldviews. This project explores what facilitates and hinders resiliency when learning about a LQTS diagnosis, adding psychological support dimensions to the existing clinical study.

Aims:

- Characterize health and psychological needs of individuals/families

- Explore what facilitates or hinders resiliency and coping for individuals/families.

- From a cultural context, understand the impact of having LQTS and concerns for the next generation.

Methods: Three participatory research methods were available to the participants. The first invited the participants to be interviewed to explore the impact of LQTS on their lives. Interviews were recorded, transcribed, and analyzed. Participants were also invited to create Photovoice stories, using photographs and written narration to portray their stories. Thirdly, Talking Circles, enabled validation of the interview analysis and participation from others preferring not to partake in the first two methods.

Results: Some of the emerging themes that facilitate resiliency include: family, faith, and knowledge. However an inability to understand the biological or clinical aspects of the condition hindered the resiliency process. These issues will be expanded upon, and recommendations to improve genetic counseling within First Nations communities will be discussed. Contact: Lee-Anna Huisman ([email protected])

A REVIEW OF COMMUNITY-BASED PARTICIPATORY APPROACH TO GENETIC AND GENOMIC RESEARCH IN AMERICAN INDIAN/ALASKA NATIVE POPULATION

D. Perkins

National Institute of Nursing Research

The use of a community based participatory approach to research is becoming an expected standard for scientific research projects with

indigenous populations. After the introduction of the Human Genomic Diversity Project in 1991, indigenous communities around the world are demanding more input and control over the research conducted with and within their communities, especially when related to genetics or genomics. Researchers are no longer allowed to conduct studies in these populations without the development of close mutual relationships. However, the spectrum of participation and collaboration varies widely. The goal of this paper is to review published American Indian and Alaska Native community based participatory research related to genetics and genomics. Community based participatory approaches will be integrated with international ethical principles, while public health/ genomic initiatives will be considered for recommendations for future genetic/genomic research in these Indigenous communities. Contact: Darlene Perkins ([email protected])

GENETIC VARIABILITY IN CIRCADIAN RHYTHMS IN AN ARCTIC MAMMAL THAT MAY HAVE HEALTH IMPLICATIONS FOR PEOPLE LIVING IN CIRCUMPOLAR REGIONS

A. Bult-Ito

University of Alaska Fairbanks

About 24-hour (circadian) rhythms are expressed by most organisms on earth, including humans. As a result, the adaptive significance of circadian rhythms has been almost universally assumed but has rarely been tested. For circadian rhythms to be evolutionarily relevant, they have to reveal genetic variability that natural selection can act upon. Unfortunately, natural variation in genes regulating circadian rhythms in natural mammalian populations is a virtually unexplored field. My research lab has developed selected lines of wild-caught Alaskan northern red-back voles, Clethrionomus rutilus, for circadian organization of wheel-running activity. We have now completed 5-6 generations of selection for strong circadian activity rhythms in constant dark conditions (DD), i.e., the circadian line, and for loss of circadian rhythms in DD, i.e., non-circadian line. This selection has resulted in a 2.5-fold difference in circadian robustness of circadian activity rhythms in DD between the circadian and non-circadian vole lines. Therefore, circadian organization of locomotor activity in voles shows considerable natural genetic variability that artificial or natural selection can act upon.

Circadian rhythms are very important for human health. Circadian rhythm dysfunction is associated with seasonal affective disorder (SAD), depression, and other mental illnesses. Suicides and depression are disproportionately higher in circumpolar regions and, therefore, investigating the role of circadian rhythms is crucial. Contact: Abel Bult-Ito ([email protected])

GENETIC REGULATION OF CIRCULATING FATTY ACIDS IN ALASKAN ESKIMOS

A.G. Comuzzie, V.S. Voruganti, S.A. Cole, S.O.E. Ebbesson, M.E. Tejero, H.H.H. Garing, S. Laston, K. Haack, R.B. Devereux, R.R. Fabsitz, J.W. MacCluer, B.V. Howard

Southwest Foundation for Biomedical Research

Alteration in plasma fatty acid composition has been linked to metabolic abnormalities related to type 2 diabetes and cardiovascular disease. The main aim of this study was to investigate genetic factors influencing the variation in circulating fatty acid distribution in Alaskan Eskimos participating in the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study. For this analysis, data were available for 761 adult related-individuals (all over 35 years of age). Fatty acid distribution in total plasma fatty acids was measured by gas chromatography. Quantitative genetic analyses were conducted using a variance components decomposition approach implemented in the software package SOLAR. All fatty acids were significantly heritable (p < 0.001), with heritabilities ranging from 0.33 to 0.66. A genome-wide scan conducted to identify chromosomal regions affecting the variation in plasma fatty acids localized a 20cM region on chromosome


8 (p12- p21) with a quantitative trait locus (QTL) for monounsaturated fatty acids (MUFAs) (logarithm of odds (LOD) score = 3.8, p < 0.00001). The same region had a QTL for polyunsaturated fatty acids (PUFAs) (LOD = 2.6, p < 0.001). Interestingly, this region has four important candidate genes, beta-3 adrenergic receptor (ADRB3), lipoprotein lipase (LPL), macrophage scavenger receptor1(MSR1) and tumor necrosis factor receptor superfamily, member 10b (TNFRSF10B), all of which have important roles in fatty acid metabolism. These results indicate that there is strong genetic influence on the variation in circulating fatty acid distribution, and that a major susceptibility locus for plasma unsaturated fatty acids appears to be present on chromosome 8. Contact: Anthony Comuzzie ([email protected])

INTERETHNIC DIFFERENCES IN FREQUENCY OF ALLELES AND GENOTYPES OF POLYMORPHIC MARKERS OF CARDIOVASCULAR DISEASES IN YAMALO-NENETS AUTONOMOUS OKRUG (RUSSIA)

E.V. Shinkaruk, N.V. Golubeva


Human genetic diversity appeared during extended period of evolution of numerous groups and tribes. People, living in different regions of Earth, differ by many features: language, appearance, genetic characteristics. Every separate species has a set of genes responsible for its unique features. Aim of our study was to evaluate interethnic differences in allele frequency and genotypes of polymorphic markers of cardiovascular diseases in samples of non-native and aboriginal inhabitants of the Russia Far North. 426 persons aged 20-59 years were examined. DNA was extracted by “RIBO-prep” kits (“AmpliSens”, Russia). Polymerase chain reaction was done in 23 microlitres of reaction mix, which contained 2 microlitres of DNA sample. Amplification was carried out by Rotor Gene 3000 (“Corbett Research”, Australia). Assessment of results was done by computer plotting of melting curves. Interethnic differences of frequency of genotypes and alleles of 1) ACE gene (I/D polymorphism), 2) PON1 gene (Q192R) and 3) MTHFR (C677T) were studied. For the first studied gene, allele frequencies in non-native and aboriginal inhabitants were the same (x2=0,014, p=0,905); it evidences the absence of differences in groups by I/D polymorphism of ACE. For the second studied gene, RR genotype was found in aboriginal inhabitants in 27,3% of cases and in non-natives in 19,7% of cases. QQ genotype did not differ between the groups. For the third studied gene, C allele prevailed (95,1%) over T allele (4,9%) in aboriginal inhabitants. In non-natives C allele dominated in 73,3% (T allele was found in 26,7%). Heterozygote number in non-natives was significantly higher (38,5%) than in aborigines (9,8%). Thus, we can conclude that by I/D polymorphism of ACE, allele frequencies are identical in native and non-native population of the Far North. In PON1 (Q192R) and MTHFR (C677T) we revealed some particular differences in allele frequencies, which can be conditioned by ethnicity. Contact: E.V. Shinkaruk ([email protected])

POLYMORPHISMS AND MUTATIONS IN GJB2 ASSOCIATED WITH HEREDITARY HEARING LOSS IN EAST GREENLANDERS

P. Homøe1, L. Tranebjærg2, N.D. Rendtorff2, M. Lodahl2, T. Andersen3, S. Andersen4, H. Eiberg5, I. Nielsen5, A. Koch6 1Department of Otolaryngology, Head & Neck Surgery, Rigshospitalet, University of Copenhagen, Denmark, 2Department of Audiology, Bispebjerg Hospital and Wilhelm Johannsen Centre of Functional Genomics Department of Cellular and Molecular Medicine, ICMM, University of Copenhagen, Denmark, 3Department of Audiology, Odense University Hospital, Denmark, 4Department of Endocrinology, Aalborg Hospital, Århus University Hospital, Denmark, 5Institute for Cellular and Molecular Medicine, ICMM, Panum Institute, University of Copenhagen,

Denmark, 6Department of Epidemiology Research, Statens Serum Institut, Denmark

Objectives: Hearing impairment is prevalent in the indigenous populations in the Arctic. It has mainly been ascribed to noise trauma and chronic otitis media. The frequency of autosomal recessive hearing loss is high and the allele frequencies of associated gene mutations vary between populations from 1-5%. The prevalence of hearing disorder with genetic etiology among the Inuit populations in the Arctic is unknown and unexplored. Clinically, many Greenlanders show a mixed (conductive/sensorineural) hearing loss. We have therefore performed a selected cross-sectional pilot study in East Greenlanders by sequencing of the GJB2 gene in order to identify mutations associated with hereditary hearing impairment. Patients and Methods: From 166 East Greenlanders who had an audiogram taken in 2004, we selected those with sensorineural hearing loss or combined hearing loss. Available patient samples were sequenced. The study was approved by the local ethical committee in Greenland. All participants gave informed consent. In addition blood samples from an unselected number of East Greenlanders without known hearing loss were examined similarly as controls. Results: Forty-eight index persons were included, 25 males and 23 females. The median age was 36 years (range: 5-76 years). No DNA was detected in three samples, leaving 45 samples for evaluation. All audiograms showed combined conductive sensorineural hearing loss except one showing sensorineural profound hearing loss. We found one index person who was homozygous for 35delG in agreement also with profound hearing loss. One index person was heterozygous for 35delG. Three index persons were heterozygous for the p.V27I mutation and one patient was heterozygous for the p.V153I mutation, both known as polymorphisms not associated with disease. We detected no 235delC mutations. The results of the control specimens will also be reported. Conclusion: Gene mutations in the GJB2 gene occur, but with low frequency in East Greenlanders. Still, the main reasons for the frequent hearing impairment in this population are chronic otitis media, noise traumas, and/or unidentified genetic causes. Contact: Preben Homøe ([email protected])

APOLIPOPROTEIN E POLYMORPHISM IN NATIVE POPULATION OF MOUNTAIN SHORIA (WEST SIBERIA) AND ITS ASSOCIATION WITH SERUM GLUCOSE LEVELS

M.I. Voevoda, E.V. Shakhtshneider, O.L. Barbarash, M.J. Ogarkov, I.V. Kulikov, V.A. Baum, N.S. Yudin, V.F. Kobzev, A.G. Romashchenko

Institute of Internal Medicine, SB RAMS, Novosibirsk, Russian Federation

Objective: we investigated apolipoprotein E gene polymorphism and its influence on a serum glucose levels in native population of Mountain Shoria (West Siberia).

Methods: The study included 40 men and 80 women aged 25-64. The apolipoprotein E polymorphism was analyzed by original method using Hixson’s approach. The serum glucose levels were determined by standard enzymatic assays.

Results: The frequencies of ε2, ε3, ε4 alleles in men were 6.5%, 80.4%, 13.1% and in women – 7.6%, 72.6%, 19.8% respectively. The frequencies of genotypes ε2/ε4, ε2/ε3, ε3/ε3, ε3/ε4, ε4/ε4 in men and women together were 1.8%, 12.4%, 51.8%, 31.2% and 2.9%. Mean fasting serum glucose levels in case of genotypes ε2/ε4, ε2/ε3, ε3/ε3,

ε3/ε4 and ε4/ε4 were 4.6 0.3mg/dl, 4.6 0.1mg/dl, 4.0 0.1mg/dl,

4.7 0.1mg/dl, 5.8 0.3mg/dl (рGLM=0,000) in man and 4.7 0.3mg/dl,

4.7 0.1mg/dl, 4.1 0.1mg/dl, 4.9 0.1mg/dl, 5.9 0.2mg/dl in women (рGLM=0,000). After glucose tolerance test mean serum glucose levels in case of genotypes ε2/ε4, ε2/ε3, ε3/ε3, ε3/ε4 and ε4/ε4 were

6.0 0.6mg/dl, 6.1 0.3mg/dl, 5.2 0.2mg/dl, 6.4 0.2mg/dl,

8.4 0.5mg/dl (рGLM=0,000) in man and 6.2 0.6mg/dl, 6.1 0.2mg/dl,

5.5 0.1mg/dl, 6.7 0.1mg/dl, 8.6 0.5mg/dl (рGLM=0,000) in women. Conclusions: The native population of Mountain Shoria is characterized by relatively high frequencies of ε4 alleles. The allele ε4 prevails in


women. The genotype ε4/ε4 has been associated with higher serum glucose level. Contact: Mikhail Voevoda ([email protected])

VENUE 4 Infectious Diseases #3 – Tuberculosis

PREVALENCE OF LATENT TB INFECTION (LTBI) AMONG SCHOOL CHILDREN IN GREENLAND

T. Rendal, K. Ladefoged, I. Kleist

Medical Department, Queen Ingrids Hospital

With an average of 76 cases of active tuberculosis per year over the last 5 years (equal to 135 cases per 100.000 inhabitants), tuberculosis remains a challenge in Greenland.

Earlier studies have shown that the prevalence of LTBI among children in Greenland is alarmingly high, a sure indication that active TB transmission is an ongoing problem. Identifying individuals with LTBI, particularly young individuals, is an essential part of TB control and elimination.

An annual screening of schoolchildren for LTBI has been implemented as a part of Greenland’s national strategy to fight tuberculosis. The children screened are those in the first and last grade of our mandatory primary school system (1st grade and 10th/11th grade). The children are tested using whole-blood interferon gamma (IFN-gamma) assay, the QuantiFERON Gold test.

The screening in the year 2008 involved 1839 tested schoolchildren from 16 districts. In total 148 (8.0%) tested positive. 5.7% of all the tested 1st graders were positive, ranging from 0 in some small districts to 11.1% in other areas. 9.7% of all the tested 10th/11th graders were positive (0 - 44.4%). As expected the prevalence of LTBI was highest in the districts with a high incidence of active TB. Other influencing factors such as BCG status are being estimated. Contact: Thomas Rendal ([email protected])

TUBERCULOSIS AMONG CHILDREN AND YOUTH IN THE ARCTIC FROM GREENLAND POINT OF VIEW

T. Skifte

The National Board of Health In Greenland

Introduction: Tuberculosis is still a disease to be taken seriously in Greenland. Over the last 10 years the occurrence has been high with 133 cases yearly per 100,000, in spite of BCG-vaccination of new-borns, and a persistent effort regarding contact tracing, control of treatment, preventive interventions and tracking sources of infection.

Objectives: To examine how the occurrence of TB among children and young people in Greenland has developed over time. To compare the TB-incidence among Greenlanders to Inuit populations in Alaska and Canada. To examine whether the TB-infected children and young people differed from the population in general in relation to social background and living-conditions.

Methods: Notifications of TB-cases from 1988-92 and from 2002-06 were compared. Register data from Alaska and Canada were related to data from Greenland. Data from a case-control study were analysed, consisting of notification forms, questionnaires regarding social conditions and living-conditions, plus information about BCG from case records.

Results and Conclusion: In the period 1988-92 there were 185 TB cases, in 2002-06, 407 cases, corresponding to an incidence of 67 to 141 incidents per l00,000 respectively. In the regions examined, Inuits have a strongly increased TB-incidence compared to the remaining population, and the incidence was highest in Greenland. In Greenland 27 % of TB patients were below 19 years old, only surpassed by Nunavut (33 %). Due to the small population involved, the results of the case-control study were not statistically significant, but they support a

correlation between living-conditions and TB. Occurrence of many infected children indicates active spreading of the disease, and the infected children may be a source of future TB transmission. Contact: Turid B. Skifte ([email protected])

ASSESSING THE EPIDEMIOLOGICAL METHODS USED IN A TUBERCULOSIS OUTBREAK IN NORTHWEST TERRITORIES, CANADA

C. Case

Government of the Northwest Territories

Objective: To review the standard epidemiological methods used to prevent and control the transmission of tuberculosis (TB) during a recent outbreak among the homeless population in the Northwest Territories (NWT).

Methods: Methods used to assess the transmission of TB included: conventional contact tracing, social networking (particularly among contacts residing in a homeless shelter), and genotyping using restriction fragment length polymorphism (RFLP) and drug susceptibility patterns of isolates. Initial contact tracing focused on high-risk contacts of the index case (highly infectious pulmonary TB) which included 326 contact and included moderate- and low-risk contacts(total was 850). Analysis on social networking patterns focused on the number of nights each resident slept in the same room or adjacent room with the index. Network analysis also included contact’s number of exposures to cases.

Results: Conventional contact tracing revealed 21 cases identified from this outbreak investigation, which include index (primary), 16 secondary and 4 tertiary cases. Genotype patterns revealed 14 of the 15 isolates analyzed were identical to the index. The case with a different genotype was identified as a low risk contact with other risk factors such as excessive alcohol consumption and incarceration in a correctional facility. Social networking identified one secondary case who had shared a minimum of three nights in the same room with the index. Focused screening on high-risk contacts with multiple (more than 3) with cases revealed one case. All 21 isolates were susceptible to first-line antibiotics with identical susceptibility patterns.

Conclusions: Social networking and genotyping analysis confirmed the concentrated efforts on high-risk contacts through conventional contact tracing method were an accurate direction for this investigation. Genotyping will be used as an epidemiology tool for subsequent cases known or unknown through conventional analysis. Molecular epidemiological findings may offer information regarding transmission among populations with neighbouring territories, provinces and circumpolar countries. Contact: Cheryl Case ([email protected])

THE DETERMINANTS OF TUBERCULOSIS TRANSMISSION IN THE CANADIAN-BORN POPULATION OF THE PRAIRIE PROVINCES: THE QUALITATIVE FINDINGS IN MANITOBA

C. Lopez1, S. Abonyi2, K. McMullin2, J. Boffa3, M. Mayan3, R. Long3, P. Orr1 1University of Manitoba, 2University of Saskatchewan, 3University of Alberta

While the rates of tuberculosis (TB) in the Canadian-born non-aboriginal population of Canada are declining overall, the rate in the Canadian-born aboriginal population is not declining. Prevention of transmission must include the development of strategies informed by the experiences and real life contexts of individuals who contract TB. Failure to understand and incorporate the individual and population health determinants, and their interplay (e.g. social disparities, socio-cultural influences, environmental factors, co-infections and co-morbidities) in health programs has much to do with the re-emergence of TB as a serious public health issue for aboriginal people. This presentation reports on an innovative research program that was conducted across the Prairie Provinces of Canada. This presentation


reports on the preliminary findings of the Manitoba qualitative study component. Extensive consultation with aboriginal organizations and ethics bodies was undertaken to ensure a respectful approach to, and inclusion of, community leaders and health centres. Provincial Network Committees (PNCs) with stakeholder representation were established for consultation on the development of collection tools for both quantitative and qualitative instruments, and for assistance with the interpretation of findings. The qualitative team undertook semi structured interviews with adult Canadian-born persons diagnosed with smear-positive pulmonary TB between January, 2007 and December, 2008. This comprised 53 aboriginal persons across the Prairies of whom 18 were from Manitoba. Coding and preliminary analysis of transcripts was undertaken through a peer team approach and member-checked with PNCs. Our interviews have revealed rich and complex narratives of loss, belonging, resilience, and strength, manifest in the experience of TB. This approach and the findings will help identify and understand the vulnerabilities in transmission pathways and contribute to the consideration of new approaches to TB prevention. Contact: Carmen Lopez ([email protected])

TUBERCULOSIS IN INDIGENOUS PEOPLE OF MURMANSK REGION, RUSSIA

R. Platonova

Murmansk Region TB Dispensary

In the Murmansk Region a programme to control tuberculosis among its residents including indigenous peoples has been developed and introduced. This programme is aimed at implementation of the national TB and its complications control policy, introduction of effective TB prevention measures into medical practice, early detection and treatment.

There has been an increase in TB morbidity on the territory of the region since 1990. By 1997 the incidence per 100 thousand doubled and reached 32.2 compared to that of 15.7 in 1990. In addition, TB mortality per 100 thousand rose fourfold. Corresponding TB morbidity and TB mortality indicators for the indigenous peoples are considerably worse.

As regards TB morbidity, at present the epidemiological welfare in the region has not been reached yet.

The number of TB mortality cases increased from 11.4 to 12.3 per 100 thousand in 2007 compared to 2006. In 2005 this figure was 13.0. TB mortality in the Russia in 2006 was 19.5 per 100 thousand. The percentage of those who died of TB within one-year medical observation is still high - 38.8%. Corresponding figures in 2005 and 2006 are 44.0 and 42.5 accordingly.

The measures taken to timely detect TB cases among the indigenous peoples are not at the sufficiently high level yet.

The significant pool of unknown infection sources is mainly centred among the socially disadvantaged population sections.

Social and economic efficiency which will resulted from implementation of the programme will represent life quality improvement and increase in life expectancy of the indigenous peoples, retention of their employment ability, healthier lifestyle, reduction in social and economic tension caused by the threat of spreading TB. Contact: Rimma Platonova ([email protected])

RIDING THE WAVES OF RECENT TB & SYPHILIS OUTBREAKS IN YELLOWKNIFE, NT- PLANNING, PARTNERSHIPS, PERSISTENCE

J. MacKinnon, H. Leslie, N. Trotter

Yellowknife Health and Social Services Authority

Yellowknife has a diverse population of about 20,000 representing First Nations, Inuit and Métis groups, non-Aboriginals and immigrants. “At-risk” populations include the homeless, those with mental illness and

addictions, the working poor and those with special needs or in crisis. Many cannot easily access the traditional health and social services system. Non-governmental organizations (NGOs) provide supportive services to the same populations.

The TB outbreak of 2007-2008 centred around men using the Salvation Army’s shelter. Since the diagnosis of the index case at the end of March 2007, PHNs have managed 15 persons with pulmonary TB and started another 9 on INH prophylaxis. They also carried out follow-up and investigation of more than 800 contacts.

The syphilis outbreak in Yellowknife began the third week of December 2008 when the number of cases rose from three to seventeen over 2 weeks. To date, the epidemiology of this outbreak is not fully understood. The public health unit, in partnership with GNWT Health and Social Services, local physicians, nurse practitioners and corrections nurses, developed a proactive approach to managing this virulent communicable disease.

The goals of communicable disease outbreak control and management are to prevent harm to infected persons and their contacts and control TB and syphilis at the population level. In addition to conventional approaches to achieving these goals, public health staff used some unique strategies for case finding, such as public education, enhanced access to testing, a street worker, links with NGOs and North Slave Correctional Centre and outreach. Strategies for case management included dedicated staff, screening, appropriate assessment and treatment and counselling.Health care providers used diverse and persistent approaches and repeat interviews of cases to improve contact tracing.

Best practices included: a public health outbreak team; a dedicated coordinator; communications; partnerships with the Salvation Army, Centre for Northern Families, the Tree of Peace Friendship Centre and the John Howard Society; social networking; trust building with specific at-risk populations; outreach; and, incentives.

Challenges included: limited resources; case finding; stigma; and, follow-up. Contact: Joanne Mackinnon ([email protected])

VENUE 5 Climate Change – Health Impacts

IS HEAT A MORTALITY RISK IN THE CANADIAN ARCTIC? WILL IT BE?

T. Kosatsky

British Columbia Centre for Disease Control

While heat waves have been recognised as a significant risk to life in warm and even temperate climates, the effect of heat on the health of Northern residents has been shown only recently. In Moscow, a V-shaped function applies when daily temperature is plotted against the level of daily deaths, with the “V’s” notch at 18 degrees C. Similar mortality nadirs have been shown for Finland and Stockholm as well, but at 12 and 11 degrees respectively. Large within-day temperature shifts present as an independent risk factor in the Moscow analyses.

Heat-mortality functions have been constructed for several Canadian cities: stronger effects have been shown for the elderly, for high temperatures occurring earlier during the summer, and for built areas with less shade. So far, no such analyses have been conducted for northern Canadian settlements.

Temperature-mortality relationships for Prince George, BC will be presented, based on a time series from 1087-2007, along with similar analyses for Yellowknife and Whitehorse, given data availability.

Pan-European studies have modeled the effect of a warmer climate on the basis of documented population responses to summers warmer than the mean. Coupling these mortality responses with climate change model predictions will allow for estimation of heat-related


mortality in northern settlements should warming continue to follow its rapid current course. Contact: Tom Kosatsky ([email protected])

CLIMATE CHANGE IMPACT ON PUBLIC HEALTH IN THE RUSSIAN ARCTIC- FIRST ASSESSMENT

B. Revich

Institute of Forecasting

Negative impacts of climate change for public health in Arctic region are more pronounced than in other territories. UN Arctic Initiative, with support of UNDP, WHO, UNEP, and AMAP, organized the first meeting of experts for analysis of this problem in 2008. Russian Arctic (RA) supports more inhabitants (6.7 million people) than any other Arctic territory. There are 46 cities and rural settlements, large metallurgy plants, mines and other industrial facilities in RA. Russian Arctic is characterized by large social and economic disparities. Most climate change models predict considerable warming of Arctic climate. For example, air temperature in Yakutia may rise by 2.7 ºC by 2020. Climate warming will bring about rise of temperature of permafrost, which may lead to major break-downs of water mains and sanitation networks. This, in turn, may cause outbreaks of enteric fevers. Breaks of oil pipelines causes contamination of drinking water supplies [Kochina, Kushnikova, 2008]. Climate warming causes northward shifts of habitats of tick-borne encephalitis. The periods of activity of tick become longer. One study reported causal link between climate change and numbers of tick in Krasnoyarsk region. The incidence of tick-borne encephalitis has increased in Archangelsk region. When annual average temperature increases by 1.5 ºC or more, the number of people bitten by tick sharply increases (Tronin et al, 2008). Hemorrhagic fevers steadily propagate further north. Isolated cases of West Nile fever have been registered in Novosibirsk region [Platonova et al, 2006]. Climate warming is a risk factor for proliferation of dangerous infections, which previously existed in RA. There are more than 200 burial grounds of cattle died from Siberian plague in Yakutia Republic, where this disease has been registered in 240 settlements (Kershengoltz et al, 2008). There are potential pockets of tularemia, leptospirosis, listeriosis and pseudo-tuberculosis in Russian Arctic. Coordinated efforts of experts in different sciences are needed during development of programs for prevention and liquidation of negative impacts of climate change on public health in Russian Arctic. Contact: Boris Revich ([email protected])

CLIMATE CHANGE IMPACT ON HUMAN EXPOSURE TO PERSISTENT CONTAMINANTS IN ARCTIC RUSSIA

V. Chashchin

Northwest Public Health Research Center

2/3 of Russia’s territory is represented by permafrost lands populated by 11 million residents. About 0.5% of those are formally entitled to indigenous minorities. Over 20% of Russia’s GNP is provided by the economy of arctic regions based on enormous concentration of unique natural resources. Some past mining, industrial and transport activities were associated with large environmental pollutions involving persistent contaminants. Although the presence of elevated human exposure to POPs in the arctic regions are confirmed by many international studies, the ecotoxicological and consequences especially those associated with climate change impact still remain largely unknown. Human reproduction appears to be of greater concern in terms of the exposure to certain contaminants such as PCBs.

There are a number of urgent questions to be clarified: How large is the climate change impact on global transfer, behavior, fate, distribution, exposure intensity and health effects of POPs? How significant such impact is? What should be done to reduce risks associated with the climatically modified human exposure to POPs?

A limited follow-up study of an arctic indigenous cohort of 30 mother-child pairs and 30 male adults for the period from 2001 to 2007 showed that there is a statistically significant decrease in blood concentrations

of those persistent contaminants coming into the Arctic mostly through the global transfer such as DDT, HCH, chlordanes, toxiphens and mirex. In the same time an obvious increase in levels of contaminants presumably originated from local sources such as PCBs is observed among children and men. Enhancement of surface/air exchange, altered contaminant fractionation, corrosion of metallic containers/drums/tanks leading to accelerated mobilization of contaminants from wastes buried in permafrost lands are discussed to be contributing factors to increased human exposure associated with climate change impact. Contact: Valery Chashchin ([email protected])

CLIMATE CHANGE CHALLENGES TO ARCTIC HEALTH (AN EXAMPLE OF THE NORTHERN PEOPLES OF YAKUTIA)

S. Vyacheslav

Researcher, Institute of Humanities and North Indigenous Peoples

Researchers of communities of indigenous people of Yakutia (chukchees, yukaghirs, evens, evenkis) have shown, that there were new threats in condition of climate change and its influence on health of the northern peoples.

Growth of death rate because of increase of natural cataclysms: flooding, strong heat, sharp pressure differences. Last years very often there are flooding, thus each 3-rd year with catastrophic consequences and deaths. The number of hits in hospitals because of sunstrokes, pressure differences, etc. In the most risky position there were older persons and the small children, already suffering any diseases (first of all, cardiovascular and respiratory). Here it is necessary to specify and increase in accidents with fishermen and hunters in connection with late icing and thickness of an ice.

1. Deterioration of water. Last years pollution of superficial waters has amplified. Rise in temperature will promote also to duplication in water of bacteria, microbes and etc, and it becomes the reason of gastroenteric diseases. Recently the number increases in Yakutia ill oncological diseases. Some experts connect it with more intensive chlorination because of deterioration of water. Long influence of the raised concentration of chlorine and its components, in opinion of doctors, increases risk of cancer diseases.

2. Deterioration of traditional food. Major factors of it include deterioration of conditions of its storage (glaciers, untimely delivery are filled in, etc.) and

3. growth of parasitic diseases among fishes and animals (trichinella at bears, worms at fishes, a salmonellosis at birds, etc.).

4. Parasites and infectious diseases. Warming has expanded areas of distribution of diseases which messengers are insects or ticks whom new territories extend on all.

5. The probability of washout of burial grounds of the cattle which has died of many years from the Siberian ulcer, and an ancient cemetery with burials of the people who have lost from epidemics of a plague and a smallpox grows. I.e. there is a threat of occurrence of the centers of distribution of viruses of dangerous illnesses.

6. Distribution on the north of new kinds of trees and grassy plants. In this connection there is a threat of growth of allergic reactions because of impracticality of an organism of people to pollen of new plants.

7. Deterioration of conditions of duly rendering of medical aid. The reason of it is washing out of small villages because of what it is impossible to make sanitary flights for export of patients in time.

Contact: Shadrin Vyacheslav ([email protected])

SEASONAL VARIATIONS OF MORTALITY FROM CLIMATE-RELATED CAUSES IN ARCTIC CITIES

B. Revich, D. Shaposhnikov

Institute of Forecasting


Climate change may influence morality rates in Arctic in many different ways. Public health experts have hypothesized that mortality from climate-related causes might both increase and decrease. To test these hypotheses, one needs to conduct a preliminary exploratory analysis of seasonal patterns of morality rates. For this purpose, we analyzed 76,500 deaths in four cities in Russian Arctic, from Norwegian border (Murmansk) to West Siberia (Norilsk) and East Siberia (Yakutsk and Magadan). We analyzed several cardio-respiratory causes and all-cause mortality, in age groups 30-64 years and 65+. Seasonal variations were measured after smoothening of daily mortality counts with a 60-day moving window. For example, in Yakutsk, seasonal variations of daily mortality have been established for all causes, except respiratory diseases in the age group 65+. Two principally different annual distribution of mortality were established: single-modal and bimodal. A single-modal distribution (established for the two respiratory causes) has a smooth profile which consists of the two sinusoidal half-waves. The half-wave of elevated mortality lasts from September to January, and annual maximum of daily mortality is observed in the beginning of autumn, instead of mid-winter. The half-period of reduced mortality is observed from February till August, and daily mortality reaches its minimum in the middle of summer. Bimodal distribution (established for all other studied causes) has two maximums and two minimums each year. The greater maximum is observed in late summer or early Fall; the secondary maximum takes place in winter. Such peaks coincide with summer and winter temperature extremes in Yakutsk. The greater maximum in the age group 65+ precedes the same maximum in the age group 30-64, by 1 or 2 months. In prospect, we are planning to employ regression analysis of time-series of daily mortality to quantify its relationships with meteorological factors. Contact: Boris Revich ([email protected])

THE HEALTH OF ARCTIC POPULATIONS: DOES COLD MATTER?

K. Young1, T.M. Mäkinen2 1Dalla Lana School of Public Health, University of Toronto, 2Institute of Health Sciences, University of Oulu, Finland

Background: The effects of cold on human health and performance is well documented. With climate change increasingly affecting the Arctic, the association between climate and population health status in Arctic regions is of public health significance.

Objective: To examine whether cold temperatures are associated with poorer health in diverse Arctic populations.

Methods: The mean January and July temperatures were determined for 27 Arctic regions based on weather station data for the period 1961-1990 and their association with a variety of health outcomes assessed by correlation and multiple linear regression analyses.

Results: Mean January temperature was inversely associated with infant and perinatal mortality rate, age-standardized mortality rate from respiratory diseases, and age-specific fertility rate for teens and directly associated with life expectancy at birth in both males and females, independent of a variety of socioeconomic, demographic, and health care factors. Mean July temperature was also associated with infant mortality and mortality from respiratory diseases, and with total fertility rate.

Conclusions: Cold temperatures are significantly associated with higher mortality and fertility of Arctic populations and should be recognised in public health planning and health risk management. Contact: Kue Young ([email protected])

VENUE 6 Pathways to Knowledge, Pathways to Health Workshop

M. Buell

National Aboriginal Health Organization and the Canadian Cochrane Network and Centre

The development of effective programs and policies requires access to, and the use of, the most complete information available. In the past, this was thought to be the most current or leading edge research or expert opinion. Currently, there is more and more recognition that to be truly balanced, complete, and potentially useful multiple sources of information require consideration. This session will discuss the links between research in policy and science, Indigenous science, and evidence based decision making. Some of the specific questions that will be considered include:

- What are the differences between traditional and Indigenous knowledge?

- What are Indigenous science and Indigenous knowledge methods?

- What are systematic reviews and how do they fit into western science?

- What is evidence-based decision making? - Where can you find health information? - What are the challenges in finding and accessing reliable

information (traditional, Indigenous and non-traditional)? - What are some of the protocols, ethics and responsibilities for

accessing traditional knowledge?

In considering these questions, this session will explore how Indigenous, traditional, and western research can be used together to improve the health of people in the North.

This panel presentation will include various perspectives on knowledge development, communication, translation, and use, including a university-based researcher, a traditional knowledge expert, an Elder, and a health care provider. Contact: Mark Buell ([email protected])

VENUE VIEWING ROOM Video #2

NUTARAQTAARNIQ NUNALINGNIRMIUNUT ALIANAIPPUQ- BIRTH A JOYOUS COMMUNITY EVENT: A SCREENING OF A LIVE-TO-TAPE 2-HOUR CALL-IN PROGRAM ABOUT INUIT MATERNITY CARE

C. Carry


Good maternity care = better birth outcomes. It is also now well understood that being supported by care providers from your own culture who speak your language is a best practice. In Inuit maternity care, this degree of cultural competency along with the knowledge about your family and community can improve the birthing experience and Results: Many people including elders also report substantial benefits when babies can be born in their own communities.

Through the live interactive broadcast, Inuit Tuttarvingat of the National Aboriginal Health Organization, along with many partners, shares encouraging examples that are helping move Inuit maternity care forward.

The 2-hour program:

- discusses the history and development of Inuit maternity care. - highlights maternity care programs in Alaska, Inuit Nunaat and

Greenland with a focus on the development of culturally appropriate services.

- discusses research, such as the “Qanuippitali? Inuit Health Survey,” that focuses on child and family health.

- explores opinions and ways forward shared by the panelists, community focus groups and callers.

- points to Web-based resources for follow-up.

This 2.5 hour session will open with an introduction to the overall Qanuqtuurniq - Finding the Balance TV series, an International Polar Year outreach project on Inuit wellness broadcast on the Aboriginal Peoples Television Network - North in May 2009 in the Inuit language


with English subtitles and simultaneously Web cast . A main objective of this series was to adapt and test a “communications for change” model for exchanging knowledge from different perspectives on several wellness issues of concern to Inuit. Following the screening of the maternity care program, evaluation highlights will be shared along with a question and answer period and an opportunity to give feedback into the model’s evaluation process. Contact: Catherine Carry ([email protected])

SESSION 6 Tuesday, July 14, 8:30-10:00 AM

VENUE 1 Mental Health & Wellness #4 – Suicide & Addictions

SUICIDE ATTEMPTS AND ALCOHOL DEPENDENCE IN GREENLAND

C.P. Pedersen, P. Bjerregaard

Centre for Health Research in Greenland, National Institute of Public Health, University of Southern Denmark

Objectives: Greenland has an alarming record in suicide rates. Alcohol is an important risk factor for suicidal behaviour. A recent survey revealed that the prevalence of alcohol dependence in Greenland has increased from 22% in 1999 to 30% in 2005-2007. The purpose of this study is to examine suicide attempts in relation to alcohol dependence.

Method: Analyses were based on data from a cross-sectional population survey of 2247 Inuit in Greenland (2005-2007). Participants age>18 years answered a self-administered questionnaire including questions on their childhood, suicidal behaviour and alcohol consumption and an interview including socio-demographic conditions. The association between suicide attempts and alcohol dependence, measured by the CAGE questionnaire, was analysed for men and Women’separately, using logistic regression and adjusted for socio-demographic factors and childhood conditions.

Results: Women more often than men reported ever having attempted suicide (17% and 11%, respectively (p<0.001)). Men (38%) were more often than woman (26%) CAGE positive (p<0.001). Being CAGE positive was associated with suicide attempts (OR=2.91 (CI 2.0-4.2) for women and OR=1.56 (CI 1.0-2.5) for men). Multivariate analysis revealed no association between suicide attempts and alcohol dependence when adjusted for socio-demographic factors and childhood conditions. Suicide attempts was associated with neglect during childhood, with frequent alcohol problems at home (OR=3.34 (CI 1.7-6.4) for women and OR=2.8 (CI 1.3-6.0) for men), having been sexual abused as a child (OR=5.88 (CI 3.5-9.8) for women and OR=4.6 (CI 2.4-8.7) for men), suicide by family members or close friends (OR=2.35 (CI 1.3-4.2) for women and OR=2.0 (CI 1.1-3.6) for men).

Conclusion: No association between suicide attempts and alcohol dependency were found when adjusted for socio-demographic factors and childhood conditions for men and women. The association between suicide and alcohol dependency is complex, however the results indicate that suicide attempts are associated with underlying factors related to a troubled childhood. Contact: Cecila Petrine Pedersen ([email protected])

SUICIDE AMONG INDIGENOUS SÁMI IN ARCTIC NORWAY 1970-1998

A. Silviken, T. Haldorsen, S. Kvernmo

Center for Sámi Health Research, Department of Community Medicine, University of Tromsø, Norway

Suicide mortality was examined in a cohort of 19, 801 persons categorized as Sámi in Arctic Norway between 1970-1998, stratified by age, gender, cultural context, and traditional Sámi core management. The results indicated that there was a significant moderate increased risk for suicide among indigenous Sámi (SMR=1.27, 95 %, CI: 1.02-1.56) compared to the reference population. In the study period, 89 suicides occurred (70 men and 19 women) with increased suicide mortality both for indigenous Sámi males (SMR=1.27; 95% CI: 0.99-1.61) and females (SMR=1.27; 95% CI: 0.77-1.99). The results showed a significant increased suicide mortality among Sámi aged 15-24 for both males (SMR=1.82; 95% CI: 1.13-2.78) and females (SMR=3.17; 95% CI: 1.17-6.91). Significant increased suicide mortality was found for indigenous Sámi males residing in Sámi core area (SMR= 1.54; 95% CI: 1.04-2.20) and for indigenous Sámi males not belonging to semi-nomadic reindeer herding (SMR=1.30; 95% CI: 1.00-1.65). Moreover, Sámi belonging to semi-nomadic reindeer herding household did not have significant increased suicide mortality.

In conclusion, the finding of a significant increased risk of suicide among Sami, is consistent with the general findings among other indigenous groups. However, compared to several others indigenous groups the suicide rates found among Sámi is moderate and may be explained by better living conditions and subsequently lower prevalence of general risk factors. Furthermore, several common features concerning indigenous suicide have been identified among the Sami, such as within group variation, age distribution, gender differences, cluster of suicides and frequent use of violent methods. Contact: Anne Silviken ([email protected])

A CULTURAL MODEL OF SUICIDE PREVENTION FOR CARRIER FIRST NATIONS YOUTH

H. Harder


Carrier Sekani First Nations Peoples have their own institutions for maintaining language, governance, health and knowledge related to all aspects of life. Carrier legal systems, such as the bah’lats, are situated to address governance of knowledge generated from within their communities and provide mechanisms for the protection of individual and community knowledge. In addition to traditional mechanisms, Carrier Sekani Family Services, an institution responsible for health, social, and legal services to eleven First Nations communities in the Central Interior of British Columbia has developed a research department and research ethics policy and in doing so has become a leader in community-based research.

The youth suicide research project is an example of a partnership with the University of Northern British Columbia (UNBC), funded by the Canadian Institutes for Health Research (CIHR), Institute for Aboriginal Peoples Health, that directly responds to goals of ethical research conducted in First Nations’ communities. The project investigates the effectiveness of community-based interventions in preventing suicide and tracks youth views of self-esteem, depression and other indicators over the course of the project. The knowledge gained from this research project will help guide CSFS and its member communities in offering programs and services that will assist in reducing the number of suicides in our communities.

This presentation will focus on how this research is reflective of the needs of community including development of a community steering committee, community ownership of information, involvement of community in all aspects of the project and the use of interventions such as culture camps that provide direct community benefit from the onset of the research. In addition, we will present our findings regarding pre testing, design of the intervention model, community overviews and results from culture camps. Contact: Henry Harder ([email protected])


THE ETHNIC AND CULTURAL FEATURES OF COURSE OF ALCOHOLISM IN INDIGENOUS PEOPLES OF THE NORTH OF KHABROVSK TERRITORY

P. Lubov

Regional Association of Indigenous Peoples of the North of Khabarovsk

Alcoholism is one of the topical and terrible health problems among IPs.

Alcoholism is one of the grave problems that needs to be solved urgently especially with regard to IPs rather than other people, because life of IPs is at stake. High level of suicides is directly related to alcoholism.

The indigenous reindeer herders, fishers and hunters lived in conjunction with nature note breaking natural sustainability. Forced sedentary way of life implied indigenous peoples had to be forcibly engaged in non-indigenous trades and occupations, new forms of work relations, new ways of behaviour . As a result they felt psychological tension and emotional depression that they could ease with the help of alcohol. Long chronic stress caused by rude intrusion of civilization that was imposed on indigenous cultures.

Causes of Destructive changes affecting health:

- Destruction of traditional way of life and change of food as a result

- Lack of qualified medical care because the villages are situated far away from towns and cities.

- Hospitals are closed in indigenous settlements - Loss of religious and spiritual roots and language - New work relations have been introduced

In some villages the medical measures were undertaken in order to cure alcoholism, however as the reality showed, the effect was short if ill people did not receive social rehabilitation. Contact: Passar Lubov ([email protected])

GAMBLING: A NEW PLAYER IN GREENLANDIC PUBLIC HEALTH RESEARCH

C.V.L. Larsen, P. Bjerregaard

Greenland Institute of Health Research and Centre for Health Research in Greenland, National Institute of Public Health, University of Southern Denmark

Background: A growing public and professional awareness of pathological gambling combined with the acknowledgement of a yearly increase in revenues among gambling suppliers, has led to an interest in gambling in public health research in the Arctic.

This paper aims to analyse gambling patterns and the prevalence of pathological gambling among Inuit in Greenland and its association with socioeconomic position and childhood conditions. The underlying hypothesis is the social epidemiological assumption of an uneven distribution of gambling problems among different social groups in society corresponding to the social inequality in health. In order to analyze inequality we need to know more about how to best define social groups in Greenland today.

Methods: Analyses include 1331 Inuit from Greenland, ~18 years, from a cross-sectional study conducted in 2005-2007. Data were collected by an interview and a self-administered questionnaire. The participants reported time and money spent regarding four different types of gambling. Four questions addressed pathological gambling. The questionnaires also included questions on current socioeconomic conditions as well as childhood conditions.

Results and Discussion: Preliminary analysis showed that 77 % of the participants had engaged in gambling activities during the last year. No difference was found between men and women but gambling varied according to age group (p<0,001). The relevance and validity of socioeconomic position and childhood condition as social determinants for gambling require a methodological study, which has not previously been carried out in Greenland. Besides sex and age,

childhood conditions, education, occupation, income and assets can be used as measures of socioeconomic position. These measures have not been sufficiently validated in an Arctic context and the quality of the variables is there for unknown. The validity of different measures of socioeconomic position among Greenland Inuit will be discussed in relation to pathological gambling. Contact: Christina V. L. Larsen ([email protected])

VENUE 2 Women’s & Family Health & Well-Being #1 – Fetal

Alcohol Spectrum Disorder

CULTURALLY APPROPRIATE RESPONSES TO FASD


Pauktuutit Inuit Women of Canada has been at the forefront in examining FASD throughout Inuit Nunaat. Through education and community-based involvement, Pauktuutit has created a variety of resources and tools for Inuit women to address this completely preventable condition. From a culturally relevant calendar to ensure Inuit women have a tool to chart their way through a healthy pregnancy to a handbook on FASD, Pauktuutit is actively promoting healthy lifestyles to ensure healthy babies. Research in the general population shows that children who are affected by FASD have much better outcomes if interventions occur early. Pauktuutit is identifying quality practices used in Inuit day care centers to work with FASD affected children. These practices will be shared with the other centers to ensure all children’s healthy development across all developmental domains and that family is supported in their role as primary caregivers. Related issues include the inherent danger of labelling children incorrectly through assessment and diagnostic tools that are not culturally appropriate, the compounded issues of FASD-affected mothers of FASD-affected children, as well as the costs associated with providing a broad range of services to assist children and their families in small communities. Pauktuutit will discuss its community-based research on quality practices that may be used when working with FASD-affected children in a culturally sensitive manner, successful Inuit-specific projects, lessons learned, and the challenges and opportunities ahead. Contact: Pauktuutit Inuit Women of Canada ([email protected])

VIEWING AND UNDERSTANDING FETAL ALCOHOL SPECTRUM DISORDER FROM A DISABILITY PERSPECTIVE

D. Reid

Government of the Northwest Territories

An examination of Fetal Alcohol facets promotes the perspective that this disorder should be viewed from a disability perspective. This view may result in an increased willingness by members of society to identify individuals who have or may have FASD, accommodate their needs, and advocate for assessment and diagnosis. An individual born with an FASD must live with this primary disability for his or her lifetime. Adequate and appropriate supports and interventions can, and should be put in place to help ease challenges and limitations for individuals as early as possible and throughout every stage of life. If such measures are not in place, individuals with this disorder are quite likely to encounter secondary disabilities. While it is much easier for service providers, professionals, community and family members to focus on visible aspects of this disability, it is imperative that efforts be concentrated on the invisible aspects; the organic brain injury. FASD can be accompanied by approximately 60 other co-occurring disabilities and disorders. Accommodation and supports for individuals with this disorder will also help individuals with other disabilities or barriers. Finally, in 2006, the Supreme Court of Canada ruled addictions, one contributing factor of FASD, is a disability.


Topics to be examined include: definition of disability, people with this disability have strengths, the spectrum of a disability, the normalcy of living with FASD, the speed of information delivery and processing, what is it like to have FASD, and what we can do to support individuals with this disability. The session will utilize lecture, interactive, discussion and Q & A formats. Contact: Doreen Reid ([email protected])

A COMPREHENSIVE APPROACH TO FETAL ALCOHOL SPECTRUM DISORDER

S.K. Clarren, A. Salmon

The Canada Northwest FASD Research Network Central Office at the Child and Family Research Institute, Vancouver, British Columbia

The governments of the Northern Territories and Western Provinces of Canada created the Canada Northwest FASD Research Network to comprehensively approach the prevention, diagnosis, and treatment of Fetal Alcohol Spectrum Disorder. FASD is a lifetime condition that needs to be understood across the life span. The Network believes that positive and efficient progress in understanding and acting on FASD will only come when government policy makers, researchers, clinicians, communities, families, and individuals with FASD can work together. To support this goal, Network Action Teams (NATs) conduct research that bridge knowledge gaps according to priorities identified by each of these stakeholder groups. In this presentation we will summarize the advances in knowledge achieved by the Network. The NAT on Diagnosis has: 1) established accurate multiethnic norms for palpebral fissure measurements; 2) established a clinical standard for assessment of the diffuse brain dysfunction typically found in people with FASD; and 3) developed a common multi-site set of forms for medical information in order to increase consistency in clinical sites. The NATs on Prevention are evaluating: 1) the effectiveness of primary prevention campaigns regarding alcohol use in pregnancy; 2) the outcomes of mentoring programs that work with women who have had alcohol-exposed pregnancies, 3) the most effective means of incorporating FASD prevention into the range of systems and programs that serve women with substance use problems. Finally, the NAT on Invention is determining the availability and effectiveness of the recommendations made by FASD diagnostic clinics in education, mental health, social service, justice, and related systems. They are also developing a lifelong developmental trajectory for understanding the multi-faceted needs of people with FASD across the lifespan. Contact: Sterling Clarren ([email protected])

AN EDUCATION OF HEART, HAND, MIND, AND SPIRIT- THE BLANKET TOSS TOOLS FOR SCREENING, ASSESSMENT, AND INTERVENTION OF FASD AND OTHER DEVELOPMENTAL CONDITIONS- A RELATIONAL SYSTEMS APPROACH

L.V. Cox

Elsipogtog First Nation New Brunswick

The Blanket Toss Tools for Northern Communities provide a wholistic community based approach to the screening, prevention and intervention of FASD and other developmental disorders. They were adapted from tools chosen by PHAC, the Public Health Agency of Canada and FNIB, First Nation and Inuit Health Branch for development nationally after consultations with community members and a panel of experts. These tools grew out of work in an indigenous community in the south, bridging the gap between traditional ways of knowing and a modern scientific perspective. One elder in the community spoke of two-eyed seeing – if we use one eye to look through traditional lens and the other a scientific lens we get a much more in-depth perspective. This approach led to wholistic interventions in the community and school that significantly increased rates of literacy and decreased rates of youth crime in the community. Members of Northern Inuit communities in Labrador and Nunavit participated in consultations to adapt the tools for a northern context.

This paper will look at this relational system approach to the problem of maintaining cultural identity in the screening, prevention and intervention of FASD and other developmental disorders caused by trauma and pre-natal exposures. Tools include Blanket Toss Student Index, Blanket Toss Community Development Tool, Blanket Toss Difference Game Cards, Blanket Toss Developmental History Tool and Blanket Toss Basic Skills Check List. A DVD of the original program in First Nation community in the south is available on the CAPHC, Canadian Association of Pediatric Health Centers website Contact: Lori Vitale Cox ([email protected])

PERSONAL ECOLOGY AND ENVIRONMENTAL STRUGGLES FOR BIRTH MOTHERS OF CHILDREN WITH FETAL ALCOHOL SPECTRUM DISORDER

D. Badry

University of Calgary, Canada Northwest FASD Research Network (Network Action Team on Women’s Health)

The birth of children with Fetal Alcohol Spectrum Disorder (FASD) represents a life phenomenon with serious repercussions for children, families, community and society. Alcohol misuse contributes to an ecology where families and children live on the fringes of society with limited opportunities to fully engage and thrive in the community. The personal ecology of women who give birth to children with FASD is important to understand in order to bring about systemic change in relation to responses to women, and in the interest of decreasing the incidence of FASD. This presentation will offer a philosophical perspective based on current research by Dr. Badry and colleagues on mentorship, the lives of birth mothers and support programs. A depth understanding of birth mothers of children with FASD offer a foundation from which to examine issues from individual and systemic perspectives. FASD is a global problem and increasing awareness of women’s issues are critical in a discourse of change. Contact: Dorothy Badry ([email protected])

YUKON FAS DIAGNOSIS TEAM; DEVELOPMENT OF A TEAM- MOUNTAINS TO CLIMB, VALLEYS TO CROSS

B. Grueger

University of Alberta and University of Calgary

This is a description and discussion around the development of an FASD diagnostic team in the north. It highlights barriers and difficulties encountered and successes, and describes the development of a team. A short overview of the work done during the last 4 years will be provided. It is designed to provide a baseline to start discussion about FASD diagnostic services in the north. Contact: Barbara Grueger ([email protected])

VENUE 3 Food Security #4 – How Are We Eating?

PEOPLE DO NOT EAT N-3 FATTY ACIDS, THEY EAT MEALS

P. Bjerregaard, C. Jeppesen

National Institute of Public Health, University of Southern Denmark and Department of Family and Health, Greenland Government

Introduction: In studies of the effects of diet on cardiovascular disease and diabetes among the Inuit there has for years been a tendency to reduce the variation paradigm of Inuit diets to a simple question of more or less intake of marine fatty acids. This approach somewhat arbitrarily focuses on the role of n-3 fatty acids and does not sufficiently acknowledge the fact that a traditional food pattern is composed of many nutrients with specific effects on cardiovascular health and diabetes. Food patterns are also associated with many non-dietary risk factors.


Design: In a cross sectional design, we studied diet and risk factors for cardiovascular disease and diabetes among 2247 Inuit in Greenland. From a 67 item Food Frequency Questionnaire, six dietary patterns were identified by factor and cluster analysis. The intake of n-3 fatty acids, saturated fat, fruit, vegetables, alcohol, sugar, fibres, and the glycemic load was computed. Non-dietary risk factors included obesity, physical activity, hypertension, smoking, socioeconomic position, and Inuit ancestry. Associations were analysed in General Linear Models and logistic regression adjusted for age and sex.

Results: The six dietary patterns comprised two patterns with significant shares of traditional food (N=548) and four patterns with predominantly imported food (N=1485). All dietary and non-dietary risk factors, except hypertension, differed significantly among the six dietary groups (p<0.001 to 0.01). A traditional diet differed significantly from an imported diet with respect to the intake of n-3 fatty acids, fruit, vegetables, dietary fibres, sugar, and glycemic load. A traditional diet was furthermore associated with a high level of physical activity, high prevalence of smoking, poverty, and Inuit ancestry.

Conclusion: Some risk factors associated with a traditional diet reduce and some increase the risk for cardiovascular disease and diabetes. Epidemiological studies of the association of diet with cardiovascular disease and diabetes among the Inuit must take the complexities of the diet and the confounding by non-dietary risk factors into consideration. Contact: Peter Bjerregaard ([email protected])

DETERMINANTS OF CHANGE IN FAT CONSUMPTION PATTERNS IN NAIN, NEWFOUNDLAND

S. Bernier, C. Furgal, K. Winters, E. Dewailly, the Nunatsiavut Government.

Nasivvik Centre for Inuit Health and Changing Environments

Inuit communities are reporting changes in individual attitudes towards traditional fats and contemporary fats. Given the potential health effects of these changes, a better understanding of how choices are made is needed.

This study is investigating the changing nature of perspectives on traditional and contemporary fats and the impacts of these perspectives on diet and other behaviours among Inuit in one community of the Nunatsiavut Settlement area, Canada.

This research project supports the role of Inuit health organizations in providing information and nutrition education tailored to local needs and preferences, on matters of food, nutrition and health. This project is being conducted in collaboration with the Nunatsiavut Government under the IPY funded project on marine fats and Inuit health: URQSUK.

The project aims to develop and apply a survey tool to increase our understanding of fat choice behavior and to determine what Inuit residents believe is necessary and possible to ensure food security for future generations.

To build this tool, in July 2008, 9 focus groups were conducted with participants 14-70 years of age (23 women, 26 men). 78% participated in harvesting activities.

Preliminary results indicate that participants have noticed changes in fat thickness in country food species over time. Observations were primarily associated with caribou and birds. Differences in thickness of seal fat were attributed to seasonal changes and possibly, climate variations. Contrary to our preliminary hypothesis, it is not only among younger participants that behaviors to cut down or stay away from “fat” in the diet were mentioned but in fact more so among participants 30 years and over. Furthermore, participants reported that fat was cut off from store foods but very rarely from country foods. Based on these results a quantitative survey is being developed to investigate the representation of these perspectives among the community population in 2009. Contact: Susie Bernier ([email protected])

THE ASSESSMENT OF BONE MINERAL DENSITY, CALCIUM, AND VITAMIN D INTAKE AND EXPOSURE IN BRITISH ANTARCTIC SURVEY PERSONNEL

D. Boon, I. Grant, L. Gawn, S. Cross, K. Knapp, G. Vivian, C. Moniz, G. Rees, P. Marquis

The British Antarctic Survey & SCAR Expert Group

In order to maintain correct bone mineralization, adequate amounts of vitamin D, calcium and exercise are required. Although vitamin D can be found in food products such as oily fish, the primary source of our intake is from sun exposure (photoactivation). It is estimated that worldwide a billion people are vitamin D deficient, where latitude and subsequent sun exposure are playing a significant role in the epidemiology of this problem.

In order to establish how reduced sun exposure is affecting the bone mineral density (BMD) of healthy individuals, this research will look at healthy personnel based in the sun-deprived continent of Antarctica in the winter months, and compare the subsequent BMD loss incurred against a healthy UK based control group. Vitamin D deficiency as a result of a lack of sun exposure has never been studied in British Antarctic Survey (BAS) personnel before. The possible health implications for such a deficiency are potentially huge.

Antarctica is a unique environment, where fit and healthy medically screened BAS employees spend up to 2 years on the continent. Their exposure to UVB radiation as well as their diet and exercise levels will be monitored. Blood tests assessing bone turnover markers will be taken every 3 months. Furthermore, DXA bone scans will be undertaken prior to leaving, and on their return from Antarctica, allowing the effects of a low vitamin D status on BMD to be assessed. This group can therefore provide valuable information regarding the extent to which latitude and sun exposure are truly influencing vitamin D status.

It is hoped that the International Congress on Circumpolar Health will provide a forum to discuss the possibility of running parallel studies in the Arctic, where the BMD of people residing at high northern latitudes can be assessed alongside those in Antarctica. Contact: Daranee Boon ([email protected])

AN ASSESSMENT OF DIETARY INTAKE IN AN INUVIALUIT POPULATION TO HIGHLIGHT FOODS FOR A NUTRITIONAL INTERVENTION PROGRAM TO IMPROVE DIETARY INTAKE: RESULTS FROM HEALTH FOODS NORTH

S. Sharma, E. De Roose, X. Cao, J. Gittelsohn, A. Corriveau


Objectives: 1) To characterize food and nutrient intake; 2) to highlight foods for a nutritional intervention program; and 3) to develop a Quantitative Food Frequency Questionnaire (QFFQ) to evaluate the program and monitor nutrition transition for the Inuvialuit population in the Northwest Territories (NWT), Canada.

Setting: Two communities in the NWT: one larger but less traditional and one smaller and more traditional.

Methods: A cross-sectional dietary study was conducted among Inuvialuit adults using 24 hour dietary recalls.

Results: 48 men and 53 women (mean age 49 and 45 yrs, respectively) aged 19-88 years completed the recalls. The response rate was approximately 70-90%. Mean energy intake was 2,352 kcal and 1,739 kcal for men and women, respectively. Mean daily intakes of many nutrients including dietary fiber, calcium, and vitamins A, C and E, and total folate were much lower than recommended. Mean daily intake of fruits and vegetables was low. The greatest contributors to energy were sugar added to tea and coffee, sweetened juices/drinks and pop. Butter and margarine were the highest contributors to total fat intake. Traditional foods were only significant contributors to protein, iron and zinc. A 145-item QFFQ was developed based on the dietary recall data.


Conclusions: This study has provided dietary intake data previously unavailable for this population, and highlighted nutrients and foods to be targeted for the nutritional intervention program. The QFFQ developed for Inuvialuit is culturally appropriate and up-to-date.

Acknowledgements: We thank Andrew Applejohn for his incredible assistance and guidance, as well the participating communities. We would also like to thank the Aurora Research Institute for their tremendous support of our work. The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57. Contact: Sangita Sharma ([email protected])

FOOD AND NUTRIENT INTAKE OF INUIT ADULTS AND THE DEVELOPMENT OF A QUANTITATIVE FOOD FREQUENCY QUESTIONNAIRE TO EVALUATE A NUTRITIONAL AND LIFESTYLE INTERVENTION PROGRAM AIMED AT IMPROVING DIETARY INTAKE AND HEALTH: RESULTS FROM HEALTHY FOODS NORTH

S. Sharma, X. Cao, C. Roache, R. Reid, J. Gittelsohn


Objectives: To characterize the diets of adult Inuit, to highlight foods for a nutritional and lifestyle intervention program, and to develop a Quantitative Food Frequency Questionnaire (QFFQ) to evaluate the program and monitor changes in dietary intake in this population over time.

Setting: Two remote communities in Nunavut, Canada.

Methods: A dietary survey using single 24 hour dietary recalls was conducted among randomly selected Inuit adults.

Results: A total of 87 (42 men and 45 women) Inuit adults aged 19-87 years participated with a response rate of approximately 70-90%. The mean energy intake for men and women was 2,278 and 1,658 kcal respectively. The intakes of dietary fiber and the majority of vitamins and minerals examined (especially vitamins A, D and E, total folate and calcium) were far below those recommended. The most commonly reported items were all store-bought foods including coffee, white bread, sugar, juice, tea, butter or margarine, coffee mate, chips and pops which were reported by between 29%-70% of respondents at least once per day. Traditional foods contributed 40% and 42%, respectively, to protein and iron intakes. We highlighted foods high in fat and sugar that will be targeted and replaced by healthier, more nutrient dense alternatives to address the dietary inadequacies as part of the Healthy Foods North nutritional intervention program. A 153-item QFFQ was developed and pilot tested based on the recall data.

Conclusions: These findings highlighted foods to be targeted for a nutritional intervention program aimed at improving dietary intake and health.

Acknowledgements: We are grateful to Ms. Annie Buchan and Ms. Rahabi Kamookak for their incredible guidance and hard work on the project. The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57. Contact: Sangita Sharma ([email protected])

QUALITY ASPECTS OF THE INUIT DIET IN GREENLAND

C. Jeppesen, P. Bjerregaard

Centre for Health Research in Greenland Directorate of Health and National Institute of Public Health

Background: Greenland undergoes a dietary transition, which together with other factors has led to an increasing prevalence of obesity and life style diseases among the Inuit. Dietary quality indexes have been found to be an useful indicator of nutritional quality of diet in many populations. This study aims to investigate how the dietary quality varies by sex, age, urbanization, and occupational level.

Methods: Data are from a cross-sectional study among Inuit >18 years in west Greenland. Data were collected by food frequency questionnaire and interviews. In the analyses we included men and women with a daily consumption of 3350-17 000 kJ and 2100-15 000 kJ, respectively. Eligible individuals totalled 2034 (43% men). We constructed a dietary quality index based (range 0-100, 100=best quality) on: gram dietary fibre/MJ and energy percentage of saturated fat. The dietary quality score (DQS) was calculated for each item based on the dietary content of the component compared to the Danish nutritional recommendations. By logistic regression we examined whether age, sex, urbanization and occupation influenced DQS constructed as a dichotomised variable: the highest 25% of DQS, and the lowest 25% of DQS.

Results: Women had significant higher chance of a high DQS than men (OR=2.4; 95%CI: 1.8-3.2). Inuit living in towns had the highest dietary quality (OR=1.3; 95%CI: 1.0-1.9) compared to the capital and villages. Fishermen and hunters (OR=0.2; 95%CI: 0.1-0.5), and the unemployed (OR=0.5; 95%CI: 0.3-0.8), had significantly higher risk of a low DQS compared to those employed where education at middle-high level was required.

Conclusions: Like in other populations women had a higher DQS than men. It seems that not having a continuously occupation leads to a higher risk of low dietary quality. Analysis could be expanded with data on household income in order to investigate this association further. Preferably, we should test other dietary quality indexes in order to find the best suitable index for an Inuit population. Contact: Charlotte Jeppesen ([email protected])

INFLUENCE OF CASUAL WEAR AND EVERYDAY DIET ON HEALTH

V. Dekabrina

Institute of Humanities and North Indigenous Peoples SB RAS

The research was carried out in December 2008 among the students of the Institute of Physical Culture and Sports of Yakut State University. 32 students (among them 12 girls) were offered to write a free-format short story on themselves. The story had to touch upon three things: what they wear in winter, where and what they eat, what they do when ail or ill. The analysis was based on comparing students’ “ideals” and their everyday practice.

By students’ admission, during winter term they often get cold, their chronic diseases (kidney, joints, heart etc.) become more acute. Chill is considered an ordinary thing, and they stay on their feet or practice autotherapy. Among usual reasons for ignoring medical assistance there are lack of time, queues in clinics, unwillingness to fail to attend classes, a doctor in the family, relatives’ and friends’ advice, possibility of self-treatment (taking advertised drugs).

However, majority of students are not inclined to connect their health problems with wearing synthetic fabric clothes, though many mentioned the necessity of warm winter clothing and the fact of being cold in their casual wear.

The analyses makes it possible to conclude on differences between imagined and usual practice. At first, dietary regime and ration difference cannot be explained only by lack of money. The possible reasons include defects both in curriculum (timetable of classes and coaching) and in everyday life of an individual student. Secondly, we must take in mind the choice of the modern wear made of synthetic fabric that is of little use in winter climate conditions in the area of permafrost. Contact: Vinokurova Dekabrina ([email protected])


VENUE 4 Infectious Diseases #4 – Hepatitis

FREQUENCY AND DISTRIBUTION OF HEPATITIS B VIRUS GENOTYPES IN GREENLAND ASSOCIATION WITH PRECORE AND BASAL CORE PROMOTER MUTATIONS

M.L. Børresen1, H. Krarup2, A. Koch1 1Department of Epidemiology Research, Statens Serum Institut, Copenhagen, 2Department of Clinical Biochemistry, Ålborg University Hospital, Ålborg, Denmark

Based on interdivergence of 8% or more in the complete hepatitis B virus (HBV) DNA-strain, HBV has been classified into eight genotypes (A-H) and many sub-genotypes with distinct geographical distribution. Recent studies have found an association between different genotypes and the clinical outcome as well as therapeutic response. Greenland is an HBV high-endemic country and between 5-10% of the population are chronic carriers. There is little knowledge of the genetic variability and molecular evolution of the HBV strains in Greenland. We therefore carried out a study to characterize the distribution of HBV genotypes/subgenotypes as well their association with basal core promoter and precore mutations in a cohort of 150 HBsAg positive individuals from the Southwest and South of Greenland. Genotypes were determined via a nested PCR of a region of the S-gene. We found four different genotypes, A, B, C and D, with 60% being genotype D2, 24% genotype A, 15% genotype B6 and 1% genotype C. To characterize the Greenlandic genotype distribution and clustering a phylogenetic tree will be constructed and compared to genome sequences of different variants of HBV from the GenBank database. Furthermore types and rates of mutations of the genotypes will be presented. Contact: Malene Landbo Børresen ([email protected])

GENOTYPIC CHARACTERIZATION OF HEPATITIS B VIRUS FROM CHRONIC CARRIERS LIVING IN THE CANADIAN NORTH

C. Osiowy1, B. Larke2, E. Giles1 1Public Health Agency of Canada, National Microbiology Laboratory, 2Yukon Department of Health and Social Services, Canada

Introduction: Chronic infection with hepatitis B virus (HBV) is the most common cause of primary liver cancer worldwide. Very little is known regarding the molecular characterization of HBV in Canadian Inuit and other Northern Indigenous populations, where HBV was considered endemic prior to the introduction of hepatitis B vaccination programs. This study expands upon an HBV seroepidemiological study conducted between 1983 and 1985 throughout the Canadian Arctic in order to further characterize HBV in these populations.

Methods: HBsAg-positive sera collected during the original study were extracted and amplified to detect HBV DNA. Sequence and phylogenetic analyses were performed to determine nucleotide variations, viral genotype and phylogenetic groupings. Associations between the HBV genotype and demographic and geographic attributes were also analysed.

Results: A total of 14,198 individuals living within the Canadian Arctic participated in the original serosurvey. Archived sera from 401 HBsAg-positive participants were tested for HBV DNA. Sixty-nine percent of samples (277/401) were DNA positive, with the majority having very low viral load (median IU/ml: 1.87E +03). The predominant HBV genotype was genotype B (HBV/B, 76%), followed by HBV/D (23%) and HBV/A (1%). Following phylogenetic analysis, all HBV/B strains clustered within subgenotype B6, a newly recognized HBV genotype among Inuit and other Aboriginal people living within western circumpolar regions. The majority of HBV carriers had mutations associated with loss of the HBeAg marker, whereas very few had mutations associated with development of hepatocellular carcinoma.

Geographic and demographic attributes were observed to be divided among the various HBV genotypes.

Conclusions: The observation of a very high prevalence of HBV/B6 within the Canadian Arctic, along with our recent finding of a relatively benign clinical outcome in patients infected with B6, presents the possibility of a reduced impact of health burden related to HBV infection among Aboriginal populations in this region. Contact: Carla Osiowy ([email protected])

A POPULATION BASED PERSPECTIVE AND RETROSPECTIVE STUDY OF LIVER RELATED MORTALITY IN ALASKA NATIVE PEOPLE WITH HEPATITIS C INFECTION

B.J. McMahon1,2, D. Bruden2, M. Bruce2, S. Livingston1, C. Christensen1, C. Homan1,2, J. Williams1, D. Sullivan3, H. Rosen4, T. Hennessy2, D. Gretch3 1Liver Disease and Viral Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK. 2Arctic Investigations Program, Centers for Disease Control and Prevention, Anchorage, AK, 3University of Washington, School of Medicine, Seattle, Washington, 4University of Utah, School of Medicine, Denver, Colorado

Hepatitis C virus (HCV) infection is a cause of significant morbidity and mortality in Alaska Native People. Risk factors associated with adverse outcome are not well elucidated. We conducted a prospective population-based study from 1/1/1994 to 12/31/05 examining the incidence of and risk factors associated with the development of endstage liver disease (ESLD) and liver related death.

Methods: Retrospective computerized medical records and stored sera were available on most patients. Univariate and multivariate analysis was performed and survival models developed to examine factors statistically associated with development of liver-related death.

Results: 1114 persons were followed prospectively for an average of 7 years and another 12 years of retrospective data were available. 695 persons had chronic HCV and 214 had recovered spontaneously. ESLD and liver-related death occurred in 80 and 50 persons respectively. The liver related death rate (per 100 person years of follow-up) among persons who drank > 50 grams of alcohol/day on average was 2.28 in chronically infected person vs. 3.50 in recovered HCV patients (p=.34). Among those who drank < 50 grams/day, rates were 0.77 and 0.09 (p=0.01). For persons who had recovered from HCV, the mortality rate was 20 times higher in those who continued to consume > 50 grams/day of alcohol vs. those who did not. On univariate analysis, heavy alcohol usage, older age at infection, AFP > 8 ng/ml, AST/ASL > 1, viral load > 800,000 IU/ml, and genotypes 1 and 3 vs. genotype 2 were associated with greater risk of developing ESLD; however, diabetes, obesity, route of infection (intravenous drug use vs. blood transfusion), anti-HBc and or anti-HBs without HBsAg were not.

Conclusion: Heavy alcohol use is associated with the highest risk of liver-related death or ESLD, regardless of whether persons are chronically infected or have recovered from HCV. Contact: Brian McMahon ([email protected])

ABORIGINAL IMMUNITY: POTENTIAL CONTRIBUTION TO THE OUTCOME OF HEPATIC INFECTION AND DISEASE

J. Rempel


One of the main tasks of the immune system is to defend the body against infectious disease. Our laboratory has been evaluating First Nation (primarily Ojibwa/Cree) immunity against hepatitis C virus (HCV) because of the high prevalence of acute HCV infection, and therefore, chronic HCV infection, relative to other Canadian populations. However, recent studies by Minuk et al and other groups suggest that First Nations clear acute HCV infection more effectively than other peoples, perhaps partially mitigating the chronic HCV burden. Our studies found differences between First Nation and Caucasian immune activity that may explain these clinical findings.


Pairing genetic and cellular assays, differences were observed in immune responses that are responsible for either activating or inhibiting the immune system. First Nations appeared to develop responses that associate with a more activated immunity, as determined by the genetic tendency and cellular ability to produce certain cytokines (immune regulatory proteins). In addition, differences in the presence of receptors (killer Ig like receptors, KIR) that modulate immune responses were found. These immune trends observed in First Nation relative to Caucasian individuals parallel trends from studies evaluating immunity upon spontaneous HCV clearance relative to chronic HCV infection. Thus, our data support the observation that First Nation immunity is more capable of clearing HCV infection than other peoples. On a cautionary note, these same immune responses that protect the body from viral infections can also predispose an individual to develop certain other conditions that are more common in the First Nation People, such as autoimmune disorders. Contact: Julia Rempel ([email protected])

LONG-TERM PROTECTION AFTER HEPATITIS B IMMUNIZATION IN ALASKA NATIVE PEOPLE

B. McMahon, L. Bulkow, J. Williams, D. Bruden, M. Snowball, S. Negus, D. Hurlburt, C. Zanis, K. Boyd-Hummel, E. Dunaway, R. Singleton, C. Homan, A.J. Parkinson, M. Bruce, T. Hennessy

Alaska Native Tribal Health Consortium & the Arctic Investigations Program, Centers for Disease Control, Anchorage Alaska

Routine immunization for hepatitis B virus (HBV) was initiated in the early 1980s. Several studies were established to determine long-term protection in cohorts of Alaska Native People and non-Natives who received a three dose primary series of hepatitis B vaccine.

Methods: Beginning in the early 1980s, 1,864 persons (334 immunized starting at birth and 1,530 immunized as children and adults) were followed for 15 to 23 years with HBV seromarkers. Booster doses were administered to persons who lost protective antibody to hepatitis B antigen (anti-HBs) to determine anamnestic response.

Results: In persons immunized as children (>6 months of age) or adults, the proportion of persons with anti-HBs > 10mIU/ml fell from 94% 6 months after primary series to 66% at 15 years and 59% at 23 years of follow-up. In the cohort immunized beginning at birth, only 8% had anti-HBs levels > 10 mIU/ml at 10 years. Anti-HBc-positive breakthrough infections were seen in 29/1,864 (1.6%) long-term vaccine follow-up participants. Of those, eight had HBV DNA present transiently, including one with 142R escape mutant. None had acute symptomatic hepatitis or became a chronic carrier. Booster dose studies performed in those immunized as children or adults showed that >80% whose levels of anti-HBs had fallen to <10 mIU/ml responded and the overall protective efficacy of this vaccine 23 years later was 94%. In contrast, response to booster dose was less vigorous in those immunized as neonates, as by 15 years only 50% had a booster response despite the evidence that there were no clinically apparent breakthrough infections.

Conclusion: Long-term protection lasts at least 23 years in those immunized as children or adults and at least 15 years in those immunized as neonates. Also, there is no evidence that vaccine escape mutants are replacing wild type HBV in this population. Contact: Brian McMahon ([email protected])

MOLECULAR EPIDEMIOLOGY OF VIRAL HEPATITIS B, C, AND D IN THE CHUKOT REGION

I.V. Karandashova1, A.D. Neverov1, E.V. Fast2, V.A. Dolgin1, S.I. Braslavskaya1, V.P. Chulanov1

Russian Association of Indigenous Peoples of the North (Raipon), 1Central Research Institute of Epidemiology, Moscow, Russia, 2Chukot Regional Hospital, Anadyr, Russia

Introduction: Genotypes of hepatitis viruses B and D can be clinically and epidemiologically relevant. We studied prevalence of genotypes of these viruses in the Chukot region.

Materials and Methods: Serum samples from 124 chronic hepatitis B (CHB) patients (65 males, 59 females) from the Chukot region were included. 113 (91%) were natives (103 Chukchi, 10 Eskimo), and 11 non-natives. Samples were studied by PCR for HBV and HDV. HBV genotyping was performed by subtype-specific PCR. 59 HBV and 48 HDV isolates were sequenced. Phylogenetic analysis was performed by ML and NJ algorithms with bootstrap analysis (1000 repeats).

Results: HBV DNA was amplified in 92 cases (74.2%). In 65 patients (70.6%) genotype D was detected, in 24 (26.1%) — genotype C, and in 3 samples (3.3%) were found to be D/C recombinants. Among sequenced samples 32 were subtype D3, 2 — D2, and 1 — D1. Subtypes D1 and D2 were isolated only from non-native patients, subtype D3 — mainly from natives (91%). Genotype C was prevalent in natives and belonged to C1 subtype. D/C recombinants were found in natives only. 62 samples (50%) were found to be HDV positive. HDV was detected in all D/C recombinants, in 59% of genotype D and in 13% genotype C samples. 47 (98%) of HDV isolates were of genotype I and 1 (2%) — of genotype II.

Conclusion: HBV genotype C and subtype D3 are much more prevalent in Chukot region than in the other regions of Russia and were shown to be endemic for Chukot natives. Half of CHB patients are co-infected with HDV. HDV is presented by two genotypes — I and II, with obvious predominance of genotype I. Significant difference in prevalence of HDV among patients with genotypes D and C of HBV could be due to different time and routes of their introduction into Chukot region. Contact: Fast E.V. ([email protected])

VENUE 5 Education and Building Resource/Research Capacity #2

BY THE NORTH FOR THE NORTH: A PAN-TERRITORIAL STRATEGY TO BUILD PUBLIC HEALTH CAPACITY

M. Bell

Skills Enhancement for Public Health: Core Competencies for Public Health in Canada & Skills Online, Public Health Agency of Canada

Note: This is the first of 3 topics in a Panel discussing the Skills Enhancement for Public Health programme. Other presenters are Jamie Rossiter/Laurie Parton and Tom Axtell.

Following extensive consultation, the Public Health Agency of Canada launched the Core Competencies for Public Health in Canada: Release 1.0 in September, 2007. Core Competencies define the essential knowledge, skills, and attitudes necessary for effective public health practice. They are foundational for public health human resource planning and workforce development. The Core Competencies are being used in a variety of settings to inform the development of orientation and performance assessment tools, identify continuing education needs, influence public health curriculum, and assist in human resource planning.

Since 2002, the Agency’s Skills Online program has offered Internet-based continuing education in English and French to interdisciplinary, front line public health professionals through a series of accessible, competency-based modules. Participation in the modules helps practitioners to acquire and maintain the Core Competencies, and contributes to the increased capacity of Canada’s public health workforce, which is widely distributed both geographically and organizationally.

While public health human resource capacity is a challenge nationally and globally, these challenges are particularly acute in the North where recruitment and retention of public health professionals can be linked to many quality of life factors. There are not enough skilled public health professionals and training and professional development


opportunities are limited. However, there are significant strengths in the North including strong, community developed and driven approaches to health and wellness.

Following northern consultations on the Core Competencies, the Skills Enhancement for Public Health program engaged stakeholders from the three Canadian territories to partner in the development of a strategic plan, tailored to the specific needs of the North, to address workforce development challenges. The pan-territorial strategy focuses on building capacity through education and training, targeted communications, and organizational support within the northern reality. The collaborative process illuminates insights and directions for putting the plan into action in Canada’s diverse North. Contact: Marnie Bell ([email protected])

PUBLIC HEALTH PROFESSIONAL DEVELOPMENT ONLINE: SUCCESSES AND CHALLENGES

J. Rossiter1, L. Parton2 1Skills Enhancement for Public Health: Core Competencies for Public Health in Canada & Skills Online, Public Health Agency of Canada, 2Yellowknife Health & Social Services Authority, Yellowknife, NT

The Public Health Agency of Canada’s Skills Online program offers continuing education to front-line public health professionals. This competency-based program contributes to strengthening capacity of Canada’s diverse public health workforce. To date, nine modules have been developed covering basic epidemiological concepts and various public health topics. Since 2002, over 2,800 practitioners have completed at least one module. In addition to Canadian learners, there have been participants from Africa and the Caribbean. Several modules have been adapted for use by universities in Canada and Australia. Evaluations indicate benefits to both individual practitioners and their organizations.

Modules are offered three times per year over eight weeks. For each module, a trained facilitator who is knowledgeable in the subject matter leads a cohort of 15 to 20 participants. Learning activities are delivered through an online asynchronous learning management system. As well as textual materials, modules contain video clips, links to important sources, assignments, discussion forums, and self-test questions. A demonstration of the format and use of the modules will be provided.

Modules are developed cooperatively by respected epidemiologists, health educators, experts in the field, and front line practitioners. Materials are reviewed regularly by a national task group to keep them current with respect to content, e-learning and adult-learning practices.

Recent research examined adaptations of modules at the University of Saskatchewan, and in the Caribbean. Results indicate that adaptations into new settings face pedagogical, technological, content development, and cultural hurdles. These challenges can be addressed through learning designs that considers appropriate learning objectives, skills of the learners, access to the Internet, and appreciation of cultural factors. These issues are especially important in the North where health care workers may not have the necessary public health background, education or experience, Internet accessibility issues are common and a range of different cultures are represented. Contact: Jamie Rossiter ([email protected])

PUBLIC HEALTH SKILLS ONLINE: PILOT FOR NORTHERN ABORIGINAL WORKERS

T. Axtell

Inuit Tuttarvingat, National Aboriginal Health Organization

Knowledge of epidemiologic concepts is essential to the practice of effective public health. Not all Inuit, First Nations and Métis in the North need to understand epidemiology, but for those who obtain jobs

in public health without a Health Sciences diploma or degree, it is essential.

Through Health Canada’s Aboriginal Health Transition Fund, the National Aboriginal Health Organization is building a Web-based clearinghouse of health-related statistics to enable the four Inuit land claim organizations and governments to further their knowledge of the determinants of health. Inuit Health Data Analysts must ensure that statistics are presented in a way that makes sense to Inuit audiences. The Naasautit (the Inuit word for meaningful numbers): Inuit Health Statistics project choose the Public Health Agency of Canada’s Skills Online Introduction to Epidemiological Concepts (EPI 1) module delivered to the desktop as the best way for staff to gain this knowledge in the context in which it would be applied, their workplaces.

In the fall of 2008, three Inuit and First Nations learners enrolled in the first Northern health worker pilot; two completed. Support through weekly teleconference meetings was the only adaptation to the module delivery for Northern learners. The meetings with an epidemiologist from the First Nations and Inuit Health Branch provided an oral learning component where knowledge was co-constructed with a mentor, co-workers, and peers. This oral communication provided some essential social support while shaping the learner’s identity as a public health practitioner.

The piloting of EPI1 has opened the door for effective online learning for Northern aboriginal health workers. Examples from the pilot describes the successes and challenges to learning in a remote setting and outlines areas for further adaptation to suit the needs of this audience. A larger second pilot in May 2009 will continue exploring module content and delivery adaptations for northern aboriginal workers. Contact: Tom Axtell ([email protected])

CREATING HEALTH RESEARCH CAPACITY: THE ABORIGINAL HEALTH NETWORK PARTNERSHIPS FOR BRITISH COLUMBIA AND THE WESTERN ARCTIC

J. Reading

Centre for Aboriginal Health Research at University of Victoria

The CIHR-Institute of Aboriginal Peoples’ Health (IAPH) is dedicated to reducing the burden of illness in the Aboriginal Peoples of Canada through a program of advanced research. The CIHR-IAPH has funded nine Network Environments for Aboriginal Health Research (NEAHR) across Canada. In British Columbia, the Michael Smith Foundation for Health Research (MSFHR) has funded eight Health of Population Networks one of which is the Network Environments for Aboriginal Research BC (NEARBC) which is dedicated to linking together the expertise of all individuals with an interest and expertise in Aboriginal health research. The Centre for Aboriginal Health Research (CAHR) is a group of researchers at the University of Victoria with an interest in Aboriginal Health Research.

In April 2008, funding from CIHR-IAPH and MSFHR was merged to create the entity called NEARBC. NEARBC is composed of three staffed geographical nodes, an oversight committee comprised of 18 experts in Aboriginal Health in BC and over 1000 members. Its main outputs are: Annual Aboriginal Health Student Fellowships and Awards, Seed Grants and Travel Bursaries, Complementary Training (i.e. workshops and conferences), Aboriginal Health Abstract Database, Website, Weekly e-news, Online Aboriginal Health Video Gallery, and Searchable Members’ Database. Task Groups: Complex Interactions in Chronic Disease, Ethics, Infectious Disease, Northern Health, Traditional Knowledge. Contact: Jeff Reading ([email protected])


THE NATIONAL COLLABORATING CENTRE FOR ABORIGINAL HEALTH: A CENTRE FOR SHARING KNOWLEDGE

G. Thomas, M. Greenwood


The Public Health Agency of Canada established six national collaborating centres in public health to support the federal strategy to strengthen public health in Canada. One of those centres is the National Collaborating Centre for Aboriginal Health (NCCAH) which is hosted at the University of Northern British Columbia in Prince George, British Columbia. Since its inception in 2005, the NCCAH has played a key role in supporting networks and facilitating dialogues focused on Aboriginal public health in Canada.

The long term goal of the NCCAH is to support a Canadian public health system that recognizes, and is respectful of, the needs of First Nations, Inuit and Métis peoples. In order to achieve this goal, its mandate is threefold: 1) to translate existing knowledge in Aboriginal public health into action; 2) to identify and address gaps in Aboriginal public health; and 3) to support networks that enhance the synthesis, transfer and exchange of knowledge in Aboriginal public health in Canada.

This presentation will demonstrate how the NCCAH has successfully brought First Nations, Inuit and Métis organizations together to address their public health issues along with strategies the NCCAH has undertaken to support them in addressing the challenges and issues they face. From the start, the work of the NCCAH was founded on a set of guiding principles that respects the diversity of First Nations, Inuit and Métis peoples and facilitates the inclusion of their voices in the work of the NCCAH, thereby ensuring its relevance to their communities.

Participants will be encouraged to lend their voices to a dialogue about public health and the needs of circumpolar peoples. Participants will also be invited to discuss activities that the NCCAH could undertake that would support them in realizing their health agendas. Contact: Ginette Thomas ([email protected])

SUSTAINING HEALTH RESEARCH ACTIVITIES IN CANADA’S NORTHERN TERRITORIES

S. Chatwood

Institute for Circumpolar Health Research

In Canada’s northern territories there have been a number of pan northern initiatives and programs over the past three years which have focused on health research. These programs include the International Polar Year Activities, the CIHR team in circumpolar health research, Tri territory health access programs and INAC Arctic Research Initiatives. All initiatives have created a stimulus for northern based health research activities and have created forums for further discussion as to what is entailed in health research and how one should proceed and make health research activities sustainable in our northern regions. These activities have also supported the creation of the Arctic Health Research Network and the Institute for Circumpolar Health Research. Through this development observations have been made around operational components which make up the health research process and the current capacity and gaps in our northern regions. This presentation will summarize some of these observations and provide a platform to discuss next steps required to continue the development of a sustainable northern health research structure. Contact: Susan Chatwood ([email protected])

A PAN-ARCTIC COLLABORATIVE FOR E-HEALTH: NEED, VALUE, AND LESSONS

R.E. Scott1, S. Khoja1, H. Durrani2

1Global eHealth Research and Training Program, University of Calgary, 2Pan Asian Collaboration for evidence-based ehealth Adoption and Application

eHealth (application of information and communications technologies (ICTs) to facilitate health, healthcare, and health related education and research), has become an accepted tool in addressing health issues, and has been stated to be “the single most important healthcare system revolution, on a par with the use of modern medicines, vaccines or even such healthcare measures as sanitation or clean water.” Similarly, networked research activities have noted benefits, including broader sharing of knowledge, increased scope for research activities, greater capacity building, and administrative resilience. Yet, no Arctic focussed eHealth research network exists, and the International Journal of Circumpolar Health shows only sporadic and low ehealth publication, with just 26 eHealth-related publications between 1988 and 2008, 19 of which were in the 2004 issue (following a special call and conference).

Given the importance of eHealth, the value of networked research undertakings, and the poor publication record for focussed Arctic eHealth research, introduction of a Pan-Arctic eHealth research network initiative may be appropriate. To highlight the value and challenges of such an initiative, the genesis and present day performance of PANACeA (Pan Asian Collaboration for evidence-based ehealth Adoption and Application) will be described, together with experience from other network research activities.

PANACeA is successfully generating evidence for eHealth within the Asian context through a network of researchers and research projects from developing Asian countries. They perform multinational projects to evaluate e-Health solutions in the field and to generate evidence through methodologically sound research. This evidence is intended to be scalable and generaliseable to other developing countries, and will be used to advocate for ehealth policies in Asian countries.

A networked research approach that focuses on eHealth implementation in the Arctic would lead to more rapid accrual of benefit from “technologically appropriate and culturally sensitive” ehealth solutions. Contact: Richard Scott ([email protected])

INTRODUCING INTERNET COMMUNICATIONS TECHNOLOGIES TO A NORTHERN HEALTH CONTEXT: BEST PRACTICES AND POTENTIAL IMPLICATIONS

R. Rawat

York University, Arctic Health Research Network - NT

In the last decade, internet communications technologies (ICTs) have rapidly emerged as a key aspect of health service provision in the developing world. From telehealth and knowledge management systems to community youth projects and personal blogs on patient and caregiver experiences, ICTs have seen widescale adoption. In the Circumpolar north, increasing internet access and bandwidth has allowed these technological practices to penetrate remote communities, although their use as aids to communications and information sharing have yet to be evaluated. This presentation will serve two purposes. For those organizations seeking to implement their own internet technologies strategies, the presentation will review the latest in open source software packages from content management systems to collaborative groupware. It will also provide a list of best practices for non-profit, service-oriented organizations to minimize costs, guarantee accessibility, and produce dynamic content. In support of this goal, insight from over ten years experience in designing, implementing, and managing ICTs in a health and social advocacy context will be shared. The second goal will take a broader look at the social and psychological implications of the introduction of ICTs. As powerful harbingers of global influences on highly localized populations, their manifold and complex impacts will necessarily have to become a field of inquiry. This presentation will take the tentative first steps in this area.


Contact: Rajiv Rawat ([email protected])

SESSION 7 Tuesday, July 14, 1:30-3:30 PM

VENUE 1 Housing & Infrastructure

HOUSING CONDITIONS AND TUBERCULOSIS: EXPLORING THE RELATIONSHIP BETWEEN DISEASE AND ENVIRONMENT IN NORTHERN FIRST NATIONS COMMUNITIES

L. Larcombe, P. Orr


Housing conditions are used as socio-economic indicators for health and well-being. Poor housing quality and overcrowding are associated with poverty, with specific ethnic groups, and with increased susceptibility to diseases. Crowding, poor air quality within homes as a result of inadequate ventilation, and the presence of mold and smoke contribute to poor respiratory health in general and have been implicated in the spread and/or outcome of tuberculosis. Qualitative and quantitative data were collected in two First Nation communities regarding housing conditions and tuberculosis. The single most important housing characteristic associated with the presence of tuberculosis (latent and disease) was the number of square feet per person. The presence of mold was recorded in over 50% of the houses but no statistically significant association was found between mold and the tuberculosis. It is hypothesized however, that the occurrence of mold in the houses may negatively affect the required cell-mediated (Th1) immune response to Mycobacterium tuberculosis (MTB) by priming a Th2 immune response. In addition, the Dené and Cree study cohorts maintain a high frequency of gene polymorphisms that may result in a less effective cell-mediated immune response to MTB than the Caucasian cohort. The a priori association between tuberculosis, poverty and inadequate housing needs to be more thoroughly investigated if we are to alleviate the burden of disease in northern Indigenous populations. Contact: Linda Larcombe ([email protected])

YOU JUST BLINK AND IT CAN HAPPEN: WOMEN’S HOMELESSNESS NORTH OF 60

A. Hache


Women have been identified as the fastest growing group in the homeless and at-risk populations. Few Northerners realize the full extent of the problem or understand the complex factors involved. Southern Canadians have less awareness. Realities of life in the North differ from those in southern Canada necessitating Northern research by Northerners. A pan-Northern consortium of Women’s groups, two from each Territory and Four Worlds Centre for Development worked closely together researching Women’s homelessness in each territory to inform policy and decision makers, social justice advocates and fellow Canadians of the reality of Women’s homelessness north of 60; to inspire political and social action.

A naturalistic research method that drew on feminist and grounded theory was used which privileged the voices of Northern homeless women, the research process remained iterative, participatory and action-oriented. Findings include: the demographics and incidence of homelessness; the determinants of homelessness; the impact of homelessness on women in the three territories; policy and bureaucratic practice environments related to homelessness; service

environments in the three territories; and relevant best practices. Research findings are presented alongside anthologies of homeless Women’s narratives giving equal value to the experiences and voices of participating homeless women.

Two main conclusions: all Northern women can be considered at risk of homelessness because a small change in their circumstances can jeopardize the fragile structure of their lives and, homelessness is largely hidden and easily ignored. Sixteen recommendations were generated for all three territories and recommendations specific to each territory.

We propose to lead an interactive workshop exploring our unique collaborative process, research process and notable findings; the impact of the research on services, awareness; ways the research has been used by communities. Participants will have an understanding of the dynamics of Northern Women’s homelessness and the power/synergy of trans-boundary work. Contact: Arlene Hache ([email protected])

EVERYONE WANTS TO HAVE A PLACE?: UNDERSTANDING HOMELESSNESS AS HOUSING INSECURITY IN THE NORTHWEST TERRITORIES, CANADA

J. Christensen

McGill University Department of Geography

Homelessness in the Northwest Territories (NWT) is commonly regarded as a recent phenomenon, and one that is growing and changing in ways particular to the northern context. The proposed Mackenzie Gas Project is expected to stimulate economic growth, as well as have other impacts, throughout the Beaufort-Delta region of the NWT. One area of social concern in the regional centre, Inuvik, is the possible consequences of resulting economic and social change on homelessness in the community.

Through this research, I explore the relationship between housing (in)security and pathways to homelessness in Inuvik; and then, examine the consequences of economic change on this relationship. The housing (in)security approach is rooted in an human security framework for studying the impacts of change on northern peoples. This research makes an important contribution to the small, but growing, body of research on the dynamics of homelessness in northern communities.

Adopting a community-based research approach, I collaborate with community members to develop a framework for understanding the meaning and context of housing (in)security in Inuvik. Using biographical interviews and housing histories, I explore the ways in which pathways to homelessness can be understood as reflections of deepening housing insecurity. Conversely, I also examine the factors that contribute to housing security and their potential for building pathways out of homelessness.

In this presentation, I discuss findings from qualitative fieldwork conducted in Inuvik through 2008 and 2009. I explore the housing insecurity framework and provide a “place-based” understanding of pathways to homelessness. In particular, I examine the ways in which patterns of colonization, government intervention and rapid sociocultural change shape geographies of homelessness in the North. Policy recommendations aimed at strengthening housing security are also presented. This project is a sub-project under the IPY Project: the Impacts of Oil and Gas Activity on Arctic Peoples Using a Multiple Securities Perspective (GAPS). Contact: Julia Christensen ([email protected])

ACUTE INFECTIOUS DIARRHEAL ILLNESS IN A FIRST NATIONS COMMUNITY IN NORTHERN MANITOBA, CANADA: EPIDEMIOLOGY AND THE IMPACT OF WATER, SANITATION, AND HOUSING

P. Hayward, B. Martin, P. Hazelton, E. Rubinstein, P. Orr

University of British Columbia


This prospective study was undertaken in partnership with a First Nations (FN) Oji-Cree community in northern Manitoba in order to describe the epidemiology and infrastructure determinants of acute infectious diarrhea (AID), and also to build capacity within FN communities to engage in research in order to answer questions of importance to them. In collaboration with the community (population 3418), the Four Arrows Regional Health Authority and the J.A. Hildes Northern Medical Unit of the University of Manitoba, persons experiencing AID were recruited over a 12 month period from 2006-2007. One hundred forty-two stool samples and questionnaires were collected. Mapping of water, sewage and housing infrastructure was performed. Microbiologic analysis of stool identified Bacillus cereus (5.8% of samples) and Campylobacter jejuni (5.8%) as the most common bacterial pathogens; Norovirus (19.7%) was the most common viral agent. Rotavirus was found in only 1.4% of samples. The presence of stool pathogens was significantly (p=0.01 for each) associated with lack of accessible clean water, and crowded housing. Toilets in some houses were found to be non-functional; those who did not have access to an outhouse were more likely to have stool positive for Aeromonas and B. cereus. Additional concerns that were identified relate to maintenance and use of chlorination systems, cisterns, home water containers and lake water; the latter receives sewage effluent. The results were shared with the community through presentations to community leaders. In this presentation we explore the meaning of these results within the larger context of the relationship between infrastructure problems and the health of FN individuals and communities. Contact: Punam Hayward ([email protected])

ALASKA’S GREAT THIRST: WATER, ENERGY, AND HEALTH IN IÑUPIAQ COMMUNITIES OF THE NORTHWEST ARCTIC BOROUGH

L. Eichelberger

University of Arizona

The cost of energy affects every facet of life in the Iñupiaq Eskimo communities of Alaska’s Northwest Arctic Borough, from traditional subsistence practices to health and household economy. This paper demonstrates the links between the cost of energy and water insecurity within this arctic environment. I combine the theoretical frameworks of political ecology and critical medical anthropology with the participatory methods of photovoice and community mapping to examine the local experiences that connect water scarcity, energy issues, and health. The energy crisis that continues to affect Alaska makes existing water scarcity more pronounced in rural villages without in-home piped water. Improving household access to domestic water supplies requires thinking about the basic utilities necessary for protecting public health. I use the term utility scarcity to underscore this relationship. Throughout, I examine how Iñupiaq residents experience and make sense of these connections, as well as local strategies to address these concerns. Contact: Laura Eichelberger, MA ([email protected])

THE ROLE OF HOUSING AS A DETERMINANT OF HEALTH FOR INUIT IN CANADA

C. Knotsch


Overcrowding, sanitation and basic housing quality are often discussed in research literature as aspects that link poor housing to poor health outcomes. Considering publicly available information on overcrowding, suicide, infant mortality, hospital admissions for infants with lower respiratory tract infections, infant mortality and tuberculosis, we observe that Inuit experience the highest rates in Canada in these indicators. There is a significant body of research addressing the relationship between housing and health; however few studies are specific to Inuit.

Crowded living conditions influence the physical and mental well-being and also many social behaviours. According to the 2006 Census, crowding rates for the four Inuit regions combined were many times higher than the rate for the non-Aboriginal population in the region. For example, crowding has been linked to poor self-reported mental and physical health, in addition to increasing an individual’s risk for bacterial ear infections and scabies skin infestation.

It is believed that overcrowding plays a role in high rates of spousal abuse, interpersonal violence and crime in general, as tight living conditions leave people (especially youth) feeling frustrated and angry. Crowding is also negatively impacting the level of education among Inuit. According to the 2006 census, 40 per cent of Inuit children aged 14 and under resided in crowded homes. This results in little to no quiet study space and some households sleeping in shifts to accommodate everyone.

This paper presents findings from parts of a larger project that documents housing and homelessness realities of Inuit in Canada and aims to contribute to our understanding of relations between Inuit housing and various health and social indicators. Contact: Cathleen Knotsch ([email protected])

LESSONS FOR HERE AND NOW. PUVALLUTUQ: THE ESKIMO POINT TB EPIDEMIC OF 1963 AND THE CONTEMPORARY HOUSING CRISIS IN INUIT COMMUNITIES

F. Tester1, P. McNicoll1, N. Lauster2 1School of Social Work, University of British Columbia, 2Department of Sociology, University of British Columbia

In February of 1963 an outbreak of tuberculosis in Eskimo Point (Arviat) resulted in the evacuation of a significant portion of the Inuit population for treatment. This costly event, which caught the imagination of the southern Canadian press, was subsequently thoroughly investigated by the Indian and Northern Health Service. The outbreak was clearly related to housing conditions in the community. Wood frame housing was first introduced in 1959 under a “rent-to-own” policy that made tiny plywood box-style housing available to Inuit, increasingly relocating to settlements of the eastern Arctic. The paper uses historical and archival documents to revisit these events, focusing on the role of public servants in both identifying the problem and advocating for change. This outbreak of tuberculosis clearly established, for the first time in northern Canada, the relationship between health and the suitability and adequacy of the housing being provided to Inuit families. The event contributed to a dramatic change in the policies and procedures for providing Inuit housing, and to the introduction of the first social housing policy designed to meet Inuit needs. The paper compares and contrasts the events and concerns reported in the 1963 epidemic with the current conditions in Inuit communities, illustrated by circumstances in Kinngait (Cape Dorset). These were determined by original and participatory action research conducted with the community. Given the complex relationship between health indicators and housing conditions, the importance of phenomenological data in determining these relationships is suggested. The paper asks important questions about advocacy and the role of communities and public officials in bringing about change – then and now – recognizing housing and housing policy as an important structural and environmental determinant of Inuit health. Contact: Frank Tester ([email protected])

INDOOR AIR QUALITY ISSUES IN FIRST NATIONS AND INUIT COMMUNITIES IN CANADA

S. Verhille, T. Marsden, M. Shum

National Collaborating Centre for Environmental Health

In 2006, Aboriginals accounted for 3.8% of the total population of Canada. The majority of Aboriginal people belong to the North American Indian community, also called First Nations people, which


represent 60% of the Aboriginal population. About 50,000 of Aboriginals identify themselves as Inuit, who mostly live in the area across Canada’s North from Labrador to the Northwest Territories. First Nations population increased 29% between 1996 and 2006 while the Inuit experienced a population growth of 26%. This rapid increase in population (about 3.5 times the increase of the non-Aboriginal population), has aggravated the existing shortage of housing within these communities. Some of the indoor air issues arising in First Nations and Inuit communities stem from overcrowding, poor ventilation, inappropriate housing, chemical contaminants, environmental tobacco and wood smoke, and mould. Health effects related to indoor air quality are not well understood due to the complex interplay of numerous factors; such as, the nature and concentration of ubiquitous biological contaminants, and the ability of the indoor environment to amplify, disseminate and sometimes concentrate these contaminants. Other factors like host susceptibility, exposure and physiologic or pathologic responses to these contaminants may also play a role. However, it is well accepted that poor housing increases rates of asthma, respiratory and other lung diseases. First Nations and Inuit children have higher rates of respiratory tract infections as well as severe otitis media (middle ear infection) than non-Aboriginal children. Also, overcrowding in conjunction with poor ventilation contributes to the transmission of communicable diseases; such as, tuberculosis, skin infections, shigellosis and other intestinal diseases. In this presentation, we will present the current state of the evidence on indoor air quality issues in First Nations and Inuit communities, identify some of the gaps in research, outline some of the challenges of conducting new research in these communities, and discuss methods of surmounting some of the challenges in order to conduct further research. Contact: Sophie Verhille ([email protected])

VENUE 2 Women’s Health & Well-Being #2

CAN THE FETAL FIBRONECTIN ASSAY AT TERM BE USED TO SAFELY DELAY EVACUATION OF RURAL WOMEN FROM THEIR HOME COMMUNITIES?

W.A. MacDonald, G.K. Healey, W. Hogg, J. Kornelsen, S. Gryzbowski


The fetal fibronectin (fFN) test is used to predict the likelihood of preterm labour in parturient women with symptoms of labour between 24 and 36 weeks estimated gestational age. The (fFN) test has been in use in Nunavut since 2004 and currently is available in most community health centres in the Territory. It has been used extensively and has proven itself reliable and to be easy to use by clinicians.

As many as 5000 women in Canada each year live more than two hours from the nearest facility offering birthing services. Many must leave their homes to wait to deliver their babies in a referral community for up to 6 weeks. This imposes a significant financial and social cost on the women, their families and the health care delivery system. There is a lack of research examining the potential of fFN testing at term to predict labour or not.

The purpose of this pilot study is to investigate the negative predictive value of the fast reacting fetal fibronectin (fFN) test at term. If the test proves reliable in predicting the absence of labour at term women might safely be able to stay home later in the pregnancy.

This pilot study will use a prospective cohort study design to examine the negative predictive value of the fFN test at term. Study participants will be recruited from the population of parturient women in Nunavut and Northern British Columbia with uncomplicated pregnancies in the study areas and asked to consent to the test starting at 36 weeks. Up to 30 participants will be recruited.

Descriptive statistics will summarize the cohort experience. The diagnostic properties of the fFN test at term will be defined,

particularly the positive and negative predictive values with confidence limits.

The pilot study is now underway in Nunavut and the results will be presented at the conference. Contact: W. Alexander Macdonald ([email protected])

SPECIAL DELIVERY: TRANSPORTING IÑUPIAT MOTHERS AND BABIES IN NORTHWEST ALASKA

L. Schwarzburg

University of Alaska-Fairbanks

Alaska Native mothers give birth in a health care system unique among all others in the world. How did the Alaska Native Maternal Transport Policy—a 30-year-old protocol of flying mothers and babies in and out of Anchorage—come to pass? What have been the economic, social and cultural forces involved in its advancement? And, what have been some of the tangible and intangible outcomes and impacts of the policy on those involved?

Tackling these questions has led to design of an Anthropological-based set of policy analysis tools that are participant-driven and sustainable for policy development over time. I am looking at childbirth practices as an element in the Iñupiat Eskimo society of Kotzebue and surrounding villages, which have changed from traditional community-based practices to participation in a more westernized medical model of childbirth. This will provide researchers 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.

Studies have found positive impacts of inclusion of cultural values in a mother’s birthing plan, and others have explored the negative impacts (higher reliance on interventions and drugs, higher C-section rates) involved when practitioners handling a non-western or religious childbirth client ignore cultural norms. This study will add to this body from an Arctic standpoint as Alaska Native cultural identity is explored.

This creative policy assessment tool might open doors to modern obstetric and neonatological literature including a more realistic look at the impact of medical birth and merits of non-medicalized birth (WHO, 2005; Wagner, 2001) in other areas, specifically from indigenous Women’s perspectives. Insight may also be gained from this investigation’s use of film and participant-analysis methodology to further future revitalization movements, or more culturally appropriate health care promotions within this and other Arctic communities. Contact: Lisa Schwarzburg ([email protected])

ARE INCREASING NUMBERS OF CESAREAN SECTIONS PLACING A BURDEN ON CANADA’S HEALTH CARE SYSTEM?

N.C. Agnew


The rate of cesarean section delivery has continued to rise in most developed countries, including Canada. . In 1993, Canada’s cesarean section rate was 17.6 percent, this increased to 26.3 percent in 2006. Pregnancy, labor, and delivery are natural human physiological events that should be allowed to transpire as a natural progression. Labor should only require intervention if there is question about the safe and healthy outcome for mother or baby.

The aim of this paper is to review literature that relates to Women’s preferences or requests for cesarean sections and review trends in elective cesarean sections. As well as examine available evidence of potential risks and benefits to the mother and infant receiving this delivery procedure. Through an examination of the trends in relation to the risks and benefits of elective cesarean sections one is able to assess the “appropriateness of care”, as an indicator of the Canadian health care systems performance.

This topic is filled with controversy and ethical dilemmas, displaying a struggle between patient autonomy and the health care system to act


in patients’ best interests. Autonomy is defined as the right to self-govern and act “freely in accordance with a self-chosen plan.” Are we ignoring a woman’s basic right to choose her own course of action if she asks for a caesarean section and is refused? The law states that everyone has the right to refuse medical treatment, but does it give them the right to demand it? Does this not give her the right to refuse vaginal delivery or is she forced into that? Can it be argued then that women who request caesarean sections are not demanding an operation, or simply refusing the alternative?

Paternalism on the other hand, defined as “overriding or ignoring the preferences of patients in order to benefit them or enhance their welfare.” The paternalistic doctor will decide the treatment plan for the patient, and provide it without further discussion. Her autonomy is not thus respected, she should be explained the reason for the preferred treatment and if not in agreement, be given the right to refuse. Here one faces the slippery slope of an ethical and medical dilemma. Is it possible to uphold ones oaths of beneficence and non-maleficence and while maintaining the patient’s autonomy? In certain situations I think not! I believe cesarean section should only be carried out when medically indicated, unless of course I believe the woman would truly be negatively affected by not having a cesarean section.

If Canada does not improve maternity services particularly in rural, and northern areas, the numbers of cesarean sections will continue to rise. Lack of training, poor or non-existant facilities will ultimately lead to fewer health care practitioners skilled in managing prenatal care, labor and delivery. This has also been recognized by the Society of Obstetricians and Gynecologists of Canada who believe “it is time for healthcare professionals who are able to support the birthing process (obstetricians, family physicians, nurses and midwives) to adopt a more collaborative approach to maternity care” they also add that “the government of Canada must recognize that there is a problem in the delivery of maternity care in Canada.” This burden will flow into other areas of the health care system, unnecessary major surgery means less access to essential care.

At present, because hard evidence of net benefit does not exist, performing cesarean sections for non-medical reasons is not ethically justified. The luxury of women choosing a cesarean section means other women may be dying of cancer, not detected because specialists are experiencing patient overload, or funds for cancer screening programs are depleted. As a medical student and future physician, I believe the choice on who should live should be decided upon, through the investigation of evidence based medicine, rather than convenience. Contact: Nicole C. Agnew ([email protected])

INUIT MIDWIFERY AND MATERNAL CHILD HEALTH


Pauktuutit Inuit Women of Canada is well-known for its role in advocating for traditional Inuit midwifery. Inuit women from all across Inuit Nunaat are often flown to southern cities to give birth rather than in their home community or even within their geographic region. Since Pauktuutit’s inception in 1984, Inuit women have expressed concern about the displacement of Inuit midwives, the loss of knowledge, and the loss of community-based birthing. It is well-documented that the legacy of modern medical intervention and this evacuation policy has not been in the best interest of Inuit women, our families, and our cultural heritage. Today’s elders are among the last generation of Inuit to have experienced giving birth on the land with the help of midwives and family members. Their skill and knowledge are no longer being passed on to younger women. Inuit women have expressed concern regarding the loss of these traditional birthing practices. With this in mind, Pauktuutit started the project Documentation of Traditional Practices Related to Pregnancy and Childbirth. The intent of this participatory research project was to gather the elders’ knowledge and to use it to support community-based birthing centres and to promote greater cultural sensitivity to Inuit preferences/practices for healthy pregnancies. Pauktuutit gathered a great deal of invaluable and

irreplaceable information which is included in a broad scope of work related to improving pre- and post-natal care and birthing options for all Inuit women. This collected knowledge has sparked many issues that need to be addressed including but not limited to: protections and practical uses for the knowledge and data; promoting knowledge of and cultural pride in Inuit midwifery and the collective Inuit birthing heritage; promoting healthy pregnancies and healthy lifestyles among young women; training more Inuit midwives; and promoting the transfer of knowledge from elders to youth. Contact: Pauktuutit Inuit Women of Canada ([email protected])

MÉTIS CONCEPTS OF HEALTHY PREGNANCY: A LOOK AT EFFECTIVE HEALTH PROMOTION, CULTURAL SAFETY, AND CONCEPTS OF WELL-BEING

M. Dyck

The Métis Centre of the National Aboriginal Health Organization

The Métis Centre of the National Aboriginal Health Organization and the Métis Women of BC, of the Métis Nation British Columbia (MNBC), collaborated on a project looking at pregnancy messaging.

In 2007 and 2008, 12 focus groups were held with Métis women across British Columbia. Various printed health promotion materials for pregnancy were used to elicit discussion around health promotion, cultural safety and wellbeing.

Analysis of the data began in early August of 2008 and the final report was completed by December 2008. Discussion within the focus groups elicited responses around several themes, which were grouped under theme thematic areas: identity, support networks and product design.

While all participants spoke to identity in some regard, it was most often in the context of Métis identity as contrasted to First Nations identity. Less frequently, Métis identity was described in comparison to non-Aboriginal identity.

Support networks was a common theme expressed throughout all of the groups, however, it took many varying forms. Most often, support networks included a broad range of relationships, and were not limited to the nuclear family. Comments most often included the importance of men, elders, the community, and Women’supporting women.

Comments within the product design section included specific recommendations regarding the design of posters and other health promotion items. Participants had strong views on the appearance of products used to target Métis.

For the Métis Centre and the MNBC, the findings of this project will help to guide promotional campaigns for pregnancy and for maternal child health, and will help to identify gaps in Métis maternal child health. The data from the focus groups will provide greater insight into issues of Métis identity, of Métis concepts of maternal child health and of cultural safety. Contact: Miranda Dyck ([email protected])

“KEEPING MYSELF WELL”: THE RELATIONSHIPS OF PERINATAL HEALTH BENEFITS AND HEALTH PROMOTION PRACTICES OF TLICHO WOMEN

P. Moffitt

University of Calgary

Traditional knowledge is recognized as salient to Women’s health and to the provision of culturally safe health care. However, health beliefs and health promotion practices evolve with culture that is not static. The dynamic, complex and diverse contexts of Women’s lives are influenced by historical, social, political and environmental factors. The intersection of these factors is portrayed in the lifeways of pregnant Tlicho women. This presentation emanates from a focused ethnographic doctoral study that explored the relationship of perinatal health beliefs and health promotion practices with 14 pregnant Tlicho women from a remote community in the Northwest Territories. Photovoice was used within the design of the research to promote


discourse between the women and create opportunity to share personal meaning of their circumstance and priorities through photographs and stories. Three domains emerged from participant observation, interviews, photographs and stories that were related to the Women’s pregnancies and lifeways. Domains included keep myself well, risk discourse and perinatal travel and upside down world. Understanding the relationship of health beliefs and health promotion practices of pregnant Aboriginal women can provide a basis for the creation and implementation of culturally safe health promotion programs and policy development. Contact: Pertice Moffitt ([email protected])

INTRODUCTION OF MIDWIFERY SERVICES AND CLIENT SATISFACTION

G. Becker, L. Paulette

Fort Smith Health and Social Services Authority

The return of midwives to the community and the introduction of regulated midwifery practice provided the practice framework for the renewal of community birthing in one community of the Northwest Territories. Since April 2005, two registered midwives have been employed by the Fort Smith Health and Social Services Authority. The midwives provide full-scope maternity care: prenatal, intrapartum, and postpartum care, with informed choice of birthplace. Women can birth either at the Fort Smith Health Centre, the woman’s home, or at Stanton Territorial Hospital. A renovated area within the hospital has created a maternity centre with a birthing room and birth tub, a midwifery office, and a prenatal assessment room.

The authors provide a review of the first four years of a program introducing midwifery services in Fort Smith, Northwest Territories. The presentation focuses on the client evaluation of midwifery care and how client satisfaction contributes to midwives’ reflective practices thus ensuring that the practice responds to the needs of clients and community. The study presents a summary of completed Midwifery Program Satisfaction Questionnaires. Contact: Gisela Becker and Lesley Paulette Gisela Becker and Lesley Paulette ([email protected])

HISTORICAL NARRATIVES AND HUMAN KINDS: THE EVOLUTION OF INUIT CHILDBIRTH INTO THE 21ST CENTURY

V. Douglas


Objectives: To construct a theoretical framework within which the historical evolution of Inuit childbirth practices may be situated.

Study Design: This study applies narrative analysis to a historical study.

Methods: Semi-structured oral interviews conducted with participants in the Arctic communities of Puvurnituq, Inukjuaq, and Rankin Inlet were analysed and compared with historical literature on Inuit childbirth practices in order to create a historical narrative of Inuit childbirth practices.

Results: Inuit childbirth is not characterised by specific practices, beliefs or rituals. These have all undergone a process of historical evolution. However, applying Hacking’s concepts of human kinds and historical ontology to Inuit childbirth constructs its identity without fixing it to specific practices at any particular place in time or space.

Conclusions: Inuit childbirth retains a historical continuity and cultural integrity that is expressed through Inuit culture itself, and must be understood as reflective of it. Contact: Vasiliki Douglas ([email protected])


BILL C-51: PROPOSED FEDERAL REGULATION OF TRADITIONAL MEDICINE

P. Orr

Independent Legislative Counsel

Bill C-51 was introduced in Parliament in 2008. The Bill included changes to the Canadian Food and Drugs Act that some argue would have a significant effect on the delivery of Traditional Medicine by Aboriginal healers in Canada. Although the Bill has “died on the order paper”, it is likely to be reintroduced by the present government in substantially the same form. The paper intends to identify the elements of the proposed changes in the federal government’s policy towards the practice of Traditional Medicine, as contained in the proposed legislation, discuss their possible effects on the practice of Traditional Medicine, and assess the potential ramifications on the rights of Aboriginal persons to practice Traditional Medicine. Contact: Patrick Orr ([email protected])

ENHANCING EXISTING COMMUNITY HEALTH CAPACITY AND INFRASTRUCTURE BY FOCUSING ON THE INTEGRATION OF INUVIALUIT, GWICH’IN, AND WESTERN MEDICINE APPROACHES TO PALLIATIVE CARE

J.E. Smith, S. Bauhaus, C. Lennie

Beaufort Delta Health and Social Services Authority

Life expectancy of Aboriginal Canadians has increased by over 8 years since 1980, and more elders are living past the age of 70 years, resulting in many chronic health problems that eventually require palliative care. Cultural traditions and beliefs define what is considered legitimate care. However, the current practice of implementing western health practice in aboriginal communities has not promoted the development of community specific needs, identified by the community, for the community. A common misconception is that cultural traditions, values, and spirituality are the same in our northern communities. Research implemented in southern aboriginal communities does not support this misconception, and we expect the same findings will be demonstrated in the remote regions of the Beaufort Delta Health and Social Services Authority (BDHSSA). Palliative care is a difficult area of practice for many health professionals, compounded when providing care in a cultural context foreign to their own culture and beliefs. At the same time, the constant flow of health providers in many northern communities is prohibitive in the development of a trusting relationship with health professionals.

Funds were obtained through the Aboriginal Health Transition Fund to develop knowledge in this area within the BDHSSA. Documentation of traditional palliative care practices was initiated in January, 2009 in each community in the Beaufort Delta. From this information educational, community specific resources for health professionals and for community members will be developed. In this presentation we will present preliminary findings from the interviews conducted with community members and permanent health professionals who practice in the BDHSSA.

Through the collection and documentation of current community beliefs and values related to death and dying, levels of understanding, awareness and perceived access to palliative care in each community can be achieved so as to promote culturally sensitive palliative health care “North of 60”. Contact: Jane Smith ([email protected])

INDIGENIZING CHILD WELFARE MODELS: METHODS AND OUTCOMES

N. Wedzin, M.A. Mackenzie, G. Gibson



Nora Wedzin, Mary Adele Mackenzie and Ginger Gibson

The Tlicho Government will shortly assume control over child protection services in the Tlicho region of the NWT. With a high rate of children in care, the Tlicho Community Services Agency is working with elders, children, foster families, and parents to design services that meet the needs of indigenous families. This research, based in the narratives, stories and histories of Tlicho elders, aims to revise the GNWT model of child welfare management. Some of the products will include custom care models, protocols and guides for social workers and RCMP, and training for social workers. The research is based in a model that has been termed “Strong Like Two People”, which combines indigenous and non-indigenous researchers in teams to tackle these complex questions. This presentation will discuss this model, review some of the outcomes, and discuss the main findings of this ongoing research. Contact: Ginger Gibson ([email protected])

GETTING IT RIGHT: USING POPULATION SPECIFIC, COMMUNITY-BASED RESEARCH TO ADVANCE THE HEALTH AND WELL-BEING OF FIRST NATIONS, INUIT, AND MÉTIS IN CANADA

M. Buell, P.C. Tremblay


The National Aboriginal Health Organization (NAHO) was created in 2000 to have a positive impact on the health and well-being of the three constitutionally recognized Indigenous Peoples in Canada: First Nations, Inuit and Métis. Each of these groups is distinct, and NAHO’s structure ensures it successfully engages with First Nations, Inuit and Métis communities to address health disparities through research, knowledge translation and knowledge-based activities.

NAHO believes this population-specific approach, and by taking a broader determinants approach to health, is central to effectively addressing the health and well-being of Aboriginal Peoples, as population-specific statistics and research are key to addressing the unique needs of First Nations, Inuit and Métis individuals, families and communities.

To illustrate NAHO’s successful approach, three case studies will be explored: suicide prevention, the protection and promotion of traditional healing practices and supporting Aboriginal midwifery. Contact: Mark Buell ([email protected])

GEGENOATATOLTIMG (SHARING THE KNOWLEDGE): A TRADITIONAL FIRST NATIONS GATHERING TO SUPPORT HEALTH AND HEALING IN CANADA

J. Robbins1, M. Porter1, R. Obomsawin1, E. Nowgesic1, E. Sock2 1First Nations Centre of the National Aboriginal Health Organization, 2Elsipogtog Health and Wellness Centre

The word “Gegenoatatoltimg”, when translated from Mi’kmaq to English, means “Sharing the Knowledge”; used for the name of a national traditional health and healing gathering conducted from September 8 to 15, 2008 in Elsipogtog, New Brunswick, Canada. The event was co-hosted by the First Nations Centre (FNC) of the National Aboriginal Health Organization (NAHO) based in Canada, and the Elsipogtog Health and Wellness Centre (EWHC). The event was primarily attended by First Nation Elders, and youth, First Nation community members, and staff from FNC, NAHO, and EWHC.

The objective of the gathering was to engage in dialogue about the retention and transfer of traditional knowledge respective to health, medicines and healing. The following activities took place at the gathering:

- Elders Circle on Grief and Healing - Youth and Elders Dialogue Circle - Youth Circle Gathering

- Traditional and Western Medicine Discussion Circle - Daily Ceremonies (sweat lodges) - Traditional healing sessions (ongoing) - Medicine Harvesting and teaching sessions - Various Elder directed traditional teaching sessions (e.g.: rites of

passage, mental health, traditional foods, prophecies ) - Shaking Tent ceremony

The outcome of the event was twofold: (1) The provision of additional knowledge of First Nations “medicine” to traditional First Nations healers; and (2) The engagement of FNC of NAHO to advance First Nations knowledge to improve the health of First Nations by means of promoting and sharing health information.

Hosting gatherings/conferences which involve actualizing the use of traditional First Nations knowledge demonstrates a concrete commitment to such knowledge rather than merely engaging in discussions around it and/or simply building an awareness of its existence. Collaboration of a large research focused organization such as the FNC of NAHO and a local community is feasible, efficient and effective in attaining common goals among both parties. The structure and planning used in Gegenoatatoltimg could be used as a model by other interested Aboriginal organizations and communities in conducting similar gatherings in Canada and abroad. Contact: Julian Robbins ([email protected])

VENUE 4 Infectious Diseases #5 – H.Pylori, Superbugs, etc.

EPIDEMIOLOGY OF HAEMOPHILUS INFLUENZAE SEROTYPE A FROM 2000-2007, AN EMERGING PATHOGEN IN NORTHERN CANADA AND ALASKA

M. Bruce1, S. Desai2, T. Zulz1, M. Garner2, Boyd K. Hummel1, D. Hurlburt1, D. Bruden1, K. Rudolph1, C. DeByle1, R. Tsang3, International Circumpolar Surveillance Working Group 1Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, 2Immunization and Respiratory Infections Division, Public Health Agency of Canada, 3National Microbiology Laboratory, Winnipeg, Manitoba, Canada

Background: Prior to introduction of the Haemophilus influenzae type b (Hib) conjugate vaccines, rates of Hib disease among indigenous people living in Alaska (AK) and Northern Canada (N Can) were among the highest reported in the world. Routine vaccination has reduced these rates to very low levels; however, serotype replacement with non-type b strains is of concern.

Methods: We identified cases of invasive Hi disease in AK and N Can from 2000-2007 through the International Circumpolar Surveillance (ICS) network. Medical charts were reviewed on laboratory-confirmed cases using standardized forms to verify clinical presentation. AK and N Can estimated populations as of 2006 were 670,053 and 132,956 respectively; aboriginal peoples comprised 20% of the population in AK and 60% in N Can.

Results: During the study period, a total of 198 cases of invasive Hi disease were reported from AK (110) and N Can (88). Among the 127 (67%) invasive Hi cases with serotype information available; 59 (46%) were serotype a, 36 (28%) were serotype b, 17 (13%) were serotype f. Among Hia isolates, 51 (86%) occurred in indigenous people; median age was 1.0 year (range 3 mo-74 years); 61% were male. Three Hia cases (one adult/2 children) were fatal. Common clinical presentations included: meningitis (32%), pneumonia (27%), and septic arthritis (12%). There were no cases of epiglotittis. Overall annual Hia incidence was 0.3, and 4.6 cases/100,000 population in AK and N Can, respectively. Annual incidence rates among indigenous children <2 years old in AK and N Can were 22 and 115 cases/100,000 persons, respectively.


Conclusion: Serotype a is now the most common Hi serotype seen in the North American Arctic, with the highest rates among indigenous children. Further research is needed to investigate regional differences in rates, and to determine sequelae, risk factors, and the utility of chemoprophylaxis. Contact: Michael Bruce ([email protected])

MYCOPLASMA GENITALIUM IN GREENLAND: PREVALENCE, MACROLIDE RESISTANCE, ETHICAL CONSIDERATIONS, AND POLICY IMPLICATIONS

D. Gesink-Law, G. Mulvad, R. Montgomery-Andersen, S. Montgomery-Andersen, U. Poppel, A. Binzer, F. Stenz, E. Rink, A. Koch, J.S. Jensen


Objective: Currently, Mycoplasma genitalium (Mg) is not tested for in Greenland. Our objective was to determine the presence and prevalence of Mg infection in Nuuk, Greenland.

Methods: Between July 2008 and October 2008, 149 Nuuk residents between the ages of 15 and 65 years of age were enrolled in the Greenland Sexual Health Project (Inuulluataarneq). Participants completed an interviewer administered sexual health survey and provided self-collected, first-void, urine samples (men and women) and vaginal swabs (women) for Mg testing. Mg was detected with real-time PCR targeting the MgPa-gene. Macrolide resistance mediating mutations in the Mg positives were detected by a molecular assay.

Results: Ten (7%) of the 149 participants tested positive for Mg infection. In nine cases, sufficient DNA allowed analysis for macrolide resistance, and all nine carried macrolide resistance determinants. The prevalence of Mg was not different for women (n=8, 9% prevalence (95%CI: 5%, 17%)) and men (n=2, 3% prevalence (95%CI: 0.9% to 11%)). On average, Mg cases were younger (21 years) than non-cases (28 years) and younger when they first had sex (cases averaged 14.6 years; non-cases averaged 16.3 years). The odds of having had an STI before were 5.3 times higher for cases than non-cases (95% CI: 0.7,240, p=0.10). Cases and non-cases did not differ significantly on ever having had forced sex (OR: 2.1, 95% CI: 0.4,9.4, p=0.27).

Conclusions: We found both a high prevalence of Mg infection and resistance to azithromycin treatment in Nuuk. These findings raised important ethical considerations for the project and may have significant impact on Greenlandic public health policy and the Greenlandic health care system, especially around Mg testing, treatment, and prevention of persistent/recurrent infections. Contact: Dionne Gesink Law ([email protected])

MONITORING AND MITIGATING PARASITIC RISKS TO HUMAN HEALTH IN AN INDIGENOUS COMMUNITY FROM NORTHERN SASKATCHEWAN

C.G. Himsworth1, E. Jenkins2, M. Nsungu3, M. Ndao4, R.C.A. Thompson5, A. McConnell6, S. Skinner6 1Department of Veterinary Pathology and 2Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, 3Northern Inter-tribal Health Authority (Nsungu), 4National Reference Centre for Parasitology (Ndao), Department of Medicine, Division of Infectious Diseases, Research Institute of the McGill University Heath Centre, 5School of Veterinary and Biomedical Sciences, Murdoch University, Australia, 6Department of Infectious Disease, College of Medicine, University of Saskatchewan

In May 2008, a 5 year-old girl from Northern Saskatchewan was found to have an Echinococcus spp. cystic hydatid in her brain, which caused significant neurological impairment and required extensive medical and surgical treatment. Echinococcosis, or hydatid disease, is caused by zoonotic Echinococcus spp. tapeworms. In humans, infection with this parasite can result in the formation of fluid filled cysts in the internal organs that may cause problems if they grow very large or occur in an unexpected location (e.g. the brain). Humans most commonly become infected through accidental consumption of

parasite eggs shed in the feces of dogs, and dogs can become infected through consumption of infected rodents, or organs from infected moose, caribou, elk, or deer.

This case raised community concerns about the risk and sources of hydatid disease. For this reason, an interdisciplinary team was established, which included animal and human health professionals, as well as members of the affected community, in order to determine the prevalence of Echinococcus spp. exposure in humans and dogs and the risk factors that influence infection in this community. This study, the results of which will be presented, has broad relevance because there is a paucity of recent Canadian information on this parasitic zoonotic disease, which has historically been a significant public health concern in indigenous Canadians, and world-wide remains a “zoonosis of global concern… and one of the most costly [parasitic diseases] to treat and prevent in terms of public health” (WHO). The ultimate goal is to facilitate the implementation of effective, community-based management of Echinococcosis using the information generated by the study.

Overall, this project supports the benefits of an interdisciplinary approach to the study and management of zoonotic disease, and may contribute to a better understanding of the complex interaction of factors associated with Echinococcus spp. ecology, which is necessary to reduce the risk of hydatid disease in Canada. Contact: Emily Jenkins ([email protected])

SUPERBUGS IN THE NWT

W. White

DHSS, GNWT

The Northwest Territories (NWT) Community Associated Methicillin Resistant Staphylococcus aureus (CA MRSA), commonly known as a superbug, rates are increasing. MRSA has been reportable in the NWT since 2002. There has been considerable difficulty categorizing MRSA according to case definition for Community Associated and Hospital Associated MRSA. A study was undertaken using isolates from MRSA infections submitted to Stanton Territorial Hospital (STH), Yellowknife between May, 2007 and October, 2008 to identify subtyping and to aid classification. MRSA was confirmed using real-time PCR to detect the nuc, mecA, and pvl genes. Isolates were typed using pulsed-field gel electrophoresis and spa typing using previously published methodologies.

A total of 70 MRSA isolates were identified over the study period from individuals from 12 communities in the NWT. Cases of MRSA increased from 15 (21%) in the last 8 months of 2007 to 55 (79%) in the first 10 months of 2008. The predominant clone in this region was CMRSA10, which represented 70% of all MRSA isolates [2007, n=12 (80%); 2008, n=38 (69%)].

In response to the high rates of CA MRSA, the NWT has initiated an ongoing Superbug Education Campaign targeting both the public and health care providers. It includes: enhanced education to both groups, efforts to promote more judicious use of antibiotics, implementation of infection control standards and practices, promoting stringent handwashing and general sanitation in at risk environments.

Conclusion: CMRSA10 is the dominant MRSA strain causing infections in the NWT, the molecular epidemiology is different from other northern communities, such as Nunavut, where reports suggest CMRSA7 is the dominant strain. The NWT has ramped up its efforts to control MRSA and will continue to monitor epidemiology, including subtypes and the results of its superbug campaign. Contact: Wanda White ([email protected])


CA-MRSA OUTBREAK IN NUNAVUT, CANADA: KNOWLEDGE OF SOCIAL NETWORKS IS KEY TO TARGETING CONTROL MEASURES

T.L. Stuart1, M. Lindegger1, D. Nibgoarsi2, O. Anoee2, L. Angalik2, L. Shah1, J. Spika3, I. Sobol4, C. Palacios4, M.R. Mulvey5, D. Gravel3, M. Ofner3, L. Panaro6 1Canadian Field Epidemiology Program, 2Nunavut Health Centre, 3Public Health Agency of Canada, 4Nunavut Department of Health and Social Services, 5National Microbiology Laboratory, 6Director Canadian Field Epidemiology Program

Background: A community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) outbreak investigation in Nunavut used social network analysis and mapping to optimize interventions. At the time, control efforts targeted symptomatic individuals at point of care.

Methods: CA-MRSA cases were defined as those having a positive MRSA culture between August 1, 2006 and December 31, 2007 with no hospitalization, surgery or dialysis in the past year and no indwelling catheters or percutaneous devices. Households with MRSA and CA-MRSA cases were mapped. Social network analysis of CA-MRSA and non-community acquired cases was conducted using information obtained from health staff and 15 in-depth interviews. Household densities of CA-MRSA cases were determined and compared to census data.

Results: From August 2006 to December 2007, 132 CA-MRSA cases were identified. Geographical mapping revealed cases were distributed throughout the community. Of the 85 homes with at least one CA-MRSA case, 67 (79%) were found within one social network. The average household density of homes affected by CA-MRSA was 6.29 persons/house (range 1-12); whereas the 2006 Statistics Canada community household density was 4.5 persons/house. Sixty-two percent of affected homes had one CA-MRSA case, 25% had two cases and 13% had 3 or 4 cases. Over half (55%) of newly diagnosed cases in January 2008 had a previously diagnosed family member.

Conclusions: Geographically, CA-MRSA affected homes were distributed throughout the community but social network analysis revealed that affected homes were linked. It is not where you live but with whom you interact that underlies CA-MRSA transmission in this community. Overcrowding is a commonality among affected homes. Family-based interventions, rather than focusing only on the patient, should be the target of control efforts. Social network analysis can help with the prioritization of at risk individuals for education, screening and infection control measures. Contact: Tammy L. Stuart ([email protected])

CA-MRSA IN A NORTHERN COMMUNITY DESCRIPTION OF OUTBREAK AND POSSIBLE CONTROL

E. Rubinstein


CA-MRSA started in a Nunavut community in 2003-4 manifesting as Skin and Soft Tissue Infections (SSTI) in predominantly younger individuals , at its peak ca. 25% of the community household and ca. 10% of the population were afflicted. As a result, an epidemiological survey was carried out in the community. Microbilogical survey revealed 2 predominant CA MRSA types namely CMRSA 7 (USA 400) and CA MRSA 10 (USA 300) circulating in one wave after another. One child age 4 years died of septic shock complicating MRSA septic artritis. As the infection is so widespread it was decided to conduct an experimental randomized cross-over intervention study in which whole house holds of afflicted patients will undergo an intervention for 18 months whilest the control group will continue with regular care. At 18 months the control group will become the interventio group and followed for additional 18 months. The intervention will include enforcement of hygenic measures, distribution of soap, alcohol-chlorhexidin swabs, individuals towels etc. In cases that fail these measures, decontamination with antibiotics, topical and systemic will

be attempted. Follow up measurements will include: monitoring of SSTI’s antibiotic use, clinic visits, documented other infections, hospitalizations and a monthly follow up of microbilological nostril cultures with genetic investigation of isolated MRSA. It is hoped that we will be able to identify which of the intervention steps was efficacious and which were not, and if the approach of household intervention is effective Contact: Ethan Rubinstein ([email protected])

METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS: A COMMUNITY-ASSOCIATED CONCERN IN LABRADOR

M. Ar-Rushdi, S. Keefe, H. Dyson

Labrador-Grenfell Health

Background: The province of Newfoundland and Labrador put Methicillin Resistant Staphylococcus aureus (MRSA) on the Reporting of Notifiable Diseases List as List B disease in 2006, then as List C for reporting in 2007. The province developed a document for passive surveillance with descriptive criteria for hospital associated (HA-MRSA) and community-associated (CA-MRSA), to be implemented in 2009.

Objective: It is hypothesized that the distinction between MRSA types might be difficult in rural and remote communities where the majority of care is delivered through community clinics, and hospitals are largely staffed by community members. We look at MRSA data from 2003-2008 in two geographically distinct regions of the Labrador-Grenfell Health Authority, and try to correlate MRSA designations with results of molecular typing.

Methods: All cultures positive for MRSA reported to the communicable disease nurses, were logged with information including community, age, sex, and type of diagnosis. MRSA cases would be designated as HA-MRSA or CA-MRSA using the proposed provincial criteria. Previous samples held either at the provincial Public Health Laboratory (for Labrador), or on site at the Curtis Memorial Hospital microbiology laboratory for the Grenfell area, were referred for molecular typing the results and will be compared to the MRSA designations.

Results: Preliminary results show an initial increase in MRSA in both regions, likely due to the mandatory reporting as of 2006. There is a doubling of cases between 2007 and 2008 in both regions. Most cases were diagnosed in the middle aged or elderly, and no differences noted by sex in either region. Soft tissue and wound infections predominated. The proportion of HA-MRSA to CA-MRSA is yet to be determined for each region. Referral of MRSA cultures to reference laboratories for molecular typing is also underway.

Conclusions: The Inuit and Innu of Labrador live in remote communities where overcrowding, and poor hygiene practices are associated with their lower socioeconomic status, and are known risk factors for transmission of MRSA. An increase of MRSA cases in the Grenfell region, with a rural Caucasian population and better socioeconomic status, suggests other factors may be involved in transmission. Distinction between HA-MRSA and CA-MRSA if it exists in a given population is important for development of targeted public health programs. This is yet to be determined for the Labrador-Grenfell region. Contact: Muna ar-Rushdi ([email protected])


PROVIDING LIBRARY SERVICES TO CONTRIBUTE TO CAPACITY BUILDING AND KNOWLEDGE TRANSLATION IN THE CANADIAN NORTH

A. Ducas, J. Linton, K. Young, L. Friesen

Neil John Maclean Health Sciences Library, University of Manitoba


Program Objective: Bringing academic health sciences library services to community-based partners in Canada’s northern territories of Nunavut, NWT, and the Yukon.

Setting: The Neil John Maclean Health Sciences Library (NJMHSL), located in Winnipeg, Manitoba, Canada has been building an Aboriginal Health Collection and Information Services component, including outreach services to health care providers in the Kivalliq Region of Nunavut since 1999. This model has been so successful that the NJMHSL was invited to join the Canadian Institutes of Health Research (CIHR) Team in Circumpolar Health by team leader, Kue Young. Several team research projects are being undertaken between 2006 and 2011.

Participants: CIHR Team members and community partners include Canadian academics, international partners, and community-based researchers.

Program: Key elements of the CIHR Teams’ projects rely on developing community partnerships. The NJM Library provides services to enhance the skills of community-based researchers, giving more equitable access to the professional literature similar to that enjoyed by most Canadian academic researchers. Librarians provide consultation, research and information services to enhance knowledge translation, scholarly communication, open access initiatives and evidence-based practice.

Conclusion: The NJM Library provides outreach services to community partners including literature searches, document delivery, and training in using open access databases like PubMed. Providing library services at no-cost to the end user enhances partnership building, creating more equitable relationships between academic researchers and community partners. Partnerships between academics and community-based researchers are found in most Canadian universities. Academic libraries have a role to play in supporting the information needs of all researchers involved in such exciting partnerships. Contact: Janice Linton ([email protected])

KSTE AND THE NORTH: HOW KNOWLEDGE SYNTHESIS, TRANSLATION, AND EXCHANGE OF EVIDENCE CAN INFORM CIRCUMPOLAR HEALTH

H. Beanlands, F. Benoit, M. Fast, D. Ciliska, R. Copes, M. Greenwood

National Collaborating Centres for Public Health

The International Union for Circumpolar Health has noted that “there has been a long-standing need for the exchange of medical knowledge, as well as the results of recent research and demonstrated solutions to problems for the benefit of humankind.” In what way can the knowledge coming out of recent research projects such as the International Polar Year be best utilized to advance the health needs of northern communities?

The National Collaborating Centres for Public Health (NCCPH) are a network of six centres across Canada providing a national focus for the synthesis, translation and exchange of scientific evidence and other relevant knowledge to improve and sustain evidence-based informed decisions by public health practitioners and policymakers.

The NCCPH defines knowledge translation as “the exchange, synthesis and ethically sound application of research findings within a complex system of relationships among researchers and knowledge users; the incorporation of research knowledge into policies and practice, thus translating knowledge into improved health of the population.”

This presentation will provide an overview of the NCCPH program with a focus on its mandate of knowledge synthesis, translation and exchange (KSTE) and provide practical examples of how KSTE works. The presentation will:

- identify the National Collaborating Centres for Public Health and demonstrate how they work as a resource for public health practitioners; and,

- provide examples of how KSTE activities that were developed at the national level could be relevant to public health in a circumpolar health context.

Contact: Philip Girvan ([email protected])

THE CIRCUMPOLAR HEALTH BIBLIOGRAPHIC DATABASE

R. Goodwin

Arctic Institute of North America, University of Calgary

The Circumpolar Health Bibliographic Database (CHBD) contains 4700 records describing publications about all aspects of human health in the circumpolar region. The database is a project of the Canadian Institutes of Health Research (CIHR) Team in Circumpolar Health Research. The CHBD includes all types of publications, both peer-reviewed and gray literature. It can be searched using words from titles and abstracts, names of diseases or conditions, types of people, geographic regions, authors, years, and special groups of publications such as all publications of the members of the CIHR Team. Search results can be sorted by year or by first author. The records in the CHBD contain citations, abstracts, subject and geographic indexing terms, library symbols, and links to 1800 online publications. As part of the CHBD project, server space is available to make PDF files of publications available online. Records created for the CHBD also appear in the Arctic Science and Technology Information System (ASTIS), the international Arctic & Antarctic Regions database, and in relevant Canadian regional databases such as the Inuvialuit Settlement Region Database, the Nunavut Environmental Database and the Nunavik Bibliography. The CHBD’s coverage is far from comprehensive, but the database includes many publications not indexed elsewhere, such as gray literature from Canada’s northern territories, all human health publications from the Northern Contaminants Program, and International Polar Year health publications. Contact: Ross Goodwin ([email protected])

THE ARCTIC HUMAN HEALTH INITIATIVE: THE ONLINE RESOURCE AT WWW.ARCTICHEALTH.ORG

S.A. Rolin, S. Smith, A.J. Parkinson

Arctic Investigations Program, Centers for Disease Control & Prevention, Anchorage, Alaska, US, and Department of Health Sciences, University of Alaska, Anchorage, US

The Arctic Human Health Initiative (AHHI) is an Arctic Council International Polar Year (IPY) coordinating project that highlights human health concerns of the Arctic people. AHHI’s goal is to build on existing Arctic Council and International Union for Circumpolar Health human health research. One important component of AHHI is its website, www.arctichealth.org/ahhi/, which serves a significant role in establishing cooperation and coordination in Arctic human health research. The AHHI website is a subpage of www.arctichealth.org, which is a portal to information concerning the northern environment and the health of the Arctic people. Funding for the AHHI website was provided in part through the NIH National Library of Medicine, and the website is hosted by the University of Alaska Anchorage’s Department of Health Sciences. This website was created at the start of the IPY and it has been an important international resource throughout the IPY for researchers, government officials, students, and the public. In addition to providing introductory information about the IPY and AHHI, the website lists all of the human health related proposals submitted for the IPY, categorized by topic area. This includes updates and contact information for each proposal. Other information available on the website includes details about IPY events, opportunities for people to get involved, and publications related to AHHI and the IPY. In particular, fellowships for young polar scientists have been advertised in order to increase awareness of available training opportunities. The website also caters to people wanting to learn more about human health concerns of the Arctic people, with photos on the website that link to captions providing detailed information about important health


issues. Examples of highlighted topics include the changing diets and lifestyles of Arctic people, gastric cancer, and invasive pneumococcal disease. The captions also provide details of ongoing AHHI-IPY projects currently addressing those issues. Contact: Stephanie Alexia Rolin ([email protected])

BRINGING EVIDENCE TO THE NORTH: CADTH’S LIAISON OFFICERS ASSIST WITH INFORMED DECISION MAKING

D. Priestly

CADTH - Canadian Agency for Drugs and Technologies in Health

Recognizing that health service structures and health technology assessment (HTA) capacity are different in each of Canada’s provinces and territories (P/T), the Canadian Agency for Drugs and Technologies in Health (CADTH) established a network of Liaison Officers to help meet local needs.

Liaison Officers are familiar with the needs of their particular regions and the approach within their jurisdictions is geared to local stakeholders.

Dawn Priestley, CADTH’s Liaison Officer (LO) for the Territories, has been in place since October 2007.

The northern LO has assisted with the expansion in use of CADTH’s Health Technology Inquiry Service (HTIS) by providing health practitioners across the north with relevant, timely information on medical technologies and pharmaceuticals.

The LO also provides educational workshops to physicians, pharmacists, nurse practitioners and nurses in the territories to assist them when making decisions about adopting new technologies, purchasing new medical devices, changing policies or clinical guidelines, adopting best practices or providing evidence for decision-making about patient care.

Introduction of the Proton Pump Inhibitor project by CADTH’s Canadian Optimal Medication Prescribing and Utilization Service (COMPUS), partnering with the Governments of Yukon, Northwest Territories, and Nunavut and in conjunction with NIHB, promotes optimal drug therapy by providing strategies, tools and services to bring this class of drug in line with the evidence.

The northern LO has also been instrumental in identifying common areas of interest among the northern territories and assisting in making linkages with those contacts.

As a local advocate, the LO for the Territories assists in bridging the gap between acquiring evidence and ensuring information is relevant to decision makers. Contact: Dawn Priestley ([email protected])

A CONTENT ANALYSIS OF WEBSITES FEATURING INUIT HEALTH INFORMATION

C. Fletcher, C. Alton, C.Y. Jean


Health information is vitally important for Inuit communities. Understanding factors that influence what sources people use and trust, as well as how information circulates, can contribute to individual and community health generally. We would expect that people rely on the advice of Elders, friends and family, and their health care providers (CHRs, nurses, doctors). Secondary sources like pamphlets, popular medical literature and media, and the Internet also play a role in health information flows. Evidence from other parts of Canada suggests that as the availability and familiarity of the Internet increases it is likely that people in the north are turning to this source for health information with greater frequency. As a first step in addressing the importance of Internet health information in Inuit communities we have undertaken a content analysis of 11 health-oriented websites that directly address an Inuit audience. Our analysis focuses on how the sites are organized with respect to definition of the intended audience, health issues addressed, visual content, navigation ease, culture and

language, health promotion and preventative strategies. While the existing websites each have elements of strength and utility for an Inuit audience, at this point health information is not systematically available in this format. The diversity of health issues each site addresses, the variability in how the information is framed, and the different orientations they adopt as to what constitutes health, speak to the challenges of using the Internet to respond to health information needs. Consequently, this paper focuses on directions forward in maximizing the potential of the Internet as source of health information for Inuit. Contact: Christopher Fletcher ([email protected])

AN INTERNATIONAL PALLIATIVE CARE SYMPOSIUM: USING VIDEO TELECONFERENCING AND VIRTUAL TECHNOLOGY TO MEET THE NEEDS OF RURAL HEALTH CARE PROVIDERS

C. DeCourtney, K. Morgan, J. Muller, S. Kelley


The Palliative Care Symposium is a core educational strategy in a multi-faceted, five-year palliative care education program funded by a National Institutes of Health National Cancer Institute grant awarded to the Alaska Native Tribal Health Consortium in Anchorage, AK. The symposium theme, Joining Together to Share Palliative Care Knowledge and Resources, reflects the partnership of separate healthcare organizations represented on the planning and implementation committee for the event.

In 2009, the last year of the education grant award, the symposium was offered internationally through technologies including Web-based streaming and video teleconferencing. Virtual marketing was used to increase social marketing outreach for the event, as well as website development which included outreach capabilities beyond the annual event. This unique and technologically advanced training delivery method was developed as a potential way of reducing costs, increasing access to information and creating a “virtual community” for future palliative care conference delivery beyond the existing funding.

The conference focused on various aspects of interdisciplinary care. Topic areas included lectures and multidisciplinary panel discussions, as well as facilitator packets for individual sites to discuss local issues post conference. The primary target audiences were healthcare provider teams (physicians, nurses, social workers, and pharmacists) from the Alaska Tribal Health System, private sector providers from across Alaska, IHS or Tribal health staff and clinicians from the Lower 48. International participants included Canada, Australia, New Zealand, and India. Contact: Christine DeCourtney ([email protected])

COLLABORATIVE PRACTICE: WALKING THE TALK

J-A., Hubert, J. Christensen, L. Harrison, A. Tumchewics


If you work in the health and social services industry you have read and heard of the importance of collaboration. In today’s world, the concept of collaboration has moved beyond achieving an understanding within each discipline to become a necessity across many groups.

Yellowknife Health and Social Services Authority (YHSSA) provide services to the communities of Dettah, Fort Resolution, Łutsel K’e, N’Dilo and Yellowknife. Over this vast geographical space, the number and variety of health care providers differs in each community as does the range of services. Recognizing the obvious challenges to delivering health care services in this area also provides opportunity for creative solutions. YHSSA believes collaboration is the heart of our integrated service delivery model. Working together each health care provider maintains their distinct practice while enhancing services to their clients.

In this presentation will bring the theoretical concepts of collaboration to reality as we share with you some of our lessons learned and the practical application of collaboration. Some of these include a grass


roots approach to promoting awareness of drug addictions; a community based strategy to prevent a pandemic influenza outbreak; the role of a Medical Social Worker with persons with chronic disease, disabilities, elderly, marginalized, low-income, addictions and unidentified trauma; and a multisystem collaboration to enhance client access to health care programs and services.

Let us share with you where we have been, where we are now and our visions for a better tomorrow. Contact: Jo-Anne Hubert ([email protected])


CVD AND ITS RELATION TO RISK FACTORS IN ALASKA ESKIMOS: THE GOCADAN STUDY

B.V. Howard, A.G. Comuzzie, R.B. Devereux, S.O.E. Ebbesson, R.R. Fabsitz, W.J. Howard, S. Laston, J.W. MacCluer, A. Silverman, H. Wang, N.J. Weissman, C.R. Wenger

MedStar Research Institute

Background: Alaska Eskimos, like other populations, are undergoing lifestyle change. Unlike others, a significant proportion report substantial physical activity and traditional diets. While State and Indian Health Service data suggest a high proportion of CVD deaths, no risk factor association analyses have been done.

Methods: A population-based sample of 1,214 predominantly Inupiat Eskimos (537 men, 677 women) age 18 or older from Alaska’s Norton Sound Region were examined in 2000-2004 for CVD and associated risk factors. Anthropometry, blood pressures, and ECG were measured using standardized criteria; behavioral risk factors assessed by validated questionnaires; and lipoproteins, glucose, and CRP assessed in fasting blood samples. Prevalent CVD (MI, PTCA/CABG, stroke, CHF) was determined via medical record review with standardized criteria. These analyses focused on the 214 men and 285 women >age 45.

Results: Average age was 58 yrs; rates of diabetes were low (3% and 8% in men and women, respectively) and HDL concentrations were relatively high (57mg/dL and 69mg/dL), but a high proportion smoked (56% and 47%) and had high concentrations of CRP and pathogen burden. Thirteen percent of men and 5% of women met criteria for definite CVD; rates were significantly higher in men (PR 2.4 [1.3-4.9]). Six percent of men and 2% of women had documented stroke (PR 3.46 [1.25-9.56]). CHD (MI plus CABG/PTCA) was documented in 6% (men) and 2% (women) (PR 2.47[1.00-1.69]). In univariate analyses of CVD (n=46) age, male gender, hypertension, diabetes, high LDL-C, high apoB, low HDL-C, and smoking were significantly related. In a multivariate model, CVD was independently related to age (OR/yr 1.06 [1.02-1.09]), hypertension (5.10 [2.00-12.5]), high LDL-C (3.54 [1.73-7.24]), and male gender 3.40[1.60-7.26]).

Conclusion: Prevalence rates support the public health data indicating that despite traditional lifestyles, CVD rates, particularly for stroke, are high in Alaska Eskimos. Aggressive blood pressure and lipid lowering and smoking cessation are warranted. Contact: Barbara V. Howard ([email protected])

HEART RATE IS ASSOCIATED WITH RED BLOOD CELL FATTY ACID CONCENTRATION: THE GOCADAN STUDY

R.B. Devereux, J.C. Lopez-Alvarenga, P.M. Okin, M.E. Tejero, W.S. Harris, L.O.E. Ebbesson, J.W. MacCluer, C.R. Wenger, S. Laston, R.R. Fabsitz, W.J. Howard, B.V. Howard, A.G. Comuzzie

Norton Sound Health Corporation, Alaska

Background: Consumption of omega-3 fatty acids (FAs) in fish oils is associated with reduced death rate from coronary heart disease (CHD), arrhythmia and sudden death. Although these FAs were originally thought to be anti-atherosclerotic, recent evidence suggests that their

benefits are is related to reducing risk for arrhythmia. Since the latter is inversely related to heart rate (HR) we have here examined the association between red blood cell (RBC) omega-3 FAs with HR. The study was conducted among a population of Eskimos currently experiencing an acculturation that involves a dietary shift from highly unsaturated to more saturated fats.

Methods and Results: We compared HR with RBC FA content in 316 men and 391 women 35 to 74 years old participating in the Genetics of Coronary Artery Disease in Alaska Natives Study (GOCADAN). Multivariate linear regression analyses of individual FAs with HR as the dependent variable and specific FAs as covariates, revealed independent negative associations between HR and docosahexaenoic acid (22:6n-3; p<0.004) and eicosapentaenoic acid (20:5n-3; p=0.009) and independent positive associations between HR and select monounsaturated and omega-6 FAs palmitoleic acid (16:1n-7; p=0.021) eicosanoic acid (20:1n9; p=0.007) and with dihomo-gamma-linolenic acid (DHLA; 20:3n-6; p=0.021). Analysis for associations between HR and groups of FAs derived by factor analysis gave similar results in that the main components of factor 1 (omega-3 FAs 20:5, 22:5 and 22:6) were negatively associated with HR (p=0.003). Factor 1 also included positively associated 18:1, 20:1 and 20:3.

Conclusion: Omega 3 FAs derived from fish oils are associated with lower HR, which may in turn reduce risk for arrhythmia and sudden death, whereas several non-omega-3 FAs are associated with higher HR, independent of covariates. Palmitoleic acid (16:1) and DHLA (20:3n-6) have been identified as directly related to cardiovascular mortality. Contact: Sven Ebbesson ([email protected])

RELATIONSHIPS AMONG LIPOPROTEIN SUBFRACTIONS AND CAROTID ATHEROSCLEROSIS: THE GOCADAN STUDY

M. Masulli, L. Patti, G. Riccardi, O. Vaccaro, G. Annuzzi, S.O.E. Ebbesson, R.R. Fabsitz, W.J. Howard, J.D. Otvos, M.J. Roman, H. Wang, N.J. Weissman, B.V. Howard, A.A. Rivellese

MedStar Research Institute

Background: Studies have been inconsistent as to whether measures of lipoprotein particle subfractions are useful indicators of cardiovascular risk. This study evaluated the relationship between lipoprotein subfraction particle concentrations and size, analyzed by nuclear magnetic resonance (NMR) spectroscopy, and measures of carotid atherosclerosis in a population of Alaska Eskimos at high cardiovascular risk but with low frequency of hyperlipidemia.

Methods and Results: In this cross-sectional, population-based sample of Alaska Eskimos ~35yrs (n=656), higher carotid intimal medial thickness (IMT) was associated with higher levels of low-density lipoprotein cholesterol (LDL-C) (p=0.03) and total LDL particle concentration (LDL-P) (p=0.04), independently of other traditional cardiovascular risk factors (age, body mass index, systolic blood pressure, and current smoking); there was a significant interaction between LDL-C and LDL-P and greater IMT (p=0.015). Carotid plaque was associated with higher levels of LDL-C (p=0.01), higher concentrations of large LDL particles (p=0.003), and a reduction in the size of the very-low-density lipoprotein (VLDL) particles (p=0.03). A significant interaction was observed between LDL-C and large LDL and carotid plaque score (p=0.006). IMT and plaque score were not associated with high-density lipoprotein cholesterol (HDL-C) or HDL subfractions.

Conclusions: Carotid IMT was associated with higher LDL particle concentrations, and the association was strongest in those with higher LDL-C levels; the presence and extent of plaque was associated with higher concentrations of LDL-C, large LDL particles, and smaller VLDL particles. It may be beneficial to add determination of lipoprotein subfractions to traditional measures of cardiovascular risk, particularly in populations with low prevalence of hyperlipidemia. Contact: Barbara V. Howard ([email protected])


CARDIOVASCULAR DISEASES IN NATIVE POPULATION OF YAMAL PENINSULA (RUSSIA)

M.A. Romanyuk


Epidemiologic trials in circumpolar regions showed that cardiovascular diseases occupy the first place in mortality. Aim of the present survey was to study the prevalence of cardio-vascular diseases in native employable Yamal population at the age of 20-59 years.

Methods: cross-sectional epidemiologic study was carried out. Coronary heart disease (CHD) and body mass were diagnosed by WHO criteria, stress angina pectoris was stated by the Rose’s cardiologic questionnaire, electrocardiogram interpretation was done according to Minnesota code, atherogenic index was evaluated by recommendations of All-Russia National Cardiologic Society. During our research it was stated that CHD prevailed in 11,8% of native population, mainly in men (12,4% vs. 10,8%), arterial hypertension was registered in 9,5%, mainly in women (13,5% vs. 9,5%). Prevalence of dyslipidemia comprised 38,3%, mainly in men (46,3% vs. 30,6%, p<0,01), among it: hypercholesterolemia was registered in 30,8%, increased level of low density lipoproteids in 26,9%, decreased level of high density lipoproteids in 19,8%, hypertriglyceridemia in 0,5%. 29,8% of tundra native residents smoked, mainly they were men (47,7% vs. 10,9%, p<0,001). Obesity prevailed in women (23,5% vs. 4,6%, p<0,001). Thus, we can conclude that changes in traditional nutrition and nomadic lifestyle worsen health of Yamal natives. Nowadays prevalence of cardiovascular diseases in aboriginal population comes closer to the level which is characteristic to modern urban society. Contact: M.A. Romanyuk ([email protected])

DIFFERENT TYPES OF CORONARY LESIONS AND THEIR IMPACT ON COURSE AND OUTCOMES OF EARLY ACUTE MYOCARDIAL INFARCTION IN THE RUSSIAN NORTH

A.S. Iakovleva, O.A. Mirolyubova

Northern State Medical University, Arkhangelsk, Russia.

Introduction: Coronary angiography (CAG) in young, affected patients is of important diagnostic value as it enables to reveal the type of coronary lesion and predict the prognosis of acute myocardial infarction (AMI). The aim of this research work was to assess the extension and types of the coronary lesions and their influence on the outcomes in patients surviving an early AMI.

Material and methods: The trial enrolled 45 patients under 45 years who were treated for AMI in Arkhangelsk Clinical Hospital in 2006-2008. The results of CAG were evaluated taking into consideration the number and diameter of involved arteries, the significance of stenosis and its extension.

Results: CAG was performed in 30 adults on admission. There were no lesions of heart vessels in 2 patients who developed AMI of II and III Killip Class. Significant reduction in luminal diameter was revealed in 72.0% of adults, the extension of stenosis varied from 0.3 cm to 2.0 cm (mean 1.2±0.11 cm). One large vessel was involved in 45.0% of cases, two large vessels in 15.2% of cases. Multivascular coronary lesions were revealed in 7.4% of adults. The majority of those who had 1 vessel’s lesion developed II Killip Class, patients with 2 vessels’ lesion III Killip Class. Adults with multivascular coronary lesion developed IV Killip Class preferably. Reinfarction occurred in 5 such patients (11.1%). The majority of adults with 2-3 vessels lesions (25 cases) developed cardiomegaly due to the results of predischarge ECHO.

Conclusion: Thus, 72.0% of patients had severe coronary lesion regardless young age. III-IV Killip Class (62.3%), reinfarction (11.1%) and cardiomegaly (55.5%) occurred more frequently in adults with 2-3 vessels’ lesion. The data obtained may be applied to predict the severity of an early AMI. Contact: Anna Iakovleva ([email protected])

CARDIOVASCULAR DISEASES AND THEIR RISK FACTORS IN THE ASIAN PART OF RUSSIA

Y. Nikitin

Institute of Internal Medicine Siberian Branch of Russian Academy of Medical Science

Siberia and the Far East is part of the Russian Federation with a population of over 30 million of people. The most of the population are europeoids.

In the structure of total mortality more than the half of deaths is because of cardiovascular and cerebrovascular diseases. According the data of epidemiologic screenings the frequency of coronary heart disease in 30-60 year old population (Novosibirsk, Chukotka, Yakutia, Altay) is 10-15%. Stroke morbidity is about 216-450 : 100 000 (both sexes and all ages). The highest levels of stroke morbidity and mortality is registered in south-east regions of Asian part of Russia.

The prevalence of hypertension is quite high - 22-41% (blood pressure higher than 160/90). Also we studied the lipid profile, anthropometric parameters, Diabetes Mellitus, nutrition peculiarities, alcohol consumption and a number of other parameters. Some differences in studied parameters were registered in indigenous Siberian population. Trends of cardiovascular mortality fro 1985-2005 years were studied in Novosibirsk an some other Siberian regions. Contact: Yuri Nikitin ([email protected])

NEW METHOD OF RESPIRATORY BIOFEEDBACK

O. Grishin

The Institute for Physiology MAC-SB

We have developed a novel technology of respiratory Biofeedback (BFB) for the treatment of functional respiratory disorders (FRD) in pediatrics. The method is based on the computer game that is managed by the patient’s breathing. To achieve it, initially we used only two capnography parameters: end-tidal CO2 fraction (FetCO2) and breath frequency (f). That version of BFB has successfully passed clinical trials concerning the treatment of hyperventilation syndrome (HVS) in children with asthma. However, in our first game version the pattern of breath could not be controlled. Our studies have shown that FRD correction is accompanied by reliable changes in breathing pattern. Respiratory cycle duration increased by an average of 15%, and exhalation plus subsequent pause time increased by 25%. On the other hand, the time of inhalation de-creased by 8 %. In view of the data obtained, a new version of BFB game was developed. We radically altered the plot; this one was named “The Flight of Breath”. In our new development the bird’s flight depends on FetCO2 as well as temporal characteristics of the breathing pattern: time of inhale, exhale, and post-exhale pause. New BFB game technology has improved potenti-alities of FRD correction due to the acquisition of controlled parameters. Contact: Oleg Grishin ([email protected])

EPIDEMIOLOGY OF CORONARY HEART DISEASE IN A POPULATION OF THE CIRCUMPOLAR REGION (RUSSIA)

E.V. Moshkova

Coronary heart disease (CHD) is the main cause of mortality in population of circumpolar regions. Aim of the survey was to study the prevalence of CHD in employable population (aged 20-59 years) of the northern part of Yamal peninsula (70-72 degrees of northern latitude) in arctic climatic zone. Material and Methods: cross-sectional epidemiologic study was carried out in Se-Yakha village (Yamal peninsula, Russia) in 2008. CHD, arterial hypertension were diagnosed by WHO criteria (1999), hypercholesterolemia was evaluated by recommendations of All-Russia National Cardiologic Society (2004). Electrocardiogram interpretation was done according to Minnesota code by strict and non-strict criteria, effort angina was stated by the Rose’s cardiologic questionnaire. The results of our study revealed that CHD prevalence by extensive criteria comprised 14,0%: 9,0% – by non-


strict criteria and 5,0% – by strict ones. Prevalence of effort angina in population was defined as 3,2%. By strict criteria painless CHD was stated in 1,4% of population, myocardial infarction – in 0,4%. By non-strict criteria painless CHD was revealed in 5,7%, probable CHD diagnosis was stated for 3,4% of inhabitants. Analysis of the main risk-factors of CHD showed that 48,8% of residents suffered hypercholesterolemia, 16,5% had arterial hypertension, smoking was stated for 28,8% of examined people. On the basis of these studies it seems justified to conclude that epidemiologically defined CHD has a great prevalence in rural population of high latitudes. Hypercholesterolemia is the most prevalent among the main risk-factors of CHD. Contact: E.V. Moshkova ([email protected])

SESSION 8 Tuesday, July 14, 4:00-5:30 PM

VENUE 1 Mental Health & Wellness #5 – Children & Youth

THE INFLUENCE OF RELIGIOUS FACTORS ON DRINKING BEHAVIOUR AMONG YOUNG INDIGENOUS SÁMI AND NON-SÁMI PEERS IN NORTHERN NORWAY

A.R. Spein1, M. Melhus1, R. Kristiansen2, S. Kvernmo3 1Center for Sámi Health Research, Karasjojk, 2Department of Religious Studies, University of Tromsø, Norway, 3Child and Adolescent Psychiatric Department, University Hospital of North Norway/Regional Center fo, Norway

Objectives: This is the first longitudinal survey investigating the influence of religious revival movement (Laestadianism or evangelics) and importance (personal Christian) on drinking behavior among indigenous Sámi and non-Sámi adolescents and young adults in Northern Norway. Study Design: A two wave longitudinal epidemiological questionnaire study including 2,950 respondents (675 Sami); 15-19 year; RR: 85% (T1:1994/95) and 1,510 follow-up respondents (360 Sami) 18-22 year; RR: 57% (T2: 1997/98). Results: More Sámi were Laestadians (10% vs. 3%) and personal Christians (14% vs. 7%) than non-Sámi (p<.001) at T1. Generally, significant negative associations were noted for religiousness and abstinence, drinking frequency and style (drunkenness), and it also influenced youth drinking context at both assessments. Ethnicity and ethnic context (region) moderated the effect of religion on drinking. The less drinking earlier noted among young Sámi may partly be explained by ethnic differences in religiosity, as the effect of ethnicity generally became non-significant when adjusted for sociodemograhpics, ethnic context, family and school factors. Conclusions: Generally, religious factors had strong protective effect upon drinking behavior. Laestadianis’s profound impact on Sámi culture and strong anti-alcohol norms may have contributed to a religious-socio-cultural context of abstinence, explaining the higher abstinence rate and lower drinking rates found among Sami. Contact: Anna Rita Spein ([email protected])

SNUFF USE AND CIGARETTE SMOKING AMONG INDIGENOUS SÁMI AND NON-SÁMI 10TH GRADERS IN NORTHERN NORWAY 2003-2005

A.R. Spein1, M. Melhus1, L. Grøtvedt2, S. Kvernmo3 1Center for Sámi Health Research, Karasjojk, 2Norwegian Institute of Public Health, Norway, 3Child and Adolescent Psychiatric Department, University Hospital of North Norway/Regional Center fo, Norway

Objectives: The presentation summarise snuff use and cigarette smoking rates and combined snuff/tobacco users among Sámi and non-Sámi 10th graders in Northern Norway. This is the first study investigating snuff use among indigenous Sami. Study Design: Data were collected from the “Youth & Health in North Norway”, a cross-sectional, school based study, conducted in 2003-2005.

Methods: The total sample included 4,880 participants (response rate: 83%). Sámi comprised 9 % (N= 450), and females 50 % (N=2,442) of the total sample.

Results: The proportion of current (occasional and daily) snuff users were 19% (N=907), and gender (males 29% vs. females 9%; p<.001) differences occurred. No significant ethnic differences existed. Similarly, the proportion of current (occasional and daily) smokers was 27% (N=1,295), and gender (females 33% vs. males 22%; p<.001) and ethnic (Sami: 33% vs. non-Sami: 25%; p<.001) differences existed. Mean age for initiating smoking averaged 13 year, with males and Sámi being slightly younger. Sámi more often non-Sámi reported living together with a smoking siblings (19% vs. 12%, p.001), while no ethnic differences occurred for living with a smoking mother (37%) or father (30%). The number of combined cigarette and snuff users were: 10% (N=503), and gender (males: 14% vs. females 7%; p<.001) and ethnic (Sami: 13% vs. non-Sami: 10%, p<.05) differences occurred.

Conclusions: After the millennium, decreasing smoking rates has been notated among Norwegian youth, while snuff use rates has increased considerably. Findings from the 1990s generally indicated similar smoking rates among Sámi and non-Sámi. Compared to these earlier findings (Spein et al., 2002) the preliminary results of more Sámi 10th graders being current smokers in 2003-05 suggest a less positive smoking development among young Sámi when compared to regional and national Norwegian trends. The findings are further discussed in light of sociodemographics, education plans, and risk-taking behaviour variables. Contact: Anna Rita Spein ([email protected])

CHALLENGING THE STEREOTYPE: A PORTRAIT OF HEALTHY INDIGENOUS YOUTH PARTICIPANTS AT THE COWICHAN (BRITISH COLUMBIA, CANADA) 2008 NORTH AMERICAN INDIGENOUS GAMES

M. Kelly, R. Link, J. Reading


Objective: Existing literature frequently and persistently portrays Aboriginal youth as having poor health and engaging in multiple risky behaviours. Reports of higher rates of accidents, injuries, substance abuse, sexual transmitted infections, school dropouts, and suicides among Indigenous youth are widespread. Using survey results, the purpose of this study is to challenge the unhealthy portrayal of Indigenous youth by exploring the role of sport in the health and resiliency of participants at the 2008 North American Indigenous Games (NAIG).

Methods: The Aboriginal Youth Lifestyle Survey was designed to inquire about youth tobacco use and other health related factors and was used to survey youth at the 2002 NAIG. The same survey, with minor revisions, was used in this study to survey Aboriginal youth athletes at the 2008 NAIG.

Results: There were 277 survey participants who met the inclusion criteria. Of those for whom smoking status could be assessed, 238 (93.7%) were currently non-smokers. Qualifying to compete at the NAIG suggests a certain level of physical fitness, but in addition, over half (55.1%) of the athletes also reported participating in physical activity without an instructor four or more times a week. Nearly three-quarters (73.3%) of participants reported very good or excellent health. In addition, the participants also scored high on self-esteem and positive peer group indicators.

Discussion: These findings indicate that the athlete participants of the 2008 NAIG are a healthy population of Indigenous youth and are consistent with the findings from the 2002 NAIG survey. This suggests


that Indigenous athletes are healthier than their Indigenous and mainstream North American counterparts and that sport may act as a protective health factor for Indigenous youth. Further research into the benefits of sport may be a crucial step in closing the gap in health status that currently exists between Indigenous and non-Indigenous people. Contact: Rachel Link ([email protected])

FAMILY HEALTH AND WELL-BEING: RESEARCH, RESPONSIBILITY, REACTION

G. Mulvad

Center of Primary Health

During the last decade, research have given a lot of knowledge about health and well-being in the family of the Arctic. I many Arctic region, we have to say that the data about “well-being” gives a lot of responsibility for the community. Responsibility to handle the knowledge about, alcohol abuse, suicide, sexual abuse, infectious diseases, inequality in health and well-being. The research, the data, and the responsibility have to be discussed between the research team and the society. Research have shown the problems, but not a way to go, handling the knowledge about the well or not well-being in the Arctic Family. The responsibility have to be taken. A family responsibility, a community responsibility, our responsibility. New reaction have to be planed. Involvement of the society and the family to cope and react on the new knowledge, will be discussed. Start with the children, the family in formative period, when the child start in kinder garden, and in school reaction have to be taken. Research, Responsibility and Reaction, we can find solution. Contact: Gert Mulvad ([email protected])

THE APPLICATION OF STRENGTH BASED ASSESSMENTS AND INTERVENTIONS WITH CHILDREN AND ADOLESCENTS EXPERIENCING MENTAL HEALTH DIFFICULTIES

E. Rawana, K. Brownlee

Lakehead University

This workshop is intended for front-line staff and their supervisors, particularly those working in a northern environment. The presentation will focus on utilizing a strengths-based perspective in working with children, adolescents and their families, including First Nations families. Clinicians will be presented with a developmental model that defines strengths and shows how strengths play an integral role in the developmental profile of children and adolescents. Clinicians will be provided with an instrument for assessing strengths in individuals and their families. The instrument used for the assessment of strengths was particularly developed with a northern focus and thus reflects the unique spiritual and cultural influences on the psychological development of northern youth. Clinicians will also be provided with a framework to incorporate the assessed strengths into their treatment plans for children, adolescents and their families. This framework complements the more commonly used diagnostic approach and emphasizes a holistic and cultural model for working with clients. Contact: Edward Rawana ([email protected])

THREE CHILDREN ON ONE BIKE: AN ANTHROPOLOGICAL STUDY WITH ON WHAT CHILDREN ARE CAPABLE OF AND WHAT CHILDREN WANT

K. Thorsen, G. Bergenholtz

Greenland Management of Health, Nuuk. Center of Health Education, Nuuk

In Greenland today children may be classified as: relatively poor, implicitly poor, need estimatedly poor and many other classifications. All these classifications children must bear without knowing it themselves. Adults give classifications to children, but how do children

look at themselves? Are they aware of classifications or are other factors and values involved?

This study focuses on children’s resources and competences instead of on privation or social inequality. The study deals with what children are concerned about and looks at children as interpreters of their own lives.

Our study has been in progress since November 2007. The study has taken place in the capital, Nuuk, and in Qaanaaq the most northern town in Greenland. The focus group is schoolchildren in different public places. The playing and moving children bring us to a tense field between the past and the modern time.

We want to show, how we are applying qualitative anthropological methods like participant observation, interviews and observations in our fieldwork. We will take you to the places where we find the children and to places children have shown us through their pictures.

In this presentation we would like to show you our pathways. Pictures from our fieldwork will be helpers in the presentation. Contact: Klara Thorsen ([email protected], [email protected])

VENUE 2 Occupational Health

PSYCHODYNAMIC ANALYSIS OF ANTARCTIC INTERGROUPS RELATIONS

G. Cobra

Escola Nacional de Saúde Pública (ENSP) - FIOCRUZ

This qualitative research was developed through indirect observation (NELSON, 1973) of 20 Brazilian researchers from Rio de Janeiro and São Paulo who went to Antarctica on the years of 2005, 2006 and 2007. The population embraced 15 men and 5 women with a mean age of 34 years old. Interviews were carried individually with the intension of getting the most personal view from the interaction of its own group with the base group (Navy) and its formal leader.

Objective: To evaluate inter-group formation, structure and interaction; the patterns of intersubjective relations and group as an emotional and material support for a confined and isolated environment.

Methods: The individual interviews were recorded and analyzed with the technique of discourse analysis. Each interviewee was taken as the spokesman of the group as a whole (Foulks, 1965). Their accounts were analyzed in the light of group psychoanalysis theory, especially W. R. Bion, S.H. Foulks and E. J. Anthony.

Results: It was identified three different reseachers’ groups: the camping group, the Comandante Ferraz Station group and the boat group (Ary Rongel). These three groups have different dynamics, structure and culture formation. Although they had superficially a formal group pattern (Nelson, 1973) the informal structure was soon revealed. Through the discourses it was possible to identify intergroups relations, more specifically, how the interaction between the researchers and the base group (Navy) is organized. Many times work-group activities were emotionally obstructed and diverted by basic assumptions of dependence, flight and fight (BION, 1975). Because the Brazilian Antartic Programme logistics is organized by the Navy and its commanding officer, one of the common assumptions to all groups, that is to do research, was not always carried out to its full extension. Therefore the Station Chief, depending on his personality, was evaluated as an autocratic or democratic leader. Contact: Geny Cobra ([email protected])

RASCH ANALYSIS OF THE OSWESTRY DISABILITY INDEX

L. Lochhead, P. Macmillan



In northern resource based communities determination of readiness to return to work can be challenging due to the heavy nature of the work, conditions in which the work is performed and the shortage of health professionals trained to assess work ability. Often health care professionals rely on self report instruments to determine when and how the worker will return to work. “The Oswestry Disability Index (ODI) has become one of the principal condition-specific outcome measures used in the management of spinal disorders.” (Fairbank, 2000).

The purpose of this study was to explore the construct validity of the ODI version 1 using Rasch Analysis. Data was collected on a sample of 300 northern dwelling individuals working primarily in the forest industry. We are looking at the measurement properties of the ODI usingthe partial credit/rating scale Rasch models. The identification of poorly functioning items allow for their elimination or improvement of these items and therefore the improvement of the instrument.

When Andrich’s rating scale model is applied, all response levels appear to function. Level 2 however had a narrower range for which it was the most probable choice. When Masters’ Partial Credit Model is applied, the level 2 response was seen to be particularly problematic for 3 items including the Pain Intensity item mentioned by White and Velozo(2002). We are not yet ready to concur that the pain intensity item does not fit adequately (i.e. warrants removal or revision)

In fact, we found that the 10 Version 1 Oswestry items showed adequate fit to the Rash model Health Professionals using this measure should be aware that the ODI is a valid measure however for some items the rating scale steps do not perform as intended. Contact: Lois Lochhead ([email protected])

OCCURRENCE AND RISK FACTORS OF FROSTBITES AT THE POPULATION LEVEL WITH A SPECIAL EMPHASIS ON WORKING LIFE

T.M. Mäkinen1, J. Jokelainen1,2, S. Näyhä1,3, T. Laatikainen4, P. Jousilahti4, J. Hassi1 1Institute of Health Sciences, University of Oulu, 2Unit of General Practice, Oulu University Hospital, Oulu, Finland, 3Finnish Institute of Occupational Health, Oulu, Finland, 4National Institute for Health and Welfare, Helsinki, Finland

Objectives: Frostbites are tissue injuries related to adverse cooling and unacceptable in the view of public health and occupational safety. The objective of the study was to examine the occurrence and risk factors of frostbites in the general population with a particular emphasis on frostbites occurring in working life.

Methods: Two national FINRISK studies and their cold sub studies (FINRISK 1997 n=2624, FINRISK 2002 n=6591) were analysed consisting of questionnaires administered to men and women aged 25-74 yrs.

Results: A total of 697 frostbites were reported in the two studies. Altogether 425 had occurred during the past year (330 mild and 95 severe) and 272 during the lifetime according to the respondents. The amount of annually occurring mild frostbite was 12.9% (330/2550) being 14.2% (170/1201) in men and 11.9% (160/1341) in women. The annual incidence of severe frostbites was 1.1% 95/8788 being 1.6% (66/4043) in men and 0.6% (29/4560) in women. The cumulative lifetime incidence of severe frostbites was 10.6% (272/2568) and 14.1% (171/1210) in men and 7.4% (101/1358) in women. Frostbites occur more often in men than women and decrease at age 65 or above. Most of the frostbites were reported in occupational groups, such as skilled agricultural and fishery workers, craft and related trades workers, plant and machine operators, assemblers and technicians and associate professionals. Occupational related risk factors included employment in a certain industry (e.g. outdoor work), high physical strain, and high reported weekly cold exposure at work. Individual factors that increase frostbite risk are: diabetes, white fingers in cold, cardiac insufficiency, angina pectoris, history of stroke, feelings of depression and heavy alcohol use.

Conclusions: Environmental and individual risk factors should be taken into account when developing risk assessment and management strategies for preventing frostbite injuries in cold work. Contact: Tiina Mäkinen ([email protected])

NUTRITION, VITAMINS, SERUM LIPIDS, AND CARDIOVASCULAR DISEASES RISK IN DRIVERS WORKED IN GAS INDUSTRY ON THE NORTH OF RUSSIA

N. Potolitsyna, N. Eseva, E. Bojko

Department of Ecological and Social Physiology of Human, Institute of Physiology, Ural Division of the Russian Academy of Sciences, Syktyvkar, Russia

The composition of the actual meal and blood level of lipids and vitamins was a studied in different groups drivers (man) working in gas industry depending on the gravity of the work (n=223). The 24-hours interview analysis of the actual meal has revealed the differences in ration of the nutrition in different groups of drivers. Ones having heavy physical activity and shift working type is often discovered a low caloric value of the nutrition, mainly, to account of the reduction carbohydrates in food and demonstrate the deficit of vitamins. In drivers group with middle heavies of work described the increased caloric value of the nutrition leads to increase of serum lipids. The analysis of serum indices has shown that examined workers had normal levels of total cholesterol and lipoproteins of high and low density, apolipoprotein A1 and apolipoprotein B, however typically they had high level of triglycerides. Biochemical analysis of vitamins in blood has shown the low level of vitamins participate in antioxidant system - α-tocopherol, retinol, riboflavine. Contact: Bojko Evgeny ([email protected])

PSYCHOPHYSIOLOGICAL ASPECTS OF ADAPTATION OF OIL SHIFT WORKERS

G. Degteva

The unfavorable production factors, flying stress, group isolation against the background of extreme geophysics and weather factors of the North influences upon adaptive reactions.

The study of physiological reactions of organism of shift workers reveals that 83% of workers has “after flying stress” formed by flying and the start of work at the oil field; 38% workers has tensions and exhaustion of regulation mechanism at the end of the shift.

From the 33-35th day of the shift 61% of workers was easily tired, had deterioration of concentration of attention, degradation with tension of organism functional systems (cardiovascular, respiratory, red blood systems).

Psycho physiological features stand as regulators of biological resources of organism under labour conditions, determine stress tolerance, form range of adaptive possibilities. The analysis of different regimes of labour and rest showed inefficiency of long shift (52 days) in the Extreme North, especially in winter. The dynamic of “vegetative coefficient” showed the attitude towards active actions with optimal mobilization of physical and psychological resources was characterized for most of shift workers at the beginning of the shift. In the middle of the shift the energetic potential of workers was significantly decreased. Then tiredness, fussiness, agitation, impulsion were increased. Hasty steps became possible because of low self-control. At the end of the shift the self-appraisal of shift workers increased in expectation of the rest and the meeting with family.

Negative climate and production factors equally impact on all workers, but the characteristics of functional state are considerably different because of diverse level of formal and dynamic features of individuality, personal, social psychological features, motive, needs, profession features. It requires different approach to professional selection and psychological maintenance of workers under the extreme conditions of the North. Contact: Galina Degteva ([email protected])


HUMAN HEALTH RISK ASSESSMENT AND BEYOND – THE COMMUNITY HEALTH

G. Brown1, M. Lee2 1Intrinsik Environmental Sciences Inc., 2Habitat Health Impact Cosulting

When plans for construction and operation of heavy industrial plants or projects are announced by large corporations, local members of the general public and of regional communities are legitimately concerned about possible adverse effects on human health and well-being. It is generally believed by the public that new industrial projects could adversely affect human health eg air quality, country foods and local water sources are particular concerns. For regulatory approval of new projects, potential environmental impacts and human health risks must be properly assessed, addressed and mitigated through the Environmental Impact Assessment (EIA) process in Alberta and other jurisdictions.

What has been inadequately addressed, or is entirely missing from the regulatory assessments required in Alberta is a process to address broader issues of community health and well-being that are scientifically separate from exposures through proposed and operating industrial facilities. Overall community health and well-being must involve integration of health risk assessment findings and mitigation plans with paradigms for assessing and mitigating bigger and broader community health issues, as well as involving open communication and involvement with all public stakeholders - not only during the approval stage, but also ongoing during the operations of large industrial projects. Contact: Gordon Brown ([email protected])

VENUE 3 Newborn & Child Health #1 – Birth Defects

THE INCIDENCE OF SEVERE CONGENITAL DEFECTS IN NORWAY AND NORTHWEST RUSSIA

A. Vaktskjold1, J.G. Petrova2 1Nordic School of Public Health, Nordic Council of Ministers, Sweden/Denmark, 2P.G. Vyletsova Clinical Children Hospital of Arkhangelskaja Oblast, Russia

Congenital birth defects continue to be a pressing challenge in both paediatric and general health work. These children eventually comprise a major part of the overall indicators of children’s health, such as disability, mortality, morbidity and hospitalisation. Our aim was to assess and compare the incidence of isolated neural tube defects (anencephaly and spina bifida) (NTD), anterior abdominal wall defects (gastroschisis and omphalocele) and trisomy 13 in the foetal and newborn populations (~12 weeks’ gestation) of the Arkhangelskaja Oblast (AO) in north-west Russia and Norway, and to study the maternal-age distribution of these defects.

In Russia, systematic population-based computerised registration of all deliveries has been lacking, which has hampered the possibilities for epidemiological studies concerning birth defects there. However, by year 2006, 34 regions (including four in the north) had put in place a programme for population-based registration of newborns and foetuses with defects, which facilitates for descriptive studies. Our study is the first submitted for publication internationally based on these data, and the first from Norway that also include abortuses with the mentioned defects.

35 per 10,000 newborns and abortuses had one of the defects in AO (whereof 24% had trisomy), and 34/10,000 in Norway (53%). Of those with trisomy, 98% in AO were live born compared to 75% in Norway. The incidence (~12 weeks’ gestation) of NTD was 21.1 (± 3.4)/10,000 in AO and 10.8 (± 1.2) in Norway; and of abdominal wall defects 5.4/10,000 (±1.7) in AO and 5.1 (±0.8) in Norway. Of the latter, 38% in AO and 65% in Norway were live born. The incidence of anencephaly

and spina bifida in AO and spina bifida and gastroschisis in Norway was highest in the young maternal age groups. The findings will be presented in more detail orally at the conference and published (1,2).

We acknowledge the services of the Medical Birth Registry of Norway and the Vyletsova Children Hospital in Arkhangelsk. The Norwegian Barents Secretariat sponsored the study collaboration. Contact: Arild Vaktskjold ([email protected])

CHART REVIEW ANALYSIS OF MATERNAL FACTORS AND MAJOR MALFORMATIONS ON BAFFIN ISLAND 2000-2005

C. Sy1, J. Cowan1, I. Sobol2, G. Osborne2, L. Arbour1 1University of British Columbia, 2Nunavut Health and Social Services

Birth defect rates have been previously (1989-1993) shown to be higher in Canadian Inuit populations (Nunavut and Nunavik) than in Alberta. A recent (2000-2005) CCASS analysis (up until 1 month of age) comparing Nunavut to the other Territories and the rest of Canada support a higher rate of birth defects in Nunavut (see Orlaw), largely because of a higher rate of heart defects. Furthermore, a chart review of all births from Baffin Island in the same time period, (n=2015) confirmed that even after folic acid fortification, the rate of echocardiography confirmed heart defects (ICD-9 745) remain three times higher than in Alberta. This study uses case control methodology from the same chart review to determine if prenatally reported maternal risk factors were associated with major congenital malformations. Cases (n=77) were selected on the basis of having a confirmed major malformation without chromosome anomaly or syndrome in ICD 9 categories 740-759. The next four births without birth defects from the same community were selected as controls (n=307). Using odds ratios (OR) and 95% confidence intervals (CI) for significance, self reported alcohol consumption at the first prenatal visit in any quantity, smoking, marijuana, and pre-natal vitamin use were analyzed. Maternal age, and term vs preterm gestation were also compared. Of these, alcohol consumption was significantly associated (OR-2.2,CI:1.02-4.87), and infants with major malformations were 6 times more likely to be born premature (OR-6.35,CI:3.15-12.80). No other factors were significant. A sub-analysis of the same risk factors on infants with cardiac defects only revealed an association with preterm birth (PDA and PFO excluded) (OR-11.59,CI:3.32-40.5). No other maternal risk factors were significant, including alcohol intake although marijuana use was close to significance. Although data were limited, there was no evidence of protective effect with maternal vitamin use. Development of a comprehensive pregnancy and child health surveillance system will provide on-going, more precise information on preventable causes of birth defects. Contact: Candice Sy ([email protected])

CONGENITAL ANOMALIES IN CANADA’S NORTHERN TERRITORIES

C. Orlaw1, J. Rouleau2, B. Hanley3, A. Corriveau4, G. Osborne5, I. Sobol5, L. Arbour6 1University of Alaska Anchorage, 2Public Health Agency of Canada, 3Yukon Health and Social Services, 4Northwest Territories Health and Social Services, 5Nunavut Health and Social Services, 6University of British Columbia

Objectives: There is little information regarding congenital anomalies in Canada’s circumpolar regions compared to southern Canada. Discovering this information is a critical first step to help direct clinical and public health resources. The birth prevalence of specific significant congenital anomalies also allows for the development of public health prevention strategies.

Methods: Data for the first 30 days of life was gathered by the Canadian Institute of Health Information (CIHI) from discharge abstracts from 2000-2005. That information was compiled into congenital anomaly categories for each province/territory as per the Canadian Congenital Anomalies Surveillance System. Totals and categories were compared per territory to those of the rest of Canada using odds ratios (OR) and


95% confidence intervals (CI). Socioeconomic indicators were gathered from Statistics Canada.

Results: Total anomalies in Canada, Yukon, NWT and Nunavut per 1000 births respectively are: 66, 57, 59, and 90. Only Nunavut had a significantly higher total rate than the rest of Canada. (OR 1.4; 95% CI 1.2-1.6). Rates of congenital anomalies in Yukon and Northwest Territories were not significantly higher in any category when compared to the rest of Canada. However, congenital heart defects in Nunavut were increased with an OR of 2.59 (95% CI 2.2-3.3). Socio-economic indicators such as infant mortality, low income and expenditures on food reflected the same trends as seen for congenital anomalies.

Conclusions: Birth defects collected in the first 30 days of life are an underestimate of the true impact since many birth defects are not detected until later. Although congenital heart defects are multifactorial (genetic and environmental), the socioeconomic indicators and congenital anomalies distributions are strikingly similar. The development of maternal child health surveillance systems will provide more specific information on potentially preventable causes of congenital heart defects. Contact: Cynthia Orlaw ([email protected])

RATES OF HOSPITALIZATION FOR LUNG INFECTION OF INUIT INFANTS FROM THE BAFFIN REGION AND ASSOCIATION WITH HEART DEFECTS 2000-2005

S. Peters1, J. Cowan1, G. Osborne2, I. Sobol2, L. Arbour1 1University of British Columbia, 2Nunavut Health and Social Services

Previous and current research has suggested that Inuit infants in Canada have a higher rate of heart defects than other Northern and Canadian populations. As well there is great concern over the rate of admissions for lung infection (lower respiratory tract infection) in the first year of life. As part of a comprehensive chart review for all births from January 1st, 2000 to December 31st 2005, all overnight hospitalizations for lung infection for infants born in the years 2000-2004 inclusive were documented considering the question: Are children with heart defects more likely to be admitted for lung infection than children without?

Methods: A chart review of all live births in the Baffin region of Nunavut was performed (n=1700). Maternal factors and birth defects were recorded, as well as all reasons for overnight hospitalizations. For all infants, overnight hospital admissions for lung infection, (single and multiple) were recorded until the first birthday. Presence or absence of a heart defect (confirmed with echocardiography, excluding PDA associated with prematurity) was noted (n=69). Annualized incidence(AI) rates/1000 (admissions/population at risk) and odds ratios (OR) with 95% confidence intervals (CI) were used in the analysis of rates and to determine increased risk for those with heart defects.

Results: Of 1688 infants, 408 were admitted at least once, with a total of 597 hospital admissions for lung infection (354/1000 AI rate). Twenty nine children with heart defects were admitted 57 times, (826/1000 AI rate). Infants with heart defects were significantly more likely to be hospitalized at least once (OR 2.36:CI 1.44-3.86), and to have repeat admissions (OR 2.6:CI 1.23-5.63).

Conclusion: Rates of hospital admissions for lung infection remain high in the Baffin Region of Nunavut. Infants with heart defects have a particular high rate of admissions impacting further on the health care system. Although more study is needed to understand the reasons for the increased rates, priority efforts in prevention of lung infections should be directed to those infants with heart defects. Contact: Sarah Peters ([email protected])

THE STATE OF BIRTH DEFECTS AND BIRTH OUTCOME SURVEILLANCE IN THE CIRCUMPOLAR REGIONS OF THE WORLD IN 2008

L. Arbour, V. Melnikov, B. Olsen, G. Osborne, A. Vaktskjold

Department of Medical Genetics, Unviversity of British Columbia, The IUCH Birth Defect Working Group

Introduction: As part of the International Polar Year, Arctic Human Health Initiative, the Birth Defects Working Group of the International Union of Circumpolar Health catalogued existing and developing birth outcome and birth defect surveillance within and around the geographic jurisdiction of the International Union of Circumpolar Health (IUCH). It was found that systematic population-based registration of birth outcomes including birth defects occurs to some degree in all circumpolar countries, but the quality of collection and the coverage in northernmost regions vary. For example, few circumpolar jurisdictions have registries that collect birth defects beyond the perinatal period. Efforts are underway in some jurisdictions (Canada and Russia) to improve the quality and comprehensiveness of the information collected in the northern regions. It is hoped this baseline review of existing and developing surveillance systems will serve as a guide for the development of additional surveillance systems and enhance the mandate of current systems with the eventual goal of comprehensive and comparable coverage throughout the circumpolar world. For now, however, although there is variability in the comprehensiveness of information collected in Northern jurisdictions limiting sophisticated comparative analyses between regions, there is substantial untapped potential for baseline analyses of specific risks and outcomes that could provide insight into geographic differences. Drs. Vaktskjold and Arbour will present a summary of the review carried out by the IUCH Birth Defect Working Group. Contact: Laura Arbour ([email protected])


THE SAFETY OF SMALL DRINKING WATER SYSTEMS IN CANADA: DISCUSSING THE NORTHERN PERSPECTIVE

H. Beanlands, F. Benoit, M. Fast, D. Ciliska, R. Copes, M. Greenwood

National Collaborating Centres (NCCs) for Public Health

The International Union for Circumpolar Health has noted that “there has been a long-standing need for the exchange of medical knowledge, as well as the results of recent research and demonstrated solutions to problems for the benefit of humankind.”

One serious problem is the safety of small drinking water systems. What support and what practical information do public health inspectors, public health nurses, and medical officers of health in northern communities in Canada require to make the best use of the knowledge and data arising from recent research initiatives into the safety of small drinking water systems?

The National Collaborating Centres (NCCs) for Public Health are a network of six centres across Canada providing a national focus for the synthesis, translation and exchange of scientific evidence and other relevant knowledge to improve and sustain evidence-based informed decisions by public health practitioners and policymakers.

The NCC for Environmental Health will present results of their study on retrospective surveillance for drinking-water related illnesses from 1993-2008 in Canada as a basis for discussion around next steps for improving small drinking water systems.

Following the presentation, participants will be invited to share their best views as to how issues surrounding the safety of small drinking water systems can be addressed and the group will explore opportunities for future collaboration.

Specifically, the objective of the presentation is to

- identify research priorities and opportunities for future collaboration regarding the safety of small drinking water systems in Canada’s North.

Contact: Philip Girvan ([email protected])


BUILDING INDIGENOUS CAPACITY TO MEET HEALTH NEEDS AND COMBAT HEALTH DISPARITIES: A MANITOBA (CANADA) EXPERIENCE

M. Hall, B. Elias, P.J. Martens, J. Mignone


Introduction: In Canada, there is an urgent need for comparable and relevant health indicators to address the health of the First Nations (FN) population. In response, a collaborative interdisciplinary university research and government partner team developed through the Manitoba First Nations Centre for Aboriginal Health research resulted in funding from the Canadian Institutes of Health Research to support targeted capacity building in identifying and reporting on comparable and unique indicators. This presentation reports on a collaborative approach for effective knowledge transfer and exchange involving FN and tribal health personnel. The workshops promote opportunities to understand and explore health indicators, as well as map out crucial indicators for a health-reporting framework.

Methods: In Manitoba, First Nations have access to a multitude of informative data sources to investigate the health of their communities, including social determinant surveys and provincial health administration data (e.g., medical and hospital claims). To clearly distinguish Registered FN/non-Registered FN individuals in the administrative databases, permission to access and link the federal government “Indian Registry” to the provincial population registry system made it possible for FNs to investigate past, current and future health status and health service utilization by tribal areas (north/south). Combining these data sources and the indicators developed by the Manitoba Centre for Health Policy, we were able to design a health indicator training program which included a manual (covering indicator development, data sources and data access protocols), presentation materials, data to story training tools, and a round-table discussion template to identify prevalent and emerging community health issues. FN health directors and program coordinators participated in the training

Results/Conclusion: The workshops enhanced the capacity of participants to understand indicator development, data linkage possibilities, data interpretation, and ways to use indicators to inform policies and programs. Contact: Madelyn Hall ([email protected])

INCREASING HIV/AIDS COMMUNITY-BASED RESEARCH CAPACITY IN NORTHERN ABORIGINAL COMMUNITIES IN CANADA

M. Mayoh, R. Masching, P. Lyta

Canadian Aboriginal AIDS Network

Issue: Unique social and environmental issues create greater susceptibility to STIs and present obstacles for engagement of northern communities in the community-based research process.

The Challenges: STI data suggests an alarming over-representation of infection in Inuit communities, compared to non-Aboriginal communities. High rates of teenage pregnancies are also a concern. Gaps in data in northern Canada limit our understanding of the current growth of the HIV/AIDS epidemic in northern communities. This situation demands efforts to develop community-based research to further understand and combat the epidemic in the north through evidence-based policy and program implementation.

Next Steps: Early promulgators of HIV prevention and advocacy in Aboriginal communities in southern Canada faced many challenges, which has led to an epidemic. Nevertheless, early acknowledgement of this growing epidemic among some led to an investment in community capacity to learn and engage in community-based HIV/AIDS research. Northern communities may circumvent a similar epidemic if they invest in prevention through community ownership and partnerships.

CAAN, in partnership with Pauktuutit, is committed to capacity building in northern communities to increase community-based

research. From developing a research topic, to gaining financial support, to presenting results, CAAN’s goal is to disseminate knowledge about the research process, while acknowledging real-life barriers that make this process challenging. Although the same intensive effort that has been applied in southern communities must also be applied to northern Canada, collapsing Inuit research into a national effort limits the ability to develop innovative and targeted community-based research strategies.

CAAN and Pauktuutit recommend normalizing the research process through storytelling. CAAN Community-Based Research Facilitators will present successes and challenges in the community-based research process drawn from eight years of experience, while community leaders from Pauktuutit will discuss how these models have been implemented in northern communities, with the goal of building enthusiasm for undertaking community-based research. Contact: Renee Masching ([email protected])

YUKON FIRST NATION

J. Jones

Council of Yukon First Nations

The Yukon First Nation Health and Social Development Commission (H&SDC) is comprised of 14 Yukon First Nation (YFN) Health and Social Directors. In the Yukon, where land claims are settled for the majority of YFNs, engaging collaboratively becomes both a barrier and a key to success. When it became apparent that monies for the Aboriginal Health Transition Fund (AHTF) would flow through a centralized body only and not to each Yukon First Nation, and that collaboration and support from Northern Region (Health Canada) and Yukon Government (YG) was required, YFNs examined means to work collaboratively amongst themselves and with the new partners.

YFNs have already identified health and social initiatives to be funded by AHTF, though a new means was required to ensure approval and collaboration from new program partners: Northern Region and YG. In all, 11 initiatives, including gathering information on gaps and linkages in existing health and social programs and services delivered to YFNs from each individual First Nation were agreed upon and approved. By defining commitment and collaboration, community engagement techniques were used to identify areas of focus for the projects. The initiatives are large in scope to incorporate different outcome needs of the partners, while keeping enough of a focus to ensure the final outcomes will be sustainable and support better access and delivery of health and social programs and services to all YFNs. The 10 additional initiatives include: developing an injury prevention strategy targeting YFNs; identifying barriers that YFNs face in accessing formal healthcare services and developing a formal health and social body in which YFN can work collaboratively.

It is through the collaboration of the YFN Health and Social Directors, YG and Heath Canada that YFNs are engaging in unprecedented research and development on a Territorial wide scale. Contact: Jen Jones ([email protected])

ANISHINABE HEALTH PLAN

J. Gordon, F. Tarrant

Sioux Lookout First Nations Health Authority

Sioux lookout First Nations Health Authority led a planning process that supported the First Nation communities in Northwestern Ontario to develop the Anishinabe Health Plan. The primary goal was to develop a Health Plan within a Primary Health Care Framework that would guide the reinvestment of federal dollars into community based services in order to enhance and improve the current Primary Health Care delivery system.

The objectives of this project was to:

- To design a comprehensive integrated primary health care model and implementation plan for the communities of the Sioux Lookout Zone.


- To design a district physicians plan within an integrated primary care framework which will include access and referral mechanisms to specialized clinical services and ensure the integration of physician services with nursing and other health programs provided by and/or funded by FNIHB at the community level.

- To develop an outline of a nursing services plan within an integrated primary health care framework.

- To design a mechanism for the governance and management of the primary health care systems that is First Nation centered.

A multi-disciplinary, collaborative approach involving health professionals, First Nations representatives, federal and provincial government representatives participated in defining the new approach to primary health care in the Sioux Lookout Zone for the First Nation communities.

The Anishinabe Health Plan identifies service delivery in the areas of health promotion, disease and injury prevention, and the management of chronic disease.

The development and the implementation of a Primary Health Care framework that will ensure that all the Anishinawbe of the Sioux Lookout area have equitable access to 24/7 services. The project enabled the Anishinawbe to define a comprehensive range of Primary Health Care services that will be delivered to the whole population through an organized primary health care system. A well defined Primary Health Care framework ensures the coordination and integration of a wide range of health services where care is provided by the right provider at the right time in the right place. Contact: Janet Gordon ([email protected])

ONTARIO FIRST NATIONS PUBLIC HEALTH PROJECT: TRIPARTITE APPROACH

L. Ogilvie1, L. Menominee-Batise1, L. Yuan2, T. Antone1, D. Dupont3 1Chiefs of Ontario, 2First Nations and Inuit Health, Ontario Region, 3Ministry of Health and Long Term Care

Objective: To improve the delivery of public health services for Ontario First Nations communities.

Methods: In 2007, the Aboriginal Health Transition Fund provided funding to the Chiefs of Ontario (COO) to develop an integrated approach for public health services in First Nations communities. This public health initiative is launched in concert with First Nations and Inuit Health -Ontario Region and the Ontario Ministry of Health and Long Term Care. There are two components to this project: the development of a Public Health Framework and the development and implementation of a strategy for the management of First Nations public health information. Multiple stakeholders will be consulted in this process. A Project Management Team and two Working Groups have been established since the launch.

Results: The presentation will describe the Public Health Initiative as well as the process used to engage First Nations partners and stakeholders in its development.

Conclusion: The First Nations Public Health Initiative is an exciting tripartite initiative which will develop a framework for delivery of public health services for First Nations on reserve. Contact: Linda Ogilvie ([email protected])

THE TRIPARTITE FIRST NATIONS HEALTH PLAN- A FUNDAMENTAL CHANGE IN GOVERNANCE OF HEALTH SERVICES FOR THE FIRST NATIONS OF BRITISH COLUMBIA, CANADA

J.D. Martin

Health Canada First Nations and Inuit Health Program

On June 11, 2007, the First Nations leadership Council, the Province of British Columbia and the Government of Canada signed the BC Tripartite First Nations Health plan to create fundamental change in

health services governance and close the gaps in health status and life expectancy between the First Nations and other British Columbians. This is a ten year health plan with four key elements: governance, relationships and accountability; health promotion, injury and disease prevention; health services; performance tracking. This is the first time in Canada that the federal and a provincial government have collaborsted with the First Nations in a formal time-focussed plan to close the gap in health inequities. This presentation will focus on the historical background leading up to the signing of the Tripartite First Nations Health Plan and the elements of the plan discussing in particular the development of a new model for health governance. The potential future benefits overall include: decisions made by First Nations in BC for First Nations in BC; a seamless continuum of care; opportunity to pool, reallocate resources and leverage funds to increase access and obtain better care; more efficient and effective programs and services; community based approach to ensure services are reflective of regional differences and provided closer to home; ability to work more collaboratively across other sectors; and clearer accountabilities at all levels. Contact: J. David Martin ([email protected])

COLLABORATIVE RESEARCH IN NUNAVUT: A CASE HISTORY

W.A. MacDonald


Many women in Nunavut and rural Canada must leave their homes to deliver their babies in a regional facility up to 4 weeks prior to their delivery date. This imposes a significant financial and social cost on the women, their families and the health care delivery system.

Several care providers in Nunavut thought that a research project into the utility of a promising laboratory test at term could improve the management of normal pregnancies in Nunavut. The care givers in Nunavut lacked the research experience to plan an appropriate research project. An alliance was established with experienced researchers at University of Ottawa, University of British Columbia, the newly created Arctic Health Research Network office in Iqaluit, and Qulliit Nunavut Status of Women’s Council.

Implementing the project required multijurisdictional ethics approval: University of British Columbia, The Ottawa Hospital; obtaining a research license in Nunavut through the Nunavut Research Institute and approval of the Department of Health and Social Services Research Review Committee. In addition to ethics and methodology we have collaborated about financing the project, determining staffing needs, approach to recruitment of patients, dissemination of information regarding the project, and implementation of the study activities in Iqaluit

The development of this project highlights a collaborative research project where a research question arises in the course of program delivery in a remote region; and where university based researchers respond to the request for assistance in a fashion which enhances the local control and research capacity building. Further, this collaboration has been enhanced significantly by the creation of a local research coordination program. (AHRN).

This process can stand as a model for research in rural and remote jurisdictions which lack local research capacity. Contact: W. Alexander Macdonald ([email protected])


VENUE 5 Community Participatory Methods #1 (workshop)

COMMUNITY-BASED PARTICIPATORY RESEARCH – CBPR 101 FOR THE ARCTIC: OVERVIEW OF THE HISTORY, DISTINCTIVE FEATURES, ADVANTAGES, AND PRACTICAL TIPS CONCERNING THIS EMERGING APPROACH IN HEALTH RESEARCH

M. Hammond, R. Collins, J. Gordon, J. Ogina, A. Kimiksana, T. Greenland, D. Dedam-Montour, L. Kuptana, A. Moses, N. Beauvais, C. Carry

This workshop would start with an overview of the history of research, from Copernicus many centuries ago, to the more recent development of the natural and social sciences, and the branches (Action Research, Participatory Research, and Participatory Action Research) which caused Community-based Participatory Research (CBPR) to emerge in the last decade. This would show where CBPR fits in to the big picture, and why this approach is so promising for circumpolar health researchers to consider.

CBPR would then be examined in detail, starting with working definitions (sample: “CBPR refers to work that recognizes the interconnectedness of three goals: research, education and action”) and moving to a detailed checklist we have developed of issues that distinguish CBPR from conventional health research. The 10 headings in the checklist include: Ethical & theoretical issues; Pre-funding phase; Administration of funding; Planning research; Data gathering; Data analysis; Data interpretation; OCAP: Ownership, control, access, and possession of data; Dissemination & reporting of results; and Community action & follow-up.

Each of these headings includes one or more specific items. For example, under the first heading, “Ethical & theoretical issues”, items include: Nature of knowledge; Purpose of research; Definition of “community”; Vested interests of researcher versus community empowerment; View of community knowledge; Community-oppressive versus community-supportive approaches; and Power relations.

We would then present an original “Framework for CBPR”. It blends many of the progressive ideas from the older Participatory Research tradition from the Third World in the 1970s, with more recent ideas of CBPR practitioners. In our opinion, this blend is most suited to work in the Canadian Arctic, given the unique social, political and cultural imperatives there. As such, it may also have merit in other circumpolar regions.

Finally, the workshop would end with some reflections on our own practice of CBPR in two communities in the NWT: pitfalls, problems, practical tips and potentials. Contact: Merryl Hammond ([email protected])


WHAT AGE GROUPS AND WHICH CAUSE OF DEATH CONTRIBUTE MOST TO THE LOWER LIFE EXPECTANCY OF THE INUIT-INHABITED AREAS OF CANADA?

P. Peters

Statistics Canada

Compared to what is known for the Canadian population as a whole, information on the contributions of specific causes to differences in mortality and life expectancy for the Inuit is not readily available. In a previous paper, Wilkins et al. (2008) explored the feasibility of using a geographic-based approach to estimate health indicators among the population of the Inuit-inhabited areas. Census subdivisions (CSD) in

which at least 33% of residents self-identified as Inuit were selected, roughly corresponding with the geographic boundaries of the Inuit Nunaat land claims area.

This paper presents detailed results for mortality, cause-specific mortality, life expectancy, probability of survival by cause (Chiang 1968), age-specific contributions to differences in life expectancy (Arriaga 1984), and cause-specific contributions to differences in life expectancy (Arriaga 1989). Life expectancy and mortality rates for the Inuit-inhabited areas are compared to the Canadian population in general. This analysis measures a) the contribution of specific age groups to differences in life expectancy and b) the contribution of specific causes of mortality to differences in life expectancy. Results show marked differences in age-specific and cause-specific contributions to the differences in life expectancy for the population of the Inuit-inhabited areas and the Canadian population in general. For instance, 29.4% of the 12.6 year difference in the life expectancy of males in the Inuit-inhabited area and the Canadian population is due to mortality differences of the 20-24 age stratum. If this is expanded to include the 25-29 age stratum, the contribution to the total difference in life expectancy is 49.4%. Contact: Paul Peters ([email protected])

DIABETES AMONG ALASKA NATIVE PEOPLE – A 21 YEAR OVERVIEW

M. Ramesh, C. Schraer, A.M. Mayer, K. Koller, E. Asay

Alaska Native Tribal Health Consortium Diabetes Program

Objectives: To examine trends in diabetes (prevalence and incidence) and complications (amputations and renal replacement) and mortality over two decades.

Methods: We used data from the Alaska Native Diabetes Registry, which has been in existence since 1985. We compared the first five (1986-1990) and last five years (2002-2006) for diabetes incidence, amputations, renal replacement and mortality. Rates of complications and mortality are reported per 1000 diabetic person-years of observation. We compared the prevalence at the beginning and end of the 21 year period. Prevalence and incidence were age-adjusted to the standard U.S. 2000 population. Since the age structure of the Alaska Native diabetes population has changed over time, complications were age-adjusted to the mid-period (1995) Alaska Native diabetes population. Further statistical analyses for complications and mortality data considering duration of diabetes are under way.

Results: Prevalence increased from 17.3 to 47.6/1,000. The number of people living with diabetes increased from 610 to 3386. Incidence increased from 16.5 to 32.7/1,o00. Comparing the five year periods 1986-1990 and 2002-2006, amputations decreased from 5.3 to 2.6/1,000, renal replacement decreased from 3.3 to 1.2/1,000 and mortality decreased from 41.7 to 33.2/1,000. The average age of death increased from 69.4 to 71.0 years.

Conclusions: Increased funding to tribal programs enabled them to increase diabetes screening and follow-up activities, which may have partly responsible for the apparent increase in prevalence and incidence. Local control enabled the tribal programs to provide clinical services specifically targeted to reduce complications and mortality. While the occurrence of diabetes itself is increasing among Alaska Native people, our results suggest that even in remote, rural areas, complications and mortality can be reduced. Contact: Meera Ramesh ([email protected])

THE EFFECT OF TRADITIONAL FOODS ON INSULIN RESISTANCE AMONG INUIT IN GREENLAND AND NUNAVIK

C. Jeppesen1, A. Ferland2, E. Counil2, E. Dewailly2, P. Bjerregaard1 1Centre for Health Research in Greenland Directorate of Health and National Institute of Public Health, 2Unité de recherche en Santé Publique Centre de recherche du CHUL (CHUQ), Canada


Background: Inuit populations all over the Arctic are undergoing a dietary and lifestyle transition, which has led to increased prevalence of overweight and obesity. Obesity is associated with insulin resistance, which is a major risk factor for type 2 diabetes. Our objective was to examine the association between traditional foods consumption and insulin resistance among Inuit from Greenland and Nunavik.

Methods: The inclusion criteria the cross-sectional study “Inuit Health in Transition” conducted from 2003-2007 were: ~ 18 years, ~ 8 h fasting, non-pregnant, and undeclared diabetes. In the analyses we included men and women with a daily consumption of 3350-17 000 kJ and 2100-15 000 kJ, respectively. Greenland Inuit totalled 1733 (43% men) and Nunavik Inuit 653 (45% men). The consumption of traditional food was reported as energy % of total energy intake (E%). The homeostatic model assessment index of insulin resistance (HOMA-IR) was used to assess the degree of insulin resistance. Linear regressions were adjusted for sex; age; body mass index (BMI) or waist circumference.

Results: The diet in Greenland had a higher E% from traditional food (19 E%) than Nunavik (13 E%; p<0.001). Prevalence of insulin resistance was higher in Greenland than in Nunavik (32% vs. 28%; p=0.02). Among Inuit in Greenland the E% from traditional foods was associated with HOMA-IR (r =-0.047; p=0.03) together with BMI (r =0.48; p<0.001). Only BMI (r =0.33; p<0.001) and age (r =0.12; p=0.005) was associated to HOMA-IR in Nunavik. No association was found between traditional food E% and HOMA-IR (in any country) in analyses including waist circumference instead of BMI.

Conclusion: Results imply that traditional food as a single component of lifestyle does not influence insulin resistance among Inuit. Future analyses will include physical activity, alcohol consumption, smoking, and socio-demographic variables. Contact: Charlotte Jeppesen ([email protected])

DO-IT-YOURSELF DIABETES PREVENTION ACTIVITIES: AN INTERACTIVE MANUAL FOR COMMUNITY-BASED DIABETES EDUCATION

J. Eskes

First Nations Health Program, Whitehorse General Hospital

Diabetes prevention training for Yukon First Nations front-line health workers has frequently been identified as a health planning priority. Such training is important in the Yukon due to remote geography, lack of diabetes professionals, and frequent turnover of health workers. Moreover, enabling First Nations health workers to educate members of their own community about diabetes is a key way to increase capacity at a local level.

In response to this identified need, a manual was created (Do-It-Yourself: Diabetes Prevention Activities – A Manual for Everyone) to allow non- healthcare professionals to educate others about diabetes prevention. The manual contains 20 hands-on activities and is based on a familiar, health-fair format. The intent of this manual is to have learners create visual displays using everyday household items. Each activity is intended to convey a key message about diabetes prevention while being interactive, understandable, and fun. All activities are evidence-based and are divided into 3 sections:

- SHOW IT: contains clearly worded instructions on creating a visual display.

- TELL IT: provides a readable script to guide the user through the activity and to relay key messages about diabetes prevention.

- KEY MESSAGE: recaps important information and rationale for the topic.

The intention behind this manual was to ensure cultural-relevance in a Yukon setting. For example, one activity highlights the recent and drastic lifestyle change among Yukon Aboriginal people and its impact on health. Another activity based on the medicine wheel helps learners put diabetes prevention in a holistic perspective by enabling the

sharing of traditional knowledge (foods, medicines, healing) along with contemporary self-care strategies.

This presentation will provide information on the creation of, and content of Do-It-Yourself: Diabetes Prevention Activities – A Manual for Everyone. Attendees will leave with new ideas and inspiration for approaching community-based diabetes education. Contact: Jennifer Eskes ([email protected])

INDIVIDUAL SATURATED FATTY ACIDS ARE ASSOCIATED WITH DIFFERENT COMPONENTS OF INSULIN RESISTANCE AND GLUCOSE METABOLISM: THE GOCADAN STUDY

S. Ebbesson, M.E. Tejero, J.C. Lõpez-Alvarenga, W.S. Harris, L.O.E. Ebbesson, R.B. Devereux, J.W. MacCluer, C.R. Wenger, S. Laston, R.R. Fabsitz, W.J. Howard, B.V. Howard, A.G. Comuzzie

Norton Sound Health Corporation, Alaska

Background: Recent increase in prevalence of diabetes and concurrent increase in saturated fat consumption among Alaskan Eskimos requires research to characterize the role of saturated fat on glucose metabolism. Here we test the hypothesis that saturated fatty acids (FAs) are associated with insulin resistance and glucose intolerance.

Research design and Methods: Data from a sub-sample of the participants in the GOCADAN study were analyzed for the association of measures of glucose and insulin metabolism with FA components in RBC measured by gas chromatography. The sample included 343 women and 282 men ages 35-74. Statistical analyses were conducted using SPSS v 9 to explore the associations of selected RBC FAs with fasting glucose, fasting insulin, 2h glucose, 2h insulin and homeostasis model assessment (HOMA) index. The models included sex and glucose metabolism status (normal, glucose intolerant or diabetic) as fixed factors and age, body mass index (BMI), waist circumference, and FA content in RBCs as covariates. Measures of insulin, glucose, and HOMA index were used as dependent variables.

Results: The mean age (SD) was 48.5 (9.9) years, with a mean BMI of 27.8 (5.8) and mean percent body fat of 39.4%. Positive associations were found between myristic acid and fasting insulin (r = 0.47, p < 0.001), 2h insulin (r = 0.53, p = 0.02), and HOMA index (r = 0.455, p < 0.001). Palmitic acid was associated with 2h glucose (r = 2.3x10-2, p <0.001) and 2h insulin (r = 5.6x10-2, p = 0.002) and stearic acid was associated with fasting glucose (r = 4.8x10-3, p = 0.006).

Conclusions: These results support the hypothesis that specific saturated fatty acids are variably associated with insulin resistance and glucose intolerance. Contact: Sven Ebbesson ([email protected])

TYPE II DIABETES MELLITUS IN GREENLAND: THE IMPACT OF ELECTRONIC DATABASE IMPLEMENTATION ON THE QUALITY OF DIABETES CARE

M. Pedersen, I. Fleischer

Center for Primary Health Care in Nuuk

Objectives: To estimate the age specific prevalence of diagnosed type 2 diabetes mellitus (T2DM) in Greenland in 2008, and to evaluate the influence of electronic database access on the quality of the clinical management of the disease.

Study Design: Observational and cross sectional study, review of medical records and databases.

Methods: Data on T2DM patients were collected from each rural district in Greenland.

Results: The number of patients with T2DM, their age and gender were collected from 15 out of 17 districts and from the outpatient clinic of internal medicine in Nuuk. This sampling represents 90% of the population in Greenland. The prevalence among Greenlanders ~ 40 years old is 2.1%. The prevalence increased with age. The quality in the management of T2DM based on process indicators is significantly higher in clinics with an electronic database than without.

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Conclusion: The prevalence of diagnosed type 2 diabetes mellitus in Greenland is low. When compared with previous population based surveys this suggests that the prevalence of undiagnosed diabetes is high, especially in the age group between 40 and 60. Consequently, the focus should be on identifying undiagnosed type 2 diabetes in this group. The quality in the management of type 2 diabetes mellitus seems to be improved by the use of an electronic database. Implementation of databases in all the clinics in Greenland is desirable. Contact: Inuuti Fleischer ([email protected])

A DESCRIPTION OF PHYSICAL ACTIVITY AND BODY MASS INDEX IN THREE INUVIALUIT COMMUNITIES: RESULTS FROM HEALTHY FOODS NORTH

S. Reaburn, S. Biggs, E. Erber, L. Beck, E. DeRoose, J. Gittelsohn, S. Sharma

Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON

Objective: To describe body mass index (BMI) and physical activity levels of Inuvialuit adults.

Setting: Three communities in the Arctic region of the Northwest Territories that vary in degrees of isolation.

Methods: The short-form of the International Physical Activity Questionnaire (IPAQ) was administered following a cross-sectional random household study design. Heights and weights were recorded in 75-84% of participants. The remainder was self-reported. Physical activity levels were stratified by age, sex and community. BMI data were stratified according to Health Canada standards.

Results: In total, 194 Inuvialuit adults (150 female and 44 male) aged 19-84 years (mean age of 43.2 years) participated with a response rate of approximately 70-90%. Overall reported physical activity levels met Health Canada recommendations. Women had statistically significantly (p=.01) lower levels of vigorous and moderate levels of activity per week than men. The mean BMI for the total population was 30.55 kg/m2. Mean BMI was higher and physical activity levels were lower in the less traditional, less isolated communities compared with the more traditional, more remote communities.

Conclusions: These results highlight the need for a nutritional and physical activity program, such as Healthy Foods North, to reduce the risk of chronic disease among the Inuvialuit.

Acknowledgements: We’d like to thank Andrew Applejohn for his incredible guidance and support on this project. We would also like to thank the Aurora Research Institute for their tremendous assistance. The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57. Contact: Sarah Reaburn ([email protected])

IMPLEMENTATION OF A PROGRAM TO PREVENT CHRONIC DISEASE RISK AMONG THE INUVIALUIT: PROCESS EVALUATION FINDINGS FROM HEALTHY FOODS NORTH

J. Gittelsohn, L. Beck, S. Biggs, S. Reaburn, S. Sharma

Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

Objective: To describe the level of implementation of Healthy Foods North (HFN) program components and to determine factors affecting implementation.

Setting: One remote and one semi-remote Inuvialuit community in NWT, Canada.

Methods: Process data were collected throughout implementation of the program. Monthly store visits documented availability of promoted foods and presence of signage, pedometer challenge activities were logged, and interventionist activities in stores and media publications and contacts were documented. Process evaluation constructs of reach (proportion of population exposed to intervention), dose (intensity of exposure) and fidelity (how well each component was implemented

according to set standards) were used to assess implementation success.

Results: HFN was implemented in 7 phases in 5 food stores and included stocking healthier foods, shelf labels, posters, taste tests, and distribution of flyers and giveaways. At the store level, HFN was implemented with moderate fidelity in terms of increased availability of healthy foods, and with high fidelity in terms of signage. At the community/worksite level, the pedometer walking challenges were implemented with moderate to high fidelity. At the individual consumer level, the program was implemented with high reach and dose, particularly in later phases of the program. Interactive sessions increased from 2-3 sessions/phase/store in phase 1 to 8 sessions/phase/store in later phases. Total attendance at interactive sessions increased from about 100 people/phase to 500 people/phase.

Conclusions: Process data provided insight that can help improve the implementation of the next round of the HFN program, which may expand to additional communities. Improved intensity and duration of community-based interventions is essential to achieve high levels of reach and dose.

Acknowledgements: The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57. Contact: Joel Gittelsohn ([email protected])

CONSUMPTION OF HIGH FAT, HIGH SUGAR FOODS BY INUVIALUIT ADULTS: RESULTS FROM HEALTHY FOODS NORTH

S. Biggs, S. Reaburn, L. Beck, E. DeRoose, J. Gittelsohn, S. Sharma

Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, V5A 1S6

Objective: To characterize the consumption of high fat, high sugar foods by Inuvialuit adults by age, gender, and community.

Setting: Three communities with differing sizes and levels of isolation in the Northwest Territories, Canada.

Methods: Cross sectional survey of Inuvialuit adults using a quantitative food frequency questionnaire (QFFQ). Frequency of consumption was assessed by eight categories ranging from “never or less than one time in one month” to “two or more times a day.”

Results: Two hundred and thirty-three Inuvialuit men and women (aged 19-84 years) participated in the survey with a response rate of approximately 70-90%. High fat, high sugar foods were consumed 6.3 times per day for the total sample. Consumption was statistically higher in younger respondents (~ 50 years) and in the least remote community. Coffee creamer (i.e. Coffeemate), butter/margarine/lard, sweetened drinks, and pop had high mean frequencies of daily consumption.

Conclusions: The high consumption of high fat, high sugar foods illustrates the need for a nutritional intervention, such as Healthy Foods North, to reduce risk of chronic disease among the Inuvialuit.

Acknowledgements: We would like to thank Andrew Applejohn for his tremendous guidance and support on our program. We would also like to thank the Aurora Research Institute for their help and commitment to our work. The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57. Contact: Samantha Biggs ([email protected])

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ANGUTIILLI QANUILIQPAT… HOW ARE WE AS MEN? A SCREENING OF A LIVE-TO-TAPE 2-HOUR CALL-IN PROGRAM ABOUT INUIT MEN’S HEALTH

C. Carry



In 2007, Inuit Tuttarvingat of the National Aboriginal Health Organization interviewed Inuit men from various communities across Canada to discuss their health and wellness. What we found was that Inuit men are in need of help. They have lower than average completion of education, they have limited access to male-specific mental health information and services, and it appears that they are suffering from a degree of spiritual loss along with difficulties relating to the changes in family dynamics and their traditional role in Inuit society.

Through the live interactive broadcast, along with many partners, we share encouraging examples that are helping men move forward.

The 2-hour program:

- discusses root causes within a historical context, looking at how Inuit men’s roles have dramatically changed in just two generations.

- highlights the need for men’s wellness and counselling programs, and looks at existing programs in Alaska and Inuit Nunaat.

- discusses related research, from sources such as the “Qanuippitali? Inuit Health Survey.”

- explores opinions and ways forward shared by the panelists, community focus groups and callers.

- shares ideas on how men’s groups can be started. - points to Web-based resources for follow-up.

This 2.5 hour session will open with an introduction to the overall Qanuqtuurniq - Finding the Balance TV series, an International Polar Year outreach project on Inuit wellness. The series was broadcast on the Aboriginal Peoples Television Network - North in May 2009 in the Inuit language with English subtitles and simultaneously Web cast. A main objective was to adapt and test a “communications for change” model for exchanging knowledge from different perspectives on several wellness issues of concern to Inuit. Following the screening of the men’s health program, evaluation highlights will be shared along with a question and answer period and an opportunity to give feedback into the model’s evaluation process. Contact: Catherine Carry ([email protected])

SESSION 9 Wednesday, July 15, 8:30-10:00 AM

VENUE 1 Mental Health & Wellness #6 – Children and Youth

CAMP COHO: A CULTURALLY APPROPRIATE GRIEF CAMP FOR ALASKA NATIVE CHILDREN

K. Morgan, C. DeCourtney, L.L. Harrigan


Background: Alaska Native children living in remote communities do not have access to cancer support resources generally available in less remote settings. There are few cancer support programs for children that incorporate cultural values. Camp Coho is a one-day camp that helps Alaska Native children ages 6-12 years better understand and share their feelings about losing a loved one. Each child teams up with a Big Buddy. Camp Coho provides activities based on national standards to support children who have lost someone close to them. The camp honors the child’s culture and incorporates cultural values. Campers learn healthy ways to remember the person and better understand their own feelings of loss. Methods: A Camp Coho planning committee was established. Staff identified 20 Alaska Native children, ages 6-12 years to attend Camp Coho. A quantitative and qualitative evaluation was developed, with debriefing of staff and Big Buddies at the day’s end to share observations. The project involved tribal, for-

profit, volunteer and non-profit organizations. Results: Through observations by staff and written evaluations completed by the campers and Big Buddies, camper participation and openness in sharing increased as the day’s activities progressed. Follow-up mailed evaluations completed by parents indicated the positive impact of Camp Coho continued in their home community. Conclusions: Camp Coho demonstrates that one-day grief camps can be an effective grief support resource when standard resources are not available. The Camp Coho model can be adapted and implemented by other special populations Contact: Karen Morgan ([email protected])

THE ROLE OF MENTORING ABORIGINAL YOUTH PARTICIPANTS OF THE COWACHIN (BRITISH COLUMBIA, CANADA) 2008 NORTH AMERICAN INDIGENOUS GAMES

M. Kelly, R. Link, J. Reading


Objective: Mentorship is believed to positively benefit the health of youth, although evidence of such benefits is limited. Indigenous Peoples of North America represent a population with unique demographic, geographic, social and cultural characteristics that may shape the nature of Indigenous youth mentorship. This paper explores the prevalence and roles of mentors identified by a sample of healthy Indigenous youth athletes.

Methods: The Aboriginal Youth Lifestyle Survey (AYLS) was designed to survey Indigenous youth regarding their tobacco use and associated factors. Four questions regarding mentorship were added to the AYLS to investigate mentorship among Indigenous youth participants at the 2008 North American Indigenous Games (NAIG). Questions were designed to be relevant to Indigenous youth and to avoid limiting the responses of youth to a Western definition of mentorship.

Results: Of the 298 participants for whom mentorship could be assessed, 259 (86.9%) reported having at least one mentor. Nearly three-quarters (74.1%) of participants reported more than one mentor while almost a third (27.0%) of participants reported more than five mentors. Almost half (43.6%) of all mentors identified were family members of the respondent while one third (34.8%) were informal non-family relationships and less than a quarter (20.8%) were formal non-family relationships. More than three-quarters (78.8%) of participants reported that they provide mentorship to others.

Discussion: This was a preliminary study of Indigenous youth mentoring, an area of research which is largely unexplored. The findings suggest that there are multiple mentors present in Indigenous communities with whom these healthy youth formed natural mentoring relationships and it seems that youth themselves can mentor others. Further research on the health benefits of Indigenous youth mentoring is warranted and of interest to educators, policy makers, Indigenous community leaders and others that seek to close the gap in health status between Indigenous and non-Indigenous people. Contact: Miranda Kelly ([email protected])

INFLUENCE OF ADVERSE ECOLOGICAL FACTORS ON PSYCHOPHYSIOLOGICAL AND EMOTIONAL CONDITION OF TEENAGERS LIVING IN THE EUROPEAN NORTH OF RUSSIA

O. Ketkina, T. Loginova, E. Bojko

Department of Ecological and Social Physiology of Human, Institute of Physiology, Ural Division of the Russian Academy of Sciences, Syktyvkar, Russia

Owing to biological and psychological reasons teenagers are especially prone to the influence of anthropogenic pollution of the environment, since the peculiarities of the juvenile age determine the increased risk for the development of adaptive disorders under adverse ecological effects. Teenagers (boys and girls) in two districts (“non-polluted” and “polluted”) in European part of Russia were put to a psychological and


psycho-physiological test. The research allowed discovering sexual differences in the psycho-emotional and functional conditions of senior schoolchildren in the investigated groups. Whereas the boys more often have functional disorders (decrease of activity, disorder of attention, headaches), the girls in addition to the functional disorders also have psycho-emotional disorders (a high level of anxiety, fear of not being able to learn the lesson material). Disorders of a number of functional conditions were discovered in both groups, such as state of health, activity, attention problems and frequent headaches. These disorders are established in the “polluted” district at that. When psycho-physiological indexes are compared, it is observed that schoolchildren from the “polluted” district have a higher intensity of nervous system, which is manifested in the increase of the dispersion of the reaction time. It was discovered that the boys from the school in the “polluted” district have a decrease of the nervous system liability (indexes of the critical frequency of shimmering). Thus, it seems to be possible to connect the discovered peculiarities to the adverse influence of ecological factors on the functional condition of the schoolchildren. No significant influence of adverse ecological factors on the psycho-emotional condition was discovered at that. Contact: Ketkina Olga ([email protected])

SEXISM/SEXUAL HARASSMENT IN SCHOOLS AND ITS CONNECTIONS WITH SEXUALIZED VIOLENCE IN INTIMATE RELATIONSHIPS IN ADULTHOOD

V. Sunnari

University of Oulu, Thule

In my presentation I will reflect the results of a study focused on schoolchildren’s experiences on physical sexual harassment (Sunnari et al. 2009, in process to be published) at school. The data for the study was collected from about 1700 boys and girls aged 11 - 12 years in the schools of North Finland and Northwest Russia. The research indicates that physical sexual harassment is common in schools even in the northern peripheries of Europe. In addition to groping explicitly in the form of physical sexual harassment, especially Russia children wrote about other types of violence. Furthermore, it was common for the Russia children to say that they did not want to describe the details of the experienced physical harassment The silence of the details gave a message that the experience had hurt their intimacy deeply. Girls constituted the vast majority of the victims of physical sexual harassment and boys constituted the vast majority of perpetrators.

In my presentation I will compare the characteristics of the harassment that the children described to have experienced at school with the research results that have focused on characteristics of violence in intimate relationships, which topic area has been researched a lot during the last decades in varied countries. Contact: Vappu Sunnari ([email protected])

ON THE LAND CANOE TRIP FOR YOUTH AND ELDERS SUPPORTING MENTAL HEALTH AND WELLNESS

W. Lahey

NWT Recreation and Parks Association

The NWT Recreation and Parks Association (NWTRPA), a non profit organization that works with communities across the territory to promote healthy living through active recreation, coordinates the Mackenzie River Youth Leadership canoe trip for youth and elders of the Dehcho and Sahtu regions of the NWT. The core curriculum of this sixteen-day canoe trip incorporates four components of an Indigenous model of mental health and healing: community, cultural identity, holistic approach and interdependence.

The canoe trip is built on the foundation of community participation through social events such as ceremonies, celebrations and feasts in each community along the route. With the help of elders, the canoe trip provides access to elements of Dene cultural identity such as language, stories, Indigenous knowledge, land and nature. A holistic

approach to programming is honoured during the canoe trip because its spiritual framework fosters respect for the historical and sacred significance of the land, the waterway and its people. Participants in the canoe trip are encouraged to build interdependence by developing mutually reliant relationships with oneself, nature and others.

As youth are given the opportunity to learn about their environment and place, they develop a relationship to the people, the land and their elders. The Mackenzie River youth trip builds on research completed with Dene elders that acknowledges the importance of on the land programs for cultural resilience. The NWTRPA aims to make valuable contributions to the mental health and well being of NWT residents by supporting the development and sustainability of an on the land canoe trip engaging youth and elders in the NWT that values the community, a cultural identity, and interdependence using a holistic approach. Contact: Wendy Lahey ([email protected])

VENUE 2 Service Delivery & Infrastructure #1 – Health Service

Delivery

HEALTH TECHNOLOGY ASSESSMENTS ON TELEHEALTH

J. Polisena

Canadian Agency for Drugs and Technologies in Health

Three health technology assessments (HTAs) on telestroke and telehealth (synchronous and asynchronous) were previously conducted to determine the available evidence. The study findings accompanied by their impact on practice and policy will be briefly described. A recent HTA on home telehealth for chronic disease management published in 2008 will also be presented. The literature was systematically reviewed and meta-analyses were performed to assess the clinical effectiveness of home telehealth compared with usual care for patients with chronic diseases. An economic review and a framework for economic evaluations on home telehealth were also conducted. Findings from the clinical review suggest that home telehealth is generally effective, but its impact on health service utilization is less certain. There is no compelling evidence that home telehealth helps to reduce costs from the health care system and insurance provider perspectives. Ethical, legal and psychosocial issues were also identified. Home telehealth may be clinically effective but its economic impact could not be established. Additional studies of higher methodological quality are required for better insights into the potential clinical and cost-effectiveness of home telehealth for chronic disease management and other forms of telehealth. Policy and practice implications will be discussed. Contact: Julie Polisena ([email protected])

TELEHEALTH IN GREENLAND

F. Christensen, L.C. Ragus, K. Kleinshmidt

Greenland Healthcare

The achieving goal of the Greenlandic Telehealth project, witch was founded at the 1st. of January 2008 and will succeed at the 31st of December 2010, is to provide a nationwide telehealth service.

The goal is to implement the Greenlandic Healthcare mission “healthcare where you live’”.

The telehealthcare are to be established in all cities and village’s which contains more than 50 inhabitants. Telemedicine are to assure better use of resources, faster and better diagnostic and more successful treatment, less waiting time and less transport of patients from village to city (nearest hospital).

In the entire project contains 70 installations of AFHCAN Carts – Alaska Federal Healthcare Access Network. The main reason for Greenland to have chosen the Alaskan model is the comparable of infrastructure.


From a clinical perspective telemedicine are a long waited possibility to collect “hard” data from patient’s in the rural area. Those patients all have one or more symptoms off diseases and would like to have fast clinical diagnoses from district hospitals.

Telemedicine give Greenland Healthcare the possibility to collect these data in a far more cost-effective way than before. This gives Greenland a unique opportunity to do preventive care.

In emergency situations in case of a medivac the collected data can save lives. Contact: Finn Christensen ([email protected])

IMPLEMENTING ON E-HEALTH PROGRAM IN CANADA’S MOST CHALLENGED REGION

T. McKinnon

Department of Health and Social Services, Government of Nunavut

Nunavut was the 1st jurisdiction in Canada to implement Telehealth in all of our communities. However, we have faced many challenges in the last 10 years of our Ehealth program, namely buy-in from our clinical community, infostructure challenges, and community readiness.

The goal of this presentation is to outline some of the challenges NU has had in both the implementation of Telehealth in Canada’s most challenged region. Our challenges range from geography, 25 communities spread over 2 million square kilomters, providing services in 4 languages, an antiquated satellite/tecommunications network.

This presentation would include video links to several Nunavut communities, with testimonials from some of our providers.

We will discuss the evolution of our program into an E-health program which will transform our health program from paper to electronic. Contact: Tina McKinnon ([email protected])

EXPANDING CLINICAL TELEHEALTH IN ALBERTA FIRST NATIONS

A. Manyguns1, C. Sarin2 1Alberta First Nations Clinical Telehealth Change Management Project, Treaty 8 First Nations of Alberta, 2First Nations and Inuit Health, Health Canada Alberta Region

Telehealth can be defined as the use of information and communication technology to deliver health services, expertise and information over distance. Telehealth has the potential to lessen the inequities in health status between First Nations living on reserve and the general Canadian population. First Nations in the province of Alberta, Canada are involved in a collaborative effort to expand clinical telehealth. Supported by Health Canada (FNIH) and Canada Health Infoway, the Alberta First Nations Clinical Telehealth Change Management project is seeking to address the barriers to clinical telehealth that exist in First Nations communities. This paper will outline the key activities of this project, summarize the lessons learned to date, and identify the next steps that are necessary to realize the potential of clinical telehealth. Contact: Christopher Sarin ([email protected])

TELESPEECH LANGUAGE PATHOLOGY

A. Geraghty

Department of Health and Social Services, Government of the Northwest Territories

In 2008/09 the Department of Health & Social Services (DHSS), through funding provided by Canada Health Infoway Inc, began a $3.5 Million dollar project to provide comprehensive, equitable and sustainable speech language pathology (SLP) services across the Northwest Territories (NWT). Services will be offered, by the end of the life of the project, in 28 communities across NWT (54 sites). The tele-speech project will also support the Child Development Team that

provides an integrated approach to assessment and treatment for children with special needs.

The challenge the DHSS faces in the provision of adequate speech services to territorial residents is the inability to hire and retain the full complement of speech language pathologists. There are currently 11 speech language pathologist positions allocated across NWT, with a current vacancy of four positions. Many Health Authorities are experiencing prolonged periods of vacancy for speech language pathologist personnel; as an example the Beaufort Delta Health Authority speech pathologist position was vacant for 3 years. NWT’s struggle in hiring speech language pathologists is due to the remoteness of NWT communities and the chronic shortage of speech language pathologist across Canada.

The business solution that was proposed for addressing the shortage of speech language pathologists and speech service provision to school age children is telespeech. Telespeech is enabling DHSS to utilize speech language services from both NWT and southern providers to be provided to children directly in their communities and, more importantly, in their schools. The telespeech solution will also support the provision of services to pre-school children and adults. Contact: Ashley Geraghty ([email protected])

VIDEO RESUSCITATION SAVE LIVES IN REMOTE COMMUNITIES

M. Jong

Memorial University

The biggest discrepancies in rural-urban death rates are seen among young people – rural Canadians less than 45 years of age have about a 30 percent higher mortality rate than urban dwellers of the same age. Ultimately, the most isolated rural Canadians live three years less than their urban counterparts. This is a reality in remote communities where there are no physicians. Our experience with video resuscitation has permitted the ability to save lives in remote communities for patients who would otherwise have died by the time aero medical services arrive.

This paper describes how to set up video resuscitation and provide tips on how to implement the program. Contact: Michael Jong ([email protected])


– Nursing Education

NURSING IN THE ARCTIC: GREENLANDIC NURSE’ PERSPECTIVE

H. Moeller

University of Alberta, Lakehead University

The objectives of this project are to highlight what, according to Greenlandic nurses, characterises nursing in Greenland and which qualifications, both personal and professional, Greenlandic nurses deem important for nurses working in Greenland. The project also attempts to paint a picture of whom the Greenlandic nurses are, and what has made them choose and continue in the profession. The healthcare system in Greenland was developed and implemented by Danes. Today it is still governed largely by Danish norms and values although it services a population that is 87% Greenlandic. Historically, the system has had difficulties recruiting and retaining nurses. In 1993 a nursing programs was established in Nuuk, Greenland. Today, 77 nurses have graduated from the program and some Greenlanders have also graduated from nursing schools in Denmark. Still, more than three quarters of nurses employed in the Greenlandic healthcare system are recruited from outside of Greenland. Most are Danish speaking Danes and the majority stay in Greenland only for shorter contracts. The


Greenlandic nurses, whether educated in Greenland or Denmark, are pioneers: They add a unique set of professional and personal qualifications and knowledge to the Greenlandic healthcare system. This project highlights and celebrates this uniqueness. The design is qualitative and ethnographic. Data come from two sources; manuscripts written by Greenlandic nurses, and, part of the data collected for a PhD research project focussing on the experiences of Greenlanders and Inuit who are nurses and nursing students. The methods employed included soliciting Greenlandic nurses writing about being a nurse and nursing in Greenland and considering their texts. It also included observation, participant observation, interviews, questionnaires and document review. Results presented at the conference will have a narrative as well as an analytical component. Contact: helle moeller ([email protected])

“I HAVE TOLD MY COLLEAGUES: WHEN I WORK I AM WHITE” ABOUT THE EXPERIENCES OF GREENLANDIC AND INUIT NURSES AND NURSING STUDENTS

H. Moeller

Department of Anthropology, University of Alberta

The objective of this study is to examine the experiences of Inuit and Greenlanders who are nursing students and nurses and who are being educated and practice in institutions dominated by western culture and language. The design of the study is qualitative and it is ethnographic in nature. It was conducted by the author 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 an Inuit language is the mother tongue of almost all participating nurses and nursing students. The majority of participants, including those who had withdrawn from the nursing program, felt more at home with western culture and language than people from the general populations. Many come from an ethnically mixed background and have been schooled almost exclusively in Western languages in the latter part of elementary and throughout high school. Despite this, almost all participants noted differences in the ways that Inuit and Western nurses care for Inuit patients. Most said that differences are rooted in language but that cultural differences also played a part. While almost all participants preferred to read, write and be taught in one of the Western languages, most had a desire for medical and nursing literature in Greenlandic or Inuktitut and said that they lacked medical, anatomical and health care vocabulary in their mother tongue, disturbing their practice. Still, almost all participants felt that it would be impossible or even undesirable to deliver the nursing education in Inuktitut or Greenlandic. As many participants did, I connect this feeling with having been schooled most thoroughly in a Western language, and with a continued dependency on, and therefore need to be able to work with, Western health professionals who speak a Western language. I understand the feeling to be systemically based, a result of Western educational and health care policy. Contact: helle moeller ([email protected])

NURSES FOR NUNATSIAVUT

G. Turner

Inuit Organization

The challenge of recruiting and retaining Community Health nursing staff in remote aboriginal communities is one of the most concerning issues in health care delivery in Canada. The solutions are as complex as the issues and include validation of what was known for years at the community level, we need aboriginal nurses , trained in the regions.

In 2002, the former Labrador Inuit Health Commission, now Nunatsiavut Government, developed a plan in response to both the critical shortage of nurses in Inuit communities and the barriers faced by Labrador Inuit who wished to pursue nursing careers. The goal was

to deliver an integrated access and baccalaureate nursing education program to prepare Labrador Inuit nurses for what is now Nunatsiavut.

The first phase was the development of an integrated access-first year nursing program that allowed Labrador Inuit to prepare for and begin nursing education without leaving Labrador. The program was innovative and sensitive , focused on both the skills required to learn in a university setting and Inuit ways of knowing and learning. Through case based scenarios, Inuit nurse mentors, the use of local literature and the inclusion of Inuit culture at every opportunity , the curriculum was unique and responsive.

The first nurses graduate in Spring 2010, Nunatsiavut is now in a place to reflect on the program and what we have learned from it, to both advise our future planning and also to share with others. The presenter will show the nurses journey with a mixture of pride and honesty, celebrating the accomplishments and identifying the obstacles and what was put in place to solve the problems. Some unexpected outcomes were the change to the indicators of success and the impact of social determinants on the lives of the students. Contact: Gail Turner ([email protected])

THE NURSE AS CARE ASSESSOR AND PRACTITIONER IN GREENLAND

A.B. Kjeldsen, E. Skifte

The Greenlandic home rule Ministry of Health

The aim of this study is to assess the extent of nurse encounters with patients who have not been diagnosed by other practitioners in district hospitals, health centers, nursing stations and physician offices in Greenland. It will identify circumstances in which nurses feel most competent and will assess whether they have sufficient access to clinical guidelines.

The study design takes the form of an internal audit (APO methodology) and will be conducted by a nursing group who will also be responsible for registering patient encounters during a defined time-frame and providing an assessment of encounter proceedings. In parallel, participating nurses will provide information regarding recruitment circumstances, amongst other details. In the first instance, the study will be conducted as a pilot to test whether the design will satisfy the questions raised in the project description.

The pilot study results will describe the reasons for the patient encounters with the nurses. Furthermore, the study will show under which circumstances the nurse uses specific clinical procedures and test results and how often she independently closes a case. The results will uncover how often it is necessary to involve the doctor in diagnosing and/or treating as well as the extent of the doctor’s intervention (either via telephone or in person).

The nurse’s area of responsibility and own competency experience as a spokesperson, care assessor and practitioner can only be described on the backdrop of patient encounter experiences. The internal audit is expected to impact the identification of future qualifying nursing study programs as well as the scope of clinical guidelines. Contact: Ann Birkaer Kjeldsen ([email protected])

SHIFTING FROM CULTURAL COMPETENCE TO CULTURAL SAFETY

R.L. Bourque-Bearskin, B.L. Cameron, M. King


Purpose: The changing landscape of nursing education in today’s diverse society is creating many challenges for nurse educators to prepare culturally competent nursing graduates. In addition, the concurrent growth of Canada’s Aboriginal population and advancing health concerns is noted as a priority throughout the health care industry. Educational institutions across Canada are responding to the need and over the last decade, an emergence of nursing programs that address the diverse needs of their Aboriginal student body. This study was convened to explore the complexities associated with educating


nursing students in the area of cultural competence and cultural safety when working with Aboriginal clients.

Methods: This exploratory research study was designed using a qualitative approach guided by an Indigenous research methodology. A convenience purposive sample of 14 nursing students was used. The students were divided into one Aboriginal group and one non-Aboriginal using the principles of an Aboriginal talking circle to compare the different perceptions of learning to care for Aboriginal individuals, as well as the students understanding of cultural competence and cultural safety in relation to their nursing practice.

Results: All participants held a strong conviction what when learning about cultural competence and cultural safety in relation to the Aboriginal clients they reported a lack of knowledge and understanding and the perpetuation of stereotyping in their nursing education. The data was further analyzed and categorized through content analysis into four themes; shared journey, valuing diversity, respectful relations and transformational learning.

Implications: This study will provide valuable information on to build a comprehensive learning experience and Aboriginal content into nursing curricula. Furthermore, it exposes a greater understating of students’ realities, knowledge, skills and attitude needed to promote nursing theory that is culturally congruent with the values and beliefs of a diverse cultures. Contact: R. Lisa Bourque Bearskin ([email protected])

PERSPECTIVES OF SOCIAL DETERMINANTS OF HEALTH: A COMPARATIVE ANALYSIS OF NURSING AND SOCIAL WORK EDUCATION

V. Faria, H. Fikowski

Aurora College, NT, Canada

This presentation will explore a comparative analysis of two disciplinary perspectives from nursing and social work that are tailored to incorporate the uniqueness of our Northern population while ensuring factors such as the social determinants of health are integrated into theory and practice teaching. A collaborative approach will be discussed evaluating how these programs address social determinants of health in practice. The lens used for each discipline will be outlined as well as current health inequities unique to our Northern populations. Qualitative findings compiled from focus group discussions with faculty and students will be shared. Our findings critique the cross-disciplinary framework and ways in which interdisciplinary practice and education strengthens Northern community practice. Recommendations for future interdisciplinary education will be made regarding the social determinants of health in Northern settings. Contact: Heather Fikowski BA, MSW ([email protected])

VENUE 4 Infectious Diseases #6

PREVALENCE OF CHRONIC OTITIS MEDIA IN GREENLAND OVER A 25-YEAR PERIOD

A. Koch


Although the high prevalence of otitis media in Greenland has been known for decades, it was not until the early 1980s that exact frequency figures was obtained. This happened when a field study in the town of Maniitsoq and an adjacent settlement Kangaamiut in west Greenland was carried out. It showed that 19% of children aged 3-8 years had chronic otitis media or sequelae of chronic otitis media. A study in the towns of Nuuk and Sisimiut a decade later showed unchanged conditions.

The Greenlandic society has undergone marked changes in living conditions, a still ongoing process. A number of other diseases have shown to change substantially in prevalence. It was therefore somewhat surprising that the high prevalence of chronic otitis media remained unchanged from the 1980ies to the 1990ies.

In January 2009 we carried out a field study among school children in Maniitsoq and Kangaamiut with the overall aim to determine the prevalence of a number of infectious diseases. Approximately two third of children in the two locations participated. To determine the prevalence of chronic otitis media and sequelae the children had otoscopy done. While a significant number of children in Maniitsoq town had chronic otitis media or sequelae, surprisingly, chronic otitis media was almost non-existing among the studied children of the settlement of Kangaamiut.

In this presentation the prevalence of chronic otitis media in 2008 in Maniitsoq and Kangaamiut will be compared with those found among children in the 1980s and 1990s to describe the development in infectious middle ear disease in an Arctic country in change. Contact: Anders Koch ([email protected])

AKLAVIK H.PYLORI PROJECT TREATMENT PHASE: SEEKING AN EFFECTIVE THERAPY FOR A CANADIAN ARCTIC HAMLET

A.L. Morse, K.J. Goodman, R. Munday, J.W. Morse, V. Van Zanten, CANHelp Working Group

Helicobacter pylori infection has been associated with gastritis, peptic ulcer disease and gastric cancer. Recent work by the Canadian North Helicobacter pylori (CANHelp) Working Group has found that the prevalence of H pylori infection is 58% in the Aklavik H pylori Project. The goal of the treatment phase of this project is to determine which treatment regimens are optimal in the Arctic Aboriginal setting, taking into account antibiotic sensitivity profiles obtained in earlier phases of this project.

Current recommended therapy for first-time H. pylori infection in Canada is multi-drug therapy with 7-10 days of a proton pump inhibitor plus clarithromycin and either amoxicillin or metronidazole (PPI-CA or PPI-CM). Canadian estimates of eradication rates for these standard regimens from a recent meta-analysis are 84% and 82% respectively (Rodgers & van Zanten 2007). A few anti-H. pylori treatment regimens have shown somewhat higher success rates in trial reports; quadruple therapy (proton pump inhibitor, bismuth, metronidazole and tetracycline) and sequential therapy (proton pump inhibitor and amoxicillin for days 1-5 followed by the same proton pump inhibitor in combination with tinidazole and clarithromycin).

Endoscopic evaluation in earlier phases of the Aklavik H pylori project (n=192) allowed for collection of samples for culture and sensitivity analysis. Microbiological data showed that 33% of the Aklavik H pylori was metronidazole resistant, 13% was clarithromycin resistant and 4% was resistant to both. The treatment phase of the Aklavik H pylori project has randomized 111 participants who had positive screening tests (urea breath test (UBT)) for H pylori infection to either standard or alternative therapy. Follow-up UBT in the winter of 2009 will provide eradication rates and help determine what therapy is optimal in this Arctic hamlet.

GASTRIC EPITHELIAL CELL APOPTOSIS IN PATIENTS WITH CHRONIC HELICOBACTER PYLORI ASSOCIATION ANTRUM GASTRITIS AMONG NATIVE AND ALIEN INHABITANTS OF EASTERN SIBERIA

O.S. Amelchugova, V.V. Tsukanov, O.V. Shtygasheva, A.B. Salmina

State Scientific Medical Research Institute for Northern Problems of Siberian Division of Russia Academy of Medical Sciences, Krasnoyarsk State Medical University, Krasnoyarsk, Khakass State University, Abakhan, Russia.


Aim: To study epithelial cell apoptosis parameters, atrophy rate and Helicobacter pylori dissemination parameters in gastric antrum mucosa in various ethnic groups of the Eastern Siberia population.

Methods: We examined 23 Evenks, 23 Khakases and 22 Europoids with histologically confirmed gastritis in the age from 18 till 50 years. All subjects underwent upper digestive tract endoscopy and antrum mucosa biopsy specimens were taken. Morphological research included microscopic examination after staining by hematoxylin and eosine with the description of results using a visual-analog scale (Dixon M.F. et al, 1996) and definition of H. pylori dissemination parameters after Gimsa staining. Epithelial cell apoptosis in gastric antrum mucosa was determined by TUNEL method (Mebstain Apoptosis kit direct, Immunotech, France). Apoptotic index (AI) was determined by counting the percentage of TUNEL-positive epithelial cells at x400 magnification.

Results: In gastric antrum mucosa AI was 5.02% in Europoids (group 1); 4.7% in Khakases (group 2); 2.67% in Evenks (group 3), p1-3<0.05; p2-

3<0.05. Rate of atrophy in gastric antrum was 25.2% in group 1; 15.2% in group 2; 14.9% in group 3 (p1-2=0.04, p1-3=0.03). H. pylori density dissemination in gastric antrum mucosa in Europoids were higher, than in Mongoloids: 206.4 in group 1; 125.1 in group 2; 126.6 in group 3 (p1-2

<0.001; p1-3 <0.001).

Conclusions: High apoptotic index in Europoids was associated with high rate of antral atrophic gastritis and high H.pylori density dissemination in comparison to different ethnic groups of Mongoloids. Contact: Olga Amelchugova ([email protected])

A HAART FULL OF LIFE: VARIATIONS IN QUALITY OF LIFE AMONG ABORIGINAL AND NON-ABORIGINAL PEOPLES EVER ON ANTIRETROVIRAL THERAPY

K.C. Duncan1, K. Clement2, D. Littlejohn5, C. Loppie6, E.K. Brandson1, K.A. Fernandes1, A.K. Palmer1, V.D. Lima1, J.S.G. Montaner1,3, R.S. Hogg1,4 1British Columbia Centre for Excellence in HIV/AIDS, 2Canadian Aboriginal AIDS Network, Ottawa ON, 3Department of Medicine, University of British Columbia, Vancouver BC, 4Faculty of Health Sciences, Simon Fraser University, Burnaby BC, 5Vancouver Native Health Society, Vancouver BC, 6School of Health and Human Performance, Dalhousie University, Halifax NS

Background: Aboriginal people remain over-represented in the HIV/AIDS epidemic in Canada. Quality of life, an important factor in overall health and well being, is significantly impacted by highly active antiretroviral therapy (HAART). Our objective was to compare the quality of life of Aboriginal and non-Aboriginal participants in a cohort of persons on HAART.

Methods: The Longitudinal Investigations into Supportive and Ancillary health services (LISA) cohort is a prospective study of HIV+ individuals on HAART. Explanatory variables are collected through a comprehensive interviewer-administered survey and clinical variables are collected through a linkage with the Drug Treatment Program (DTP) at the BC Centre for Excellence in HIV/AIDS. Associations between Aboriginal status and categorical variables were tested using Fisher’s Exact Test and associations between Aboriginal status and continuous variables were tested using the Wilcoxon Rank-Sum Test. A multivariable model was used to investigate the association between Aboriginal ethnicity and quality of life while accounting for potential confounders.

Results: Of 457 LISA participants, 150 (33%) reported Aboriginal ethnicity. Aboriginal ethnicity was associated with younger age, being female, lower CD4 count, higher viral load, lower education, unstable housing, food insecurity, higher depression, current illicit drug use, and ever being incarcerated. In regards to the quality of life scale, Aboriginal participants reported greater life satisfaction, more health worries and lower HIV mastery in unadjusted analysis. After adjusting for clinical variables, being Aboriginal remained associated with greater life satisfaction. After adjusting for clinical and socio-

demographic variables, Aboriginal ethnicity was significantly associated with greater life satisfaction, fewer financial worries, and higher provider trust.

Conclusion: Positive quality of life results highlight the resilience of the Aboriginal population despite worse socio-economic and clinical status. Findings also indicate that, although clinical outcomes for Aboriginal peoples need improvement, the positive experiences of Aboriginal people already receiving HAART should encourage the expansion of culturally appropriate antiretroviral therapy programs. Contact: Eirikka Brandson ([email protected])

THE INCIDENCE RATES OF THE GASTRIC CANCER AND PREVALENCE OF HELICOBACTER PYLORI AT THE POPULATION OF EASTERN SIBERIA

V.V. Tsukanov, N.N. Butorin, A.A. Maadi, O.S. Amelchugova

State Scientific Medical Research Institute for Northern Problems of Siberian Division of Russia Academy of Medical Sciences, Krasnoyarsk; Russia.

Aim: To compare interconnection of Helicobacter pylori (HP) prevalence, atrophic gastritis and gastric cancer incidence rates in various ethnic groups of the Eastern Siberia population.

Methods: We carried out large scale epidemiological research of adult persons in Tyva, Khakassia and Evenkia. Esophagofibregastroduodenoscopy and HP definition are executed in 3494 patients (1365 Mongoloids, 2129 Europoids). IgG cagA was diagnosed by enzyme immunoassay method in blood serum in 533 Khakasses, 493 Evenks, 316 Tyvins and in 1352 Europoids. Morphological research was carried out to 128 Khakasses, 125 Evenks , 132 Tyvins and 374 Europoids. Data studying on gastric cancer incidence rates using Medline system since 1996 till 2007 was done.

Results: Stomach cancer incidence rates was 22 per 100000 in Evenks, 25 in Khakasses, 50 in Tyvins, and 30 in Europoids. Prevalence of HP had no differences at the studied populations and deviated about 90%. Prevalence of cagA HP was 44,0% in Evenks, 36,4% in Khakasses, 60,0% in Tyvins, 59,8 % in Europoids (p1-3 <0,001; p2-3 <0,001). Prevalence of antral atrophic gastritis was 14,9% in Evenkia Mongoloids, 15,2% in Khakasses, 25,8% in Tyva, 25,2% in Europoids (p1-3 <0,03; p2-3 <0,04).

Conclusion: The highest frequency of atrophic gastritis and gastric cancer was recorded in Tyva Mongoloids and Europoids, among which parameters of cagA HP detectability were maximal among the studied populations. Contact: Vladislav Tsukanov ([email protected])

THE ASSOCIATION OF HELICOBACTER PYLORI CAG A STRAINS PREVALENCE WITH ULCER DISEASES IN SIBERIA MONGOLOIDS

V.V. Tsukanov, J.L. Tonkikh, O.S. Amelchugova, O.V. Shtygasheva, I.M. Ponomareva, E.P. Bronnikova


Aim: To study interconnection of Helicobacter pylori (HP) cagA strains and ulcer disease in Mongoloids and Europoids in different regions of Eastern Siberia.

Methods: We carried out large scale epidemiological research in Tyva, Khakassia, Evenkia, Yakutia and Eastern Siberia middle latitudes. HP was determined by serological, morphological (Gimza staining), urease methods and by polymerase chain reaction in 3494 patients (1365 Mongoloids, 2129 Europoids). IgG cagA was diagnosed by enzyme immunoassay method in blood serum in 533 Khakasses, 493 Evenks, 316 Tyvins and in 1352 Europoids. Esophagofibrogastroduodenoscopy was carried out in 5215 subjects (2701 Europoids and 2514 Mongoloids).


Results: Total prevalence of ulcer disease in Europoids was 8.4%, in Mongoloids - 3.5%. HP prevalence was in Mongoloids 91.3%, in Europoids - 89.6%. Prevalence of cagA HP was 44,0% in Evenks, 36,4% in Khakasses, 60,0% in Tyvins, 59,8% in Europoids (p1-3 <0,001; p2-3

<0,001). HP dissemination density in stomach antrum mucosa was higher in Europoids than in Mongoloids in 1.5-3 times in all regions.

Conclusion: HP cagA strains was associated with ulcer disease in Mongoloids, but not in Europoids of Eastern Siberia. Ulcer disease was associated with HP dissemination density in all populations. Contact: Vladislav Tsukanov ([email protected])

VENUE 5 Food Security #5 – Food Security and Indigenous

Wellness: Knowledge to Action PART A

M. Van Bibber, N. Kassi, J. Christensen, S. Wadowska

In this workshop participants who are interested in indigenous wellness and the impacts of food security will have the opportunity to discuss next steps – moving research and knowledge into action as we journey towards food security for all. A guided discussion format will be used.

SESSION 10 Wednesday, July 15, 1:30-3:30 PM

VENUE 1 Focusing on Children and Families in Northern Canada:

Moving Forward with University/Community Partnerships

CHILD HEALTH RESEARCH IN A NORTHERN CANADIAN CONTEXT: ROLES AND RESPONSIBILITIES OF AN ACADEMIC DEPARTMENT OF PEDIATRICS

B. Armstrong, A. George, S. MacLeod

University of British Columbia, Department of Pediatrics and Child & Family Research Institute

There is active and ongoing debate about the roles and responsibilities of academic health science centres. As the broad determinants of health are increasingly recognized in medical curricula, attention has focused on the parallel social contract that should guide the relationship between medical schools and the populations that they serve. These responsibilities are particularly prominent in child and youth health.

The Department of Pediatrics at the University of British Columbia has committed itself to a program of population health, clinical and basic research needed to inform decision making about child and youth health in Canada’s north. Working through the Child & Family Research Institute, the researchers who are listed at the end of this submission have addressed research questions in a number of spheres important to child and youth health in a northern setting.

The themes to be explored in a workshop format include:

- community-based injury surveillance research - environmental health - toxicology - optimal access to pediatric therapies for vulnerable populations - FASD research across the province - genetic/genomic factors in therapeutic choice

Presenters will examine the challenge of matching academic southern research capacity with northern needs to inform policies that will

improve health outcomes for children and youth. The experience of the UBC Department of Pediatrics in this regard will be described and analyzed in a panel discussion format:

OPTIMAL DRUG THERAPY FOR CHILDREN

S. MacLeod

COMMUNITY-BASED INJURY SURVEILLANCE RESEARCH

A. George

FASD RESEARCH ACROSS THE PROVINCE

S. Clarren, A. Salmon

COMMUNITY READINESS TO ENGAGE IN FASD RESEARCH

M. Van Bibber

FIRST NATION-UNIVERSITY PARTNERSHIP: LAXGALTS’AP VILLAGE GOVERNMENT’S PARTNERSHIP WITH UNIVERSITY-BASED RESEARCHER

W. Martin, A. George

A PARTICIPATORY APPROACH TO ADDRESSING LONG QT SYNDROME IN A LARGE NORTHERN BC COMMUNITY

L. Arbour Contact: Stuart MacLeod ([email protected]

VENUE 2 Indigenous Pedagogy on Mental Health Workshop

Indigenous pedagogy in mental health: Healing teachings for mental health workers, valuable knowledge for clients.

VENUE 3 Newborn & Child Health #2 – Maternal Health &

Surveillance

A DETAILED COMPARISON OF PERINATAL MORTALITY BETWEEN NORTHERN NORWAY AND MURMANSK COUNTRY (RUSSIA)

E. Anda, E. Nieboer, T. Wilsgaard, A.A. Kovalenko, J.Y. Odland

University of Tromsø

Objectives: To explore perinatal mortality (PM) related to birth weight, gestational age, optimal birth weight (OBW) and “small for gestation age” (SGA) between two Arctic populations: Murmansk County [Murmanskaja Oblast (MO)] and Northern Norway (NN). The study is focused on supplying useful information to the Russian Health Care Officials.

Study Design: A registry-based cohort study.

Methods: By the use of the existing Norwegian Medical Birth Registry (NMBR), and the newly established Murmansk County Birth Registry (MCBR), we compared the PM-characteristics of two Arctic populations, with cohorts of N= 17303 (MO), 2006-2007, and N=16006 (NN), 2004-2006.

Results: The PM rate was 10.9/1000 in MO and 5.8/1000 in NN. The population risk based on the proportion in the residual birth weight distribution was 3.2% (NN) and 3.9% (MO). MO had a higher per cent of preterm deliveries (8.8%) compared to (6.9%). The adjusted odds ratio (OR) or risk of mortality (NN as the reference group) was higher for all gestational ages in MO, but the largest risk difference was at term deliveries (OR=2.5). Proportionately more babies were born in the


vicinity (+/- 500 g) of the OBW (67.2% in MO and 47.6% in NN). The SGA 10 percentile cut-off weight was comparable at all GAs up to 37 weeks. From 37-43 weeks, the difference in the cut-off weight increased to it being about 500 g higher in NN.

Conclusions: The PM was higher in MO at all birth weight strata and at all gestational ages, but the difference was most significant for higher birth weights and term deliveries. Separate SGA standards are needed for MO. The observed smallest OR difference for preterm deliveries is most likely due to an artefact related to GA estimation-methods and MCBR inclusion-issues related to some very preterm mortalities. The potential use of the MCBR in environment-and- health studies is explored. Contact: Erik Eik Anda ([email protected])

REMOTE MIDWIFERY IN NUNAVIK: PERINATAL OUTCOMES 2000-2007

V. Van Wagner

Ryerson University, Midwifery Education Programme

The Inuulitsivik midwifery service has provided maternity care on the Hudson coast of Nunavik since 1986, attracting international attention as a model for returning birth to remote communities and local Inuit midwifery education. The birth centres in Puvirnituq, Inukjuak and Salluit represent a community based, Inuit-led initiative that has been recognized as an effective, sustainable perinatal health care model for the remote north, and as part of community healing and the reestablishing of meaningful Indigenous roles and practices for the Inuit. This presentation reports on a FNIHB funded project that analyzed the outcomes data from over 1200 births from 2000-2007, and highlights several important ICCH themes, including partnerships and Northern capacity development, knowledge transfer and exchange, and community involvement. Data will be presented in context with previous evaluations and explore policy implications for maternity care in northern Canada and internationally. Our study involves a retrospective review of perinatal outcome data collected at the time of each birth. Data on women, who gave birth in other centres after pregnancy risk screening or medical evacuation, were identified and collected through an audit of the archived health records as well as through correlation with other sources such as audit of midwifery pregnancy lists and birth books. A Microsoft Access™ database was developed and used to calculate statistics. Indicators were chosen based on a review of other Canadian and international databases to identify key comparators and to reflect the priorities of the Inuulitsivik midwives and northern and remote maternity care. Analysis shows outcomes, such as low rates of intervention, morbidity and mortality, consistent with previous evaluations, thus supporting return of birth to rural, remote and aboriginal and Inuit communities. Contact: Vicki Van Wagner ([email protected])

BIRTH OUTCOMES AMONG FIRST NATIONS, INUIT, AND NON-INDIGENOUS WOMEN IN NORTHERN QUEBEC

Z.-C. Luo1, M. Heaman2, J. Smylie3, P.J. Martens2, N.G.L. McHugh4, E. Labranche5, F. Simonet6, S. Wassimi6, K. Minich3, W.D. Fraser6, R. Wilkins7 1University of Montreal, CHU Sainte-Justine, 2University of Manitoba, 3University of Toronto, 4First Nations of Quebec and Labrador Health and Social Services Commission, 5Nunavik Regional Board of Health and Social Services, Canada, 6University of Montreal, 7Statistics Canada

Background: In near-Arctic countries like Canada, northern regions represent a unique geographic entity characterized by remoteness, long frigid winters, and a relative shortage of tertiary care facilities. There is a lack of comparative data on birth outcomes among Indigenous and non-Indigenous sub-populations within northern regions and compared to southern regions.

Methods: We assessed birth outcomes in a cohort study of all births by maternal mother tongue to northern (2,616 First Nations, 2,388 Inuit and 5,006 non-Indigenous) and southern (2,563 First Nations, 810,643

non-Indigenous) residents of Quebec 1991-2001, based on Statistics Canada’s linked birth and infant death data.

Results: Births to northern mothers of all the three mother tongue groups were at substantially elevated risks of infant death (adjusted odds ratios (aOR) ranged 1.7-2.9) especially postneonatal death (aOR ranged 2.2-4.4) as compared to births to southern non-Indigenous mother tongue women. Within northern Quebec, births to Inuit mother tongue women were most vulnerable to preterm birth (aOR=1.4) and infant death (aOR=1.6) especially postneonatal death (aOR=2.5); births to First Nations mother tongue women were much more likely to be macrosomic (aOR=2.3) but without elevated risks of perinatal and infant death as compared to births to non-Indigenous mother tongue women.

Interpretation: There was a substantial need for improving infant health for all northern residents. Within northern Quebec, there were substantial differences in birth outcomes among Indigenous and non-Indigenous sub-populations. These risk differences should be considered in assessing unmet needs and designing programs for improving maternal and infant health in the northern regions. Contact: Zhong-Cheng Luo ([email protected])

THE DEVELOPMENT OF A COMPREHENSIVE MATERNAL CHILD HEALTH SURVEILLANCE SYSTEM FOR NUNAVUT

G. Osborne1, S. Lauson2, M. Allan3, G.K. Healey4, C. Orlaw1, S. McIntosh2, L. Arbour2 1Health and Social Services, Nunavut, 2University of British Columbia, 3Qikiqtani General Hospital, 4Arctic Health Research Network, Nunavut

Nunavut is the most northerly jurisdiction in Canada, inhabiting 31,000 people, of which 85% are Inuit. There are great challenges to delivering active and preventative health care throughout this land mass of 1.8 million km2. Although most infants are born healthy, Nunavut leads the country for adverse early child health outcomes such as infant mortality, rates of birth defects, low birth weight and prematurity. Public health and community efforts are needed to understand and improve outcomes. To inform these issues and others, as a combined Canadian Institutes for Health Research circumpolar health team grant/Nunavut public health strategy effort, the development of a comprehensive maternal-child health surveillance system (from 16 weeks gestation to 4 years of age) is underway. With the support of the Arctic Health Research Network, a diverse group of professional and lay stakeholders were brought together initially to determine local interest. To follow, a series of small working groups commenced to decide on the collection of potential prenatal, perinatal, and early child health variables. Over 50 local participants have now had some role in the development of the system which is planned to be launched by the summer of 2009. This paper will discuss in more detail the overall goals, utilization of public health structures as data sources, planned variables, data base development, privacy protection, planned research review process, and developing research questions. It is hoped this will be a straight forward, user-friendly system that can be utilized in improving the understanding of aboriginal maternal child health. Contact: Laura Arbour ([email protected])

THE ANAANA PROJECT: MATERNAL HEALTH SURVEY IN THE QIKIQTANI REGION OF NUNAVUT

M. Potyrala, J. Brewster

Government of Nunavut

Objectives: To assess the health status of pregnant Inuit women in the Qikiqtani (Baffin Island) region of Nunavut.

Study Design: Cross-sectional survey. Study participants were recruited by convenience sampling between December 2005 and January 2007.

Methods: Inuit women who were pregnant 36 weeks or more, and living in one of the 12 communities in the Qikiqtani region were invited to participate. A questionnaire collected data on demographics, country food access and consumption frequency (1 year recall), food security,


nutrition knowledge in pregnancy, breastfeeding practices, adoption, vitamin use, smoking, prior and present drug and alcohol use. Blood and hair samples were also collected to measure selected nutrients and environmental contaminants. In total, 101 women completed the confidential interviews, 100 women provided blood samples and 86 gave hair samples.

Results: Of the 101 women who participated, 22% were first time mothers, 90% had completed at least a Grade 9 education, and 89% smoked during their pregnancy. Most had depleted iron stores (Ferritin) and were deficient in Vitamin D. Marine mammals, particularly seal and mattaaq, were reported as the most regularly consumed country food. Of the data comparable to a 1996 maternal survey in the same region, no change in the rate of smoking is noted, a general decline in the consumption of country food is observed and there is an overall decrease in maternal blood levels of long-range environmental contaminants (including lead, total mercury and PCBs).

Conclusions: This research was timely. Maternal and infant health is identified as a priority concern in two recent strategies from the Department of Health and Social Services; the Public Health Strategy and Nutrition in Nunavut: A framework for action. To date, there is limited availability of Inuit-specific maternal health data in Nunavut. The study was a further step in addressing the health-related needs of pregnant Inuit women. Contact: Mary Potyrala ([email protected])

BREASTFEEDING INITIATION, DURATION, AND DETERMINANTS AMONG CANADIAN INUIT IN NUNAVUT

K.E. McIsaac1, T.K. Young1, N. Faraj2, G.M. Egeland2, Qanuippitali Steering Committee (Nunavut)3 1Dalla Lana School of Public Health, University of Toronto, 2Centre for Indigenous People’s Nutrition and Environment, McGill University, 3L. Gunn, Nunavut Association of Municipalities; L. Williamson, Nunavut Tunngavik Incorporated; I. Sobol and G. Osborne, Government of Nunavut Department of Health and Social Services; K. Young, University of Toronto

Background: Canadian Inuit are less likely than other Canadians to begin breastfeeding (66% compared to 80%), although there is notable geographical variation. The determinants of infant feeding practices among Canadian Inuit have only been examined in a few communities using small samples, limiting the ability to extend these results to other communities. Of particular interest is the impact of differing degrees of traditional culture retention on infant feeding practices, which have yet to be evaluated.

Objectives: To evaluate the prevalence of initiation, the duration, and the determinants of breastfeeding among Canadian Inuit who reside in Nunavut, using a population based health survey.

Methods: We examined infant feeding practices in communities participating in the Child Inuit Health Survey (IHS) of Nunavut. This cross-sectional survey randomly sampled 388 children ages 3 to 5 years from 16 selected Inuit communities in the Nunavut territory (Canada). Trained bilingual interviewers administered questionnaires to parents or guardians between August 2007 and September 2008. Infant feeding practices as well as information on various potential determinants related to sociodemographic, behavioural, and environmental factors were collected, with a particular focus on those relating to traditional culture (e.g. language spoken). Initiation and duration of breastfeeding in all communities and in each of the 3 regions was estimated. Multivariate logistic regression was used to examine factors associated with initiation and duration of breastfeeding.

Results: Results are embargoed until dissemination of results to communities is completed in May of 2009. Full details of results will be provided at the ICCH.

Conclusions: Identifying determinants of breastfeeding in Inuit communities can facilitate the creation of targeted public health strategies to increase the initiation and duration of the behaviour.

Contact: Kathryn McIsaac ([email protected])

DEVELOPMENT OF A PERINATAL SURVEILLANCE SYSTEM FOR THE NORTHWEST TERRITORIES, CANADA

K. Machalek, S. Chatwood, L. Paulette, G. Becker

Institute for Circumpolar Health Research, Dalla Lana School of Public Health, University of Toronto

Background: Government, clinicians and researchers have expressed a need for a comprehensive, territory-wide perinatal surveillance system in the Northwest Territories (NWT), Canada that would collect data on all women conceiving and/or giving birth as well as their fetuses/newborns.

Objectives: The objectives of the research conducted were to undertake an assessment of the needs for a perinatal surveillance system in the NWT and to design a perinatal database that would reflect these needs.

Methods: Stakeholder consultations to identify the needs for a perinatal surveillance system in the NWT were undertaken. Objectives and the design of the database were elucidated. Perinatal database development was based on a number of background sources, including variables suggested by the World Health Organization, the Canadian Perinatal Surveillance System, the Canadian Perinatal Programs Coalition, the Canadian Congenital Anomalies Surveillance Network, and the Fort Smith Health and Social Services Authority Midwifery Program Evaluation Framework, amongst others.

Results: Stakeholder consultations identified the need for a flexible perinatal database that would meet a variety of objectives. Objectives included: program evaluation and quality assurance, surveillance and research. Approximately 400 variables related to maternal and infant health were identified for data collection. Special considerations for northern and indigenous populations included documenting variables such as transfers for birth, type and number of caregivers, ethnicity, and risk factors such as smoking and alcohol consumption during pregnancy. Results indicated that data collection must be dynamic in order to fulfill the objectives and cater to a variety of stakeholders.

Conclusions: The proposed NWT perinatal database has the capacity to meet data collection needs for surveillance, program evaluation and research related to maternal and infant health. The collection of data specific to northern and indigenous communities ensures its relevance to a variety of stakeholders interested in the health of women and children from a circumpolar region. Contact: Karolina Machalek ([email protected])

VENUE 4 Infectious Diseases #5

INTERNATIONAL CIRCUMPOLAR SURVEILLANCE OF INVASIVE NON-TYPEABLE HAEMOPHILUS

T. Zulz1, M. Bruce1, M. Garner2, D. Parks1, A.J. Parkinson1 1Centers for Disease Control/Arctic Investigations Program, 2Public Health Agency of Canada

Background: The International Circumpolar Surveillance system conducts population-based surveillance of invasive bacterial diseases caused by Haemophilus influenzae (Hi) in Northern Canada (NCan) and in the U.S. Arctic (Alaska [AK]).

Methods: Invasive Hi was defined as an isolate from a normally sterile site drawn from a surveillance region resident. Isolates were forwarded to reference laboratories in AK and NCan for confirmation and serotyping. Serotyping was performed by slide agglutination or polymerase chain reaction (PCR) [Quebec (QC) only]. Clinical and demographic information were collected on standardized surveillance forms. Data reported are for the years 2000 through 2007.


Results: A total of 198 Hi cases were reported (AK=110, NCan=88). 191 isolates were serotyped; of those, 64 (34%) were non-typeable either by PCR [QC=8 of 13 (62%)] or slide agglutination [AK=44 of 105 (42%), rest of NCan=12 of 73 (16%)]. Isolates serotyped by PCR were more likely to be determined non-typeable than those serotyped by slide agglutination (p=0.03). Age adjusted rates of invasive disease caused by non-typeable Hi (NT-Hi) were 1.2/100,000 (AK) and 3.5/100,000 (NCan). Case ages ranged from 0 to 90 years. Age distribution differed between countries; 64% of AK cases were > 40 years compared with 30% in NCan (p=0.03). For all ages, pneumonia was the most common clinical presentation [AK (41%), NCan (45%)]. Ten fatal cases were reported in AK, two in children less than 1 year old and eight among adults ranging 22-90 years old. One fatality was reported in NCan (71 year old). There were no significant differences in case fatality ratios between AK and NCan when stratified by age.

Conclusion: The variability in proportions of NT-Hi from areas using different typing methods should be further evaluated. Cases are more likely to occur in older persons in AK and young children in NCan; age distribution differences warrant further study. Contact: Tammy Zulz ([email protected])

COMPARISON OF INVASIVE PNEUMOCOCCAL DISEASE RATES IN ALASKA AND NORTHERN CANADA FOLLOWING PCV7 INTRODUCTION

M.G. Bruce1, T. Zulz1, M. Garner2, D. Bruden1, M. Lovgren3, L. Jette4, K. Rudolph1, D. Hurlburt1, J.D. Wenger1, T. Hennessy1, A.J. Parkinson1 1Arctic Investigations Program, National Center for Preparedness, Detection and Control of Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, 2Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, 3National Centre for Streptococcus, Edmonton, Alberta, Canada, 4Quebec Public Health Laboratory, St.-Anne-De-Bellevue, Quebec, Canada

Background: The International Circumpolar Surveillance Project is a population-based surveillance network for invasive bacterial disease among 7 Arctic countries. The 7-valent pneumococcal conjugate vaccine (PCV7) has been used for routine infant immunization in Alaska since 2001, and in northern Canada (NCan) since 2003; however, the start date varied by region in the latter.

Methods: Invasive pneumococcal disease (IPD) data from the North American Arctic (1999-2007, Alaska and NCan, total population 783,500) were analyzed to determine predominant clinical findings, disease rates, serotype distribution and antimicrobial susceptibility.

Results: 1,386 cases of laboratory-confirmed IPD were reported. Bacteremic pneumonia was diagnosed in 63% of IPD cases. Annualized incidence rates of IPD in Alaska and NCan were 18 and 27 cases/100,000 persons, respectively (rates among indigenous persons: 47 in Alaska and 35 cases/100,000 persons in NCan). Rates in children <2 years of age were 109 and 156 cases/100,000 persons in Alaska and NCan, respectively (rates in indigenous children: 251 in Alaska; 170 in NCan). IPD rates in children <2 due to PCV7 serotypes declined by >80% after routine vaccination (Alaska: 130 to 11 cases/100,000 persons, p<.001; NCan: 129 to 37 cases/100,000 persons, p<.001). Rates of disease with non-PCV7 serotypes in children <2 increased in Alaska (25 to 76 cases/100,000 persons, p<.001), and in NCan (41 to 74 cases/100,000 persons, p=.17). Rates of IPD with penicillin-non susceptible isolates decreased from 63 to 27 cases/100,000 children in Alaska (p=0.001), and from 10 to 8 cases/100,000 persons (p=1.00) in NCan.

Conclusions: The high IPD rates among Arctic Indigenous people have declined in Alaska and NCan following PCV7 introduction. An increase in non-vaccine type disease of the magnitude seen in Alaska was not observed in NCan. Continued surveillance is needed to determine the impact of PCV7 and future higher valency conjugate vaccines when they come into use. Contact: Michael Bruce ([email protected])

RESPIRATORY SYNCYTIAL VIRUS: POTENTIAL TRENDS IN INFECTION OF CHILDREN IN NUNAVUT, CANADA

L.A. Butler1, G. Osborne2

Government of Nunavut; University of Toronto 1Dalla Lana School of Public Health, Department of Public Health Sciences, University of Toronto, 2Dept. of Health & Social Services, Government of Nunavut, Iqaluit Nunavut, Canada

Background: Respiratory Syncytial Virus (RSV) is the primary causative agent of lower respiratory tract infections (LRTI) in young children. Bronchiolitis is a common LRTI that affects children and approximately 50-80% of these infections are due to RSV. These factors are particularly important in Nunavut as children living in northern communities have an increased risk for bronchiolitis in comparison to children living in southern communities.

Objective: To investigate possible trends in RSV infections in Nunavut children under the age of 24 months, paying attention to potential differences in demographics, seasonality, hospitalization and use of palivizumab (Synagis) prophylaxis.

Methodology: Descriptive analyses will be conducted on demographic, seasonality and hospitalization data extracted from the Government of Nunavut’s Medical Travel Database and Community Health Reporting System Database, as well as the Canadian Institute for Health Information’s Discharge Abstract Database and the Qikiqtani General Hospital’s emergency room records. The utilization of palivizumab will be analyzed using data extracted from Nunavut’s Synagis Program records.

Conclusion: The results of these analyses will be used to provide insight into the past and present burden of RSV and bronchiolitis in children less than 24 months of age in Nunavut and across its three regions: Baffin, Kitikmeot, and Kivalliq. These results will also be used to evaluate the effectiveness of palivizumab and make informed decisions about the future use of this treatment in the prevention of serious LRTIs caused by RSV, such as bronchiolitis, in this population. Contact: Leigh Ann Butler ([email protected])

A TWO-YEAR SURVEILLANCE OF RESPIRATORY VIRUS IN SICK AND HEALTHY CHILDREN IN GREENLAND

A. Koch, L.P. Nielsen, M. Andersson, M. Melbye


Introduction: Although respiratory tract infections are highly prevalent in children in Greenland, there is very little knowledge about the involved respiratory virus. We carried out a two-year continuous surveillance of such virus in a cohort of children aged 0-4 years of age.

Methods: Nasopharyngeal aspirates were taken both from children with symptoms and without symptoms. Aspirates were frozen at -80 degrees C until tested by PCR for 12 virus (Influenza A & B, RSV A + B, human Metapneumovirus (hMPV), Parainfluenzavirus 1, 2, & 3, Adenovirus, Coronavirus 229E, OC43, & NL63, and Rhinovirus).

Results: Among 432 children 2612 aspirates were taken. All aspirates from episodes of lower respiratory tract infections (LRI, n=209) and 1633 aspirates drawn at random from children with upper (URI) or no respiratory tract infections were tested for virus. Nine of the 12 tested virus were found, while Influenza B, Parainfluenza 2, and Corona 229E virus were not. Virus was found in 857 aspirates (46.5% of all); in 54% of aspirates from URI episodes and in 50% from LRI episodes. Rhinovirus was the most frequent virus (found in 27% of tested aspirates), followed by Adenovirus (19%), RSV (5%), Coronavirus NL 63 (1.7%) and hMPV (1.1%). hMPV appeared significantly more often in children with LRI than with URI; RSV and rhinovirus equally often in children with URI and LRI, but significantly more often in aspirates from children without infections. Adenovirus occurred more frequently in children with URI than with LRI, but not significantly. There were clear calendar variations in the incidences of influenza, RSV, parainfluenza and Corona NL63 virus, while there was no variation in the incidence of the frequently occurring adeno- and rhinovirus.


Conclusions: Most virus tested in a standard western respiratory panel are found in Greenland. Some of these appear endemic, while others show epidemic patterns. Contact: Anders Koch ([email protected])

INVASIVE PNEUMOCOCCAL DISEASE IN ALASKAN CHILDREN: THE ROLE OF WATER SUPPLY AND THE SEVEN VALENT PNEUMOCOCCAL CONJUGATE VACCINE (PCV7)

J.D. Wenger1, T. Zulz1, D. Bruden1, M.G. Bruce1, L. Bulkow1, D. Parks1, K. Rudolph1, D. Hurlburt1, R. Singleton1, T. Ritter2, J. Klejka3, T. Hennessy1 1Arctic Investigations Program, National Center for Preparedness, Detection and Control of Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, 2Division of Environmental Health and Engineering, Alaska Native Tribal Health Consortium, Anchorage, Alaska, 3Yukon-Kuskokwim Health Corporation, Bethel, Alaska

Background: Recent studies in Alaska show an association between a lack of in-home piped water and higher incidence of pneumonia, RSV infection, and skin infections, but not gastrointestinal illness. It is likely that scarce water supplies lead to decreased handwashing and other personal hygiene practices, enhancing person-to-person transmission of pathogens. One third of rural Alaska Native villages lack in home piped water and sewage service. We evaluated the role of water supply in childhood invasive pneumococcal disease (IPD) after use of seven-valent pneumococcal conjugate vaccine (PCV7).

Methods: Cases of IPD (defined as the isolation of S. pneumoniae from normally sterile sites in a resident of Alaska) were identified through population-based laboratory surveillance from 1996-2007. The association of IPD with immunization coverage, socioeconomic status and in-home water service was assessed.

Results: IPD rates in Alaskan children < 5 years of age declined from 87 cases/100,000 during 1996-2000 to 37/100,000 during 2001-2004 and then rose to 61/100,000 during 2005-2007. Introduction of PCV7 in 2001 resulted in elimination of IPD caused by serotypes contained in the vaccine, but was followed by increasing rates of IPD caused by non-vaccine serotypes. IPD rates were 3 to 10-times greater in the region with the smallest percentage of houses with in-home piped water than in other regions in the state. Within that region, the rate of IPD in children <5 in villages where <10% of houses had in-home piped water was 390/100,000, compared with 150/100,000 in villages where > 80% of house had in-home piped water (p= 0.008). This association remained after controlling for household crowding, village size, and income.

Conclusions: Introduction of PCV7 led to elimination of vaccine-type disease in high risk areas, but IPD recurred in these areas with disease caused by other serotypes, especially in areas with low levels of in-home piped water. Provision of in-home piped water is a critical component to control of pneumococcal disease in Alaska Natives. Contact: Jay Wenger ([email protected])

A RANDOMIZED, PLACEBO-CONTROLLED TRIAL OF HEAT RECOVERY VENTILATORS FOR THE PREVENTION OF LOWER RESPIRATORY TRACT ILLNESS IN INUIT CHILDREN

T. Kovesi

Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON Canada

Objectives: Inuit infants have high rates of reported hospitalization for respiratory infection, including bronchiolitis and pneumonia. We have previously shown that this is associated with overcrowding and reduced ventilation.

Study Design: We performed a randomized, double-blind, placebo-controlled trial to determine whether home heat recovery ventilators would improve ventilation and reduce the risk of respiratory illnesses in young Inuit children.

Methods: Inuit children under 6 years of age living in several communities in Nunavut, Canada were randomized to receive an active or placebo heat recovery ventilators. Placebo ventilators increased air circulation, but did not draw additional fresh air from the outside. We monitored respiratory symptoms, health center encounters, and indoor air quality for six months.

Results: Heat recovery ventilators were placed in 68 homes, and 51 houses could be analyzed. Subjects had a mean age of 26.8 months. The active ventilators brought indoor carbon dioxide concentrations to within recommended concentrations, and also reduced relative humidity. Use of an active heat recovery ventilator was associated with a significant reduction in the risk of reported wheeze. Rates of reported rhinitis were significantly lower in the heat recovery ventilator group than the placebo group. There were no significant reductions in the number of health center encounters. There were no hospitalizations in either group. Occupants in both groups reported concerns about the devices appearing to make the homes feel cooler.

Conclusions: Use of heat recovery ventilators was associated with in improvement in air quality and reductions in reported respiratory symptoms in Inuit children. Contact: Tom Kovesi ([email protected])

VENUE 5 Food Security #5 – Food Security and Indigenous

Wellness: Knowledge to Action PART B

M. Van Bibber, N. Kassi, J. Christensen, S. Wadowska

This workshop is a continuation of the discussions and action strategies identified in the morning workshop. Those planning to attend are invited to bring copies of any examples of strategies and/or resources from their jurisdictions that will help to move action forward.

VENUE 6 Service Delivery & Infrastructure #2 – Health Service

Delivery

SPEECH LANGUAGE PATHOLOGY TELESPEECH SERVICE DELIVERY MODEL FOR REMOTE COMMUNITIES

D. Anderson

Anderson Speech Consultants

This paper is designed to provide solutions with an emphasis on an innovative service delivery model which includes building community partnerships both in Canada and internationally. The extreme shortage of Speech Language Pathologists (SLP) in Canada has resulted in the remote areas of Northern Canada being without SLP services for years. Anderson Speech Consultants (ASC) has been a pioneer in developing and implementing innovative solutions to this problem with a focus on building partnerships within communities. Our goal has been to provide consistent speech services within the Northwest Territories, Nunavut, and Northern Ontario. All services utilize an adaptation model for the aboriginal/northern culture as well as a training model for local assistants. ASC, in conjunction with northern hospitals, health centres, daycares, and schools, has provided assessments and therapy to hundreds of children/adults through the use of TeleSpeech, community visits, and capacity building.

Practical methods on the “how to” of developing and implementing a service delivery model that incorporates a culturally sensitive approach will be addressed. A strong emphasis on building relationships within a community is emphasized to ensure the success of the service delivery model along with methods of training local people to be assistants. Realistic expectations of various levels of remote assistants will also be


explored. Family responses to the TeleSpeech model including attendance, equipment issues and client progress will be addressed.

In conclusion, our model of SLP service delivery in Northern Canada has demonstrated exceptional success in achieving an innovative solution for remote communities. Distance has not been an obstacle in providing consistent, high quality services as evidenced by the positive feedback and strong support of participating families and local partnerships. The potential for providing exceptional SLP services to remote communities is unlimited through the implementation of this innovative service delivery model. Contact: Deborah Anderson ([email protected])

THE MANITOBA FIRST NATIONS PATIENT WAIT TIME GUARANTEE PILOT PROJECT

M. Horton

The Canadian government’s health care plan calls for a guarantee that ensures that all Canadians receive medical treatment within wait times that are clinically acceptable. Fundamental to a wait time guarantee is defined time frames for care and a set of alternative care options, should that time frame be exceeded (recourse). In January 2007, a unique Patient Wait Time Guarantee (PWTG) pilot project for the prevention, treatment and care of diabetic foot ulcers among Manitoba First Nations (MFNs) was announced. The project involved a partnership between an innovative home care nursing organization, Saint Elizabeth Health Care (SEHC), and a First Nations leadership advocacy organization, the Assembly of Manitoba Chiefs (AMC).

Within a PWTG framework, the project partners sought to establish a clinical care pathway, benchmarks for care and recourse options for patients who do not receive treatment within this time frame. The guidelines for diabetes foot care were updated and standardized with a diabetes foot risk assessment and management tool developed by Manitoba foot care providers. This tool consists of a comprehensive screening assessment, risk category descriptions, and interventions and standardized referral plans based on risk. This tool included clinical benchmarks and time frames for care.

The difficulty in testing the clinical benchmarks is that the real challenge facing people living with diabetes in MFN communities was more a matter of access than wait times. Funding for community based foot care services is inconsistent and insufficient resulting in considerable disparity in foot care services available across MFNs. As a result persons living with diabetes rarely have their feet assessed. This lack of assessment, early intervention, and care means that all too often MFNs are presenting for care of their diabetic foot ulcer at a stage when amputation may be the only option.

Basic primary foot care services are critical to addressing this issue. However, the project partners also understood that there were challenges far more fundamental then access to health care impacting this issue for MFNs. Action on the broader determinants of health (housing, water, food) impacting MFNs will be necessary to truly address the higher rates of diabetes and the shockingly disproportionate rates of amputations. The issues of care and access to care also cannot be viewed only through a western or biomedical model. This project was committed from the outset to consider all effective options, including traditional healing, and to build a solution that would work and that recognized and emphasized Manitoba First Nation cultural values and perspectives.

This project demonstrates that the most effective model to change wait times, and understand the reasons underlying those waits, is not to rely on health care professionals alone, but instead, to adopt different ways of involving the people most affected. The project also documented important lessons learned for improving health care and wait times for First Nations and for all Canadians. The approach, finding, and recommendations from this important project will be shared in this presentation. Contact: Mabel Horton ([email protected])

VIRTUAL COMMUNITIES AS LOCATIONS

N. Poole

British Columbia Centre of Excellence for Women’s Health

In a context of fast-paced, globalization of information, and persistent inattention to inequities in women’s health, a Canadian network of researchers and research collaborators have found that virtual communities can provide those interested in improving the health of marginalized women, with opportunities to collectively examine various forms of knowledge, as well as power relations that impede social change.

This session will describe the work of a virtual community comprised of indigenous and non-indigenous women, working in the north and south of Canada, who are interested in the prevention of fetal alcohol spectrum disorder. The community, comprised of researchers, service providers, educators and health system planners, is a Network Action Team (NAT) of the CanNorthwest FASD Research Network. Over the past three years this community/NAT has collectively shared, generated and synthesized various forms of knowledge, and discussed routes for action on this knowledge (translated it into practice, policy and further research), in virtual and face-to-face contexts.

The presentation will contribute to our understanding of the potential for web-based technological supports to bridge geography, sectors, and other diversities to involve those interested in accelerating the application of research, to health care practice and health & social policy. The session will describe the community’s model, process and the technological support it has used, in order to support and learn from others, who are or might find such virtual collaboration helpful in their work. Contact: Nancy Poole ([email protected])

TRACKING PUBLIC HEALTH FROM ORBIT: CSA EO SUPPORT TO EMERGENCIES, DISASTERS, DISEASES, ENVIRONMENT

G. Aubé

Canadian Space Agency

Over the last decade, the Canadian Space Agency (CSA) has been involved in the support of scientific initiatives, demonstration projects and operational activities related to the Arctic ecosystems. Through the Government Related Initiatives Program (GRIP) and the Earth Observation Application Development Program (EOADP), the CSA and its public and private sector partners have fostered the development of Earth Observation (EO) information and services related to emergency and environmental management, food security, health and diseases, etc. The CSA understands the tremendous role and value that space-based EO systems and information have regarding health and security in the North and its environmental and socio-economic impacts and benefits. The proposed presentation provides a brief description of the importance of the “Health” thematic area for the CSA EO programs and a brief review of the Canadian EO activities affecting circumpolar regions. It discusses the critical role the CSA applications development programs can play in ensuring the integration of EO in the management and stewardship of this sensitive area and a greater awareness and appreciation by Canadians of the benefits that they receive from the use of EO information, services and products. Contact: Guy Aubé ([email protected])

MEDICAL IMAGING IN NORTHERN CANADA: A STUDY BY THE CANADIAN RADIOLOGICAL FOUNDATION

W. Mason

Canadian Radiological Foundation

The Canadian Radiological Foundation (CRF) is a charitable organization of radiologists promoting the art and science of radiology through research and education within Canada and internationally. Through the Canadian Radiological Foundation, and its sister organization, the Canadian Association of Radiologists, radiology


physicians assume a proactive role in assisting governments and medical institutions in finding solutions to the growing challenges in distributing healthcare resources within Canada.

Through late 2008 and early 2009, the Canadian Radiological Foundation undertook a research study entitled Medical Imaging in Northern Canada to report on the status of radiological care in the Yukon, Northwest Territories and Nunavut. The Canadian Radiological Foundation undertook the study recognizing that the north is an often under-serviced region of Canada with very unique challenges in the provision of quality radiological care to its population. The study results are compiled into a comprehensive report bringing together for the first time ever detailed information on the service delivery and infrastructure for imaging in the north. Topics covered in the report include: the types of modalities and imaging services provided; the distribution of imaging services and resources, including which ones are imported or sought elsewhere; the payment of services; the application of teleradiology in the north; and a look at the professionals providing the care. The Canadian Radiological Foundation worked directly with health ministries, hospital administrators and other regional stakeholders of the northern territories to complete this study, and gratefully acknowledges their participation. The report will be a valuable resource to policy makers and administrators as they work to address the north’s distinctive challenges. Key results of the Medical Imaging in Northern Canada study will be shared during the presentation of the Canadian Radiological Foundation. Contact: Gregory Butler, MD ([email protected])

ABORIGINAL NURSES ASSOCIATION OF CANADA – CHANGING THE PICTURE OF ABORIGINAL HEALTH

J. Lys

Nurse Practitioner, Fort Smith, NT

The current picture of Aboriginal health in Canada and many countries in the world is often bleak. Aboriginal people are often at the extreme ends of the spectrum and for the most part, are not as healthy as non-Aboriginal Canadians. Aboriginal people, once grounded in holistic cultural practices, were previously much healthier than they are today.

By recognizing the importance of cultural and addressing issues that affect the health and well being of Aboriginal people, the Aboriginal Nurses Association of Canada (ANAC) aspires to change the picture of Aboriginal health in Canada to one of health and wellness. ANAC promotes Aboriginal health and well being by bringing the voice of Aboriginal people from the frontline of the healthcare system to the national level and advocating for improvements to the healthcare system.

This session will highlight the efforts made by ANAC at the national and local levels to improve health and healing for Aboriginal people in Canada. Issues such as cultural competence in health care and nursing education, recruitment and retention of Aboriginal professionals, Aboriginal health research, patient advocacy and holistic health practices will be discussed. Contact: Julie Lys ([email protected])

VENUE 7 Social Determinants of Health #2

SOCIAL DETERMINANTS OF INDIGENOUS HEALTH: THE JOURNEY OF CANADA’S FIRST NATIONS, INUIT, AND MÉTIS VOICES AT THE INTERNATIONAL LEVEL

M. Greenwood, B. Downey


There has been growing interest in social determinants of Indigenous health at the international level. After two years of consultations

around the world, the WHO Commission on Social Determinants of Health (CSDOH) tabled its final report in October 2008. The report challenges nations to address the gap in health inequalities in a generation. But what does this mean for Indigenous peoples around the world?

The fact that Indigenous health was included in the work of the CSDOH is due to the dedicated efforts of two Commissioners on the CSDOH, one Canadian and one Australian, who were instrumental in ensuring that Indigenous health would be addressed. Indigenous organizations from around the world came together at an International Indigenous Social Determinants of Health Symposium in Adelaide Australia in April 2007 to prepare a presentation on Indigenous health that was subsequently presented to the CSDOH Commissioners in June 2007. It was one of the most coordinated activities in Indigenous health at a global level. In Canada, the process to coordinate First Nations, Inuit and Métis voices was undertaken by the National Collaborating Centre for Aboriginal Health (NCCAH).

This presentation will describe the process that was undertaken to bring together First Nations, Inuit and Métis organizations in order to ensure that their voices were heard at the international level. It will also outline the learnings and issues from this process as well as the findings that are captured in the final report of the CSDOH.

Participants will be invited to discuss the relevance of these findings as they apply to the public health needs of circumpolar populations and what actions they would recommend to ensure that the Canadian public health systems integrates and respects these needs. Contact: Margo Greenwood ([email protected])

LOW PHYSICAL ACTIVITY AT WORK IS ASSOCIATED WITH SEX, OCCUPATION, AND COMMUNITY SIZE AMONG INUIT OF GREENLAND

I.K. Dahl-Petersen, P. Bjerregaard, M.E. Jørgensen

Centre for Health Research in Greenland, National Institute of Public Health and University of Southern Denmark

Background: Greenland has undergone a rapid transition in life style resulting in more sedentary jobs and potentially lower total daily energy expenditure. Low energy expenditure is a well known risk factor for several chronic diseases. Promotion of physical activity requires an identification of factors associated with physical activity.

Methods: The International Physical Activity Questionnaire - long version (IPAQ) - was used to record physical activity in a representative, cross-sectional population survey of Inuit ~18 years in Greenland (N=2247) (2005-2007). Energy expenditure in leisure time and at work was estimated in MET-minutes per week, divided into quartiles and entered in the analyses as quartile 1 vs. the rest and quartile 4 vs. the rest. By logistic regression we analysed the association between physical activity at work and leisure time and socio-demographic factors: sex, age, occupational status, marital status and community size.

Results: No association was found between energy expenditure at work and leisure time stratified by sex. The results showed association between a low energy expenditure at work and being a woman (OR=1.5 (CI 1.1-1.9)), living in the largest community (Nuuk) compared to smaller villages (OR=1.6 (CI 1.0-2.4)) and having a work requiring a mid-level or higher education compared to an unskilled work (OR=2.2 (CI 1.5-3.1)). Being a man (OR=2.3 (CI 1.8-3.0) and having an unskilled work (OR=4.6 (CI 2.9-7.5)) or being a hunter/fisher (OR=4.8 (CI 2.7-8.5) was associated with a high energy expenditure at work. Living in smaller villages compared to Nuuk (OR=1.9 (CI 1.3-2.7)), being a hunter/fisher compared to having a work requiring a mid-level or higher education (OR=1.8 (CI 1.1-3.0)), and being 25-59years vs. 18-24years were associated with a low energy expenditure in leisure time.

Conclusion: Living in a large community compared to a small village, being a woman and having a job requiring a mid-level or higher education is associated with low energy expenditure at work not necessarily compensated by high energy expenditure in leisure time.


Contact: Inger Katrine Dahl-Petersen ([email protected])

REDUCING HEALTH DISPARITIES AND PROMOTING EQUITABLE ACCESS TO HEALTH CARE FOR ABORIGINAL PEOPLES

R. Martial1, B. Cameron2, M. King3, R.L. Bourque-Bearskin2, A.S. Savalas4 1NEAHR-ACADRE University of Alberta, 2Faculty of Nursing, University of Alberta, 3Faculty of Medicine and Dentistry, University of Alberta, Canadian Institute of Health Research-Indigenous Aboriginal People Health. (CIHR-IAPH), 4RN PhD, Chile

Background: Addressing access to health care issues began with a community consultation held by the Alberta ACADRE Network (AAN) at the University of Alberta. This community request gave birth to three strategies that created a relational structure. The first being an Access to health care services research initiative to address issues of access to health care for Aboriginal peoples. Second, was the formation of an interdisciplinary, intersectorial, and intercultural collaborative research team with representatives from Aboriginal communities, Aboriginal organizations, and health care agencies. Thirdly, three exploratory projects were undertaken to investigate the experiences of access to health care services in the urban setting. Participants involved Aboriginal people from the urban, rural, and inner city residents. The findings from these studies supported further research to action plans and tied our projects together in a strongly effective way. In follow up to the exploratory inquiry, a research proposal outlining five interrelated components was funded by the Canadian Institutes for Health Research.

Methods: A qualitative Indigenous research approach was used to address critical elements in promoting equitable access to health care services and are listed as follows: 1) Consultation component Gathering with the community. 2) Knowledge exchange/translation component titled creating respectful spaces for intercultural dialogue. 3) A CHR intervention project aimed at taking action towards developing effective treatment partnerships. 4) An evaluation component to develop culturally appropriate access indicators. 5) An International wing to initiate a two-way knowledge exchange between Indigenous peoples in Chili and Canada

Results: Currently, the research team is actively immersed in initiating the Community Health Representative (CHR) Intervention project in both an urban and rural hospital setting which has been lead by the vision of our Elder Rose Martial, who will be discussing further some of the initial findings on the work to-date including the challenges, and successes of this project.

Conclusions: This multilayer relational approach includes research training, collaboration with community stakeholders and expanded community research projects. These five-core areas of research targets the urban, rural, inner city hospital settings as well as health professionals with a related goal to understand the roots of health disparities and build reciprocal research capacity with Indigenous Peoples, health care professionals, and scholars with a view to promote effective and comprehensive improvements in the health of Indigenous Peoples both locally and globally. Contact: Rose Martial ([email protected])

SOCIAL CAPITAL AND THE WELL-BEING OF ABORIGINAL SINGLE MOTHERS

B. Parlee, V. Napoleon

Native Studies, University of Alberta

Social capital plays an important role in the well-being of Aboriginal peoles, particularly those living in urban centres. For single Aboriginal mothers moving from the north to southern centres, the knowledge, support and resources found through urban social networks are critical to their ability to cope with the challenges of inadequate housing, employment and education. The researchers interviewed twenty

women in a northern community and twenty women in the city of Edmonton in 2006. The paper discusses the factors affecting rural to urban migration and the urban experience. The difference between social capital in remote communities of the north and that emerging in urban centres is also discussed. As the population of Aboriginal people in Canada becomes increasingly urbanized, understanding these social factors that affect rural to urban migration and “well-being” in urban environments is important. Contact: Brenda Parlee ([email protected])

ROLE OF EDUCATION IN INFLUENCING COMMUNITY WELL-BEING

R. Salokangas, B. Parlee


Health is variously defined across cultures. Indigenous communities have been shown to conceptualize “health” more broadly and holistically than western models with links to family, community and the environment. Through various tools of social change and acculturation, these “traditional” beliefs about health held by Canada’s Aboriginal peoples, have been transformed. The role of education in defining and delivering on the determinants of health has not been well explored. This paper traces the link between the formal education system and “a good life” of the Inuvialuit of Tuktoyaktuk from the early 1900s to the present day. The paper is based on secondary literature review and field work in Tuktoyaktuk during 2008. Salokangas conducted 25 multigenerational interviews with youth, parents and grandparents and key informants in the education system over a period of three months. The discussion reveals the influence of the formal education in defining and delivering a “good life”. Contact: Raila Salokangas ([email protected])

SESSION 11 Thursday, July 16, 8:30 – 10:00 AM

VENUE 1 Mental Health & Wellness #7 – Attitudes and

Experiences in Mental Health

NATIONAL STRATEGY TO PREVENT ABUSE IN INUIT COMMUNITIES AND NATIONAL INUIT RESIDENTIAL SCHOOLS HEALING STRATEGY

D. Tagornak


Pauktuutit Inuit Women of Canada is the national organization that represents all Inuit women across Canada. Established in 1984, the non-profit organization has achieved widespread recognition for its dedication to and advocacy for Inuit women. Our mandate is to foster a greater awareness of the needs of Inuit women, and to advocate for their equitable participation in community, regional and national concerns in relation to social, cultural and economic development.

Pauktuutit has developed two strategies in the area of abuse prevention and addressing the impacts of residential schools.

1. National Strategy to Prevent Abuse in Inuit Communities

Pauktuutit is actively implementing its National Strategy to Prevent Abuse in Inuit Communities. This strategy has six main priorities that the current project will address: 1- Make abuse in Inuit communities a priority issue; 2- Raise awareness and reduce tolerance of abuse; 3- Invest in training and capacity development; 4- Sustain front-line workers and community services; 5- Deliver services that heal Inuit; and 6- Expand on programs that build on Inuit strengths and prevent


abuse. The overall goal of the strategy is a steady reduction in incidents of violence and abuse in Inuit communities and the eventual predominance of caring and respectful relationships.

2. Journey Forward – the National Inuit Residential Schools Healing Strategy

Pauktuutit has also developed a National Inuit Residential School Healing Strategy. This strategy has main priorities that the project will address: 1. Strengthen Inuit language and culture; 2. Form partnerships and strengthen relationships; 3. Increase the number of Inuit who can help others; 4. Develop the knowledge of service providers in Inuit Communities; 5. Educate and raise awareness about Inuit in Residential Schools; 6. Share information and effective healing practices; 7. Identify and fill gaps in healing services and programs.

Implementation activities of both strategies will be presented. Contact: Deborah Tagornak ([email protected])

PSYCHOSOCIAL RISK FACTORS AMONG SÁMI WOMEN OF REINDEER HERDING FAMILIES

A. Edin-Liljegren, L. Daerga, M. Eriksson, L. Jacobsson, P. Sj’lander

Southern Lapland Research Department

Objective: The aim of the present study was to identify psychosocial risk factors among reindeer herding Sámi women.

Materials: The data originate from a comprehensive health and working environment study, performed 2003-2006, in collaboration with individuals from seven Sámi communities in Sweden (women=66). The women of reindeer-herding households were compared with two control populations of Swedish women who participated in the MONICA-project in 2004, one living in rural (n=132) and one in urban (n=132) areas of northern Sweden. The control populations were matched by age to the study population.

Methods: Questionnaires on psychological factors as demand-control at work, well being, social support and sense of coherence were used together with interviews of 13 women from reindeer-herding households. The interviews were performed in focus groups and via telephone calls and included questions about what they regarded as important in life e.g. about meaningfulness, participation, appreciation and support.

Results: The reindeer-herding Sámi women experienced a significant lower sense of coherence than both the rural (p<0.002) and the urban Swedish women (p<0.011). The meaningfulness (p<0.000 for both groups) and manageability (p<0.007 and p<0.026 for urban and rural women, respectively) were significantly lower among the Sámi women, but not the comprehensibility that was similar in all populations. The reindeer-herding women had larger social networks (p<0.000) and reported more close relations (p<0.000) than the control groups. There were no differences in work-demand, decision latitude, intellectual discretion, job strain ratio or social support at work between the three populations. Also the well being in the social, the physical and the mental domain was reported to be very similar between the groups. The interviews were analysed by content analysis and will be further discussed at the meeting.

Conclusions: It seems that the reindeer-herding Sámi women experience a lower sense of coherence in life in comparison with other Swedish women. The Sámi Women’showed similar comprehensibility but reported lower degree of meaningfulness and manageability. These results might be explained by a life situation that is unpredictable and characterized by low status, low profitability, lack of external understanding and appreciation. Contact: Anette Edin-Liljegren ([email protected])

BORDERLANDS: A NARRATIVE INQUIRY INTO FIRST NATIONS’ WOMEN’S EXPERIENCES OF DEPRESSION

B. Green

First Nations University of Canada

The central focus of this study is the examination of how rural reserve living effects individual First Nations’ women’s lives and ability to cope with depression within a highly politicized context. These issues of social structure where biology, history and politics intersect, play a particular role in how experiences of depression is conceptualized, practiced, and expressed and therefore can effect how First Nations’ women construct their individual and social identity. Women who reside on reserve land, live, love and experience life within the boundaries of their rural, and First Nations’ identities. This study will challenge the political ideals that have created these social and cultural borderlands and will attempt to offer insights into First Nation’s women’s two-world and multifaceted construction of self by exploring the First Nation’s women’s stories of wellness and depression, and how these experiences affect their understanding and construction of identity when living within the context of rurality. Narrative Inquiry will be used to portray the experiences of 5 women over a ten-month period through individual interviews and focus groups called peace gathering. This process is a suitable and meaningful method that utilizes traditional possibilities that are common and familiar to First Nation’s people. Contact: Brenda Green ([email protected])

EFFECTS OF CLIENT AND THERAPIST ETHNICITY AND ETHNIC MATCHING

S. Møllersen

The Sámi National Centre for Mental Health (SANKS), Norway

We explored the effects of ethnicity on mental health treatment in the population of North Norway that largely consists of indigenous Sámi and non-Sámi Norwegians. As the two groups are comparable in their socioeconomics, ethnic effects can be separated from their most common confounders. The effect of client and therapist ethnicity and client-therapist ethnic match on treatment was examined among psychiatric outpatients in this setting.

Methods: Client (n = 335) and therapist (n = 33) demographics and ethnicity were recorded prior to intake. Self-reported psychosocial distress was recorded at intake, termination and 20-month follow-up. Therapists reported their clinical assessment, treatment delivery at intake and discharge. The association between the ethnic variables and treatment delivery, clinical status and improvement were examined with regression analyses and analyses of variance. We used linear growth curves to explore ethnic variation in change in psychosocial functioning over time.

Results: The results indicated that therapist ethnicity was associated with the amount and type of service provided, but improvement was not. Both the delivery of treatment and improvement did not differ significantly by client ethnicity. Ethnic matching was associated with greater symptomatic improvement in treatments of moderate duration.

Limitations: This study was conducted in the small multiethnic communities in Northern Norway. The sample size was moderate and the measures used to describe clinical status were global. The use of a categorical ethnic classification and globally categorization of the types of interventions may have served to veil the complexity of the interaction between ethnicity and treatment

Challenge: Little is known about how therapist ethnicity shapes treatment, something that warrants further investigation. Contact: Snefrid Møllersen ([email protected])

AWARENESS OF THEIR HEALTH & HEALTH ATTITUDES IN MALES AND FEMALES AGED 25-64 YEARS DURING SOCIAL AND ECONOMIC CRISIS IN RUSSIA (MONICA-PSYCHOSOCIAL PROGRAM)

V. Gafarov, I. Gromova, A. Gafarova, D. Santrapinsky, Y. Kabanov

Collaborative laboratory of Epidemiology Cardiovascular Diseases SB RAMS


Aim: To assess the attitude of the population in Russia towards its health, its readiness to participate in preventive measures and to implement guidelines for changing lifestyle.

Methods: A random representative sample of males and females (2400) aged 24 to 64 years from 2 districts city Novosibirsk was examined within the framework two screening “MONICA-psychosocial” program. We used questionnaire “Awareness and Attitude towards Health”

Results: More than 60% of the males (p<0,0001) and 85% of the females (p<0,0001) reported that they were not quite healthy or ill, only 7% of the individuals had their health examined, although almost 100% noted that they were most likely to fall ill with a serious disease within 5-10 years. The males were more optimistic in their assessments than were the females. With age, the frequency of assessments, such as “not quite healthy” and “ill” (p<0,05), concern about their health, and participation in prophylactic examinations increased. 45% of the respondents reported about the high level of stress in their working place. The opportunity of the examinees to have a rest at home was extremely little. Family stress was significant for both sexes. The females showed a more negative attitude towards smoking than did the males The males more frequently considered that they did not need to alter dietary habits and to do exercises than did the females. A total of 2.4% of the males and 2.5% of the females changed their dietary habits for their health. Only 50% of the males and 31% of the females slept well or very well, this parameter decreased with age.

Conclusion: Despite a positive motivation in the context of prophylaxis, there are negative trends in both social and behavioral characteristics of the population. Contact: Valery Gafarov ([email protected])

RESILIENCY AND INHALANT ABUSE TREATMENT

D. Dell

National Coordinator, YSAC

In Canada, a major and innovative national response to inhalant abuse among First Nations youth has been the establishment of residential treatment centres through the federally funded National Native Youth Solvent Addiction program (NNYSA). This paper focuses on the role of a holistic conception of resiliency in inhalant abuse treatment in the NNYSA program. A blending of policy and practice issues and their contribution to the health status of First Nations youth inhalant abusers guide the paper’s discussion of resiliency and its fundamental role in NNYSA’s traditional Native teachings program. A holistic conception of resiliency is viewed as a key contributor to the program’s achievements to date. The focus on resiliency has been identified in assisting youth in uncovering their inner spirit and strengthening their spirit by drawing on available community resources. Data and case illustrations from two NNYSA treatment centres–White Buffalo Youth Inhalant Treatment Centre (Prince Albert, Sask.) and Nimkee NupiGawagan Healing Centre (Muncey, Ont.)–are presented. The paper also offers NNYSA policy solutions that have been guided by a holistic concept of resiliency and account for the intersecting roles of culture, spirituality, and community in creating and maintaining the health of First Nations youth solvent abusers. The paper concludes with suggestions for future research. Contact: Debra Dell ([email protected])

MAKING THE PATH BY WALKING IT: A COMPREHENSIVE EVALUATION OF THE WOMEN AND CHILDREN’S HEALING AND RECOVERY PROGRAM

A. Hache


Making the Path by Walking It: A Comprehensive Evaluation of the Women and Children’s Healing and Recovery Program (WCHRP) Pilot. A review prepared by the Four Worlds Centre for Development Learning examines the outcomes of a 3-year pilot project focused on addressing the therapeutic needs of Northern women. Specifically, the

evaluation looked at whether or not the Program met the needs of the women they intended to serve, whether the models and strategies used by the program were aligned with best practice, and whether or not the partnership and management structures were effective and appropriate.

The WCHRP was created to assist women who have suffered the impact of trauma as a result of colonization and ongoing violence with their journey to greater wellness. The vision which shaped this initiative called for a program which would be especially for women, would work on the underlying trauma which perpetuates self-destructive behaviours such as addictions, would offer longer-term options than the traditional twenty-eight day treatment cycle, would have strong roots in the communities it serves, and would be sensitive to the cultural values, worldviews and experiences of the Aboriginal peoples of the North. The implementation of this vision brought together two agencies with a long history of working for the well-being of women and their families—the Yellowknife Women’s Centre and the YWCA of Yellowknife. This dynamic partnership was designed to maximize impact through building on existing institutional strengths.

The primary findings revolved around 10 thematic headings: 1) The Quality and Integrity of Services, 2) Assessing Participant Outcomes, 3) Cultural Sensitivity, 4) A Holistic Approach, 5) Using an Empowerment Model, 6) Services for Children, 7) Community Ownership and Involvement, 8) Partnership Approach, 9) Territorial or Yellowknife-only Service Base, 10) Strengthening Program Management and Operations. Contact: Arlene Hache ([email protected])

VENUE 2 Sexual Health #2

EVIDENCE-BASED STRATEGIES FOR SEXUAL HEALTH EDUCATION: ARE THEY CULTURALLY SAFE FOR ABORIGINAL COMMUNITIES?

A. Reeves


This presentation uses a northern First Nation as a case study for examining the cultural appropriateness of evidence-based sexual health education curriculum in on-reserve schools. This First Nation community, highly affected by such colonial forces as the Hudson Bay and North West companies, the Anglican Church, Residential Schooling, and more recently, major hydroelectric developments, has seen change resulting in a generation of youth facing multiple sexual health issues. Recent influxes of hydro workers have brought with them money and alcohol, resulting in relationships with local community members, as well as negative health outcomes related to violence and sexual assault. Because of religious undertones and other factors, healthy sexuality has been absent in this environment for several generations and local schools lack appropriate health programmes to address these concerns. Recent research on evidence-based sexual health education strategies reveals several directions for curriculum improvement: teacher training for skills development with a sexual health expert, and comprehensive content on reproduction as well as social factors through a health promotion lens, among others. However, curriculum content based on research from Western test groups will be unsuccessful in addressing community concerns if it is incongruent with community social values and beliefs. This may be of concern to Aboriginal communities, as Western sexuality models differ significantly from Indigenous teachings around sexuality. This presentation reviews the literature on evidence-based practice and examines both where it might be applicable to Aboriginal communities, as well as where it should be applied with caution. Finally, suggestions for culturally safe curriculum, including instruction from Elders, sharing circles and Coming of Age Ceremonies, will be discussed as tools for restoring traditional ways. This information is


relevant and timely for all northern or rural communities who are challenged by issues related to sexual health and cultural continuity in their communities. Contact: Allison Reeves ([email protected])

PARTNERSHIP AND PROCESS IN COMMUNITY-BASED RESEARCH IN THE NORTH

A. Daniels, R. Drybones, L. Lafferty, T. Moore, J. Naedzo


The Tlicho Community Services Agency’s (TCSA) Healing Wind Strategy identifies a number of activities and interventions to address the prevention of STI/HIV/AIDS in the Tlicho region of the Northwest Territories. As a part of this strategy, the TCSA and CIET facilitated research to develop a foundation for interventions targeting sexually transmitted infections. The project recruited and trained 16 community-based researchers to understand the objectives of the survey, the instruments for data collection, facilitation and interview techniques, the importance of consent and confidentiality; research methodology and how to translate it in practice. The team of CBRs conducted a research survey on sexual health attitudes and behaviours in the four Tlicho communities, covering 65% of the population above 9 years of age. CBRs also received hands on training in data entry, and analysis as they began to make sense of their findings. The research process, outcomes, and the strategic plan that arose from the research findings produced a clear framework for interventions that are grounded in the community, but could also influence national and territorial policy. The approach may be relevant in other settings. Contact: Nancy Gibson ([email protected])

CONNECTING THE DOTS: SOCIAL DISPARITIES AMONG PEOPLE LIVING WITH HIV ON HAART

E.K. Brandson1, K.A. Fernandes1, S. Coulter4, A. Thio4, F. Sussman4, C. Laviolette4, M. Tyndall1,3, V.D. Lima1, J.S.G. Montaner1,3, R.S. Hogg1,2 1British Columbia Centre for Excellence in HIV/AIDS, 2Faculty of Health Sciences, Simon Fraser University, 3Faculty of Medicine, University of British Columbia, 4Downtown Community Health Centre, Vancouver, BC, Canada

Background: High rates of adherence are fundamental to the success of HIV therapy. Social disparities, such as unstable housing, drug dependence, and poor mental health, create barriers to adherence. Directly Observed Therapy (DOT) is used to optimize adherence among vulnerable groups. Our objective is to evaluate the social disparities and clinical outcomes among persons enrolled in a DOT program.

Methods: The Longitudinal Investigations into Supportive and Ancillary health services (LISA) cohort is a prospective study of HIV+ persons on highly active antiretroviral therapy. Participants are ~18 years of age and recruited from the Drug Treatment Program (DTP) at the BC Centre for Excellence in HIV/AIDS. Explanatory variables are collected through a comprehensive interviewer-administered interview. Clinical variables are obtained through linkages with the DTP. Bivariable analyses used Fisher’s Exact Test for categorical variables and Wilcoxon Rank Sum Test for continuous explanatory variables. A multivariable confounder model was used to investigate the association between viral load suppression and being in the DOT program.

Results: There were 481 LISA participants, of whom 64 were enrolled in a DOT program as of 07/08. In spite of social disadvantages, no major differences were found on clinical variables. DOT participants were more likely than others to have unstable housing (<0.001), be food insecure (0.030), receive provincial income assistance (<0.001), and be unemployed (<0.010). They were also more likely to be current illicit drug users ((p<0.001), to have been recently (past 6 months) incarcerated (p<0.001) and co-infected with HCV (p<0.001). Clinical variables were similar including the rate of viral suppression (68% vs.

61%), CD4 > 200 (87% vs. 78%), and >95% adherence (61% vs. 61%) between DOT participants and others.

Conclusion: Preliminary findings demonstrate the success of this program, as DOT participants showed similar clinical outcomes when compared to their peers in the cohort. However, the self-adherent patient will only exist when the social inequalities and other “root” causes are addressed. Contact: Eirikka Brandson ([email protected])

YOU’RE BREAKING MY HAART: HIV AND VIOLENCE AMONG A COHORT OF WOMEN ON TREATMENT IN BRITISH COLUMBIA, CANADA

E.K. Brandson1, A.K. Palmer1, C. Miller2, E. Ding2, K.A. Fernandes2, J.S.G. Montaner1,3, R.S. Hogg1,2 1British Columbia Centre for Excellence in HIV/AIDS, 2Faculty of Health Sciences, Simon Fraser University, 3Faculty of Medicine, University of British Columbia

Background: HIV infection in Canada is most prevalent among marginalized groups and the past decade has shown women are increasingly making up higher rates of infections. While associations between HIV and violence are well documented, the impact of current violence on treatment outcomes is not well understood. Our objective is to examine the rates and predictors of violence among women on highly active antiretroviral therapy (HAART).

Methods: The Longitudinal Investigations into Supportive and Ancillary health services (LISA) cohort is a prospective study of HIV+ persons on HAART. Participants are ~18 years of age and recruited from the Drug Treatment Program (DTP) at the BC Centre for Excellence in HIV/AIDS. Explanatory variables are collected through a comprehensive interviewer-administered interview. Clinical variables are obtained through linkages with the DTP. Two bivariate analyses compared differences between women who ever experienced violence and those who have not, in addition to recent violence (<6 months) with ever violence. A multivariable logistic regression model was used to examine predictors of experiencing recent violence.

Results: Of 573 LISA participants, 151 (26%) are women with 125 (83%) reporting ever having experienced violence. Recent violence (<6 months) was reported by 31 (25%) women and 76 (61%) reported violence before the age of 16. Half of the women who have experienced violence reported more than 5 violent episodes. Mental illnesses (p=0.007) and perceived stigma (p=0.001) are more common in women who have ever experienced violence. Women with recent violence (<6 months) were more likely to be current illicit drug users (p=0.004) than those with ever violence. The multivariable model showed stable housing to be protective of recent violence (AOR 0.22, (0.08-0.59) (p=0.003).

Conclusion: The women in this cohort are experiencing unprecedented levels of violence. Stable housing could make a critical difference in a woman’s ability to escape violence, remain safe, and improve treatment outcomes. Contact: Eirikka Brandson ([email protected])

REPORTING FROM GROUND ZERO: A SURVEY OF NUNAVUT HEALTH CARE PROFESSIONALS’ PERCEPTIONS ON SEXUALLY TRANSMITTED INFECTIONS

A. Kumar

Circumpolar health providers face many challenges. The high incidence and prevalence rates of Sexually Transmitted Infections (STIs) in Nunavut Territory are well documented. This is the first study to document health providers’ perceptions of Inuit health status in relation to STIs in Nunavut Territory.

Research ethical approval was provided by means of UK ethics committee & Nunavut Research Licence. A detailed 12 page questionnaire with 109 questions was distributed to each health centre


in the Baffin (Qikiqtani) Region, Nunavut. Anonymous responses from 8 of 11 health centres were received.

All respondents reported concern regarding the continuing high rates of STIs, occasional cases of Hepatitis C and community risk to HIV infection. It is also reported that while many community members hold fears and misconceptions about STIs, there is good uptake in STI testing. However, poor uptake of HIV testing is reported with explanations including fear of stigma and discrimination with documented leaks in confidentiality.

The average age of Inuit treated for STIs is a concerns shared by all respondents. Respondents identified 12-25 year olds as a target audience for prevention efforts, with the need to start sexual education in schools before Grade 7. Respondents also agreed that there is an obvious knowledge deficit within this group. Well known potentially serious complications due to STIs, including pelvic inflammatory disease, were a cause for further concern.

Factors reported as perpetuating local STI incidence rates included unprotected intercourse with multiple partners and sexual abuse. This situation is reportedly exacerbated by the effects of the poor local social determinants of health including high rates of unemployment and housing shortages.

Condoms are widely available for free at health centres and also for purchase at local stores. Respondents reported condom use as an important but underutilised device in prevention.

Respondents reported that sexual education initiatives from groups such as Pauktuutit Inuit Women’s Association are useful but infrequent, without full coverage. Community Health Representatives reportedly remain underutilised. Respondents acknowledge there is a lack of published epidemiological data on STI rates in Nunavut.

In summary, respondents believe the development a community led commitment towards prevention efforts by encouraging respect and self-esteem and tackling local stigma remains crucial to achieving a reduction in the burden of infections and improving Inuit health status. Education remains key to prevention. Contact: Alexander Kumar ([email protected])

VENUE 3 Human Biology #2

IMMUNE HOMEOSTASIS IN CHILDREN OF THE FAR NORTH AT DIFFERENT VARIANTS OF VEGETATIVE MAINTENANCE OF ACTIVITY

N.S. Polovodova, T. Malzeva


The main function of vegetative nervous system in homeostasis sustention is known to be vegetative maintenance of activity (VMA). But nowadays, data provided by surveys of immune homeostasis on the background of immune dysfunctions in children are highly debatable. Thus, aim of our research was to study the characteristics of immune homeostasis at different variants of VMA in children, residing in the Far North. 133 practically healthy schoolchildren (mean age 13,7±0,19 years), living in the Far North (Yamalo-Nenets Autonomous Okrug, Russia) since their birth took part in the survey. By the results of orthostatic probe we distinguished seven variants of VMA. Normal reaction to orthostatic probe was stated only in 16,0% of examined schoolchildren – no complaints, heart rate increase by 20-40% from a baseline. Contact: Nataly Polovodova ([email protected])

THE BLOOD LYMPHOCYTES METABOLISM IN STRANGE POPULATION OF EVENKIAY, HEALTHY, AND WITH IMMUNE REACTIVITY DISTURBANCES

V.T. Manchuk, S.V. Smirnova, A.A. Savchenko, A.G. Borisov, S. Valeriy

State Scientific Research Institute of Medical Problems of the North, Siberian Division of RAMS, Krasnoyarsk, Russia

The optimal realization of immune response to great extent depends from functional activity of lymphocytes, which determined their metabolic state. Especially oxidation-reduction enzymes possess of the high information for investigation of metabolic processes in cells. These enzymes carry out the key reactions of cellular metabolism and coordinate different metabolic routs. The aim of our investigation was the study of NAD(P)-depended dehydrogenases activity in blood lymphocytes in strange population of Evenkiay, healthy and with immune reactivity disturbances.

We examined 108 strange population of Evenkiay in age 22-45 years. Among them there were healthy, with secondary immune deficient state and with allergic diseases patients. The determination of NAD(P)-depended dehydrogenases activity in blood lymphocytes was made by bioluminescent method.

The disturbance of adaptive process to new climate geographical conditions in strange population was displayed in development of secondary immune deficient state and accompanied with decrease of mitochondrial metabolic processes in blood lymphocytes. The developing compensated activation of anaerobe reactions in cells of immune system in patients of this group support the intracellular ATP concentration on level of healthy people. The same time, in strange population with allergic diseases on the contrary we revealed the activation of mitochondrial metabolic processes. The stimulation of energetic reactions in lymphocytes was realized because of substrate output from the intermediate routes for synthesis processes. Contact: V.T. Manchuk ([email protected])

THE DISTURBANCE OF IMMUNE SYSTEM FUNCTION IN PATIENTS WITH ACUTE LEUKEMIA IN SIBERIA

V.T. Manchuk, O.V. Smirnova

State Scientific Research Institute of Medical Problems of the North, Siberian Di-vision of RAMS, Krasnoyarsk, Russia

The aim was to study the peculiarities of cellular and humoral compartments of immunity in patients with acute no lymphoblast (ANLL) and acute lymphoblast (ALL) leukemia in Siberia.

We examined 100 patients with ANLL and 73 patients with ALL. Popula-tion and subpopulation contents of blood lymphocytes were estimated with the help of method of indirect immune fluorescence. Immunoglobulin concentrations were calculated by immune enzyme method.

The state of cellular immunity in patients with ANLL in attack was charac-terized by decrease of T- and CD4+- cells, in remission by decrease lymphocytes, T-, CD4+-, cytotoxic lymphocytes, NK-cells, B- and HLA-DR+-lymphocytes con-tent. In recurrence we observed the leukocytes, lymphocytes T-, CD4+-, cytotoxic lymphocytes, NK-cells, HLA-DR+-lymphocytes decrease. We revealed in attack no changes in humoral immune compartment, in remission the IgG concentration was decreased, in recurrence the IgA, IgM, IgG concentrations were lowering.

The state of cellular immunity in patients with ALL in attack was character-ized by increase of lymphocytes content and decrease of T-cells; in remission we revealed the blood lymphocytes, T-, NK-, B- and HLA-DR+-lymphocytes content decrease. In recurrence only there was the T-lymphocytes content reducing. In at-tack we observed no changes in humoral immune compartment, in remission there was the decrease of IgA, IgG concentrations, in recurrence there was the decrease of IgA, IgM concentrations.

In Siberia the patients with ANLL in attack and remission had T-cellular immune deficiency, in recurrence the combined immune deficiency


with defeat of T- and B- immune compartments. The peculiarity of ANLL was the lowering NK-cells content; probably it was responsible for recurrence development. In all stages of ALL there was T-cellular immune deficiency. The decrease of T-lymphocytes content and the reducing of immune regular index value influenced on ALL attack appearance. The peculiarity of ALL recurrence was the increase of NK-cells content. Contact: V.T. Manchuk ([email protected])

IMMUNE STATE CHARACTERISTICS IN NATIVE (SCANTY) POPULATION OF THE RUSSIAN FAR NORTH (YAMALO-NENETS AUTONOMOUS OKRUG)

N.A. Pashina, N.S. Polovodova, A.A. Buganov


Adaptation of a man’s organism and immune system, in particular, to extreme conditions of the Far North is influenced by worsening of ecologic situation. Nowadays ecology of circumpolar regions is under the great stress of anthropogenous factors, those lead, at the end, to dysadaptive changes even in native (aboriginal) population. Aim of our survey was to study immune state characteristics of native (scanty) population in the Russia Far North. 447 persons of employable age took part in the survey (297 natives and 150 non-natives). A number of standard laboratory unified tests was used for immunologic examination. It was stated that in native residents of circumpolar region absolute number of lymphocytes is higher by 37,0% (p<0,05), monocytes by 27,3% (p<0,05), absolute and relative eosinophil number by 35,0% (p<0,05) and 17,7% (p<0,05) respectively when compared to those of non-natives. Relative number of segmented neutrophils was found to be lower by 6,7% (p<0,001) when compared to that of non-natives. Analysis of lymphocyte-cellular part of immunity showed that in natives absolute number of lymphocytes with immunophenotype CD3+ in 2,08 times (p<0,05), CD4+ in 1,70 times (p<0,05) and CD8+ in 1,73 times (p<0,05) lower when compared to those of non-native residents. Analysis of humoral part of immunity showed that in aboriginal population relative number of lymphocytes with immunophenotype CD20+ is higher by 15,9% (p<0,05) and serum IgM by 56,3% (p<0,001) than in non-natives. The examination of system of nonspecific resistance showed that index of phagocyte neutrophil activity in natives is lower by 12,5% (p<0,05) when compared to that of non-natives. The results obtained demonstrate that immune state of native inhabitants is characterized by imbalance of peripheral blood cell content, lower values of main lymphocyte subpopulations and indices of system of nonspecific resistance. At the same time content of CD20+ -cells and IgM is increased. Contact: N.A. Pashina ([email protected])

MICRO ELEMENTAL STATUS AND STRUCTURE OF SICKNESS RATE

G. Mironova


The health of the population is determined by a number of ecological determinants in addition to medical care. The purpose of study is determination of the microelemental status and structure of sickness rate among the adult population of Sakha republic living in the region of mining pollution (Udachny) with its well-developed diamond extraction industry in comparison with rural habitants living in the region without mining pollution (Tit-Ary).

In order to reveal the structure of the sickness rate we carried out thorough biomedical exams of 497 miners in Udachny and 297 rural habitants in Tit-Ary. State of health was determined by means of functional, X-ray, hematological, biochemical and cytological methods. As an indicator of unfavorable ecological factors influence the levels of 15 chemical elements were determined in hair by means of

atomic emission spectrometer “Optima-3100RL” of the “Perkin-Elmer” firm.

We established the increasing Cr, Sb, Ba levels among 100%, Sr among 54%, Mg among 60%, Al and Ni among 64% miners which we were examined. It caused by diamond extraction industry pollution. The excess of Ba level among 82%, Sb 69%, Sr 50%, Cr 49%, Al 48% and Ag 24% among rural habitant’s hair was revealed. The comparative analysis showed that level of Cr in miners hair was 16 times higher, Al twice higher, Sb 4,6 higher than in rural habitant’s hair. The level of Ca in rural habitant’s hair was 2.6 times higher than in miner’s hair. The accumulation of chemical elements in hair depends on environmental factors. The Northern nature can’t process pollution itself by natural way. In Permafrost conditions purification mechanism is retarded and don’t work efficiently.

Our data demonstrate that different microelemental status causes different structure of sickness rate. For example, the miners suffer of the pathology of nerve system more often than rural habitants. In structure of miners’ sickness rate the pathology of nerve system is in 3 position, meanwhile the same of the rural habitants is in 8 position. Despite equal frequency of gastric diseases both of miners and rural habitants, but rural habitants suffer of cholelithiasis 10 times often than miners, because they drink Lena river water with high level Ca.

Thus ecological factors together with other factors influence on microelemental status of population that consequently influences on structure of the sickness rate. Contact: Galina Mironova ([email protected])

POPULATION AND SUB-POPULATION CONTENT OF BLOOD LYMPHOCYTE AND CYTOKIN PROPHILE UNDER DIFFERENT CLINICAL PATHOGENIC FORMS OF ALLERY RHINOSINUSOPATHY

I.A. Ignatova, S.V. Smirnova, V.T. Manchuk

State Medical Research Institute for Northern Problems of Siberian Division of Russia Academy of Medical Sciences, Krasnoyarsk

The actuality of nose allergy is remarkably high. This fact is explained by prompt growth of prevalence and modification of allergy rhinosinusopathy (AR) course. Differential diagnosis of AR various forms is impeded by complicated variability of terms and also by the absence of unified, pathogenically reasonable and clinically useful classification. Taking into account the main pathogenic mechanism, AR forms are divided into 2 groups: true AR and pseudo AR.

Aim: To study IL-2, IL-4, IL-6 and IFN-α concentration in blood serum and nasal wash-out. To study population and sub population content of blood lymphocytes according to AR clinical pathogenic form.

Materials and Methods: We examined AR patients (n=305) in ages 17 to 60 years. We marked IL-2, IL-4, IL-6 and IFN-α (μg/ml) concentration in blood serum and nasal wash-out by IEA method; investigated population and sub population content of lymphocytes by immune fluorescent method with mono cloned antibodies.

Results: We marked the predominance of cytokines, produced mainly by T-helpers of the 2nd type: IL-4 (blood serum 70.9 and nasal wash-out 213.2, as well as IL-6: (correspondingly 21.8 and 58.4 in true AR. In pseudo AR we marked higher concentration of cytokines, produced by T-helpers of the 1st type IL-2 (blood serum 36.8; nasal wash-out 19.1, as well as IFN-α correspondingly 354.3.

The study for population and sub population blood lymphocyte content in accordance with AR pathogenic form showed established increase of CD4+-cells 41.8 and -CD72+-cells 19.3, the lowering of CD8+-lymphocytes 23.3 and CD16+-cells 13.2 in true AR. In pseudo AR we marked the lowering of CD4+-lymphocytes, the increase of CD8+, CD16+-CD72+-cells. Contact: Irina Ignatova ([email protected])


THE BIOACTIVITY OF COMPLEX POP MIXTURES IN HUMAN SERUM AND THE POTENTIAL RELATION TO HEALTH EFFECTS

E.C. Bonefeld-Jørgensen, T. Krüger, M. Long, P. Hjelmborg, M. Ghisari

Centre of Arctic Environmental Medicine, Cellular and Molecular Toxicology, School of Public Health, University of Aarhus, Denmark

Background: Persistent organic pollutants (POPs) including PCBs, pesticides and dioxins can interfere with endogenous hormone functions and are suspected to have the potential to introduce developmental and reproductive disorders. The toxicological assessment of the POPs is complicated since individuals are exposed to a complex mixture of contaminants.

Aim: To compare the integrated xenobiotic activities of the actual serum POP mixture on the function of sex hormone receptors and the Aryl hydrocarbon receptor (AhR) among study groups from different districts in Greenland and European study groups (males from Sweden, Poland and Ukraine). To evaluate associations of xenobiotic POP bioactivities to chemical determined serum POP proxy markers and to sperm DNA damage as a health biomarker.

Methods: Serum samples were extracted to obtain the serum POP fraction being free of endogenous hormones for the xenohormone activity analyses. The effects of serum POPs on the estrogen receptor (ER), the androgen receptor (AR) and the AhR function and the AhR-TCDD equivalent (AhR-TEQ) were determined using chemical activated luciferase gene expression (CALUX) assays applying the MVLN, CHO-K1 and Hepa1.12cR cell lines, respectively. Human sperm DNA damage was assessed by TUNEL assay.

Results: In overall, the effect of the actual serum POP mixtures on hormone receptors (ER, AR) and AhR transactivity differed among Inuit from different Greenlandic districts, and data of Inuit and Europeans differed significantly. Compared to Europeans Inuit had significantly higher level of sum POPs, lower level of ER transactivity, AhR-TEQ, and sperm DNA damage but a higher AR transactivity. The actual serum POP mixture of Inuit elicited antiestrogenicity, whereas estrogenecity was observed for some samples from Europe. No consistent association between the xenobiotic POP bioactivities and the level of chemically determined POP proxy markers was observed across the study groups suggesting that the selected POP proxy markers alone cannot predict integrated xenobiotic POP serum activities.

Conclusions: The actual serum POP mixtures elicited hormone disruption. The variances of serum xenobiotic activities reflects differences in the actual serum POP mixture profile and can contribute to the assessment of POP exposures and related health risks. Single chemical POP proxy markers alone cannot predict the integrated serum xenobiotic activity and may not reflect the risk of health outcome. Diet / nutrient factors, life style and genetically factors should be considered as determinants for the sensitivity to POPs and sperm DNA damage. Contact: Eva Cecilie Bonefeld-Jørgensen ([email protected])

VENUE 4 Database & Surveillance #2

IPY HEALTH SURVEY DATABASE MANAGEMENT SYSTEM AND META DATA 2007-2008

N. Sheikh1, D.M. Sparks2, G.M. Egeland1 1Centre for Indigenous Peoples’ Nutrition and Environment (CINE), McGill University, 2DJH Training Solutions

The Inuit Health Survey Database is designed to capture baseline data generated in the comprehensive survey carried out in 36 Arctic communities in 2007 and 2008. The most crucial steps in the development of the database were addressing issues related to the

security and sustainability of the database, and maintaining the confidentiality of sensitive information.

The database was structured in view of three main Objectives: (1) Build in-house data bank to maintain the data in a supervised and secure place. (2) Document complete questionnaire contents, maintains and tracks comprehensive information of respondents. Retain information on regions, sub-regions and communities participating in the study. (3) Provide simple and powerful interface to promptly disseminate data for analyses. The database is developed in Microsoft Access platform interfaced with Microsoft Excel and STATA (statistical analysis software). It has 16 relational datasets which are programmed to retain thousands of data points generated from the study.

Keeping in view the magnitude of the data and the issues of security and confidentiality, the 2007 and 2008 data are stored without identifiers. Only sub-sets of data for analyses are available for researchers and no community is identified in the data used for analyses for added assurance of anonymity. Further, the database is only accessible to the administrator of the database and data entry staff using two tier security levels. The database is compacted and repaired fortnightly and backed up twice every day to guard against data loss. META data reporting requirements of Canadian Federal Program for IPY includes a description of the various types of information collected during the health survey. Contact: Nelofar Sheikh ([email protected])

HEALTH SURVEILLANCE FOR FIRST NATIONS: DATA SOURCES AND LIMITATIONS

L. Clearsky, T. White, L. Svenson, S. Samanani

First Nations EpiCentre of Alberta

Background: One of the major limitations in reporting health statistics for First Nations communities is determining place of residence. Accurate reporting of community level data is further complicated by the lack of ability to identify client residence in sources of numerator data, such as health care utilization, vital statistics and Non-Insured Health Benefits.

Methods: Data sources used for health statistics for Alberta First Nations communities from Indian and Northern Affairs Canada (INAC), Alberta Health and Wellness (AHW), Statistics Canada and Community Planning Management System (CPMS) were reviewed. Definitions and limitations of the various data sources are summarized. Data from Non-Insured Health Benefits were provided from one community to demonstrate the limitations of reporting.

Results: In Alberta, the available annual sources of population data for calculating health surveillance measures (e.g. prevalence, mortality rates) for First Nations are INAC or AHW. Provincial level reports using INAC data are expected to underestimate prevalence, as total band registrants is not limited to Alberta residents. Community level reporting using INAC data for persons living on their own reserves is also likely to be inaccurate, as the residence information is only recorded at life events. AHW data likely provides a reasonable estimate of total First Nations persons living in Alberta, but also has limitations for reporting health status at the community level. However, this data may no longer be available since provincial health care premiums in Alberta have been discontinued. Other potential sources of population data for First Nations communities include Statistics Canada census data and the CPMS, which provides data on the number of persons who present at local community health centres. Depending on the data source and definition used to define community members, diabetes medication use for the example ranged from 5.4% to 9.5%.

Conclusion: The example of diabetes medication use using these various data sources demonstrates the challenges in providing meaningful data to First Nations and highlights the need for more accurate enumeration in this population. Any reports on First Nations health statistics using the currently available data sources should include several caveats related to the limitations of these data sources, particularly for reporting at the community level.


Contact: Salim Samanani ([email protected])

LINKING THE CANADIAN INDIAN REGISTRY SYSTEM TO THE MANITOBA PROVINCIAL HEALTH REGISTRY: LESSONS LEARNED

B. Elias, M. Hall, C. Kasper, A. Doraty, C. Burchill, P.J. Martens, E. Kliewer, A. Demers, D. Turner


Introduction: There is no comprehensive Canadian health information system generally, or for Indigenous peoples specifically. As a consequence, comparable and relevant information on the health of the indigenous population is lacking. In the province of Manitoba, First Nations (FN) have been operating with a health information deficit. Until only very recently, the Manitoba Health Registry (MHR) undercounted FN individuals by about 35%. This paper describes a new research initiative to link federal and provincial health information systems to improve identification for the purpose of informing health policies, such as health system integration.

Methods: A request was made to Indian and Northern Affairs Canada for access to information from the federal Indian Registry System (IRS) to identify Registered FN individuals residing in Manitoba (approximately 143,000). Historically, membership lists were established to track indigenous people who received treaty payments. The IRS database was a by-product of that history and is now a means to track membership of people as defined in the Indian Act and Bill C-31. The resulting file, which is a living file, was linked with the MHR through a rigorous process of deterministic and probabilistic linkage based on name, gender, birthdate and geographic indicators.

Results/Conclusion: Linkage of the IRS data with the MHR has resulted in identification of approximately 95% of records, reducing the undercount of Registered Manitoba FN individuals from 35% to 5%. The project resulted in a much greater ability to identify Registered FNs in the Manitoba health administrative databases and will provide accurate information about FN health service utilization and health status, such as chronic and infectious conditions (e.g., diabetes, sexually-transmitted diseases) and mental health (e.g., depression, suicidality). This research initiative has paved the way in Manitoba for accurate and timely information for FN communities to inform health integration and other policies. Contact: Brenda Elias ([email protected])

MORTALITY OF MÉTIS CANADIAN AND REGISTERED INDIAN ADULTS: AN 11 YEAR FOLLOW-UP STUDY

M. Tjepkema, R. Wilkins, S. Senécal, E. Guimond

Statistics Canada

Objectives: To date there has been little information on the mortality of the Métis people of Canada. The objective of this study was to describe and contrast mortality patterns for Métis and Registered Indian adults to those of the population of Canada as a whole, for both all-cause and cause-specific mortality.

Methods: The 1991-2001 Canadian census mortality follow-up study tracked mortality over more than a decade among a 15% sample of adult (aged 25 and older) residents of Canada, including 11,800 Métis, 56,700 Registered Indians and 2,666,700 others, all of whom completed the 1991 census long-form questionnaire Age-specific and age-standardized mortality rates were calculated, as were period life tables. Métis were defined by ethnic origin (ancestry), since questions on Aboriginal identity were not part of the 1991 census. Registered Indians were identified by a direct question concerning status under the Indian Act of Canada.

Results: Métis and Registered Indians had higher mortality rates and lower life expectancy compared to the entire cohort: remaining life expectancy at age 25 was 3.1 and 5.3 years shorter for Métis men and women, respectively, and 4.2 and 7.1 years shorter for Registered Indian men and women, respectively. For both groups, age-

standardized mortality rate ratios were highest in the younger age groups and diminished with advancing age. Rate differences for Métis men were particularly elevated for external causes, circulatory, respiratory and digestive system diseases, while for Métis women, they were particularly elevated for circulatory system diseases, cancers, digestive and respiratory system diseases. Rate differences for Registered Indian men and women were generally even further elevated for most of the same causes.

Conclusions: For most causes of death, Métis adults had higher mortality rates compared to other residents of Canada. However, their rates were not as high as those for Registered Indians. Contact: Michael Tjepkema ([email protected])

DOCUMENTATION CENTRE ON CHILDREN AND YOUTH IN GREENLAND

L. Lynge

MIPI - Documentation Centre on Children and Youth

MIPI - Documentation Centre on Children and Youth in Greenland collects and systematizes existing knowledge. MIPI also creates and conveys knowledge on children and youth. The Documentation Centre was officially established in 2004, and has two academic employees. MIPI publishes statistics concerning Children and Youth in Greenland every second year. The purpose of Statistik om B¯rn og Unge i Gr¯nland (Statistics concerning Children and Youth in Greenland) is to create an overview of the conditions under which children and Youth live in Greenland, and thereby improve the basis for debate. Statistics concerning other indigenous children and youth is sparse, and MIPI is therefore distinctive because it concerns only with knowledge about children and youth in Greenland where only 10% is non-inuit - divided by place of birth.

MIPI creates new knowledge and information that is needed and evident in preparation for policies concerning children and youth in Greenland. From 2003 to 2008, MIPI has published 10 titles. Almost every publication has created a massive debate on living condition among children and youth. The publications contribute to the political debate. The documented knowledge on children and youth not only creates debates among the politicians, but citizens are also active debaters. One of the reasons is that MIPI seems to bring up important subjects in Greenland by publishing documented knowledge concerning children and youth. MIPI finds it important to maintain focus on the child and youth-perspective, because children and youth cannot speak for themselves.

Currently MIPI has 5 on-going projects about different areas of living conditions of children and youth in Greenland. Among them is a project that deals with how to convey and convert research-based knowledge concerning children and youth into action in order to strengthen the national effort to improve the life for children and youth. Contact: Lona Lynge ([email protected])

VENUE 5 Newborn & Child Health #3 – Child Health Determinants

MORTALITY AFTER ADMISSION IN THE PEDIATRIC EMERGENCY DEPARTMENT OF REPUBLIC SAKHA (YAKUTIA)

D. Chichakhov

Design: Prospective, longitudinal study, conducted in 1998-2007.

Setting: Pediatric Emergency Department at the Pediatric Center in National Center Medicine of Yakutia and Child Hospital Infection Diseases in Yakutsk City, Republic Sakha (Yakutia), Circumpolar Region Russia.


Patients: The children of 1 month to 14 years of age who required acute care in the Pediatric Emergency Department (PICU).

Results: Data included demographic variables, clinical profile, diagnoses, therapy, and in-hospital mortality after admission (outcome). In a cohort of 12 707 children, there were 206 deaths (1.6%). Mortality was highest in the postneonates group (24.4%), which accounted for 74% of all deaths. Among the postneonates, breathlessness, fever and fits ranked were the common presenting problems. Multivariate analyses to determinate risk factors were done separately for postneonates, and those aged 1-3, 3-14 yrs. Among the postneonatal group, respiratory failure requiring ventilation and hemodynamic failure were significant risk factors for mortality. In those aged <1 yr, respiratory failure and polyorgane dysfunction were major risk factors.

Conclusions: The incidence of mortality is high in ours settings and further research is needed to identify causes of preventable deaths. Children presenting with signs of hypoperfusion and respiratory failure had poor outcomes. This raises the concern that children may be presenting late, with advanced, severe illness to our Pediatrics Emergency Departments. Contact: Dulustan Chichakhov ([email protected])

EARLY CHILD DEVELOPMENT AS A DETERMINANT OF HEALTH: EXPLORING THE CONTRIBUTION OF HOME VISITING

C. Betker, M. Greenwood, H. Beanlands, A. MacLeod

National Collaborating Centre for Determinants of Health

Early child home visiting is a public health strategy that is widely used around the world. Here in Canada, home visiting is practiced, in varying forms, in every province and territory. Yet, there is a well-recognized shortage of communication and collaboration between and among those involved in the practice of home-visiting, in various capacities, across Canada. There is also considerable debate about essential components of an early child home visiting program, human resources. community supports needed and evaluation methods required. Based on that recognition, the National Collaborating Centre for Determinants of Health, in partnership with the National Collaborating Centre for Aboriginal Health, hosted a pan-Canadian forum in October 2008, “Early Child Development Forum: Exploring the Contribution of Public Health Home Visiting.” The purpose of the forum was to facilitate knowledge synthesis, translation and exchange around effective strategies for home visiting and the contribution to early child development as a determinant of health.

The forum brought together more than 120 participants from every Canadian province and territory. It profiled selected Early Child Home Visiting Programs and explored the relationship between home visiting and health equity; provided an opportunity to identify and prioritize policy and practice issues; and, explored the utility of stories as a tool for knowledge synthesis, translation and exchange. The forum, which included presentations from practitioners working in northern communities, was formally evaluated and was found to be a tremendous success, and a well valued exercise.

The objectives of this presentation are to:

- describe the Early Child Development home visiting forum - share lessons learned and next steps - discuss the strengths and complexities of early child home

visiting as a public health strategy Contact: Claire Betker ([email protected])

THE MAIN PROBLEMS OF CHILDREN’S HEALTH IN THE RUSSIAN FAR NORTH

S.A. Tokarev, A.A. Buganov


Complex economic situation in Russia, extreme astroheliophysical conditions, intensive industrial exploration in circumpolar regions combine into specific complex of factors, which influence adversely upon children’s health. The results of our continuous survey in Yamal region (Russia) confirm this statement. The most serious risk factors revealed in children, are high prevalence of iodine deficiency, alcohol intake and low physical activity. The last one was found in every third child at the age of 11-12 years. More than 70% of schoolchildren at the age of 13-14 years suffer hypodynamia. In the 5-6th forms 8,3% of schoolchildren smoke, their number dramatically increases to the 9th form (smoking was stated for nearly 50%). Serious concern is risen by girls’ smoking and alcohol addiction, as they become mothers in the future. More than 60% of adolescents undergo passive smoking. Every fourth child in Yamal region is characterized by dyslipidemia – the main predictor of atherosclerosis. Every fifth teenager suffers low blood magnesium level, the factor preceding cardiometaboloc deviations. According to our data nearly fifth part of children lives in maternal families. 57,5% of fathers and 22,7% of mothers are employed in a shift labour, this factor leads to deficiency of parental care. The most part of children, residing in circumpolar region is characterized by psychic and emotional tension. The increased levels of aggression (65,8%), hostility (73,7%) and anxiety (48,3%) are stated in population. The prevalence of the foregoing factors increases with every passing year. Taking into account the present situation, in order to reduce the prevalence of risk-factors in children, population approach should be elaborated. It should be based on cooperation of children, parents and teachers/tutors. To our opinion, Regional Centre on Children Health should be organized on the basis of State Scientific Research Institute on Medical Problems of the Far North (Nadym city, Russia). Contact: S.A. Tokarev ([email protected])

PROPOSING INDICATORS REGARDING CHILD HEALTH ON THE FOCUS AREAS IN THE GREENLANDIC PUBLIC HEALTH PROGRAM

B. Niclasen

Aim: To propose indicators on the focus areas in the present Greenlandic public health programme regarding child health and health determinants

Background: In spite of the high political priority given to children’s and youth issues, no one has yet proposed a coherent strategy on the improvement, protection, and monitoring of children’s health and well-being in Greenland. Proposing indicators for children’s health and well-being based on the focus areas in the Greenlandic public health programme, Inuuneritta, on the structural level with the highest responsibility for impact on the single child is an important supplement to the monitoring of children’s health at the national level. Inuuneritta focuses on health promotion and prevention, especially regarding alcohol use, violence and abuse, diet, physical activity, smoking, and sexual health. It also includes programs on suicide prevention, early interventions to secure health and development, and dental health. To secure a context also indicators on demographic and social factors as well as resources were proposed.

Methods: Criteria for selecting the indicators were set up. Indicators were searched and included in 4 domains (demographic and socio-economic conditions; health status and well-being; determinants of health, risk, and protective factors; and health systems and health policy) together with available data sources. In total 24 indicators on Inuneritta’s focus areas, 6 on socio-demographic conditions, and 9 on resources proposed. Data on the indicators on capital, municipalities with a larger town, a smaller town, and remote municipalities were compared as well as data on the capital city, cities, and villages.

Results: Data revealed large differences between municipality types and between the capital city, cities, and villages between many of the selected indicators. In general, children in remote communities and in settlements had the most unfavourable socio-demographic and health conditions. At the same time, larger communities’ access to health care services is more favourable.


Contact: Birgit Niclasen ([email protected])

UNDERSTANDING OF ABORIGINAL CHILDREN IN ALBERTA - AN ANALYSIS OF CANADIAN ABORIGINAL CHILDREN’S SURVEY

X. Cui, J. Lamba, C. Werk, K. Schreiner, S. Tough, N. Reynolds

Child and Youth Data Lab, Alberta Center of Child, Family and Community Research

More and more Aboriginal families are leaving reserves and living in cities which leads to changing conditions and challenges. There is a lack of understanding of the situation of Aboriginal children especially younger children (0 to 5 years) who are living in such a changing environment. Given that early childhood is a critical time period for brain development, understanding the early years is particularly important for policy development. Programs and services designed to improve children’s environments have a potential to impact the intellectual, emotional, and social development of these children later in life. Policy makers and service providers are in great need of current and pertinent information to enhance the quality and relevancy of these services for Aboriginal children living off reserves.

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 a picture of the early development of Aboriginal children and the social and living environment in which they are learning and growing. For the current study, data collected on Aboriginal children in Alberta and their parents were analyzed to generate a detailed descriptive profile of this population. Key characteristics including health status, developmental milestones, mental health, childcare situations, living arrangements, social support networks, housing and other social economic circumstances were described and contrasted by geographic locations such as urban and rural areas, different Children and Family Service regions in Alberta, and by Aboriginal self-identification (First Nations and Métis children).

Policy makers from the provincial ministries, local Children and Family Service Authorities, and representatives from Aboriginal communities were involved in defining research questions that related specifically to provincial policy priorities. An iterative process involving these partners at different stages of the research and dissemination processes is also discussed. Contact: Xinjie Cui ([email protected])

CORRELATES OF EMERGING OBESITY AMONG PRESCHOOL AGED CHILDREN: NUNAVUT CHILD INUIT HEALTH SURVEY

T. Galloway, A. Pacey, L. Johnson-Down, T.K. Young, G.M. Egeland, Qanuippitali Steering Committee (Nunavut)2

Dalla Lana School of Public Health, University of Toronto, 2L. Gunn, Nunavut Association of Municipalities; L. Williamson, Nunavut Tunngavik Incorporated; I. Sobol and G. Osborne, Government of Nunavut Department of Health and Social Services; K. Young, University of Toronto

Among North American Aboriginal populations, obesity and metabolic disease pose significant risk to health and well-being. Little anthropometric data exists, however, especially for preschool aged children in the Arctic. Identification of risk factors for obesity early in life can help identify the need and means for preventing obesity in adulthood and the many obesity related chronic diseases that are now emerging in the Circumpolar North. The collection of uniform statistics in the Arctic is costly and logistically problematic. Through the International Polar Year Inuit Health Survey, accurate and timely data on the health of Inuit Canadians has been collected. The field activities of 2007 and 2008 included a child nutritional health survey of 3-5 year olds residing in 16 Nunavut communities. Data were collected by a team that included a nurse, bilingual interviewers, study coordinator and lab technician/graduate student. The prevalence of preschool children with an at risk body mass index (BMI kg/m2) > 95%ile by age

and gender was evaluated. Socioeconomic and dietary factors associated with an at-risk BMI %ile in preschoolers was evaluated including traditional food use, sweetened beverage consumption, and other indicators of unhealthy and healthy dietary habits. Results are embargoed pending disclosure of findings to

participating communities scheduled for completion in the May of 2009. Full details of findings will be presented at the Congress. Contact: Tracey Galloway ([email protected])

PROGRESS TOWARDS OPTIMAL PEDIATRIC DRUG THERAPY: A NORTHERN CHILD/YOUTH HEALTH IMPERATIVE

S. MacLeod, N. McCullough, R. Peterson

Child & Family Research Institute, University of British Columbia

The millennium development goals set a standard to reduce child mortality by 2/3 before 2015. Drug manufacturers, regulators, pediatricians, pharmacologists, and pharmacists have, until recently, failed to meet the need for properly validated therapies available in formulations suitable from infancy to adolescence. Nowhere is the lack of evidence to inform optimal therapy more evident than in remote communities where, in many cases, the majority of the population is aged 18 years or less. There are, worldwide, an estimated 5 million deaths annually among children 5 years or younger that could be prevented by effective, affordable, accessible drug therapy.

In 2007 steps were taken to rectify this situation following passage of resolution 60.20 “Better medicines for children” by the World Health Assembly. The WHO subsequently published an essential medicines list for children with considerable input by experts from circumpolar countries.

Importantly, a group of pharmacologists, pharmacists and pediatricians have created the International Alliance for Better Medicines for Children. The Alliance comprises scientific and clinical organizations, regional leadership groups, and national societies as well as individuals committed to research and knowledge transfer relevant to pediatric therapeutic advances.

Priority Alliance objectives 2009-2010 are to:

- pursue international regulatory harmonization - identify knowledge gaps and support WHO listing of essential

medicines for children - clarify regional needs through formal needs assessments - improve understanding of drug toxicity - develop and test appropriate pediatric formulations - catalyze improved access to effective pediatric therapies in

vulnerable populations - develop guidelines for optimal and safe use of medications for

children and youth

While much work to date has focused on tropical disease and developing countries the initiative is equally relevant to the needs of northern children and youth. Contact: Stuart MacLeod ([email protected])

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POSTER SESSIONS Tuesday & Wednesday, July 14-15, 12:15-3:30 PM

A B C

DEVELOPMENT AND IMPLEMENTATION OF AN ABORIGINAL FRAMEWORK AND MEASURES OF COMMUNITY HEALTH IN NORTHERN SASKATCHEWAN, CANADA

S. Abonyi1, B. Jeffery2, C. Hamilton3, T. Lidguerre4, E. Throassie5, F. Michayluk6, V. Robillard6 1University of Saskatchewan, 2University of Regina, 3SPHERU, 4Fond Du Lac Denesuline First Nation, 5Black Lake Denesuline First Nation, 6Athabasca Health Authority

There is a growing interest in developing relevant community level health indicators for the purpose of measuring health status and evaluating progress in reducing health disparities in Aboriginal communities in Canada. This interest is reflected from the national level in recent publications commissioned by the Canadian Institutes for Health Information (CIHI) and in statements made by the National Aboriginal Health Organization, and from the local level in work being carried out in individual Aboriginal communities. This presentation will report on an ongoing program of community-based and participatory research on the development of a community health framework and indicators in northern Saskatchewan. Throughout, northern Saskatchewan Aboriginal health organizations and communities have been active participants and leaders in setting the research agenda, conducting the research, and interpreting and implementing the results. This research contributes to their goal of locating control over the definition and tracking of changes in community health in Aboriginal health organizations and communities; recognizing that ownership of health information is a component of self-government. Following one CIHI author’s reflections on the process of developing a health community index for Aboriginal communities, the first phase of research in northern Saskatchewan has considered two of his four questions, “what is a healthy community?”, and “how would we measure that?”. Our presentation will highlight process, activities, and outcomes of the first phase of research that produced a conceptual framework that reflects northern Saskatchewan views of healthy community and includes approximately 165 potential indicators appropriate to the framework. The two remaining questions, “how healthy is our community”, and “why would we measure that” are being considered in the second phase of research. We will highlight our progress in the first year of considering these questions, and outline our planned activities and outcomes. Contact: Sylvia Abonyi ([email protected])

CULTURAL SAFETY AND KNOWLEDGE SHARING: WORK ON MENTAL WELLNESS AT THE INUIT TUTTARVINGAT OF NAHO

L. Amagoalik


This poster presentation explains important concepts and techniques used in the centre’s work on mental wellness. The poster summarizes concepts of cultural safety and knowledge translation and explains how the Inuit Tuttarvingat of the National Aboriginal Health Organization (NAHO) applies these concepts in the materials it produces for Inuit on the topics of mental illness, suicide prevention and resilience.

In the effort to pass on knowledge about coping strategies, our centre published several booklets, a poster and factsheet. There were particular challenges in preparing these products. Namely, the underlying research addressed Inuit traditional practices, yet the

publications were required to find a way to communicate the traditional knowledge as well as research results and coping strategies coming from Western counselling models. This presentation illustrates that in order to be effective, the knowledge transfer strategy used needs to ensure a sense of cultural safety. The poster explains that presenting original wording and statements from Inuit who are traditional knowledge holders in the text can provide this sense of cultural safety and encourage learning.

Considering the intrinsic relationship that exists between coping and knowledge, the mental wellness materials are based on the understanding that learning is a key process in developing coping strategies. As learners need to understand why something is useful or necessary to learn, it is equally important that the individual learner recognizes how her/his life experiences and prior learning successfully contribute to new learning and the building of new knowledge. Contact: Lily Amagoalik ([email protected])

BEHIND THE SCENES: MANAGEMENT OF LARGE EXTENDED FAMILY TREES FOR GENETIC ANALYSIS

F. Balbi, R. Plaetke

Center for Alaska Native Health Research, University of Alaska Fairbanks

Background: At the Center for Alaska Native Health Research (CANHR), investigators collect information about extended family trees (pedigrees) for a genetic study of obesity and diabetes. Whenever they come back from the field, they need to update the pedigree information and perform merges of new and old pedigrees. So far, the pedigree merge procedures have been performed “by hand” using a pedigree drawing program. But this approach can be tedious and error prone.

Purpose: To help investigators with this type of problem we developed the program PedMerge.

Methods: PedMerge natively runs on Windows and has a user friendly interface. The program merges smaller pedigrees into larger ones. Several error checks are performed to ensure a correct output. The merge is based on “key persons”, i.e., individuals that occur in more than one pedigree. For example, one woman can be in one pedigree as a daughter, while in another pedigree as a mother having multiple children and a husband.

Results: By using PedMerge a routine update of the pedigree structure can easily be performed after collecting information about newly recruited family members in the field. The merging algorithm is fast. It takes a fraction of a second to merge large numbers of pedigrees to a single pedigree consisting of over 1000 individuals. The user can decide the produced output format: A standard format for several genetic analyses or a master file for the genetic database Pedsys. In addition Pedmerge generates a log file to help the user track the merging process. Contact: Federico Balbi ([email protected])

ARCTIC HEALTH WEB SITE: AN INFORMATION PORTAL TO ISSUES AFFECTING THE HEALTH AND WELL-BEING OF OUR PLANET’S NORTHERN-MOST INHABITANTS

L. Bartlett, P. Maez, K. Murray

National Institutes of Health, National Library of Medicine

The Arctic Health Web site (www.arctichealth.org) is a collaborative effort between the University of Alaska, Anchorage (UAA), Health Sciences Information Services (HSIS), at the Consortium Library and the National Institutes of Health, National Library of Medicine, Outreach and Special Populations Branch. The goal of the Web site is to bring together, in one location, information on diverse aspects of the arctic environment and the health of northern peoples. It gives access to evaluated health information from hundreds of local, state, national, and international agencies, as well as from professional societies, universities and Native Alaskan and indigenous communities. The portal contains several resources for both researchers and


consumers. The topic areas covered are: publications and research, environmental health, telehealth and telemedicine, traditional healing, health topics and links to government organizations and programs. A climate change and circumpolar health section is being developed and seeks to provide access to unique and special collections not currently available on the Internet.

Arctic Health has made several unique and special collections available on the Internet. The traditional healing page offers interviews and video panel discussions about traditional healing and practices in the Native Alaskan community. These provide a great resource for understanding the practices and utilize the storytelling tradition to pass on stories and understandings from generations of Native Alaskans. Arctic Health has created robust databases containing bibliographic information, research projects and grey literature. The Frostbite collection is a series of photographs and notes from the leading frost bite expert Dr. William J Mills, Jr. The collection illustrates the danger of frost bite, treatments, and progression of the injury. Arctic Health also hosts several educational cancer videos for consumers created by the Alaska Native Tribal Health Consortium. Arctic Health strives to locate, preserve and provide access to special collections for future generations. Contact: Laura Bartlett ([email protected])

FRUIT AND VEGETABLE CONSUMPTION AMONG INUVIALUIT OF THE NORTHWEST TERRITORIES: RESULTS FROM HEALTHY FOODS NORTH

L. Beck, E. De Roose, S. Biggs, S. Reaburn, E. Erber, J. Gittelsohn, S. Sharma

The Canadian Public Health Association, Inuvik, NT

Objective: To determine mean daily intake frequencies of fruits and vegetables among Inuvialuit by age, sex and community.

Setting: Three Inuvialuit communities in the Northwest Territories, Canada, which vary in terms of size and isolation.

Methods: Cross-sectional random household Quantitative Food Frequency Questionnaires (QFFQs) were conducted with Inuvialuit adults. Thirteen fruit items and 16 vegetable items were selected for analysis from the QFFQ and ranged from fresh, canned and frozen varieties.

Results: A total of 233 Inuvialuit adults (183 women and 50 men) aged 19-88 years participated with a mean age of 43 years. The response rate was approximately 70-90%. The overall mean frequency of daily fruit and vegetable consumption was approximately 3 times a day: fruit 1.3 times a day and vegetables 1.8 times a day. The three communities differed significantly in mean frequency of daily consumption of fruit, ranging from 0.9 to 1.5 times per day. Frequency of daily vegetable consumption, ranging from 1.5 to 2.1 times per day, were not significantly different by community.

Conclusions: Low mean frequency of daily consumption of fruits and vegetables among the Inuvialuit highlights the need for a nutritional intervention program, such as Healthy Foods North, to promote fruit and vegetable intakes to reduce risk of chronic disease. The community-based Healthy Foods North program will include components to address the unique issues/challenges to fruit and vegetable consumption in isolated northern communities.

Acknowledgements: We thank Andrew Applejohn for his amazing guidance and support of the program, as well as the participating communities. We also thank the Aurora Research Institute for their incredible assistance. The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57. Contact: Lindsay Beck ([email protected])

CHALLENGES TO TUBERCULIN SCREENING AND FOLLOW-UP IN AN URBAN ABORIGINAL SAMPLE IN MONTREAL, CANADA

P. Brassard, K.K. Anderson, K. Schwartzman, M.E. Macdonald, D. Menzies

McGill University

Background: Tuberculosis (TB) incidence rates in Canadian Aboriginal peoples are substantially higher than the general population. Health problems faced by Aboriginal people are compounded when migrating to urban areas.

Objective: We sought to describe the prevalence and predictors of tuberculin skin test (TST) reactors in a high-risk sample of urban Aboriginal people, and to evaluate adherence to medical evaluation and latent tuberculosis infection (LTBI) treatment among those with TST reactivity.

Design: We obtained a convenience sample of high-risk Aboriginal peoples in Montreal and administered a one-stage TST. Financial compensation ($10 CAD) was provided for participation in the TST screening and an interview, and again for returning for TST reading within 48 to 72 hours.

Results: Of the 164 participants tested, 86% returned for TST reading. Positive TST reactions (~10mm) were observed in 17.7% (25/141, 95%CI 11.4-24.0) of participants, and were associated with older age (OR per 10 year increase 1.8, 95%CI 1.2-2.7) and Inuit Aboriginal group (OR 2.8, 95%CI 1.1-7.3). We attempted to refer all individuals with TST reactivity for medical evaluation, a step for which participants were not compensated. Only four participants presented for evaluation, of whom one initiated and none completed LTBI treatment.

Conclusion: Tuberculin screening in this population can be an effective strategy for identifying TST reactive individuals; however, screening efforts will have minimal impact without additional efforts in this high-risk group. A costing exercise indicates that the provision of financial compensation for medical evaluation and treatment may be one cost-effective strategy for improving adherence and subsequently preventing cases of active TB in addition to addressing other barriers to health care faced by urban Aboriginal people. Contact: Paul Brassard ([email protected])

KNOWLEDGE AND PERCEPTIONS OF TUBERCULOSIS AMONG A SAMPLE OF URBAN ABORIGINAL PEOPLE

P. Brassard, K.K. Anderson, D. Menzies, K. Schwartzman, M.E. Macdonald

McGill University

Achieving a high level of tuberculosis (TB) awareness is crucial for the success of prevention and treatment efforts in high-risk groups, and thus represents a key challenge for public health initiatives. Research exploring knowledge and perceptions of TB in Aboriginal populations has been lacking to date. We sought to explore the knowledge and perception of TB in a sample of high-risk Aboriginal peoples in Montreal who were undergoing a tuberculin skin test (TST) as part of a larger study. We conducted standardized, face-to-face interviews using a structured interview guide. The interview explored participants’ knowledge and perception of TB using a combination of both structured and open-ended questions. We also asked a series of open-ended questions that probed for participants’ experiences with urban health services, whether TB is discussed in Aboriginal communities and participants’ intentions should their TST result be positive. A total of 164 eligible Aboriginal persons volunteered to participate in our study. Close to one-third (54/164) reported knowing little about TB, and participant responses indicated that there were many prevalent misconceptions about the symptoms, transmission, cause and risk factors for the disease. The majority of respondents felt that TB was not openly discussed in their homes and communities, and approximately half (90/164) of respondents reported that they were not concerned about contracting TB. We conclude that there is a lack


of knowledge and several misconceptions about TB among our sample of urban Aboriginal peoples. Contact: Paul Brassard ([email protected])

CENTRE FOR SÁMI HEALTH RESEARCH

A.R. Broderstad

Centre for Sámi Health Research

The Centre for Sámi Health Research was established at the University of Tromsø, Karasjok, Norway in 2001, marking the culmination of 50 years of health activism and capacity development among Sámi health care professionals. Since then, the centre has made major strides in surveying and developing culturally appropriate health care services for Sámi people.

ELECTRONIC BULLYING IN TWO PROVINCIAL NORTH ELEMENTARY SCHOOLS

K. Brownlee, E. Rawana, J. Rawana, M. Probizanski, J. Martin, J. Franks, J. Whitley

Lakehead University

With the current increase in use of communication technologies such as cell phones, internet, chat rooms and e-mail concern has arisen about the incidence of electronic bullying. Reports have indicated that in Canada over 90% of youths between 12-18 years old use the internet and nearly half of these youths have their own cell phones and that many of these youths are using these mediums to bully their peers. This type of bullying has received much media attention but the extent of the problem in northern communities is unclear. As part of a wider project on bullying and safety in the schools this study explored the experiences of students with electronic bullying. This study administered a Safe School Survey to 102 school children in grades four to eight who were enrolled in two schools from the public school system in a north western Ontario city. Students were invited to self-report on their participation in electronic bullying. The students were asked about their experiences of being victims of electronic bulling, their participation in electronically bullying others and whether they were aware of others who were being bullied. Analysis of the results included an examination of gender and ethic differences in electronic bullying. The results showed that electronic bulling was present in both schools, although less prevalent than other forms of bullying such as physical, verbal and social bullying. The results indicated that females experienced more electronic bullying than males, that Aboriginal students experienced similar levels of electronic bullying to non-Aboriginal students and that students were more reluctant to admit to perpetrating electronic bullying compared to being victims of electronic bullying. The implications of the results for school programming are discussed. Contact: Keith Brownlee ([email protected])

AURORA COLLEGE’S INTRODUCTION TO ADVANCED PRACTICE PROGRAM: PRODUCING ADVANCED-PRACTICE NURSES WITH NORTHERN-SPECIFIC SKILLS

J.M. Buck

Aurora College, Tlicho Community Health Services

Providing quality health care in northern communities requires overcoming many barriers, one of which is the dearth of qualified human resources. Aurora College, in conjunction with the Government of the Northwest Territories, has addressed this problem by developing a program called the Introduction to Advanced Practice (IAP) that provides registered nurses the skills and knowledge to provide basic primary health care to specifically northern populations. Nurses attend the IAP from across Canada’s north and from many southern provinces, often as a pre-requisite to working in remote locations. This program is delivered in Yellowknife, NWT, and in a short time frame (6 weeks) moves the nurse from hospital-, community-, or public health nursing practice to the (novice) independent primary and

emergent care practice that is required when working in isolated northern regions. Advanced health assessment and primary health care theory (diagnosing and treating common illnesses, suturing, x-ray imaging and interpreting) are learned. Evidence-based education using northern health research, as well as instruction and mentoring by experienced nurse-instructors, is used to introduce the nurse to northern health care. The course is considered a vital part of the GNWT strategy for northern health care provision, and is especially relevant at a time when many provinces are considering formalized certification for nurses providing primary care. This educational model would be of interest to other northern primary health care providers, managers, and administrators. Contact: Jennifer M Buck ([email protected])

FOOD SECURITY IN NUNAVUT: A KNOWLEDGE SHARING TOOL FOR POLICY-MAKERS

M. Bzdell, G.K. Healey

Qaujigiartiit Arctic Health Research Network Nunavut

Background: Food security exists “when all people, at all times, have access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life” (FAO 1999). Food security has been raised as a priority issue to Qaujigiartiit Arctic Health Research Network Nunavut (AHRN) by AHRN board members and by Nunavut community members. Policy-makers are essential to determining focus and effecting change on this important topic.

Purpose: to develop a tool to assist policy-makers to better understand important aspects of Food Security in Nunavut such as current statistics about food security; the nature of the issue; and current perspectives of stakeholders.

Methods: Academic literature was reviewed and a grey literature search was conducted in fields pertaining to food security in Nunavut. Interviews were held with policy-makers who work on the issue of food security in Nunavut. The knowledge sharing tool was developed by AHRN.

Findings: Relevant topics for the policy-makers’ food security tool in Nunavut include the multi-jurisdictional approach needed to examine this topic in the local context; the need for an Inuit-specific definition of food security; relevant socio-economic factors affecting food security in Nunavut; the impact of the high cost of store-bought food; the inclusion of information about successful interventions in the territory; the importance of harvesting country food and its impact on food security; the repercussions of increasing fuel prices on harvesting country food; climate change and its relation to food security; and information about the Food Mail program.

Conclusion: Literature review and interviews with food security policy-makers has led to the identification of relevant topics and statistics about food security in this context. These perspectives were used to develop a knowledge sharing tool to assist policy-makers who work in Food Security in Nunavut. Contact: Mandie Bzdell ([email protected])

A RAPID, HIGHLY DISCRIMINATORY GENOTYPING METHOD FOR MYCOBACTERIUM TUBERCULOSIS ISOLATES IN MANITOBA, CANADA

S. Christianson, J. Wolfe, P. Orr, M.K. Sharma

Public Health Agency of Canada

Objective: In order for any genotyping method to be highly effective in the clinical microbiology laboratory, the method should be technically straightforward, rapid, highly discriminatory, and generate easily interpretable results for inter-laboratory comparisons. Though the IS6110 RFLP typing method (RFLP) has proven to be a highly discriminatory method for typing Mycobacterium tuberculosis complex (MTBC) organisms, it fails to achieve any of the other qualities mentioned above. MIRU-VNTR typing has proven itself on all of the above criterion but lacks the discriminatory power of the IS6110-RFLP

129 POSTER SESSIONS: D E F

typing method. Recent improvements to the MIRU-VNTR method, namely the addition of 12 new MIRU-VNTR loci and spoligotyping, increased the discriminatory power of MIRU to more closely resemble that of the RFLP method. Our aim was to determine if typing the additional 12 loci, with the addition of spoligotyping would provide further discrimination within the Manitoba MTBC genotyping database.

Methods: A total of 315 MTBC isolates that were previously typed using the 12 locus method were further tested using the additional 12 loci. A selection of these samples was also genotyped using RFLP and/or spoligotyping. The methodologies were then compared based upon discriminatory power and clustering rate.

Results: Cluster analysis using MIRU-VNTR data shows that by adding the additional 12 loci to the traditional method, clustering rate is decreased from 76% to 62%. With the addition of spoligotyping to the 24 locus MIRU-VNTR, the Hunter Gaston discriminatory index (HGDI) is equal to that of RFLP, 0.8628. That said, the clustering patterns generated by the two techniques are not identical.

Conclusions: The addition of 12 new MIRU-VNTR loci to the traditional MIRU-VNTR typing scheme vastly improves the discriminatory power. The addition of spoligotyping to the 24 locus method increases the discriminatory power to equal that of RFLP. Using 24 locus MIRU-VNTR combined with spoligotyping will allow for rapid, highly discriminatory typing of Manitoba isolates. Contact: Joyce Wolfe ([email protected])

PAN-TERRITORIAL PARTNERSHIP: SOCIAL MARKETING TOOLS IN SEXUAL HEALTH PROMOTION

K. Colbourne, L. Gushue

Public Health Agency of Canada, Government of the Northwest Territories

Background: Sexually transmitted infections (STIs) are a growing health concern — globally, nationally, & especially within the Northwest Territories. The most commonly reported STIs in Canada are Chlamydia, Gonorrhea, and infectious Syphilis (Canadian Guidelines on Sexually Transmitted Infections, 2006). STIs can cause serious life-long problems such as infertility, tubal pregnancies, premature births, damage to unborn children, and possibly death. STIs spread quickly and can create hardships for individuals, families, and communities. Importantly, social factors such as violence, substance abuse, and coercion contribute greatly to the issue of STIs.

The incidence of STIs in the Northwest Territories is up to 12 times higher than the national average and the NWT has the highest rate of Gonorrhea in the country and the second highest rate of Chlamydia. Rates of these infections have escalated exponentially in some regions. Youth aged 15 to 24 years are disproportionately affected by STIs compared to other age cohorts. Epidemiological indicators point to the likelihood that HIV could become a significant issue in the North if serious steps are not taken to address this important health issue. Yukon, Nunavut & Northwest Territories share many commonalities, similar demographics & comparable issues with STI rates. Communication & collaboration between Territories is an effective method of pooling resources to achieve positive outcomes including decreased STI rates.

Methods: A partnership was developed between the three territories through Pan Territorial Funding (Territorial Health Access Fund - THAF). Deputy Ministers from each territory supported a Pan Territorial Sexual Health Website portal, linking health information from all three territories. This collaborative project is a broad campaign with common elements. It also includes specific niche marketing and is flexible with room to create different messages for different populations within Northwest Territories, Nunavut & Yukon. The diversity between territories & within territories will be represented through these websites.

Anticipated Results & Goals: Much collaboration between the territories has occurred to date via teleconferences, meetings & idea sharing.

New mass media ideas for Sexual Health promotion are being explored. Examples include: texting, innovative condom distribution, wireless communication, and audio podcasts. Language & literacy is being taken into consideration and strategies to connect with high risk populations & how they receive information are being examined. Website Development has begun in the Northwest Territories with a website launch planned for Spring 2009. Contact: Karen Colbourne ([email protected])

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FOOD SOURCES AND DIETARY INTAKE OF VITAMIN D AND CALCIUM AMONG INUVIALUIT IN THE NWT: RESULTS FROM HEALTHY FOODS NORTH

E. De Roose, X. Cao, A. Donnison, J. Gittelsohn, S. Sharma

Government of the Northwest Territories, Department of Health and Social Services, Yellowknife, NT

Objective: To describe food sources contributing vitamin D and calcium to the diet of the Inuvialuit.

Setting: Two communities in the northern Northwest Territories that vary in degrees of isolation.

Methods: A cross-sectional random household dietary study was conducted with Inuvialuit adults using 24-hour dietary recalls. All reported food items were coded, entered and analyzed using Nutribase Clinical Manager 5.18.

Results: 101 Inuvialuit adults (48 men and 53 women) aged 19-88 years completed the dietary recalls with a response rate of approximately 70-90%. The food sources for calcium in both communities included low fat, chocolate and evaporated milk, as well as oatmeal, white bread, cheese and orange drinks and juices. Food sources that were major contributors to vitamin D in both communities included milk and butter and margarine. Traditional food sources provided minimally to intakes of these nutrients. Dietary intakes of vitamin D and calcium were also found to be low in the population.

Conclusions: These findings indicate the need for increased consumption of foods rich in vitamin D and calcium among the Inuvialuit. Healthy Foods North, a nutritional intervention program in the surveyed communities, will promote a combination of traditional and store-bought foods that are rich in vitamin D and calcium for this population.

Acknowledgements: We give our heartfelt thanks for the incredible support and guidance of Andrew Applejohn and the Aurora Research Institute. We would also like to thank the participating communities. The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57. Contact: Elsie De Roose ([email protected])

RESILIENCY AND INHALANT ABUSE TREATMENT

D. Dell

YSAC

In Canada, a major and innovative national response to inhalant abuse among First Nations youth has been the establishment of residential treatment centres through the federally funded National Native Youth Solvent Addiction program (NNYSA). This paper focuses on the role of a holistic conception of resiliency in inhalant abuse treatment in the NNYSA program. A blending of policy and practice issues and their contribution to the health status of First Nations youth inhalant abusers guide the paper’s discussion of resiliency and its fundamental role in NNYSA’s traditional Native teachings program. A holistic conception of resiliency is viewed as a key contributor to the program’s achievements to date. The focus on resiliency has been identified in assisting youth in uncovering their inner spirit and strengthening their spirit by drawing on available community resources. Data and case


illustrations from two NNYSA treatment centres—White Buffalo Youth Inhalant Treatment Centre (Prince Albert, Sask.) and Nimkee NupiGawagan Healing Centre (Muncey, Ont.)—are presented. The paper also offers NNYSA policy solutions that have been guided by a holistic concept of resiliency and account for the intersecting roles of culture, spirituality, and community in creating and maintaining the health of First Nations youth solvent abusers. The paper concludes with suggestions for future research. Contact: Debra Dell ([email protected])

PLACE OF RESIDENCE AND NEONATAL OUTCOME IN THE NORTHWEST TERRITORIES

B. Denning

Queen’s University; Public Health Agency of Canada

Purpose: To examine the relationship between place of residence and neonatal outcome within the Northwest Territories

Background and Rationale: In the Northwest Territories, available prenatal care and birthing options vary widely by community. Women in Yellowknife, Inuvik and Fort Smith have access to continuity of caregiver, as they can have the same caregiver that provided their prenatal care present at the birth. As well, there are more social programs available throughout their pregnancy, and they are not subject to the psychological, social and financial stressors that are inherent in leaving their families and communities for an extended period of time. This study hypothesizes that living in a community with more prenatal care options, including the option to give birth in their home community, will lead to better neonatal outcomes.

Exposure: Transfer for Childbirth

Women will be evaluated as being in either a “non-transfer” group, consisting of women who have the option to give birth in their own community, or as in a “transfer” group, consisting of women who reside in communities where transfer is mandatory.

Outcome: Composite Neonatal Outcome Variable

A composite neonatal outcome variable will be used to compare the two groups. A negative neonatal outcome will be recorded if the newborn exhibits one or more of the following: a five-minute Apgar score of less than seven; a birth weight of less than 2500 grams; a birth weight of greater than 4500 grams; stillbirth.

Results: Currently pending data collection; results should be available by May 2009.

Relevance: This study is designed to provide a more accurate picture of the effects of choice in care and availability of care on neonatal health outcome indicators. The findings of this study will hopefully provide evidence to inform future decision-making regarding childbirth policies in rural and remote regions. Contact: Bryany Denning ([email protected])

INTEGRATIVE APPROACHES TO INFECTIOUS DISEASE PREVENTION AND CONTROL IN CANADA’S NORTH

E. Du Plessis, S. Shaw, L. Thompson, C. Sevenhuysen, M. Fast

National Collaborating Centre for Infectious Diseases

Introduction: Public health program and policy planning are often very specialized, focusing on one pathogen or population. The conceptual integration of public health services happens naturally, if not by design, in communities or regions with relatively small populations (and a limited number of health service providers) and innovative, integrated approaches may better reduce infectious disease threats. Practitioners in northern and remote communities experience numerous geographic, administrative, and social conditions which influence their response to public health threats. Although some features are unique to specific communities, many are common to several regions due to natural or historical linkages. Sharing program and practice tools among regions and agencies promotes knowledge translation and

exchange which may enhance public health capacity and facilitate strategic resource allocation in these regions.

The role of the National Collaborating Centre for Infectious Diseases (NCCID) is to enhance knowledge exchange to strengthen public health responses to infectious diseases. Consultations with practitioners, decision-makers and researchers working in northern reasons has initiated a dialogue to explore integrated public health programming which is responsive to strengths and vulnerabilities in populations rather than focusing only on individual pathogens or single interventions.

Results: Drawing from NCCID’s consultation in June 2008 and Forum in March 2009, this presentation will describe infectious disease epidemiology and transmission dynamics in northern and remote communities and strategies to enhance and integrate existing public health programs and services.

Steps needed for implementing new prevention and control strategies, focusing more on populations as opposed to individual pathogens will be presented. Avenues to enhance existing strategies through innovation and collaboration will also be discussed.

Conclusion: Efficient and effective use of limited resources in small and geographically-dispersed communities may be facilitated by identifying commonalities in the public health responses to a variety of infectious diseases, and integrating prevention messaging with surveillance tools. Collaboration between regions and with existing networks or organizations may further strengthen public health programming. Contact: Elsabé du Plessis ([email protected])

PROVIDING LIBRARY SERVICES TO CONTRIBUTE TO CAPACITY BUILDING AND KNOWLEDGE TRANSLATION IN THE CANADIAN NORTH

A. Ducas, J. Linton, K. Young, L. Friesen

Neil John Maclean Health Sciences Library, University of Manitoba

Program Objective: Bringing academic health sciences library services to community-based partners in Canada’s northern territories of Nunavut, NWT, and the Yukon.

Setting: The Neil John Maclean Health Sciences Library (NJMHSL), located in Winnipeg, Manitoba, Canada has been building an Aboriginal Health Collection and Information Services component, including outreach services to health care providers in the Kivalliq Region of Nunavut since 1999. This model has been so successful that the NJMHSL was invited to join the Canadian Institutes of Health Research (CIHR) Team in Circumpolar Health by team leader, Kue Young. Several team research projects are being undertaken between 2006 and 2011.

Participants: CIHR Team members and community partners include Canadian academics, international partners, and community-based researchers.

Program: Key elements of the CIHR Teams’ projects rely on developing community partnerships. The NJM Library provides services to enhance the skills of community-based researchers, giving more equitable access to the professional literature similar to that enjoyed by most Canadian academic researchers. Librarians provide consultation, research and information services to enhance knowledge translation, scholarly communication, open access initiatives and evidence-based practice.

Conclusion: The NJM Library provides outreach services to community partners including literature searches, document delivery, and training in using open access databases like PubMed. Providing library services at no-cost to the end user enhances partnership building, creating more equitable relationships between academic researchers and community partners. Partnerships between academics and community-based researchers are found in most Canadian universities. Academic libraries have a role to play in supporting the information needs of all researchers involved in such exciting partnerships.


Contact: Janice Linton ([email protected])

A FOLLOW-UP STUDY OF BLOOD LEVELS OF PERSISTENT TOXIC SUBSTANCES (PTS) AMONG INDIGENOUS PEOPLE OF THE COASTAL CHUKOTKA, RUSSIA, 2001-2007

A. Dudarev1, V. Chupakhin1, J.O. Odland2, L.O. Reiersen2, V. Chashchin1 1Northwest Public Health Research Center, Russian Federation, 2AMAP Secretariate, Norway

Data obtained during the Russian Arctic PTS study in 2001-2002 revealed the highest (for the Russian North) levels of PCBs and some other POPs in the blood of indigenous populations of the coastal Chukotka (AMAP 2004, 2009). It is well known that many POPs and some metals easily cross the placental barrier and are excreted into the breast milk. A follow-up study was undertaken during 2007. The possible influence of breast feeding duration on maternal POPs blood serum levels has been assessed as well as the potential impact of the children`s POPs blood serum levels on the frequency of infectious diseases.

Materials and Methods: Individual data on PTS levels of blood samples from 17 mothers and cord blood from their 17 babies born in two settlements (Lorino and Lavrentiya) of Chukotka coastal area in the period August 2001 - February 2002 were compared with PTS levels in blood sampled from the same women and their 5-year old children in 2007. Chemical analysis of all samples was performed in the “Typhoon” laboratory (Obninsk, Russia), having international accreditation according to standard procedures. Data on maternal and child health were collected from the mother’s medical files, newborn’s delivery records and questionnaires of the mothers.

Results and conclusions: Maternal blood serum levels of POPs have generally decreased significantly in 2007 compared with corresponding levels in 2001-2002. Reduction of total PCBs was 43.8% (average from 3.52 to 1.98 mcg/L serum), of merged PCB congeners 29.8-48.2%, oxychlordane 73.5%, trans-nonachlor 72.3%, mirex 43.1%, total HCH 33.1%, HCB 18.9%, total DDT 72.0%. However, the ratio 44DDE/44DDT did not change, but remained about 12. Maternal blood levels of lead decreased 21% while the average mercury level was the same. Children blood serum levels of POPs generally have increased significantly in 2007 in comparison with corresponding cord blood serum levels in 2001-2002, except oxychlordane and 44DDT which dropped by about 30% each. Increment of total PCBs was 132.1% (average from 1.43 to 3.33 mcg/L serum), of merged PCB congeners 88.2-161.6%, trans-nonachlor 14.3%, mirex 27.8%, total HCH 89.7%, HCB 72.4%, total DDT 13.1%, the ratio 44DDE/44DDT 84% (from 10.6 to 19.5). Children blood levels of lead did not change, remaining 38 mcg/L whole blood, while the average mercury level decreased by 31.4%. During 5 years the levels of POPs in maternal blood serum generally have decreased so that the levels of some organochlorines in 2007 became similar to that observed in cord blood in 2001. Vice versa - the levels of POPs in children blood serum are generally much higher than cord blood serum levels and in 2007 the levels of some organochlorines became similar to the maternal levels of 2001. Of 17 women (Chukchi ethnicity) with average age 30,7 years in 2007 (range 22-39 years) 13 women already had children born before 2001 (7 of them had more than one child). Eight women gave additional births during 2002-2007 (2 of them more than once), all except one breastfed during the 2001-2007 period (average duration 24.4 months, range 1-72 months). All 17 children born in 2001-2002 had infectious diseases (mostly acute respiratory) during 2001-2007, in average 4.8 events per year (range 0.9-9.6 incidents). No associations of breast feeding duration with maternal POPs blood serum levels have been found. No correlation between children’s POPs blood serum levels with infection frequency has been derived. Further amplification of the study cohort will add more statistical power. Contact: Alexey Dudarev ([email protected])

CADTH’S HEALTH TECHNOLOGY INQUIRY SERVICE

L. Dunfield

Canadian Agency for Drugs and Technologies in Health

The Health Technology Inquiry Service (HTIS) was officially launched by the Canadian Agency for Drugs and Technologies in Health (CADTH) in February 2005 to meet the needs of Canadian health care decision makers. While comprehensive HTA reports are used to support many important deliberations, the urgency of some decisions requires a more immediate response. The goal of HTIS is to provide evidence-based information in a quick and efficient manner.

HTIS reports can be completed in 24 hours to 90 days. The types of reports include a list of references (completed in 24 hours to five business days), a summary of abstracts (10 business days), a summary report with critical appraisal (30 business days), and a peer-reviewed systematic review (90 days).

HTIS responds to inquiries about drugs, medical devices, diagnostic tests, and medical and surgical procedures from Canadian health care decision makers in the federal government, provincial health ministries, hospitals, regional health authorities, and Local Health Integration Networks. Each response is tailored to the specific needs of the requestor.

Feedback is gathered from the requestors to determine how reports were used in decision making. Users of the service indicate that HTIS has met their decision making needs when information is required in short timeframes. HTIS reports have been used to make decisions about purchasing medical equipment, to determine coverage of specific pharmaceuticals, and to make policy changes.

Since the service began, HTIS has responded to over 1000 inquiries. The service has grown substantially, and almost 300 of those requests were completed from April 1, 2008 to December 31, 2008. Contact: Lesley Dunfield ([email protected])

EVALUATION OF HELICOBACTER PYLORI INFECTION IN PATIENTS WITH PATHOLOGY OF THE GASTROINTESTINAL TRACT

A.V. Efremova, A.V. Struchkova, A.S. Golderova, G.E. Mironova


According to P.M. Ivanova (2003) in the country every second revealed a tumor in men (45.1%) and third in women (32.4%) is localized in the digestive system, which confirms the high frequency of malignant tumors of Gastroenterology located in the North and Aboriginal patients with non-ethnic long-term stay at high latitudes.

Chronic gastritis in many cases is accompanied by atrophy iron machine, which belongs to the background illness or “precancerous conditions”, prior to the development of stomach cancer. We know that gastric cancer often occurs against a background of atrophic gastritis and the risk of significantly higher in patients with severe atrophy of gastric mucosa than in those with unmodified mucous membranes. The important role given to Helicobacter pylori, chronic gastritis with calling the outcome of atrophic and is a carcinogen 1 st group.

The purpose of the study to identify the degree of Helicobacter pylori infection with various forms of pathology of gastrointestinal tract.

We conducted a study to identify the antibody H. pylori in 70 patients (55 women, 15 men) aged 30-50 years with various forms of pathology of the gastrointestinal tract.

In the study of Non-invasive method used for determining the presence of antibodies to H. pylori in the serum of patients by ELISA. Among the surveyed patients, 50 people found the picture of chronic superficial gastritis, in 15 patients - atroficated form of gastritis, peptic ulcer disease was found in 5 cases. Hp (+) - positive results were observed in all (100%) patients, and in cases of superficial gastritis results were 18% medium and 82% - a high degree of infection. In


atrophic gastritis with 75% of Np (+) the result of a high degree of infection. In patients with peptic ulcer disease in 80% of Np (+) was characterized by a high degree of infection. Thus, gelikobakterial infection among surveyed patients with various forms of pathology of the gastrointestinal tract was high and is a major risk factor for onkopatology that requires a serious approach to the prevention and treatment of these diseases. Contact: Agrafena Efremova ([email protected])

EVALUATING THE TOXIC EFFECTS OF METHYLMERCURY ON NEUROTROPHIN CONFORMATION

J. Eibl

Northern Ontario School of Medicne

Methylmercury is a common industrially-derived environmental neurotoxicant that is detrimental to the development and physiology of the nervous system. One possible mechanism for methylmercury’s toxicity stems from its ability to interfere with the signaling of the neurotrophins nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF). It has been proposed that methylmercury’s effects may be due to either; (1) alterations in neurotrophin levels, or (2) abnormalities in cell signaling due to altered neurotrophin-receptor interactions. It has previously been demonstrated that metal ions such as Zn2+, Cu2+ and Hg2+ directly alter the conformation of NGF and BDNF, decreasing their ability to bind the neurotrophin receptors and potentiate intracellular signals. It has also been demonstrated that metalorganics such as methylmercury inhibit neurtorophin signaling receptor as measured by a decrease in Trk phosphorylation. In this study, we examine the effect of methylmercury to determine if it interferes with neurotrophin signaling in a manner similar to Hg2+, or if it occurs via an alternate mechanism. Our findings indicate that although MeHg inhibits neurotrophin signaling, its toxic effects are not mediated via an induced conformational change, as seen with other metal ions, including Hg2+. Contact: Joseph Eibl ([email protected])

ASSESSMENT OF DIETARY INTAKE IN AN INUVIALUIT POPULATION: RESULTS FROM HEALTHY FOODS NORTH

E. Erber, E. De Roose, S. Reaburn, S. Biggs, L. Beck, J. Gittelsohn, S. Sharma


Objective: To describe current dietary intake of adult Inuvialuit using 24 hour recalls.

Setting: One remote Inuvialuit community in the Northwest Territories, Canada.

Methods: Adult Inuvialuit were enrolled in a cross-sectional, random household dietary study and completed up to three 24h recalls each. Mean daily energy and nutrient intake, most commonly reported foods, and foods contributing to energy and nutrients were analyzed using NutriBase clinical nutrition manager and SAS statistical software.

Results: Fourteen men and 49 women (n=63) aged 19-74 years completed the 24-hour dietary recalls with a response rate of approximately 70-90%. Mean daily intake of energy was higher than recommended in men (2,777 kcal) and women (2,457 kcal). The dietary recommendations were not met for many nutrients for men and women. For example, intake of iron did not meet the recommendation for 69% of women, dietary fibre (92%), vitamin A (91%), vitamin C (66%), vitamin D (80%), vitamin E (98%), folate (84%), and calcium (96%) did not meet the dietary recommendations for both sexes. Although consumption of traditional foods was low, these nutrient-dense foods did contribute significantly to intake of energy, fat, and calcium. Sweetened juices and drinks were the main contributor to total energy, carbohydrates, and sugar.

Conclusions: These data highlight specific nutrients and foods to be targeted by a nutritional intervention program (Healthy Foods North) to reduce risk of chronic disease among the Inuvialuit.

Acknowledgements: The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57. Contact: Eva Erber ([email protected])

CARDIOVASCULAR REACTIONS IN HYPERTENSIVE PERSONS IN THE FAR NORTH

T.K. Erdakova, L.V. Salamatina


Cardiovascular reactions play a great role in development of adaptive mechanisms in hypertensive persons in the Far North. In order to study these reactions, we examined 109 hypertensives (arterial hypertension, stage I-II; mean age – 41,5±8,3 years; duration of arterial hypertension – 7,1±5,2 years; period of residing in the Far North – 23,2±6,2 years). These people were divided into 2 groups – the first group comprised 39 persons who lived in circumpolar region less than 10 years. The second group included 68 persons, who resided in high latitudes more than 10 years. Control group comprised 38 practically healthy persons. All persons underwent exercise test; hemodynamic parameters were assessed by “Vivid-7” (USA). In group of healthy people cardiac index (CI) was 2,5-3,5 l/min/m2; 26,3% of persons had hyperkinetic hemodynamic type, 52,6% – eukinetic type, 21,1% – hypokinetic type. In hypertensives these types were revealed in 48,5%, 29,0% and 22,5% respectively. During exercise test statistically significant increase of CI and decrease of total peripheral vascular resistance (TPVR) were registered. In healthy persons, who had hyper- and eukinetic hemodynamics, CI became 29-35% higher and TPVR – 39% lower when compared to baseline. At hyperkinetic hemodynamic type both indices changed for 35%. In hypertensive patients, independently on their hemodynamic type, TPVR fell insufficiently towards raised CI. This gap reached maximum in the second group of hypertensive patients – we registered 49% CI rise (p<0,05) and 18% TPVR fall (p<0,01) in comparison to the patients of the first group. It is apparent from the present study that along with prolongation of period of a man’s residing in the Far North, discrepancy between CI and TPVR at exercise tests rise. Contact: T.K. Erdakova ([email protected])

ENDOTHELIAL DYSFUNCTION AND MYOCARDIAL REMODELING IN HYPERTENSIVE PATIENTS IN THE FAR NORTH



Assessment of contribution of endothelial dysfunction (ED) to processes of myocardial remodeling is of prime importance, as it enlarges our understanding of pathogenic mechanisms of arterial hypertension development in unfavorable climatic conditions. 113 hypertensive patients (arterial hypertension, stage I-II) were examined. Mean age – 43,0±8,2 years, duration of arterial hypertension – 7,1±5,5 years, period of residing in the Far North – 23,8±9,8 years. The patients were divided into 2 groups in dependence on the results of endothelium-dependent vasodilatation test (Celermajer D.S.). The first group comprised 55 hypertensives with normal endothelial function (NEF), the second one included 58 hypertensive persons who showed ED. All the patients underwent echocardiography (“Vivid-7”, USA). The changes in spherical form of left ventricle in both groups were represented by statistically significant increase in interventricular septum thickness and left ventricular posterior wall thickness (p<0,05). These parameters grew along with prolongation of period of a man’s residing in the Far North. Left ventricular mass index (LVMI) in patients of the second group who lived in high latitudes more than ten years was statistically higher than LVMI in patients of the first group, who


resided in circumpolar region less than ten years. In order to prove the previously described facts we analyzed the frequency of different types of myocardial remodeling in these groups. Left ventricle hypertrophy was revealed in 88,8% of hypertensives with ED, who lived in high latitudes more than ten years, among them 66,6% had concentric type 22,2% - eccentric type of hypertrophy. In hypertensive patients with NEF, who resided in the Far North less than ten years, we registered concentric remodeling in 57,7%, concentric hypertrophy - in 24,0% and eccentric hypertrophy - in 19,2%. The data presented in this study indicate that endothelial dysfunction contributes greatly to processes of myocardial remodeling in hypertensive patients in the Far North. Contact: T.K. Erdakova ([email protected])

INTERCONNECTION OF CARDIAC STRUCTURAL-FUNCTIONAL CHANGES IN HYPERTENSIVE PATIENTS IN THE FAR NORTH



Aim of the research was to study the ways of interconnection of cardiac structural-functional changes in hypertensives residing in the Far North. 113 hypertensive patients (arterial hypertension, stage I-II) were examined. Mean age – 43,0±8,2 years, duration of arterial hypertension – 7,1±5,5 years, period of residing in the Far North – 23,8±9,8 years. All the patients were divided into 2 groups in dependence on their period of living in high latitudes – the 1-st group (n=42) – less than 10 years and the 2-nd group (n=71) – more than 10 years. By ultrasound examination (“Vivid-7”, USA) the following indices were defined: interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT) and diastolic function (duration of isovolumic relaxation phase and structural index of active relaxation, known as a ratio of time of acceleration of early left ventricle filling to period of isovolumic relaxation). It is known, that increased thickness of myocardial walls contributes to prolongation of isovolumic relaxation phase. Thus, in hypertensives referred to the 1-st group, correlation coefficient between duration of isovolumic relaxation phase and IVST at diastole was equal 0,3 (p<0,01), between duration of isovolumic relaxation phase and LVPWT at diastole – 0,28 (p<0,01). In the 2-nd group this dependence appeared to be weak and was revealed only for IVST (r=0,2; p<0,05). A ratio of time of acceleration of early left ventricle filling to period of isovolumic relaxation in both groups changed in stereotype way; the strongest changes were revealed in people, suffering isolated interventricular septum hypertrophy with concentric left ventricular hypertrophy and eccentric hypertrophy with left ventricular dilatation. Weight of relaxation which took part in left ventricle filling at diastole, dropped along with progression of left ventricle hypertrophy, independently on period of living in the Far North. Thus, processes of structural-functional remodeling in hypertensive patients in the Far North are closely interconnected. Contact: T.K. Erdakova ([email protected])

RESILIENCY OF VASCULAR WALL IN HYPERTENSIVE PATIENTS IN THE FAR NORTH



Aim of the research was to study structural-functional changes of vascular wall in hypertensive patients residing in the Far North. 69 hypertensives, referred to main group, were examined (mean age 43,08±8,26 years, duration of arterial hypertension – 8,17±5,54 years, period of residing in the Far North – 21,83±9,88 years.). Control group included 19 practically healthy persons. Parameters of carotid elasticity were defined by O’Rourke’s recommendations during duplex ultrasound scanning (“Vivid-7”, USA). 24-hour profile of blood pressure was registered by “AND” system (Japan). In control group resiliency indices of carotid vascular wall – rigidity coefficient (b), Young’s

module (E) were significantly lower; distensibility coefficient (DC) and cross-sectional compliance (CC) were higher than in the main group. b coefficient increased along with age, thus in persons younger 29 years it was 6,01±3,09, at the age of 30-39 years – 7,29±3,01, 40-49 years – 8,26±4, 50 years and more – 10,19±3,71 (p<0,05). For DC, CC and E statistically significant variations in different age groups were not defined. Resiliency indices of carotid vascular wall were analyzed in dependence on period of a patient’s residing in the Far North. In hypertensives, who lived in high latitudes more than 10 years, significant increase in E and b indices was stated, when compared to those of people, residing in the Far North less than 10 years. (E– 629,61±295,32 and 439,21±238,21 kPa respectively, p<0,05; b – 8,53±3,76 and 6,34±3,23 respectively, p<0,05). DC and CC, on the contrary, decreased in hypertensives, who lived in high latitudes more than 10 years, when compared to the same indices in people, who stayed in the Far North less than 10 years. DC – 21,23±8,02 and 28,18±12,32x10-6Pa-1 respectively, p<0,05. CC – 8,73±3,21 and 12,10±4,91x10-7m2/Pa, respectively, p<0,05. Conclusion: Resiliency indices of vascular wall in hypertensives worsen along with prolongation of period of a man’s residing in unfavorable conditions of the Far North. Contact: T.K. Erdakova ([email protected])

FACTORS THAT INFLUENCE THE BIOCHEMICAL CHARACTERISTICS AND HORMONES OF HYPOPHYSEAL-THYROID-ADRENAL SYSTEM OF MEN

R. Fedina

State Educational Institution of Higher Professional Education, Novosibirsk State Medical University

The purpose of the investigation: to determine the most significant factors that influence the biochemical and hormone characteristics of hypophyseal-thyroid-adrenal system of men (HTAS).

The biochemical and hormone characteristics of HTAS in the population sample from 1058 almost healthy donor men at the age of 18-60 in the Novosibirsk megapolis were studied comprehensively. The hormone status was determined using a radioimmunoassay technique; protein, carbohydrate and lipid metabolisms, by biochemical methods. The parametric Student t-criterion and nonparametric Wilkinson-Mann-Whitney testing were applied. A multifactor variance analysis revealed 15 factors that influence the biochemical characteristics and hormones of HTAS. The comparison of biochemical characteristics (crude protein, common lipids, total cholesterol, triglycerides, glucose, unesterified fatty acid, and lipid peroxidation) and hormones (adrenocorticotropin, somatotrophic hormone, adrenocortical hormone, triiodothyronine, thyroxine, and thyrotropic hormone) makes it possible to find the significant differences among the donors (p > 0.003) who live in “clean” and “dirty” districts. Insufficient stability to the urbanization factors starts to manifest at the age of 18-19.

The social-economic conditions in combination with ecological factors require the extreme tension of adaptive biological and psychoemotional mechanisms. The combination and summation of different stress vectors under present conditions of life activity make regulatory components of men adaptation vulnerable. This leads to the fast waste of reserves and dysaptation, first of all, of functionally deficient components in the organism, as well as the rapid progress of diseases, and the lower lifetime of Russia men. The main factors that influence the biochemical characteristics and hormones of HTAS are as follows: age, ecological conditions, and duration of living under such conditions, year season, tobacco smoking, and alcohol drinking.

Therefore, the obtained data can be used to examine men, to make prognosis as well as to reveal persons with risk factors, as well as a regional norm for men in Novosibirsk. Contact: Roza Fedina ([email protected])

134 POSTER SESSIONS: G H I

G H I

SLEEP DISTURBANCE AND RISK CARDIOVASCULAR DISEASES THE PERIOD OF 10 YEARS IN MEN 25-64 YEARS OF AGE IN RUSSIA

V. Gafarov, E. Gromova, I. Gagulin, A. Gafarova, D. Santrapinsky, Y. Kabanov

Collaborative Laboratory of Epidemiology CVD SB RAMS

Purpose of the study: To study influence of sleep disturbance on risk of occurrence of cardiovascular diseases (CVD) at men of 25-64 years.

Methods: Within the framework of program WHO “ MONICA- psychosocial” was representative sample of men of 25-64 years is surveyed 1994 (657 persons) . Sleep disturbance were measured at baseline with the use of the MONICA - psychosocial Interview Sleep Disturbance scale. The incidence new arterial hypertension (AH), myocardial infarction (MI) and stroke were ascertained under systematic surveillance the 10-year follow-up (1994-2004). Cox - proportional regression model was used for an estimation of relative risk (RR).

Results: Sleep disturbance was in 9,1 % men with new incidence AH, in 18,4 % men with new incidence MI and, 29,4 % men with new incidence stroke. The risk of occurrence CVD in men with sleep disturbance within 5 years was the following: for AH - in 5,4 times more, for MI - in 2,4 times more (p < 0,05) and for stroke - in 3,9 times more (p < 0,01) in comparison with men non sleep disturbance. During 10 years periods the risk of occurrence CVD in men with sleep disturbance has decreased and has made: for AH - in 2,3 times, for MI - in 2,6 time, for stroke - in 2,7 times is higher in comparison with men who marked quality of sleep as satisfactory or good.

Conclusion: The received results testify that sleep disturbance, first of all, the problem social and doing the powerful contribution to risk of occurrence of cardiovascular diseases at men. Contact: Valery Gafarov ([email protected])

ARTERIAL HYPERTENSION AND PSYCHOSOCIAL FACTORS IN MALES AGED 25-64 YEARS IN RUSSIA (WHO MONICA-PSYCHOSOCIAL PROGRAM)

V. Gafarov, E. Gromova, Y. Kabanov, A. Gafarova, D. Panov


Purpose: To study connection of arterial hypertension (AH) with psychosocial factors (PF) at men in the age of 25-64 years in Russia.

Methods: A random representative sample of males (a total of 2149 individuals) aged 25 to 64 years from one districts of the city Novosibirsk was examined within the framework of the screening of the WHO “MONICA-psychosocial” program (“MOPSY”) (1984,1988,1994). The following psychosocial methods were used: the test “MOPSY” (depression (D), a vital exhaustion (VE), hostility (H), sleep disturbance); test Berkman-Syme (social support - index of close contacts (ICC) and index of social connections (SNI)); Spilberger’s test for estimation personal anxiety (PA) For AH accepted the arterial pressure > 140/90 m.Hg.

Results: Determined, that persons with AH have tendencies: 1.in higher parameters of “average”, “bad” sleep, than “very good” and “good” (40,8 %, 8,7 % and 32,4 %, 4,4 %, p<0,001, accordingly) 2.in lower values of indexes of social support - (a low ICC with AH - 65,1 %, without AH - 55,4 %, p<0,01) and SNI (low SNI with AH - 45,1 %, without AH - 39,6 %, p<0,05) 3. in increase of a parameter of PA (with AH - 52,3 %, without AH - 46,2 %, p<0,05). Authentic connection AH is precisely determined with:1. education, achieving a maximum of distinctions at an initial education (initial : with AH - 25,1%, without AH - 15,0%, p<0,05) 2.an professional level (heads with AH - 1,9 %, working trades - 10,7 % p<0,001) 3. with VE (a high level of VE: with AH - 16,6 %, without - 10,3 % p<0,05) 4.with D (with AH - 55,3%, without

AH - 41,2 %, p<0,05) . In too time at hostility of distinctions between groups it is not determined.

Conclusion: Received results testify to interrelation AH in a population with psychosocial factors and once again emphasize importance of their correction Contact: Valery Gafarov ([email protected])

AVERAGE LEVELS OF ARTERIAL PRESSURE AND PSYCHOSOCIAL FACTORS IN MALES AGED 25-64 YEARS IN RUSSIA (WHO MONICA-PSYCHOSOCIAL PROGRAM)

V. Gafarov, E. Gromova, Y. Kabanov, D. Panov, I. Gagulin, A. Gafarova


Purpose: To study connection of average levels of arterial pressure (ALAP) with psychosocial factors at men in the age of 25-64 years in Russia.

Methods: A random representative sample of males (a total of 2149 individuals) aged 25 to 64 years from one districts of the city Novosibirsk was examined within the framework of the screening of the WHO “MONICA-psychosocial program” (“MOPSY”) (1984,1988,1994). The following psychosocial methods were used: the test “MOPSY” (depression (D), a vital exhaustion (VE), hostility (H), sleep disturbance); test Berkman-Syme (social support - index of close contacts (ICC) and index of social connections (SNI)); Spilbergers test for estimation personal anxiety (PA)

Results: ALAP in a man’s population with age grow and achieve a maximum in the most senior age group (25-34 years old; systolic arterial pressure (SAP) - 125 m.Hg; diastolic arterial pressure (DAP) - 82 m.Hg; 55-64 years - the SAP - 149 m.Hg; DAP- 89 m.Hg). The tendency is marked: 1. more high levels the SAP and DAP at sleep disturbance, than at good sleep (138 m.Hg and 86 m.Hg; 131 m.Hg and 84 m.Hg accordingly); 2.in lower levels the SAP and DAP at high values of indexes of social support - an ICC (low ICC - SAP - 134 m.Hg; DAP - 86 m.Hg., high ICC - SAP - 131 m.Hg; DAP - 84 m.Hg) and an SNI (low SNI - SAP - 135 m.Hg; DAP - 86 m.Hg; high SNI - SAP - 132 m.Hg; DAP - 85 m.Hg) . Authentic connection ALAP is precisely defined and: 1. personal anxiety (PA) (high PA - SAP - 134 m.Hg; DAP - 86 m.Hg; lower PA - SAP - 123 m.Hg; DAP - 81 m.Hg); 2. VE (high VE - SAP - 135 m.Hg; DAP - 88 m.Hg; is not present VE - SAP - 128 m.Hg; DAP - 83 m.Hg); 3.D (big D - SAP - 135 m.Hg; DAP - 86 m.Hg; is not present D - the SAP - 132 m.Hg; DAP - 85 m.Hg). In too time at H a little bit other picture - is observed at high levels H the SAP a little bit below, and DAP is higher, than at its absence (high H - SAP - 131 m.Hg; DAP - 86 m.Hg; is not present H - SAP - 132 m.Hg; DAP - 84 m.Hg).

Conclusion: The received results testify to close connection of ALAP pressure in a population with psychosocial factors. In this connection, one of the main ways of correction arterial pressure in a population, is correction of psychosocial factors. Contact: Valery Gafarov ([email protected])

EPIDEMIOLOGY OF INVASIVE BACTERIAL DISEASES IN NORTHERN CANADA, 1999 TO 2007

M. Helferty, S. Desai, M. Garner, T. Leung, Canadian International Circumpolar Surveillance Working Group*

Public Health Agency of Canada

Background: Since 1999, the northern regions of Canada (Northwest Territories, Yukon, Nunavut, Northern Quebec, Northern Labrador) have participated in the International Circumpolar Surveillance (ICS) network, a population-based invasive bacterial surveillance network of circumpolar regions, which includes: USA (Alaska), Denmark (Greenland), Iceland, Finland, Norway and Sweden. The organisms under surveillance are Streptococcus pneumoniae (Sp) Group A Streptococcus (GAS), Group B Streptococcus (GBS), Haemophilus influenzae (Hi), and Neisseria meningitidis (Nm).


Purpose: To describe the epidemiology of diseases reported through ICS from 1999 to 2007.

Methods: Cases are reported to health regions by the laboratory or physician. A communicable disease officer completes a surveillance report form. Isolates are sent to a reference laboratory for serotyping and antimicrobial resistance testing. The completed form, which includes both laboratory and epidemiologic information, is sent to the Public Health Agency of Canada.

Results: A total of 519 cases were reported: 323 cases of Sp, 88 cases of Hi, 77 cases of GAS, 20 cases of GBS and 11 cases of Nm. Over 60% of all cases reported to ICS were Sp. In children < 2 years of age were 56.7% of Sp cases were serotypes included in the pneumococcal conjugate vaccine (PCV-7). The majority (95%) of Hi cases were among Aboriginal people. Fifty percent of Hi cases were type a; 68.2% of Hi cases were among children < 2 years. Incidence rates of invasive GAS for the surveillance period ranged from 1.5/100,000 to 13.5/100,000. Sporadic cases of invasive GBS and Nm were also reported.

Conclusions: Active surveillance that includes both laboratory and epidemiologic information remains important for early recognition of invasive bacterial diseases patterns. This information is used in the formulation of prevention and control strategies, including immunization recommendations, and for monitoring and evaluating current and recently implemented immunization programs.

* The Canadian International Circumpolar Surveillance Working Group includes the following members: Yukon (R. Robertson), Northwest Territories (C. Case, N. Fraley), Nunavut (C. Ogbuneke), Quebec (R.Carlin, J.-F. Proulx), Newfoundland and Labrador (M. ar-Rushdi), Laboratoire de santé publique de Québec (R.A. Laurence), National Centre for Streptococcus (M. Lovgren, G. Tyrrell), National Microbiology Laboratory (R. Tsang), Public Health Agency of Canada (M. Helferty, S. Desai), and the Arctic Investigations Program, U.S. Centers for Disease Control (M. Bruce, T. Zulz) Contact: Michael Helferty ([email protected])

INFLAMMATORY MARKERS FOR PATIENTS WITH ISCHEMIC HEART DISEASE (IHD) AFFECTED BY CONDITIONS IN YAKUTIA

A.S. Golderova, C.D. Efremova, E.A. Alexeeva, A.N. Romanova

Establishment of RAMS, Yakutsk Research Center of complex medical problems SB RAMS.

Research of some authors are established that for Yakuts smaller frequency and the area of atherosclerotic defeats, and also “the slowed down” rate of development of an atherosclerosis in comparison with unradical inhabitants. In our day, we’d received some facts about a considerable role of an inflammation in mechanisms of development of an atherosclerosis. It is known that citokins regulate intercellular interactions, support a system and local inflammation in an atherosclerotic plaque. A research objective – the comparative characteristic of the maintenance of inflammatory markers at patients IHDin dependence about a national identity. 72 men (Yakutsk - 35, Russia - 37) with verified diagnosis IHD at the age from 45 till 67 years which were in cardiological branch of Clinical centre RB - 1 - NCM have been surveyed. In way of blood sick by a method immunofermated analysis have been defined level of C-reactive protein (CRP), proinflammatory cytokines - TNFα, IL-6, IL-1b, γ-IFN, antibodies A, M and G (sets of firm of Joint-Stock Company “the Vector-Best” (Novosibirsk, Russia). Statistical processing has been spent with the using of package SPSS-11.5. At patients IHD depending on a nationality authentic distinctions are revealed under maintenance CRP. At 78,8 % of Yakutsk of patients IHD level CRP exceeding “base” value of 5 mg ml whereas at Russia such values meet in 91,2 % is marked. At comparison of both groups concentration CRP authentically above at Russia, than in Yakutsk (9,7 ± 0,61 and 7,76 ± 0,56, expediently, p <0,035). Level proinflammatory citokin IL-6 at Russia tends to increase in comparison with Yakutsk (8,6 ± 1,7 and 5,3 ± 0,74 pg ml). Yakutsk habitants have a high value of an antibody of M in comparison with

Russia (1,94 ± 0,17 and 1, 44 ± 0,13 is revealed, expediently, at p <0,035). The obtained data of the preliminary analysis of inflammatory markers at patients IHD testifies to distinction depending on an ethnic accessory which demand the further studying. Contact: Aitalina Golderova ([email protected])

A MEASURE OF RURAL PARTURIENT WOMEN’S EXPERIENCES OF PREGNANCY

S. Grzybowski

Rural Maternity Care New Emerging Team (RM-NET), Centre for Rural Health Research, UBC Family Practice

Background: Rural maternity services have eroded in British Columbia over the past decade. The centralization of health care has led to the closure of 17 maternity centres in rural communities across the province since 2000. As a result, rural women are obligated to travel to tertiary care centres to receive obstetric care.

Objectives: 1) To validate a stress survey against existing stress measures and 2) To measure stress in rural parturient women from communities with and without local access to maternity services.

Methods: The survey has been validated against the Depression Anxiety Stress Scales (DASS). The second phase of this research is underway and to date, we have distributed over 500 surveys to rural women.

Findings and Significance: The R value is 0.34, and this indicates a reasonable concordance with the existing stress measures. Survey data collection is still underway. Analysis will be completed prior to the conference. We will organize our findings according to Maslow’s Hierarchy of Needs, as outlined in the “Theory of Human Motivation”. These themes include access to obstetrical care; the need for security, stability and predictability during pregnancy; social support during pregnancy; actualization of vision of ideal pregnancy; and self actualization. Contact: Stefan Grzybowski ([email protected])

PLANNING THE OPTIMAL LEVEL OF LOCAL MATERNITY SERVICE FOR SMALL RURAL COMMUNITIES: A SYSTEMS STUDY IN BRITISH COLUMBIA

S. Grzybowski, J. Kornelsen, N. Schuurman

Rural Maternity Care New Emerging Team (RM-NET), Centre for Rural Health Research, UBC Family Practice

Background: Over the past 10 years, 17 rural maternity services have closed in British Columbia. Similar closures have occurred across rural Canada. A review of the policy literature demonstrates no systemic planning strategy defining appropriate and optimal maternity services for rural communities.

Goals and Objectives: To develop and apply a population isolation model to define the appropriate level of maternity service for rural communities in British Columbia, Canada.

Methods: Iterative, mathematical model development supported by extensive multi-method research in 23 rural and isolated communities in British Columbia, Canada, which were selected for representative variance in population demographics and isolation.

Findings/Significance: Main outcome measure was the Rural Birth Index (RBI) score for 42 communities in rural British Columbia. In rural communities with one-hour catchment populations of under 25,000, the RBI score matched the existing level of service in 32 of 42 (76%) communities. Inappropriate service for the rural population was postulated and supported by qualitative data available on 6 of the remaining 10 communities. The RBI is a potentially pragmatic tool to help policy makers define the appropriate level of maternity service for a given rural population. This model may be applicable to other health service planning problems. Contact: Stefan Grzybowski ([email protected])


HYPERTENSION IN CHUKOTKA INDIGENOUS POPULATION DURING THE LAST 20 YEARS

L. Gyrgolkau

Institute of Internal Medicine SB RAMS

Purpose: During the expeditions of 1983, 1991 and 2002 we three times studied the indigenous population of the Chukotka region.

Methods: In villages of Novoe Chaplino, Lorino, Sireniki, Yanrakynnot live coastal aborigines, in a village Kanchalan with tundra aborigines. Using the method of random numbers we select 508 coastal aborigines and 159 tundra aborigines. The age of all subjects was from 25 to 64 years old. Design of the study was cross-sectional. Blood pressure was measured twice; results were adjusted to age and body mass index.

Results: In the whole age group there were no gender differences in systolic, diastolic and pulse BP. By the age of 55 systolic, diastolic and pulse BP increased, comparing with younger ages.

Comparing of the results of I (1983), II (1991) and III (2002) screenings shows the decrease in in average levels in systolic and diastolic BP in all age groups. The number of hypertensive aborigines (BP 140/90) during this period decreased in men from 38% to 34%, in women from 42% to 21%. Such dynamic is possibly connected with corresponding diagnosis and treatment of hypertension. Thus, in 1983 only rare individuals had taken anti-hypertensive medications, in 1991 - 4%, in 2002 - 10%.

Conclusion: Consequently, during the last years significantly increased awareness of indigenous Chukotka population about the hypertension, and also a number of aborigines receiving effective anti-hypertensive treatment. Contact: Larisa Gyrgolkau ([email protected])

FIERY AVENS GIRLS EMPOWERMENT GROUP

M. Hall


“Empowerment is a broad thing, and invokes in me a lot of images. I think of a woman who taught me to make moccasins, Condoleeza Rice addressing the press. I think of my mother fighting for the under-privileged over many, long, hard years. I think of every mother who has had to balance the needs of her family on limited resources. I think of girls skate-boarding and snowmobiling, my girlfriend beating up a guy for making a rude, sexist comment... maybe that’s not the best example?”

In spite of all of these images we can draw upon of empowered females, how many of us are dogged by thoughts and feelings telling us that we aren’t good enough? That we aren’t strong enough? We are too fat, too thin, no one likes us. If we could change something about ourselves we *would* be like those powerful women we see?

Contemplate the powerful females around you (INCLUDING YOURSELF!). Take a picture, draw a painting, depict your vision of an empowered female.

Fiery Avens is an empowerment group for girls initiated by young women. Girls between 13-16 years of age meet on a weekly basis to participate in activities that use traditional and contemporary creative arts to address social determinants of health. The group is peer led and provides a safe, supportive environment free of judgment where we can network, gain confidence, build self-esteem and learn new skills.

Firey Avens has partnered with two national groups, Taking It Global a web based youth initiative that connects youth around the world and the National Girls Power Camp, a Canadian girls group that has a project specifically designed to involve northern girls in empowerment and community organizing activities.

This poster presentation highlights the work of Fiery Avens. Contact: Mira Hall ([email protected])

RANGIFERINE BRUCELLOSIS ON SOUTHAMPTON ISLAND, NUNVUT

N.J. Harms, M. Campbell, B. Elkin, F.A. Leighton, K. Nielsen, W-L. Yu, A. Neimanis

University of Saskatchewan, Western College of Veterinary Medicine

Brucella suis biovar, the causative agent of rangiferine brucellosis, is present in barren-ground caribou (Rangifer tarandus groenlandicus) and reindeer (Rangifer tarandus tarandus) herds across North America. However, until 2000, there was no evidence of the disease in barren-ground caribou on Southampton Island, Nunavut. B.suis can cause abortion and has an affinity for the reproductive tract in caribou and reindeer; it is also a zoonotic disease which poses a potential human health risk to people who are exposed to infected tissues during butchering or consumption of infected caribou. Over the previous eight years, routine serological testing of caribou on Southampton Island for antibodies to Brucella spp. has shown increasing numbers of seropositive caribou. In response to concern over potential effects of B. suis infection on the reproductive success and health of caribou on Southampton Island, we evaluated reproductive tract lesions associated with B. suis infection in male and female caribou and examined the relationships between these pathologic changes, the enhanced AMOS-PCR results from the reproductive tract tissue, and the serological evidence of Brucella spp. exposure. We found gross reproductive tract lesions consistent with B. suis infection in 38.8% (29/75) of male and 4.2% (3/72) of female caribou. The reproductive organs of a subset of male and female caribou were examined histologically and tested for evidence of B. suis using AMOS-PCR. In the males, 100% of animals with gross lesions had histologic lesions and were positive for B. suis with AMOS-PCR. Though no gross or histologic lesions were noted in the uterus or placenta of examined pregnant females, 43.8% were positive for B. suis on AMOS-PCR. Histologic lesions were noted in 15% of non-pregnant females, and 60% were positive for B. suis on AMOS-PCR. These results indicate that B. suis is present in the reproductive tracts of caribou on Southampton Island, and may be a factor affecting the reproductive success of individual animals, the declining reproductive success of the herd, while also posing a zoonotic risk to humans who contact infected animals. Contact: N. Jane Harms ([email protected])

CLIMATE CHANGE, WATER QUALITY, AND HUMAN HEALTH IN NUNATSIAVUT, CANADA

S. Harper1, V.L. Edge1,2, C. Wallace3, S.A. McEwen1 1Department of Population Medicine, University of Guelph, Guelph ON, 2Office of Public Health Practice, Public Health Agency of Canada, Guelph ON, 3International Network on Water, Environment and Health, United Nations University, Hamilton ON

Background: Generally it is suggested that climate change will cause changes in precipitation, runoff, and hydrological extremes which will alter the environmental conditions that we live in. These ecological changes might increase the risk and incidence of infectious disease. For example, heavy rainfall events, flooding events, and increased temperature increase the risk of waterborne illnesses substantially.

Objectives: The main purpose of our study was to investigate associations among weather patterns and drinking water quality and infectious gastrointestinal illness (IGI) outcomes in Nunatsiavut, Canada. The main objectives of the study were to (1) compare water quality variables with recorded weather events; (2) compare weekly water quality and weather events with local health clinic records of IGI; (3) provide the summary results in the form of educational material on climate change, water quality, and health for local residents.

Methods: Meteorological stations provided weather and turbidity data (objectives 1-2). Trained personnel conducted water quality testing using Colilert® tests. Health data related to IGI was obtained from retrospective (2005-2007) and prospective (2008) clinic records (objective 2). Community members were encouraged to collaborate in


all phases of planning, implementation, assessment, and evaluation of this study. An interactive workshop for local high school students will show how data are collected and analysed, and encourage students’ participation in competitions to develop educational media for communicating study results to the larger community (objective 3).

Outcomes: Our study engages Inuit in a study that will use generated knowledge to create sustainable interventions, while developing the community’s capacity to adapt and manage changes in water quality due to a changing climate. Results from our study might inform policy making decisions and help improve Inuit public health infrastructure. Contact: Sherilee Harper ([email protected])

PREVALENCE, RISK FACTORS AND CONSEQUENCES OF VITAMIN D DEFICIENCY AMONG INUIT CHILDREN

J. Hayek, H. Weiler, Qanuippitali Steering Committee (Nunavut), G.M. Egeland

McGill University

Rickets and hypovitaminosis D remain a public health concern in North America, and particularly among Aboriginal children living in the North. Age, winter season, higher body mass index, ethnicity, elevated parathyroid hormone (PTH) concentrations, and low socio-economic status have been associated with lower 25 (OH) D concentrations.

The current research objectives were to: 1) assess vitamin D and PTH levels of preschool Inuit children. 2) determine the incidence of vitamin D deficiency and insufficiency in preschool Inuit children. 3) identify which gender seems most at risk of vitamin D deficiency. 4) identify risk factors for deficiency (time of year and socio-economic status); and 5) evaluate the consequences of deficiency (slower growth and lower bone mineral density (BMD) T-scores.

A total of 383 Inuit preschool Inuit children (3-5 years of age) participated in the IPY Child Inuit Health Survey of Nunavut. A traveling child survey team conducted the research and included a nurse, trained bilingual interviewers, a survey coordinator and lab technician/graduate student. Bone mineral density was assessed by heel ultrasound. Dietary intake was assessed through the administration of a 24 hr dietary recall and a food frequency questionnaire, anthropometrics (height, weight) were assessed. Nurses collected venous blood samples from the children which were centrifuged on site and stored in -20o freezers until transported on ice to McGill University. Serum 25(OH) D and PTH were measured by Chemiluminesent technology (Diasorin, Liaison).

Results are embargoed until presentation to communities is completed in May of 2009. Full details of results will be provided at the ICCH. The data indicated a high degree of deficient or sub-optimal levels of serum 25(OH) D among pre-school children and highlight the need for interventions to improve vitamin D status among Inuit children. Contact: Jessy Hayek ([email protected])

SHARING HEALTH RESEARCH KNOWLEDGE AMONG NORTHERN COMMUNITIES: A MULTI-PRONGED APPROACH

G.K. Healey


Introduction: Commonly, the concept of knowledge translation has been developed to refer to the creation and implementation of a strategy to translate health research results into applicable findings for those requiring the information. In the context of Qaujigiartiit/Arctic Health Research Network - Nunavut and the work that is conducted by this Iqaluit-based organization, Knowledge Sharing is defined as “the synthesis, translation and communication of health knowledge between various knowledge holders, such as policy-and decision-makers; researchers; community members; and health care providers. Knowledge is dynamic and does not flow in a line from top to bottom, but fluidly between people and groups.”

Approach: A multi-level approach has been implemented at Qaujigiartiit to facilitate knowledge sharing among 4 identified

stakeholder groups in Nunavut: researchers; policy- and decision-makers; community members; and front-line health workers. This approach has included: electronic communication via website and electronic mailing list, in English and Inuktitut; face-to-face meetings including community visits and community consultations; a quarterly newsletter in English and Inuktitut; development of teaching resources and delivering of community workshops on community-identified topics in northern health research; review of the literature on knowledge sharing in the North and in Canada.

Findings: Evaluation of these initiatives in on-going. At this time we have found: national and territorial organizations; researchers; and non-governmental organizations make the greatest use of the Qaujigiartiit web site and publications section; the electronic mailing list has been very helpful in sharing information and soliciting feedback from community members, front-line health workers, and other stakeholders in Nunavut communities; face-to-face meetings and workshops in Nunavut have been well-attended by community members across the territory and have been the arenas where knowledge sharing has been most effective between community members, health professionals, and policy-makers. They have been positive and exciting learning and sharing forums to date.

Conclusion: A multi-pronged, creative and dynamic approach to knowledge sharing is necessary to ensure effective communication and opportunities for knowledge sharing with different audiences in Nunavut. Knowledge Sharing is an essential part of northern health research and Qaujigiartiit/Arctic Health Research Network-Nunavut is playing a key role in the process. Contact: Gwen Healey ([email protected])

EXPLORING PROCESSES IN HEALTH RESEARCH ETHICS IN CANADA’S NORTH

G.K. Healey1, J. Butler Walker2, S. Chatwood3 1Qaujigartiit/Arctic Health Research Network- NU, 2Arctic Health Research Network – YU, 3Arctic Health Research Network – NT

There exists a need throughout the North to increase capacity to address issues of health research ethics, and in each territory, the needs are diverse.

The goals of this project were to:

- Develop a tri-territorial strategy for ethical review of health research involving Indigenous peoples

- Conduct a survey of existing ethical guidelines and literature that are relevant to northern populations.

- Evaluate community capacity to provide input on ethical review of health research projects by

- To develop a draft of a Health Research Ethics Checklist for community proposal reviewers.

A review of literature and community ethical guidelines for health research was conducted in 2007-08. Common themes in community ethics across the territories revealed in the review were related to: licensing; principles of respect – for communities and for researchers; meaningful community engagement; the use of appropriate research methods; use of data and ownership, control, access and protection/possession (OCAP) of data; sharing knowledge obtained from research.

In January, 2009, a meeting of stakeholders from Yukon, NWT, Nunavut, Nunavik and Labrador met in Iqaluit, NU to discuss opportunities to collaborate on health research ethics review for northern communities. The result of this meeting was a commitment to work across jurisdictions to meet the health research ethics needs of communities and northern regions by working to build capacity for ethical review; to collaborate to share tools and resources; to provide education opportunities when possible; and to form a working group to explore the possibility of developing a Northern Health Research Ethics Council. Contact: Gwen Healey ([email protected])


USE OF THE FETAL FIBRONECTIN TEST FOR DETECTING PRE-TERM LABOUR IN NUNAVUT 2004-2007

G.K. Healey1, W.A. MacDonald2 1Qaujigiartiit Arctic Health Research Network Nunavut, 2Qikiqtani Regional Hospital

Pre-term birth is the most important cause of peri-natal morbidity and mortality in industrialized countries. Fetal Fibronectin is a glycoprotein involved in the adhesion of cells present in extracellular matrix of the decidua basalis, adjacent to the intervillous space. The presence of fetal fibronectin in vaginal secretion has been shown to be predictive of both pre-term and term delivery. In 2006, the FullTermÆ The Fetal Fibronectin Test kits were distributed to all 26 community health centres and hospitals in Nunavut.

Methods: This study was a retrospective review of test forms and charts for patients who were administered the fetal fibronectin test in Nunavut between 2004 and 2007. Test use records from the Qikiqtani General Hospital Laboratory were the singular source of data regarding test use in the territory. A review of charts for outcome (birth) data was conducted at the Qikiqtani General Hospital and the Cambridge Bay Regional Health Centre. Birth outcome data for cases outside of the 2 institutions were collected via fax directly from the administering health centre.

Results: One hundred and sixty-six test records were obtained for the period between July 2004 and December 2007. Twenty-five test results were excluded from the analysis for not meeting review criteria. A negative fetal fibronectin test result was 98.3% likely to be a true negative test result among this sample. A positive fetal fibronectin test result was 23.8% likely to be a true positive test result among this sample. The sensitivity of the fetal fibronectin test in this sample was 71.4%. The specificity of the fetal fibronectin test in this sample was 88.1%.

Comment: The high negative predictive value of the test (98.3%) is encouraging for health care providers treating pregnant women in Nunavut, however continuing surveillance o The importance of ensuring that all health centres have current, up-to-date, step-by-step procedures for using the test and reporting the results to the laboratory was emphasized by health care providers. Contact: Gwen Healey ([email protected])

“SAFE IN A SWIM VEST” – COMMUNITY HEALTH REPRESENTATIVES AS WATER SAFETY CHAMPIONS

A.C. Hegeman, G. Edwards, B. Tetso

H&SS, Government of the NWT

Summary: NWT “Safe in a Swim Vest” is a swim vest loander program for children aged 0-6 years. Community Health Representatives(CHRs) are champions and promoters/managers this loaner program.

Need: December 2004: NWT Injury Report 1990-1999 identifies drowning as the third leading cause of injury mortality (17%) of NWT children aged 0-14 (Source: NWT Vital Statistics)

Response:

- March 2005: Key stakeholders responses during Injury Prevention Community Consultation Tour (a partnership initiative with NWT Native Women’s Association) confirm need for prevention of all drowning deaths.

- January 12, 2007: 7 CHR receive certification as First Aid and CPR Instructors - incorporate water safety in teaching

- January 19, 2007: CHRs accredited in First Aid and CPR: 21. - January 12, 2007: Safe in a Swim Vest images and messaging

developed by 12 NWT CHRs Regional posters developed in all NWT Aboriginal languages

- Spring, 2007: regional launch of Swim Vest Loaner Program (aged 0-6)

- Summer, 2008: 2,000 swim vests distributed (loaner programs) in 29 NWT communities

Promotion of “Safe in a Swim Vest” includes

1. Posters and Flyers: “Safe in a Swim Vest” - door to door or mail-drop

2. Tags: “Always be Careful” and “NWT Swim Vest Loaner Program” 3. School-based Promotion of Water Safety 4. CKLB Native Communication Services – Radio Documentary on

Injury Prevention, features “Safe in a Swim Vest” Pilot Project (note: listening audience is + 10,000 First Nations, Inuvialuit and Métis residents of the NWT)

5. Water Safe BBQ hosted by Health Centre in each community (wrap up event for return loaner vests at end of summer)

Contact: A.C. (Lona) Hegeman ([email protected])

ACUTE MASTOIDITIS IN GREENLAND BETWEEN 1994-2007

P. Homøe1, R.G. Jensen1, S. Brofeldt2 1Department of Otolaryngology, Head & Neck Surgery, Rigshospitalet, University Hospital of Copenhagen, 2Department of Otorhinolaryngology, Dronning Ingrids Hospital, Nuuk, Greenland

Objectives: The indigenous populations in the Arctic are prone to middle ear infections starting with early and frequent epidodes of acute otitis media during childhood. A high proportion develops chronic otitis media. Acute mastoiditis is a serious complication of acute otitis media in childhood with postauricular swelling, erythema, and tenderness, protrusion of the auricle, high fever and general malaise. The disease may protrude intracranially. The incidence rates for acute mastoiditis in the western world range from 1.2 to 3.8 cases/100.000/year. There exists no epidemiological data on acute mastoiditis in the Arctic.

Patients and Methods: We have retrospectively searched for the WHO ICD-10 coding entity DH70.0 for acute mastoiditis using the National Greenland Inpatient Register between 1994-2007 inclusive. We found 15 patients with this diagnose. However, four were misclassified, leaving 11 patients for evaluation. The medical records were available in 10 patients. The diagnostic criteria for inclusion were written clinical signs of acute mastoiditis.

Results: The incidence-rate was 1.4 for the whole population and 7.4 for children between 0 and 10 years of age. Median age was 14 months (5-105 months) and 8 (72%) were females. Seven of ten were exclusively treated with antibiotics and three had additional ear surgery. Culturing for bacteriology was performed in five of ten. One 8 months old female developed a contemporary facial nerve paralysis and was treated with intravenous antibiotics and one 8 years old female was evacuated to Copenhagen for acute surgery due to signs of meningitis. Acute CT-scan showed a cerebellar absces and a thrombosis in the sigmoid sinus. At surgery was found an extensive cholesteatoma that was eradicated. Six weeks later the patient returned home with maximal conductive hearing loss as the only complication. All patients recovered from the disease.

Conclusion: The acute mastoiditis incidence in Greenland is seemingly relatively low although acute otitis media occur frequent among small children. The disease is serious and must be immediately treated with intravenous antibiotics and if no improvement also acute surgery. Contact: Preben Homøe ([email protected])

NUTRIENT INTAKE AMONG INUIT IN THE CANADIAN ARCTIC: RESULTS FROM HEALTHY FOODS NORTH

B. Hopping, E. Mead, E. Erber, C. Roache, R. Reid, J. Gittelsohn, S. Sharma


Objective: To determine nutrient intakes of Inuit adults to guide a community-based nutrition intervention program (Healthy Foods North) in Nunavut, Canada.

Setting: Data were collected in a remote community in Nunavut.

Methods: Twenty-four hour dietary recalls were conducted among Inuit adults utilizing a cross-sectional study design. Up to three 24-hour


dietary recalls were conducted for each participant on non-consecutive days, capturing both weekday and weekend consumption (n=209 days). These data were entered into and analyzed by Nutribase Clinical Nutrition Manager and SAS Statistical Software.

Results: With a response rate of approximately 70-90%, 7 men and 69 women between the ages of 19 and 89 years participated in the recall data collection. Mean energy intake was 1,970 kcal for women and 2,215 kcal for men. For both men and women, the mean percentage of calories from fat was 30%. However, men had a lower mean percentage of calories (16%) from protein and a higher percentage from carbohydrates (54%) compared to women (24% and 46% respectively). Intakes of calcium, folate, fiber, and vitamins D and E were well below the recommendations.

Conclusions: The inadequacy of intake of several essential nutrients in this Inuit community indicates a need for a nutritional intervention, such as Healthy Foods North, that highlights nutrient-dense foods to improve the quality of the diet.

Acknowledgments: The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57. Contact: Beth Hopping ([email protected])

QAMANITUAP NIQISIALIRIJIQUTINGIIT NUTARAQSALINGNUT: A COMMUNITY BASED PROGRAM FOR PRENATAL NUTRITION IN BAKER LAKE, NUNAVUT, CANADA

B. Hughson, L. Kreuger

Community Health Advocate

In this presentation we describe the history, goal, methods, results and challenges of the Baker Lake Prenatal Nutrition Project. Created out of a desire to support women and their families in achieving healthy pregnancies and newborn babies, this community based project was established in 1995 with funding from the Public Health Agency of Canada and community in-kind donations. It provides nutrition education, prenatal classes, breastfeeding promotion, contact between mothers and elders, food hampers to those in need, and weekly cooking classes. There are 75 participants (including fathers-to-be) and 800 client contacts every year in this Inuit community of 1700 people. Provision of on-site day-care allows more participants to attend. During cooking classes guest speakers, such as elders, dental therapists and others are invited to give educational talks. The program has resulted in publication of a cookbook called “Qamanituaq Cooks”, which has been distributed across Nunavut. Women who join the program as prenatals often continue participating after delivery. The program is guided by a volunteer board consisting of community members. Shared operating space with another program presents a current challenge. Evaluations reveal the empowerment that participants experience through renewed connection with traditional healthy food choices and food preparation, within a supportive social setting, and the link between food/nutrition and the physical, social, emotional, and mental dimensions of health. Contact: Betty Hughson ([email protected])

DEVIATIONS OF COGNITIVE FUNCTIONS IN OBESE HYPERTENSIVE PATIENTS

G.I. Ievleva, E.F. Teslya, D.M. Biktimirova, A.V. Kiklevich


Pathologic changes in cognitive functions represent one of the early vascular complications of arterial hypertension (AH). These deviations adversely affect the course of AH. There is no doubt that risk of cardiac events increases greatly if AH is combined with obesity. Taking into account the vast prevalence of this combination together with poor data about cognitive deviations (CD) in hypertensive patients who live in the Far North, the study of cognitive deficiency is of prime importance, both from medical and social-economical points of view.

Aim of the research was to study cognitive functions in hypertensive patients in dependence on the obesity stage. We examined 97 hypertensives (47 women and 50 men; AH, stage I-II; mean age – 50,8 years, mean duration of arterial hypertension – 9,9 years, period of residing in the Far North – 26,7 years). Obesity was identified on the basis of body mass index calculation (WHO, 1997), CDs were stated by MMSE questionnaire. By the results of our study, obesity was revealed in 63,9% of examined sample: the I-st stage – 33 persons (53,2%), the II-nd stage – 22 persons (35,5%), the III-rd stage – 7 persons (11,3%). CDs were absent only in 14,3% and 18,2% of patients having the III-rd and II-nd stages of obesity respectively. Number of people without CDs was significantly greater in a group of people having the first stage obesity– 33,4% (p<0,05). Prevalence of slight dementia increased along with obesity progression: the I-st stage – 3,0% of patients, the II-nd stage – 27,3%, the III-rd stage – 28,6% (p<0,05). Moderate dementia was registered only in hypertensives, suffering obesity of the III-rd stage (14,2%). From the foregoing it seems reasonable to conclude that along with obesity progression the number of hypertensive patients without cognitive deficiency decreases, while cognitive deviations become more pronounced. Contact: G.I. Ievleva ([email protected])

FINDING GENES FOR TYPE 2 DIABETES IN YAKUT POPULATION

P.M. Ignatyev1, F.A. Platonov1, L.G. Goldfarb2, V.L. Osayueskiy1, L.L. Alekseeva1, I.V. Osokina3 1Health Institute, Yakutsk; Russia, 2NINDS/NIH, Bethesda, USA, 3Institute for Medical Studies of the North, Krasnoyarsk, Russia

Introduction: Yakutia (Sacha) Republic is located in Eastern Siberia. Two thirds of its vast territory lay north of the Polar Circle. During the last decades there is the significant increase in incidents of type 2 diabetes (T2D) among Yakuts. Probably the reason is the change in traditional nutrition and lifestyle.

Several T2D-susceptibility genes have been identified through candidate gene and positional cloning approaches. For example, common variants in PPARG and KCNJ11 each predispose to T2D in diverse populations. Thanks to the discovery of molecular mechanism of rare congenital forms of diabetes, the progress happened in understanding of T2D. They connected with membrane ion-transport protein, which is widely represented in cellular membranes in organism tissues, including beta-cells of pancreas. This protein coded by ABCC8 and KCNJ11 genes. It controls the process of insulin secretion, forming the channel for potassium ion transfer.

Aim: To search for the genes of predisposition to type 2 diabetes in Yakut population.

Methods: The gene-typing for variants of ABCC8 gene (exons 12, 16, 31) and KCNJ11 gene (E23K, 1339V exons) was performed in Yakut population (213 patients with T2D and 231 control subjects). Gene research was carried out in NINDS/NIH, Bethesda, MD, USA.

Results: There were significant differences (OR=1.312; p=0.047) between diabetes group (0.23) and control (0.29) in frequency of allele A (exon 31) of ABCC8 gene. This gene predisposes to type 2 diabetes in Yakut population. G allele of ABCC8 gene showed higher frequency in the whole population and didn;t show true differences between the compared groups.

Conclusion: ABCC8 gene (A allele, exon 31) plays predisposition role in T2D development in Yakuts and determines the peculiarities the disease in this native Siberian population. Contact: Irina Osokina ([email protected])

THE ARCTIC SOCIAL INDICATORS PROJECT

S. Irlbacher-Fox, J.N. Larsen, Steffanson Arctic Institute, et al.

Arctic Social Indicators Working Group

The Arctic Social Indicators (ASI) project is a project following up on the activities of the Arctic Human Development Report (AHDR), and is

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initiated by the Stefansson Arctic Institute, Akureyri, Iceland, which also hosts the secretariat. ASI has been endorsed by the Arctic Council, and has also received the endorsement of the IPY.

The goal is to device Arctic social indicators which will help facilitate the tracking and monitoring of human development in the Arctic over time. While the AHDR is a major achievement, it is apparent that the development of some means of monitoring trends in human development in the Arctic would be extremely helpful from the perspective of those involved in the policy process. Those wishing to track developments relating to the status of Arctic cultures, the evolution of indigenous rights, or the growth of the region’s economy, for example, can take the picture presented in the AHDR as a point of departure and compare developments at various temporal intervals in order to get a handle on changes over time in human development or social welfare in the Arctic. What the AHDR does not do, however, is to provide time series data regarding the various elements of human development in the Arctic, and nor does it present a suite of quantifiable indicators suitable for use on the part of those seeking to monitor or track changes in human development in the Arctic.

The goal of the ASI project is to move toward filling this gap. It is the first step in a long-term effort to monitor and track human development in the Arctic. The development of indicators falls within six domains:

(1) Fate control and or the ability to guide one’s own destiny; (2) Cultural integrity or belonging to a viable local culture; (3) Contact with nature or interacting closely with the natural

world; (4) Material Well-being; (5) Education; (6) Health/Population.

Contact: Stephanie Irlbacher-Fox ([email protected])

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MERCURY EXPOSURE AND LINKS TO HUMAN HEALTH IN A COMMUNITY IN TROMSØ, ARCTIC NORWAY

M.T.S. Jenssen1,2, I. Njålstad2, T. Larssen1, S. Rognerud1 1Norwegian Institute for Water Research, 2Institute for Community Medicine, University of Tromsø

Persistent pollutants in the Arctic have received much attention. It is well known that these contaminants accumulate in food webs and potentially can cause severe physiological damages to top level predators, including humans. People in Arctic regions tend to be more exposed to these pollutants due to a potential high intake of wild fish and animals. In many studies, focus has been on persistent organic pollutants (POPs), rather than mercury, although food consumption limits for fish often are driven by Hg. The present study assesses mercury exposure and seriousness of Hg in a population in northern Norway.

Through a large epidemiological public health survey, around 9 000 people in the town of Tromsø have delivered hair samples in addition to blood samples and supporting health information, including questionnaires related to potential contaminant exposure and other health related issues. Hair samples are analysed for MeHg and/or TotHg in order to evaluate the levels and seriousness of Hg in the general Tromsø population in relation to diet. Additionally the unique connection to the health survey eventually will enable assessment of links between mercury exposure and possible health impacts, as variables such as e.g. diet, sex, ischemic risk profiles and vitamin D become available.

Although Tromsø is a coastal town with high access to high quality fresh fish and sea food, the dietary pattern show a surprisingly low intake of fish. Hence, the general population has a low Hg exposure through diet, although certain people with high intake of fish and other food from nature show higher Hg concentrations. Still, Hg

concentration levels in this Norwegian population are low compared to values reported for other populations in the Arctic, especially indigenous populations in Greenland and Arctic Canada. Contact: Marthe Torunn Solhaug Jenssen ([email protected])

TRADITIONAL FOOD USE AND DIETARY ADEQUACY AMONG NUNAVUT PRESCHOOL CHILDREN

L. Johnson-Down1, G.M. Egeland1, Qanuippitali Steering Committee (Nunavut)2 1Centre for Indigenous Peoples’ Nutrition and Environment (CINE) and School of Dietetics and Human Nutrition, McGill University, 2L. Gunn, Nunavut Association of Municipalities; L. Williamson, Nunavut Tunngavik Incorporated; I. Sobol and G. Osborne, Government of Nunavut Department of Health and Social Services; K. Young, University of Toronto

Dietary change and nutrition transition are ongoing concern in Indigenous Peoples of the Canadian North. Nutrient inadequacy have also been observed among Indigenous children in US and Canadian communities and traditional food use correlates with greater nutrient intake.

A cross-sectional survey of 388 Inuit children, aged 3-5 yrs, from 16 Nunavut communities between August 2007 and September 2008 was conducted with funding from the Canadian Federal Program for International Polar Year. Bilingual and trained interviewers conducted 24-hour recalls and food frequency questionnaires with the child’s caregiver in order to quantify diet from both market and traditional foods. Anthropometric measures such as height and weight were measured by a nurse.

Assessment of dietary adequacy was done using the Estimated Average Requirement (EAR) cut point method as outlined in the Institute of Medicine’s Dietary Reference Intakes (DRIs). The method requires a statistical adjustment of the nutrient data in order to compare it to the EAR. Some nutrients such as calcium, vitamin D and fiber do not have an EAR and intakes of these nutrients were compared to Adequate Intakes (AI) as defined in the DRIs. The extent of traditional food use was evaluated using a food frequency questionnaire. Dietary quality assessment included the extent to which dietary habits followed the Canadian Food Guide recommendations and the degree of consumption of high sugar and high fat food and sugar beverage consumption.

Results are embargoed until presentation to communities is completed in May of 2009. Full details of results will be provided at the ICCH. The results will help lead to appropriate interventions and health promotion strategies for Inuit children in the Canadian Arctic. Contact: Louise Johnson-Down ([email protected])

DEVELOPMENT OF A FOOD FREQUENCY QUESTIONNAIRE TO MEASURE DIETARY INTAKE IN AN ALASKAN NATIVE POPULATION

J.S. Johnson1, E. Asay1, X. Cao2, E. Mead2, S. Sharma3

Alaska Native Tribal Health Consortium 1Office of Wellness and Prevention, Alaska Native Tribal Health Consortium, C-DCHS, Anchorage, AK, 2University of North Carolina at Chapel Hill, Nutrition Research Institute, Kannapolis, NC, 3Affiliation during research: Cancer Etiology Program, Cancer Research Center of Hawaii, University of Hawaii, current affiliation: University of North Carolina at Chapel Hill, Nutrition Research Institute, Kannapolis, NC

Objective: To describe the development of a food frequency questionnaire (FFQ) that will be used to evaluate the Food Distribution Program for Indian Reservations (FDPIR) in the Western region of Alaska.

Setting: Geographically isolated villages in the Western region.

Subjects: Alaska Native people.

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Methods: 24 hour recall data from a previous project in the Western region of Alaska was used to construct an FFQ. Foods reported more than six times were included. Other foods of interest were added, including FDPIR foods.

Results: The FFQ containing 150 food items was developed and included eight food categories: Breads and crackers (14 item); Cereals (3 items); Dairy foods (including eggs, 11 items); Meat, poultry and fish (including mixed dishes, 69 items); Fruits (including locally gathered berries, 13 items); Vegetables (including wild greens, 22 items); Snack and desserts (9 items); and Beverages (9 items). Consumption frequencies ranged from never to two or more times per day for food items and from never to six or more times per day for beverage items during the last 12 months. Usual amount consumed was assessed using culturally appropriate food models.

Conclusions: The FFQ will be used to assess total dietary intake of the Alaska Native Yup’ik people before and after the FDPIR program and to evaluate the program’s impact on diet.

Acknowledgements: This research was supported by the United States Department of Agriculture Cooperative State Research, Education and Extension Service, Award no. 2007-55215-17923 Contact: Jennifer Johnson ([email protected])

THE FIRST HUMAN CASE OF Q FEVER IN THE ARCTIC - AN UNDERDIAGNOSED OR EMERGING INFECTION?

A. Koch, C.B. Svendsen, J.J. Christensen, M. Kemp, L. Vindfeld, C.B. Christiansen, S. Villumsen


The zoonosis Q fever is caused by the bacterium Coxiella burnetii. Q fever is believed to be world-wide distributed, but has never been observed in Arctic areas. We describe the first Arctic case of Q fever, a case of Q fever endocarditis in a native person from a small settlement in East Greenland. In 2001 the patient had two cardiac valves replaced with biological valves due to rheumatic fever in childhood. In the fall of 2007 he developed signs of endocarditis and in 2008 the affected valves were replaced by mechanical valves; routine PCR and bacterial culture from the removed valves showed massive C. burnetii infection. A serum sample from 2008 was strongly positive for C. burnetii antibodies, while a stored serum sample from 2004 was antibody negative. The fact that the patient had not been outside of East Greenland since 2001 indicates that he was infected locally. Likely animal sources include sledge dogs and seals. Q fever may be underdiagnosed, but may also represent an emerging infection in the Arctic. Contact: Anders Koch ([email protected])

A COST ANALYSIS OF THE UNIVERSITY OF MANITOBA NORTHERN MEDICAL UNIT’S DIABETIC RETINAL SCREENING PROGRAM FOR RURAL AND REMOTE COMMUNITIES

E. Koop, M. Routledge

University of Manitoba J. A. Hildes Northern Medical Unit

Objective: Conduct a cost analysis of a Diabetic Retinal Screening Program for First Nations Communities in rural and remote Manitoba, Canada.

Study Design: A quantitative analysis which uses statistics from published literature to estimate costs and compares these with experiential data.

Methods: Statistics of prevalence rates of diabetes, diabetic retinopathy, and associated costs for transporting clients from rural/remote First Nations communities in order to provide retinal screening were analyzed. These costs were compared to those identified from the past three and a half years of providing a mobile retinal screening service which is based out of the nearest urban centre.

Results: The cost comparison showed that a mobile retinal screening program in rural/remote communities proves to have various financial benefits.

Conclusions: These findings, in conjunction with other factors such as the increasing prevalence of diabetes and evidence that patients prefer community based service, support the need for further expansion of this type of mobile retinal screening program. These experiences also raise many prospective uses for a mobile retinal screening program which could have many positive implications for rural and remote regions. Contact: Eileen Koop ([email protected])

DIABETIC RETINAL SCREENING IN RURAL/REMOTE FIRST NATION COMMUNITIES IN MANITOBA: SUCCESSES AND CHALLENGES

E. Koop, M. Routledge

University of Manitoba Northern Medical Unit

Objectives: 1) Examine the successes and challenges from a program initiated in 2005 by the University of Manitoba’s Northern Medical Unit in providing diabetic retinal screening services and 2) Use these findings to generate recommendations for improving the effectiveness of retinal screening services for Aboriginal populations in rural/remote communities.

Study Design: Qualitative and quantitative program review.

Methods: 1) Quantitative data focusing on client assessments taken from the NMU retinal screening program’s trip reports and the Secure Diagnostic Imaging (SDI) database and 2) Qualitative information describing some of the successes and challenges experienced over the course of the program’s development.

Results: Both the quantitative and qualitative reviews indicate that the program has been an effective one, specifically in regards to improving access to an integral service, and they also identify opportunities for further program development.

Conclusions: Continuation and expansion of the current Manitoba retinal screening model is needed in order to meet current Canadian Diabetes Association clinical guidelines for diabetic retinal screening. This type of program also provides opportunities for new models of health promotion and disease prevention services to populations living in rural and remote communities. Contact: Eileen Koop ([email protected])

THE INDICATORS OF LIPID METABOLISM FROM THE RESIDENTS OF YAKUTIA

Z.N. Krivoshapkina, G.E. Mironova


Given the role of lipid metabolism in the body to adapt to the adverse factors, the objective of this work was to assess indicators of lipid metabolism in the ethnic groups of Yakutia.

Materials and Methods: Total surveyed 1719 residents of Yakutia, including indigenous people, it was 1340, visitors - 379. The control group consisted of 50 healthy individuals.

Results and discussion: At 35% of those surveyed, the concentration of total cholesterol in the blood serum was higher than the norm. The level of total cholesterol in both groups, although not higher than the generally accepted norms, but is within the limits considered to be currently moderately elevated. Triglycerides in the blood of the population of Yakutia comers 1,5 times higher (1,60 ± 0,06 mmol / l) than the indigenous population (1,06 ± 0,03 mmol / l), and ranged on the upper boundary of the rules. Reducing HS HDL combined uptrend CS LPNP levels, in which ethnic groups were at the upper limit of normal. The content of CS LPONP in blood in comparison groups was below the generally accepted standards, and most expressed reduction found in the indigenous inhabitants of Yakutia.

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The level of APO A-I in the blood varied within the normal values and are not dependent on age and ethnicity. Contents apoprotein has been the ethnic dependence, if the indigenous population, this figure ranged lipid metabolism in normal quantities, the arrivals level of APO in excess of normal values, and was 1.5 times higher than in Yakuts.

Thus, the residents of Yakutia observed shifts indicators lipid metabolism. The representatives comers population dyslipidemia is characterized by an increase in blood triglycerides and APO B, which indicates a reduction in reserve capacity in the adaptation of the liver, and at the same time, one can not exclude the contribution of the type of food in dyslipidemia from visitors who have traditionally preferred the carbohydrate diet. Indigenous residents of Yakutia has been a steady increase in the number of diseases that are in violation of lipid metabolism, possibly due to the decline in adaptive capacity. Contact: Zoya Krivoshapkina ([email protected])

TRACKING RISK: A REVIEW OF INFECTIOUS DISEASES WITHIN CIRCUMPOLAR POPULATIONS

A. Kumar

University of Oulu, Finland

Background: Health indicators for circumpolar populations are poor with a high burden of infectious diseases, similar to African countries. This review discusses the rates of infectious diseases within the Arctic.

Methodology: Literature searches identified relevant and useful research sources on all infectious diseases among Arctic aboriginal and indigenous populations including but not limited to Inuit, Eskimo, Inupiaq, Sámi and Chukchi living in circumpolar countries including Russia, Canada, Greenland, Alaska, and Fenno-Scandanavia.

Findings: There exist many challenges for local public health in the control of the disproportionately high rates of infectious diseases for example sexually transmitted infections and respiratory tract infections including Tuberculosis. Such infections are not indigenous to the Arctic. Arctic health providers and community members share concerns about the continuing burden of infectious diseases. There is an identified lack of knowledge in regard to risk and routes of transmission shared among Arctic populations. Perceptions of infection risk and transmission are influenced by government, media, religious and sources. Risk factors including overcrowding, alcoholism, sexual promiscuity and relative poverty, elevate rates of infections. Migration, travel and new natural resource extraction activities in the Arctic pose new routes of transmission for infectious diseases imported from Southern populations.

Conclusion: Circumpolar populations remain at high risk to foreign infections and suffer a considerable burden of disease. Education is key to prevention. A proactive, creative, culture-specific, local community level approach is needed with international collaboration sharing successful methods to curb the rates of preventable infections to improve local health status. Contact: Alexander Kumar ([email protected])

MÉTIS HEALTH/WELL-BEING DATA COLLECTION: CONCEPTUAL SNAPSHOT OF FACTORS BEHIND DATA PAUCITY AND ACTION STEPS

M. Kumar

Métis Centre of National Aboriginal Health Organization

Numerous reports, environmental scans and discussion papers allude to the dearth of Métis health/well-being data. The shortcomings of the current sources of data range from poor data quality, insufficient/inadequate data to a complete lack of data. These deficiencies have serious consequences including an inadequate understanding of the true state of Métis health, the disparities and determinants, and insufficient funding for programs, all of which collectively perpetuate health/wellbeing disparities. In this paper we present some of the limitations of current sources of Métis data, including surveys and peer-reviewed publications. Further, we

elucidate a conceptual snapshot of the factors behind the scarcity of data, with some emphasis on jurisdiction/exclusion issues. Following this, some recommendations including potential approaches to achieving a wide-ranging set of Métis health/well-being data are discussed. A comprehensive collaborative strategy which may incorporate many of the outlined approaches is explored. Contact: Mohan Kumar ([email protected])

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A REVIEW OF INUIT ONCOLOGY PATIENTS TREATED AT THE OTTAWA HOSPITAL CANCER CENTRE

J.P. McGhie

The Ottawa Hospital Cancer Centre

Background: Nunavut, Canada’s largest territory (1.9 million km2), is roughly 3 times the size of Texas, but is sparsely populated with only 27,000 residents. Its demographics are unique, with a median age of 22, 85% are Inuit, and 85% speak Inuktitut. No oncology services are available within the territory. Residents must travel to cancer centers in Ottawa, Winnipeg, or Edmonton. The Ottawa Hospital Cancer Centre (TOHCC) is responsible for all oncology consultations for the Baffin region of Nunavut (distance 2,100-2,700km), where half of Nunavut’s population reside (population 14,000).

Methods: Consecutive Nunavut patients seen in consultation at TOHCC from January 2002 to August 2007 were identified. Chart review was undertaken; extracting demographic information, ethnicity, diagnosis, stage, treatment, outcome, complications of care, and use of translation services.

Results: 113 cancer patients of Inuit descent were identified. The average age at diagnosis was 57 years, (50%M, 50%F). Fifty-four percent were actively smoking at the time of diagnosis. Previous tuberculosis (TB) infection was reported by 40%, while only 1 case of TB reactivation while on therapy was identified. An Inuktitut/English interpreter was required by 73%. Oncologic services at TOHCC included surgery (39%), radiation (64%), and chemotherapy (58%). Lung cancer was the most common (n=55), with the following histological distribution: squamous (n=25), small cell (n=7), adenocarcinoma (n=3), and unspecified non-small cell (n=20). A rare case of Kaposi’s sarcoma was identified in an HIV negative patient. No cases of prostate cancer were identified.

Conclusions: Cancer in the Inuit population differs radically from the rest of the Canadian population. Causes for the variation may include high incidence of smoking, young population, high parity and breastfeeding rates. Contact: John Paul McGhie ([email protected])

THE PSYCHOSOCIAL DETERMINANTS OF DIET-RELATED BEHAVIORS AMONG THE INUVIALUIT: RESULTS FROM HEALTHY FOODS NORTH

E., Mead, E. De Roose, S. Biggs, S. Reaburn, J. Gittelsohn, S. Sharma


Objective: To describe the dietary behaviors and their psychosocial determinants of the Inuvialuit in the Northwest Territories, Canada, for the development of a culturally appropriate chronic disease prevention program.

Setting: Two remote and one semi-remote community in the Arctic region of the NWT.

Methods: Cross sectional random household surveys were conducted with Inuvialuit adults. Descriptive statistics were generated for sociodemographic, psychosocial (i.e., food knowledge, self-efficacy, and intentions), and behavioral (i.e., healthy food getting, unhealthy food getting, and healthiness of food preparation) dependent and


independent variables. Their associations were analyzed using multivariate linear regression in Stata.

Results: Among the 230 Inuvialuit respondents (181 females and 49 males; mean age of 43 years), unhealthy foods (e.g., potato chips, pop, high sugar cereal) were acquired 2 times more frequently than healthy foods (e.g., baked potato chips, diet pop, high fibre cereal). Food preparation methods that added fat were more often utilized than methods that reduced fat content and neutral methods that neither added nor subtracted fat. Higher levels of food knowledge (0.2, p<0.001), self-efficacy (0.1, p<0.001), and intentions (0.1, p<0.01) were statistically associated with utilization of healthier cooking methods. Only increased intention was associated with greater frequency of acquiring healthy foods (1.2, p<0.01), and only increased self-efficacy (-1.1, p<0.01) was associated with decreased frequency of acquiring unhealthy foods.

Conclusions: These results highlight the need for nutritional intervention programs, such as Healthy Foods North, to target food knowledge, self-efficacy, and intentions to positively impact food preparation and acquisition among the Inuvialuit. By understanding and incorporating these factors, Healthy Foods North will be able to address the specific risk needs of this population to reduce the risk of chronic disease.

Acknowledgements: The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57.

ENVIRONMENTAL DETERMINANTS OF PERIPHERAL CIRCULATION IN NORTHERN AND SOUTHERN SIBERIAN POPULATIONS - A COMPARISON

V.N. Melnikov, Novitskaya, S.Yu., T.G. Komlyagina, A.O. Ondar

Institute of Physiology, SB RAMS, Novosibirsk, Russian Federation

The prevalence of a number of risk factors for hypertension is increasing among northern populations. It is thus thought of interest to compare blood circulation parameters between northern and southern populations and to relate them to environmental factors. We measured forearm muscle blood flow at rest and at maximum reactive hyperemia by venous occlusion plethysmography in 209 hypertensive inhabitants of Novosibirsk, the southern Siberian city (63 women and 146 men; mean±SD mean arterial pressure, 115+/-9 mm Hg; mean age, 41+/-9 yr.) and 204 age matched Russia permanent residents of Mirny located in western Yakutia (41 women and 163 men, 114+/-10 mm Hg). We consider the latter location a northern setting. All subjects were industrial workers and examined in 1999-2004 while being patients of academic clinic in Novosibirsk where they were treated for hypertension. The examination was conducted before treatment.

The resting forearm blood flows were 1.89+/-0.93 vs. 2.16+/-1.07 ml/100 ml tissue per minute for women (p<0.1) and 2.62+/-1.14 vs. 2.99+/-1.33 for men (p<0.01), Siberian group vs. northern group. Similarly, the peak flows during reactive hyperemia were higher in northern subjects (p<0.1 for women and p<0.003 for men). The values of resting forearm vascular resistance (RVR*10(11)) were 6.04+/-5.43 vs. 4.52+/-2.21 N*m(-5)*sec for women (p<0.053) and 3.75+/-1.84 vs. 3.22+/-1.34 for men (p<0.005).Venous outflows as well as venous capacities were higher in the northerners compared to southerners for both sexes (p<0.05 for all cases). No differences were found between sex-matched subpopulations in diastolic, mean and systolic arterial pressure and heart rate.

The results show the higher arterial and venous blood flows and the less peripheral vascular resistance in patients from the northern town compared to Novosibirsk. We suggest the difference can be partly attributed to the adaptation of residents of Mirny to special geomagnetic field that is observed in the northern setting. Contact: Vladimir Melnikov ([email protected])

SHARING YOUTH PERSPECTIVES ON MENTAL HEALTH AND WELLNESS: PHOTOVOICE PROJECT

J. Mike, M. Bzdell, G.K. Healey


Introduction: This project is part of a pilot to to test and evaluate knowledge sharing projects within the Qaujigiartiit specifically targeting 2 groups: policy- and decision-makers in Nunavut on the issue of food security, and community members in Nunavut on the issue of youth mental health and wellness. The latter, described here is a youth-led photovoice project to facilitate the sharing of key youth mental health and wellness issues with community members. This topic has been identified at the community and territorial level as an important topic to address. Particularly, it has been highlighted as priority area for raising awareness by the Qaujigiartiit Arctic Health Research Network Nunavut Board of Directors.

Methods: This youth-led knowledge-sharing initiative directed at communities included a review of commonly identified health and wellness issues for youth in Nunavut; youth meetings about the topic; training for the youth participants in photography and the use of related equipment; the production of photographs; the analysis of the photographs and discussion of key messages they felt the photos represented.

Findings: The youth focused primarily on messages with a positive focus, such as “have fun”, “stay positive”, and “take breaks”. The photographs shown here are a selection of the many and varied artistic and creative concepts the youth shared on this topic.

Conclusion: This project was a youth-implemented project to raise awareness about youth mental health issues in Nunavut. The focus on positive messages highlights the need for youth programs and youth-centred materials to focus on their strengths and abilities when addressing youth mental health and wellness in our communities. The photographs have been developed into posters and shared with Nunavut communities through local health centres, schools and youth centres, as well as on the Qaujigiartiit web site to help promote the messages identified by the youth group. The youth found the experience to be both fun and challenging. The excitement generated among the group for the project and the discussions that ensued around the photographs was meaningful and it is hoped that this project will be repeated in the future. Contact: Jesse Mike ([email protected])

PREVALENCE OF CLINICAL RISK FACTORS FOR OSTEOPOROSIS IN WOMEN 50 TO 69 YEARS; THE BONE HEALTH NUNAVIK (BOHN) PROGRAM

S. Morin1, A. Robitaille2, J. Poliquin3, S. Déry4, B. Young1,2 1Department of Medicine, McGill University, 2Nunavik Centre, Montreal General Hospital, Montreal, Canada, 3Ungava Tulattavik Health Centre, Kuujjuaq, Canada, 4Nunavik Regional Board of Health and Social Services, Kuujjuaq, Canada

Osteoporosis is a skeletal disease that compromises bone strength and increases the risk for low-trauma fractures. Clinical risk factors known to increase the risk for fractures include a history of low-trauma fractures, family history of hip fractures, certain medications, advancing age, smoking and low body mass index. Studies have documented higher incidences of fractures in Canadian Aboriginal women from Manitoba compared to white women. In the 2004 health survey of women of Nunavik, osteoporosis and low bone mineral density (BMD) were documented in 77% of menopausal women screened by a heel ultrasound device, though data on clinical risk factors were not reported. Although measurement of BMD is used in practice to improve assessment of fracture risk, access to such technology is lacking in Nunavik. Because the presence of clinical risk factors has been shown to accurately predict the risk for fractures in Caucasian women, we sought to determine the proportion of Inuit women who would be identified at high risk on the basis of clinical risk factors.


The primary objective of this study was to describe the prevalence of clinical risk factors for low-trauma fractures in Inuit women aged 50 to 69 years via the administration of a questionnaire. A trained nurse administered a 12-item questionnaire (~5 minutes) to 166 Inuit participants from the region of Ungava in Nunavik, who were taking part in a breast cancer screening program. Demographic information, height and weight and prescription medications were also recorded. Descriptive statistics will be used to describe the group characteristics. Subgroup analyses will be conducted with stratification of the cohort by age groups (50 to 59 years and > 60 years).

The results of this project will guide the development of the Bone Health Nunavik program which will consist of a comprehensive osteoporosis management program for the people of Nunavik. Contact: Suzanne Morin ([email protected])

CLIMATE CHANGE IMPACTS ON DIETARY NUTRIENT STATUS OF INUIT IN NUNAVUT, CANADA

T. Nancarrow1, H.M. Chan1, A. Ing1, H.V. Kuhnlein2 1Community Health Program, University of Northern British Columbia, 2Centre for Indigenous Peoples’ Nutrition and Environment (CINE), McGill University

Introduction: Traditional food (TF) is locally derived plant, animal, and fish foods, harvested from the environment, which give vital sustenance to Inuit. TF contributes significantly to daily required amounts of nutrients, despite consumption of market foods. Rapid Arctic climate change is affecting reproduction, foraging and migration patterns of key TF species. Changes in access and availability of TF have the potential to affect nutrient intake in Inuit.

Objective: To characterizes the nutritional implications of climate change related to the TF system of Inuit in Nunavut, Canada.

Methods: Focus groups and a food frequency questionnaire (FFQ) consisting of 111 food items from 12 TF species were carried out in two Nunavut communities to record climate change observations and TF intake (g/day). Intake of 22 nutrients was compared to respective Dietary Reference Intakes.

Results: Focus group participants observed that climate change was affecting the TF harvest in both positive and negative ways. Key nutrients that could be affected were found to be protein, iron, zinc, ω-3 fatty acids, selenium and vitamins D and A. Median daily intake of TF was 386 g/day for the whole population. TF provided 100% of the Estimated Average Requirements (EAR) or Adequate Intake (AI) for protein, omega 3 fatty acids, vitamins A and B6, riboflavin, phosphorus, iron, copper, zinc and selenium. Caribou was the most commonly consumed country food (by weight and frequency).

Conclusions: Community members confirmed that climate change is affecting their traditional food system, which is extremely important to their dietary nutrient status. Some changes occurring in the communities appeared to increase access to TF. If this translates to an increase in the TF harvest, nutrient intake may increase. Climate changes that have the potential to reduce access to TF may have serious consequences on dietary nutrient status of Inuit if no countermeasures are taken. Contact: Tanya Nancarrow ([email protected])

FROM RESEARCH TO PREVENTION IN GREENLAND

I.M. Nielsen1, P. Kern2, H. Eiberg1 1Dept. of Cellular and Molecular Medicine, University of Copenhagen, 2Queen Ingrids Hospital, Nuuk, Greenland

Three 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 propionyl 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 childrens closest relatives have died from sudden unexpected death. It is suspected, that PA could be the course. 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 for the two diseases 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: Tests: 2.587 pregnant women, 264 men, 13 children and 15 foetuses. Normal tests: 2653. Pregnant carriers of GFG/PA: 108/80. Men carriers of CFG/PA: 11/4. Children carriers of CFG/PA: 5/1. Foetuses carriers of CFG/PA: 7/2. Homozygous foetus of CFG/PA: 1/0 and the pregnancy was terminated. Carriers of both CFG and PA: 6 pregnant and 1 child. Contact: Inge-Merete Nielsen ([email protected])

THE HEALTH OF SÁMI

A. Niittyvuopio1, R. Magga1, E. Näkkäläjärvi1, A. Rautio2 1Dearvasit Eallin - Terveempi Elämä hanke (Healthier life project), SámiSoster, Inari, 2Centre for Arctic Medicine, Thule Institute, University of Oulu, Finland

The aim of Dearvasit Eallin - Healthier Life project was to increase the participation of working-age and elderly Sámi population in promoting their own heath and well-being. It was funded by Ministery of Social Affairs and Health during the years 2006-2007. At the moment in the Sámi population, as well as globally, the heart and cardiovascular diseases and diabetes are increasing. Obesity, alcohol consumption and smoking have also increased among Sámi people. The risk factors for the diseases are high levels of serum cholesterol and glucose and rather high blood pressure.

The focus area of the project was the importance of change in the life-style in preventing diseases. The aim was to inform the professionals in the counties of S·mi area about the traditional features of Sámi culture and perspectives of the life. During the project it was important to organize the new structures of health care services suitable for Sámi and thus increase their own efforts of health promotion. The sphere includes tradition, values and habits, which are hard to change. E.g. cooking recipes, which have been transferred from one generation to another are rather resistant to new dietary recommendations.

The main results of the projects are: 1) it is import to give the health promotion by using Sámi language and based on the cultural background; 2) the traditional food can be changed to lighter; 3) the health promotion is multidisciplinary work, which needs a good infrastructure; 3) the usefulness of new technology; and 4) development of co-operation with Norwegian professionals in Sámi area. Contact: Arja Rautio ([email protected])

INNOVATIONS IN KNOWLEDGE TRANSLATION: CHILD INUIT HEALTH SURVEY RESULTS DVD

Qanuippitali Steering Committee (Nunavut), A. Pacey, H. Weiler, G.M. Egeland

Centre for Indigenous Peoples’ Nutrition and Environment (CINE), McGill University

Background: All too often research results are inaccessible to communities and research participants. In efforts to improve


knowledge translation and dissemination, a DVD describing the key findings of the International Polar Year Child Inuit Health Survey of Nunavut was developed.

Methods: Key findings were reviewed with steering committee members and other key stakeholders, a draft DVD was developed in English and translated into Inuktitut, Nettilik, and Innuianaqtun, representing the 3 primary Inuit dialects found in the communities that participated in the child health survey conducted in Nunavut.

Results: A total of 384 pre-school children, aged 3-5 years, participated in the survey in 16 Nunavut communities. Key findings relating to household crowding, passive smoking, food security, traditional food use, dietary adequacy and dietary quality, healthy weight, visual acuity, methylmercury exposures, and other health indicators are presented. Recommendations were provided for promoting health of children in the Arctic. Specific information of results is embargoed until dissemination of information on findings to communities is completed in May of 2009.

Conclusions: Presentation of research results in a multilingual DVD format enhances uptake of research results by communities and other stakeholders and improves the capacity of research to empower communities, inform policy, and ultimately make meaningful differences that will improve the health of children living in Arctic communities. Contact: Grace Egeland ([email protected])

NEGOTIATING PATHWAYS TO ADULTHOOD: SOCIAL CHANGE, MENTAL HEALTH AND INDIGENOUS CULTURE

K. Nystad

Sámi University College/University of Oslo

Contemporary dynamics of rapid social change have dramatically affected the political, social, cultural, and economic systems of circumpolar Indigenous peoples (Allen 2007). The study seeks to contribute to knowledge about how young people in one Sámi community adjusts to the rapid changes. The study will add new knowledge about how the youth manage the transition from childhood to adulthood in a society totally different from that in which their parents and grandparents lived.

By focusing on local narratives about the everyday lives of young indigenous people and how they negotiate pathways to adulthood, the study aims to explore ways youth are mobilizing themselves and how communities and families can support the safe passage of their young members. How do the youth identify themselves with their cultural background and what is the significance of this identification in a society touched by rapid changes? The answer to this question may contribute to our understand of how to give indigenous youth the mental support necessary to allow them to successfully reach adultuhood. Sámi youth, like other indigenous youth in the North, must be able to find a life strategy in balance between two cultures in a world where social and environmental changes are rapid. In their planning of careers the yout must be aware of the traditional and the modern, their own culture and the majority culture. The choices they may have to make may require deeper reflection than for other youth. Coping and belonging are central elements, as is the need to feel acceptance and this can affect their choices. How do the youth cope with these challenges? Some will succeed and others will experience failure and have problems in coping and belonging.

The project will be carried out on three levels: in the local community, with families and with individual (youth). The elders are also involved in the project.

This PhD research project is the Norwegian part of an international circumpolar project: “Negotiating pathways to Adulthood: Social Change and Indigenous Culture in five Cirumpolar Communities” Contact: Kristine Nystad ([email protected])

PROGRESSION OF RESEARCH IN CANADA’S ARCTIC: INTRODUCTION OF INUIT RESEARCH ADVISORS

S. O’Hara

Inuvialuit Regional Corporation

Recently headway has been made to conduct research in Canada’s Inuit regions, and since, it has increased at an unprecedented rate. This increase is based on concerns expressed by Inuit populations, different levels of government, regional and national Inuit organizations, and is now part of the advancement of research programs such as the International Polar Year. Some national concerns of Inuit include climate change, contaminants, resource development and arctic sovereignty. Community level concerns include food security, water quality, infrastructure, industrial development, coastal erosion, and local contaminated sites. A priority for Inuit is to build capacity in our regions to keep pace with this increased research and development in the arctic. In 2005, progress was made in Canada, when Inuit Research Advisors (IRAs) were introduced in the four Inuit regions by national research funding organizations ArcticNet, Nasivvik and the Northern Contaminants Program.

This poster explains how IRAs work on community issues of importance to Inuit. It will also explain how IRA’s assist researchers meet regional guidelines and consultation requirements when working in Inuit regions. Lastly, it will introduce the network of contacts IRAs draw from to be productive in their roles. It will introduce aspects of research IRAs wish to improve including, building capacity, research ethics and licensing, meaningful community participation, advocating language and culture, seeking out education and training opportunities, ensuring the inclusion of traditional knowledge in research, ensuring research results, and helping communities and researchers understand the research process. IRAs are a resource for researchers and students by acquiring; community support, planning of logistics, and recruiting local assistance. Finally, this poster will examine the network of contacts IRAs have at the regional and national level, including committees and working groups which IRAs are members of on behalf of our regions. This involvement ensures that Inuit stay at the forefront in decision making and are active partners in guiding future research. Contact: Shannon O’Hara ([email protected])

A REPORT OF THE JAPAN WORKSHOP ON ANTARCTIC MEDICAL RESEARCH AND MEDICINE – WE NEED A BROAD NETWORK OF ANTARCTIC MEDICAL RESEARCH

G. Ohno1, K. Watanabe2 1Tokatsu Hospital, 2National institute of Polar Research

Background: Antarctic medical issues are very widespread and some of them are related with Arctic ones. In Japan, Antarctic medical researches are treated by Antarctic doctors employed each expedition. In spite of so many medical problems, Antarctic medical research group is very small without permanent specific departments. To conquer this obstacle, we set up the workshop of Antarctic medical research and medicine.

Methods: Primary members of the workshop were medical doctors with Antarctic experience. The task of this workshop is to discuss previous medical studies and to make research plan with the next expedition doctors. Extensive specialists are invited to lecture in various concerns of Antarctic medicine. We also manage the joint research between participants and Antarctic medical group. Since 2006 we invited Asian nations’ members to this workshop.

Results: We started the workshop on 2004 with 23 participants from 16 institutes, universities and hospitals. The workshop on 2008 was held on gathering 63 participant from 38 departments of four Asian nations putting into Antarctic winter over operations. The resident doctors at Antarctic Station joined the discussion through a real-time telecommunication system. The issues discussed were psychological studies in closed extreme society, the mortality and morbidity in Antarctic wintering team, medical equipments, the telemedicine


system, the relationship between Antarctic medicine and space medicine, nutrition and metabolism in cold environment, survey of Regionella species in Antarctic stations and so on.

Several joint researches has realized and some are running now.

Conclusions: The Antarctic medical workshop successes to gather many researchers from various institutes, universities and also from Asian nations. The joint researches develop the Antarctic medical study. We will pursuit still more co-operations with many fields including Arctic area. Contact: Giichiro Ohno ([email protected])

THE STATUS OF LIPID PEROXIDATION OF SPORTSMEN IN CONDITIONS PREVAILING IN YAKUTIA

E.D. Okhlopkova, A.I. Yakovleva, L.D. Olesova, E.I. Semenova, G.E. Mironova


Sportsmen in the North are often marked chronic physical stress, which is a pathological condition. Physical stress caused by intense physical exertion and extreme climates.

The aim of this study is to evaluate the intensity of lipid peroxidation for sportsmen.

We examined 16 highly skilled sportsmen whos aged 15-16. The first group of athletes involved in wrestling (n = 10), second - athletes engaged in archery (n = 6). Control group consisted of 20 healthy young men engaged in physical exercise at least twice a week. The intensity of sex was determined by concentration, malonable dialdehyde (MDA) in eritratsitation of blood. Indicators of antioxidant (HPA) is defined as low total content of antioxidants (NMAO).

According to information received from the athletes noted an increase in the floor. In the first group, the level of MDA increased to 2.3 times in the second group - at 3.8 times, compared with control. Concentration NMAO statistically significantly reduced by more than 2 times in both groups. At the same time, a free-style wrestlers NMAO level was below 2.3 times, and the athletes involved in shooting at 2.8 times.

The level of CS and TG in athletes vary depending on the sport. The content of CS and TS in the first group of athletes was higher by 20% and 7%, compared with control. In the second group of athletes the level of HS was lower by 1%, the level of TG - 12%, compared with control.

Thus, the observed changes in indicators of lipid metabolism (MDA, TG, CS) in athletes, depending on the sport. In the first group of athletes tended to increase lipid metabolism. In the second group observed a reduced (TS and HS), while raising the level of MDA. Intense exercise increases the rate of lipid peroxidation and reduce unfermentative AOC athletes. The state of LPO depends on the type of sport. Contact: Elena Okhlopkova ([email protected])

THE CYTOTOXICITY OF INDUSTRIAL AEROSOLS FORMED IN DIAMOND

L.D. Olesova, G.E. Mironova


Lyuminal dependant of hemilyuminestions dust particles generated in the processing of diamonds, which was detected at spektrolyuminometry firm Perkins Elmer in termostatiruemable cuvette. Atomic-emission analysis showed the presence in the dust generated during the processing of diamonds 18 chemical elements, which took the largest share of metals: iron, chromium, nickel, manganese, copper and zinc. As the diamond dust should be composed of carbon, the presence of metals due to their allocation of grinding wheels in the processing of diamonds. According to literature

data on high-layer grinding wheels to cut diamond coating is applied by the plasma at 1500 C, while agglomerate solid alloy is made up of particles of metal carbides. Stimulated chemiluminescence cells in the presence of luminol - informative indicator of the functional state of phagocytes of blood and tissues, their ability to generate reactive oxygen species, that is to carry out its protective function. Adding dust generated when cutting diamonds (2mg/ml) in termostatiruemable cuvettes suspension of leucocytes (106 in 1 ml) caused their activation. Increased chemiluminescence recorded with a wavelength of 555 nm in a sharp peak.

The dust generated during cutting of diamonds, has caused a rapid response type of hemilyuminested one peak intensity of 3799 units and the addition of dust generated during obdirke diamond, causing hemilyuminested response to the three peaks from 3810 to 3818 units in the range of 545 -560 nm. The nature of chemiluminescence response of leukocytes stimulated pylyami, resulting in the cut and obdirke diamonds indicate that they have a high zeta - potential. Elektrostatical binding due to the composition of the investigated dusts containing in iron, strontium, lead, copper, zinc, which causes the uneven distribution of electron density on the surface of the Dust and cause a rapid activation of phagocytes. Dust, enabling a quick XL-response type of chemiluminescence different high biological aggressiveness and form a type of pneumoconiosis exogenous alveolita (Velichkovsky, 1980, 1995, 2001; Kudryashova, 1993; Snegovaya, 1990). That’s why we can assume that citotoxic properties of dust formed in result of cutting diamonds, is not only carbon but also metals allocated grinding discs. The analysis of our results show that the dust generated when we cut the diamonds and it have a high cytotoxicity, as well as their fast typical chemiluminescence response. Contact: Luba Olesova ([email protected])

HORMONAL STATUS AND PREVALENCE OF ENDOCRINE DISEASES IN WORKERS OF GOLD COMPANY “POLE”

I.V. Osokina1, T. Starosotskaya1, M. Shapran2 1State Research Institute for Medical Studies of the North, Krasnoyarsk, Russia, 2Institute of Polyclinic Medicine

Objectives: Today Gold Company “Pole” accounts for almost 85% of gold output in Krasnoyarsk territory and is the largest gold producer in Russia. Gold Company “Pole” operates in the climatic conditions of the Far North practically unbearable for people’s permanent living. Therefore the work is done by shift method and labour resources are attracted from regions with good climatic conditions.

Aim: To study the hormonal status and prevalence of endocrine diseases in shift workers of Gold Company “Pole” in the north of Krasnoyarsk territory.

Methods: In the North-Eniseysk region of the Krasnoyarsk territory (Eruda settlement, 62°N) we examined 400 workers (age median 36 years, 348 men). The assessment included clinical examination, measurement of weight and height; thyroid and hepatic ultrasound scan; an oral glucose tolerance test, plasma lipids, glucose, hormones: TSH, free thyroxine (fT4), insulin, testosterone (for men older 40 years).

Results: The average level of TSH was 1.53 mU/l, fT4 - 17.0 pmol/l, testosterone - 4.4 ng/ml (normal 3.0-12.0). Hypothyroidism was revealed in 5 patients (1 - after thyroid surgery and 4 - autoimmune thyroiditis), hyperthyroidism - in 3 cases (2 - Graves’ disease, 1 - toxic nodule). Endemic goiter was found in 16.6%. 97 workers (24.3%) were overweight. Metabolic syndrome was diagnosed in 44 workers (11.0 %). Four patients had diabetes type 2 (2 cases was diagnosed at first time) and six had impaired glucose tolerance. Liver steatosis was found in 32 workers. Testosterone was reduced (1. 7 - 2.7 ng/ml, average 2.4 + 0.6) in 26 from 119 men older 40 years (21,8%).

Conclusion: We found out high prevalence of thyroid diseases, hypogonadism, obesity, and metabolic syndrome among workers of Gold Company “Pole”. Contact: Irina Osokina ([email protected])

147 POSTER SESSIONS: P Q R S

P Q R S

RISK FACTORS FOR IRON DEFICIENCY ANEMIA AMONG INUIT CHILDREN, AGES 3–5, LIVING IN NUNAVUT

A. Pacey1, Qanuippitali Steering Committee (Nunavut)2, G.M. Egeland1 1McGill University, School of Dietetics and Human Nutrition, 2Representatives from Nunavut Association of Municipalities and Nunavut Tunngavik Incorporated; I. Sobol and G. Osborne, Government of Nunavut Department of Health and Social Services; K. Young, University of Toronto

High rates of childhood iron deficiency anemia (IDA) have been previously reported in some Inuit communities. This suggests that IDA may be a public health concern for Inuit children living in Nunavut but information surrounding this health issue is lacking at the population level. In addition, underlying food insecurity and household crowding may predispose young children living in Nunavut to low iron in the diet and infection with Helicobacter pylori (H. pylori), both of which are risk factors for iron deficiency. As such the overall objectives were to report the prevalence of and investigate key risk factors for iron deficiency anemia among preschool-aged Inuit children living in Nunavut. We conducted a cross-sectional survey with 388 Inuit children, aged 3-5, from 16 Nunavut communities between August 2007 and September 2008. Trained interviewers conducted interviews with the child’s caregiver and completed questionnaires about the child’s diet, household conditions and food security. A nurse measured height and weight and collected a venous blood sample. Hemoglobin (Hb) was measured in whole blood. Serum was frozen and later analyzed for serum ferritin, C-reactive protein (CRP) and antibodies to H. pylori. Weighted prevalence estimates of anemia (Hb < 110 g/L or 115 g/L) and iron deficiency anemia (SF < 12 ug/L, CRP < 8 g/L coupled with anemia) were calculated. Odds ratios and 95% confidence intervals were used to examine the relationship between iron deficiency anemia and various risk factors including exposure to H. pylori, food security status, iron intake and household crowding. Results will be presented pending delivery of summary results to Nunavut hamlets and health departments. Contact: Angela Pacey ([email protected])

A COST-CONSEQUENCE ANALYSIS OF THE NEW 10-VALENT PNEUMOCOCCAL NON-TYPEABLE HAEMOPHILUS INFLUENZAE PROTEIN-D CONJUGATE VACCINE SYNFLORIX™ AND PREVNAR™, ON THE REDUCTION OF ACUTE OTITIS MEDIA IN CHILDREN

J. Pereira

GlaxoSmithKline

Background: Acute otitis media (AOM) is a prevalent pediatric condition, affecting approximately 80% of children by three years of age. Prevnar™, a 7-valent pneumococcal conjugate vaccine, has been included in routine immunization programs and is associated with a reduction of AOM events caused by Streptococcus pneumoniae. The objective of this study was to compare the costs and effects of Prevnar™ with Synflorix™ which has been newly approved in Canada and employs an active protein D-carrier associated with reduction of nontypeable Haemophilus Influenzae (NTHi) AOM.

Methods: A vaccine steady-state, population-based model with a one-year time horizon was developed, and calibrated with Canadian epidemiologic and demographic data, to investigate the costs and effects associated with AOM episodes and other diseases across the Canadian population. A 4-dose schedule for Synflorix™ vaccination was compared with a 4-dose schedule for Prevnar™ vaccination. The base-case included herd-protection for invasive pneumococcal disease and serotype 6A cross protection. A healthcare system perspective was taken with the assumption of 100% vaccination coverage.

Results: Compared with Prevnar™, vaccination with Synflorix™ could prevent an additional 170,951 ambulatory visits for AOM, 144,454 antibiotic prescriptions for AOM, and 9,830 hospitalizations for myringotomy per year. With Prevnar™, the total direct costs per year associated with AOM are $119.8 million of which $16.9 million could be off-set by implementation of routine vaccination with Synflorix™.

Conclusion: Based on the base-case analysis, inclusion of Synflorix™ in routine immunization programs across Canada would be cost-saving to the healthcare system compared with Prevnar™. Synflorix™ offers substantial benefits in terms of reduced ambulatory visits, antibiotic prescriptions and hospitalizations for AOM, a highly prevalent childhood condition.

Synflorix™, is a trademark of the GlaxoSmithKline group of companies. Prevnar™ is a registered trademark of Wyeth. Contact: Jennifer Pereira ([email protected])

BACTERIAL VS. VIRAL PATHOGENS: A SYSTEMATIC REVIEW OF THE ETIOLOGY OF ACUTE OTITIS MEDIA

J. Pereira

GlaxoSmithKline

Background: Acute otitis media (AOM) is a common childhood condition with viral and bacterial etiology. Routine immunization programs currently include pneumococcal conjugate vaccine Prevnar™, which is associated with AOM reduction caused by Streptococcus pneumoniae only. The study objective was to conduct a systematic literature review to identify current pathogen causation of AOM.

Methods: OVID (Medline, Current Content and International Pharmaceutical Abstract databases), EMBASE, Google and Google Scholar engines were searched with the following combination of keywords: “acute otitis media”, “bacteria” and “virus”. Eligible articles were in English, published between 1995 and 2008, and described studies of pediatric AOM patients with cultures for bacterial and viral isolates.

Results: Of the 398 articles screened, 24 separate studies met eligibility criteria, including only one study in a circumpolar region (Greenland). Based on a fixed-effects meta-analysis across all studies, pathogens isolated were more frequently bacterial (74%) than viral (19%). U.S studies reported a similar isolation rate for bacterial pathogens (73% vs 74%) and a slightly higher rate for viral pathogens (23% vs 17%) compared with non-North American studies. Twenty-three studies included data on the specific bacterial pathogens cultured. Based on a fixed-effects meta-analysis of patients in these studies, S. pneumoniae and Haemophilus influenzae were isolated with similar frequency (35% vs. 36%) and Moraxella catarrhalis at 6%. Slightly lower rates of H. influenzae (31%) and higher rates of M. catarrhalis (10%) were observed in U.S. patients, compared with non-North American patients.

Conclusion: Bacterial pathogens are frequently associated with AOM in pediatric populations worldwide and were isolated 3-times more often than viral pathogens. S. pneumoniae and H. influenzae are the bacterial pathogens most commonly isolated in AOM cases, with nearly equal frequency. A vaccine that addresses both leading causes of AOM could greatly reduce the clinical and economic burden associated with this common condition.

Prevnar™ is a registered trademark of Wyeth. Contact: Jennifer Pereira ([email protected])

INVASIVE PNEUMOCOCCAL DISEASE CAUSED BY SEROTYPES 1, 5 AND 7F IN CIRCUMPOLAR REGIONS

J. Pereira

GlaxoSmithKline

Background: Routine pneumococcal immunization programs provide Prevnar™, which protects against invasive pneumococcal disease (IPD)


caused by seven serotypes. The recent introduction of Synflorix™ warrants a review of IPD events attributed to the three additional serotypes against which this 10-valent vaccine provides protection. This study summarizes the distribution of IPD cases due to serotypes 1, 5 and 7F in circumpolar regions.

Methods: OVID and EMBASE were searched with the following key words: invasive AND pneumococcal AND (serotype 1 OR serotype 5 OR serotype 7F) AND (Canada OR United States OR Greenland OR Iceland OR Russia OR Norway OR Sweden OR Finland). Eligible articles described studies in circumpolar regions, and published in English from 1999-2008.

Results: Of 1,024 articles identified, five met the eligibility criteria. In a Greenland study describing 51 IPD cases (1996-2002, prior to Prevnar™ use), serotype 1 was the second most common cause (n = 6), while 7F caused 2 cases. A Northern Quebec study described an 11-case serotype 1 outbreak in 2000-2002, but only 3 cases from 2002-2004, after mass immunization with a 23-valent vaccine that protects against serotype 1. Three studies examined the incidence of non-vaccine serotypes pre- and post-2001 (when Prevnar™ use became widespread). While one Alaskan study found 80% and 67% reductions in serotype 1 and 7F incidences, respectively, across all ages in 2002, a study in Alaskan children found that serotype 7F cases tripled, from 3 cases (1995-2000) to 9 cases (2001-2006). Finally, a study of 11,244 IPD cases in six circumpolar regions from 1999-2005 identified serotypes 1 and 7F among the five most prevalent serotypes throughout this period.

Conclusion: The majority of evidence indicates that IPD incidence due to non-Prevnar™ serotypes — and 1 and 7F in particular — has been significant in recent years. Routine vaccination with Synflorix™ could provide the benefits of Prevnar™ while addressing this protection gap.

Synflorix™ is a trademark of the GlaxoSmithKline group of companies. Prevnar™ is a registered trademark of Wyeth. Contact: Jennifer Pereira ([email protected])

IMMUNE HOMEOSTASIS IN CHILDREN OF THE FAR NORTH AT DIFFERENT VARIANTS OF VEGETATIVE MAINTENANCE OF ACTIVITY

N.S. Polovodova,T.V. Maltseva


The main function of vegetative nervous system in homeostasis sustention is known to be vegetative maintenance of activity (VMA). But nowadays, data provided by surveys of immune homeostasis on the background of immune dysfunctions in children are highly debatable. Thus, aim of our research was to study the characteristics of immune homeostasis at different variants of VMA in children, residing in the Far North. 133 practically healthy schoolchildren (mean age 13,7±0,19 years), living in the Far North (Yamalo-Nenets Autonomous Okrug, Russia) since their birth took part in the survey. By the results of orthostatic test we distinguished seven variants of VMA. Sympatheticoastenic variant was revealed in 10,5% of cases, hyperdiastolic – in 22,5%, asympatheticotonic variant – in 36,0%, astenosympathetic – in 4,5%, paradoxical – in 9,8%, hypersympatheticotonic – in 0,7% of cases. Normal reaction to orthostatic test was stated only in 16,0% of examined schoolchildren – no complaints, heart rate increase by 20-40% from a baseline,+++ systolic and diastolic blood pressure growth within acceptable range were registered. Indices of this group of children were used as controls during immune state assessment. At insufficient VMA variant, serum IgA and IgM levels, relative monocyte number, relative eosinophil number, relative number of lymphocytes with immunophenotype CD3+ and CD8+ were higher when compared to normal VMA variant. At hybrid variant – relative eosinophil number and serum IgA and IgE levels were lower, but serum IgM and neutrophil number were higher when compared to normal VMA variant. Thus, we can conclude, that in children who live in high latitudes, at least seven variants of phenotypic

adaptive reactions, which are aimed to provide successful adaptation to life conditions can be found. Persons with insufficient variants prevail (68,3%). In examined schoolchildren with different VMA variants, changes in indices of immune state were defined predominantly in humoral part of immunity. Contact: N.S. Polovodova ([email protected])

NUTRIENT INTAKES AND VITAMIN D STATUS IN INUIT WOMEN 40 YEARS OF AGE AND OLDER

A. Pronovost1, G.M. Egeland1, S. Morin2, H. Weiler1, Qanuippitali Steering Committee (Nunavut)3 1Centre for Indigenous Peoples’ Nutrition and Environment (CINE) & School of Dietetics and Human Nutrition, McGill University, 2Faculty of Medicine, McGill University, 3L. Williamson, Nunavut Tunngavik Incorporated; K. Young, University of Toronto; L. Gunn, Nunavut Association of Municipalities; G. Osborne, GN Department of Health and Social Services

Objectives: To determine nutrient intakes and vitamin D status in Inuit women ≥40 y.

Study Design: Participants were a sub-sample (n=416, ages 40-90 y) of those randomly selected to participate in the 2007/2008 IPY Inuit Health Survey from two regions in Nunavut.

Methods: Nutrient values were derived from single 24-hour recalls using CANDAT. The concentration of 25-hydroxyvitamin D (25(OH)D) was measured on fasting serum samples using a LIAISON® automated analyzer. Nutrient intakes were compared between three sub-groups (40-49 y, 50-60 y, >60 y) using nonparametric K-sample tests on equality of medians. The proportion of women in each vitamin D status group (severely deficient (25(OH)D≤25 nmol/L), mildly deficient (25.1-50 nmol/L), suboptimal (50.1-75 nmol/L), optimal (75.1-125 nmol/L), supra optimal (>125 nmol/L)) was compared between sub-groups using a Pearson chi-square test.

Results: Complete nutrient data and 25(OH)D measurements were obtained for 333 and 374 women, respectively. Trends towards increasing intakes of protein, manganese, phosphorus, zinc, polyunsaturated fatty acids, vitamin D, calcium and magnesium per 1000 kilocalories with age was observed. Median intakes were below the EAR for vitamin A in all groups and vitamin C in those >60 y, and below the AI for vitamins D and K, and calcium. The proportion of women with serum 25(OH)D <75 nmol/L significantly decreased with age (40-49 y, 72.2%; 50-60 y, 45.9%; >60 y, 20.0%).

Conclusions: Women >50 y tend to have higher vitamin D levels and more nutrient-dense diets. The adequacy of vitamins A, D, K, and calcium in all age groups, and vitamin C in those >60 y, warrants further investigation over multiple days. Contact: Amy Pronovost ([email protected])

ENVIRONMENTAL HEALTH – FROM EXPOSURE TO BIOMARKERS

A. Rautio1, P. Myllynen2, K. Vähäkangas2,3 1Centre for Arctic Medicine, Thule Institute, University of Oulu, 2Department of Biosciences (Pharmacology and Toxicology), University of Oulu, 3Department of Pharmacology and Toxicology, University of Kuopio, Finland

Biological, biochemical and molecular markers are needed in order to find a pattern of measurable parameters for environmental health. Our project concentrates on a selection of potentially useful molecular biomarkers, by using human placental perfusion, cell culture models as well as animal models. Our studies pursue toxicokinetics of environmental chemicals in placental and human and animal hepatic models and their effects on the development of fetus in vitro.

We are among the first to systemically study human fetal exposure to chemical carcinogens and environmental chemicals by human placental perfusion. In addition to providing actual data on transplacental transfer processes our studies give more insight of the


usability of placental perfusion as a method for fetal exposure. The function of placental transporter proteins that may cause variation in fetal exposure between individuals are not yet well understood. Already we have shown that ABCG2/BCRP, one of the major efflux transports in human placenta affect the transport of PhIP, a heterocyclic amine and food carcinogen. The studies on the role of ABCG2 in fetal protection will continue with environmental chemicals. The studies of bank and field voles living at the old sawmill area contaminated by chlorinated dibenzo-p-dioxins and –furans (PCDD/Fs) have a significant difference in their body burden of PCDD/Fs. Concentrations are much higher in bank voles, and the next steps of the research are the dose-response effects of TCDD on the xenobiotic metabolizing enzymes.

This work is closely connected to the AMAP Human Health –program and EU projects (ReProTect, NewGenerics and ArcRisk). Contact: Arja Rautio ([email protected])

DO PSYCHOLOGICAL STRENGTHS ACT AS PROTECTIVE FACTORS AGAINST EARLY ADOLESCENT BULLYING IN SCHOOLS?

E. Rawana, C. Anderson, K. Brownlee, J. Whitley

Lakehead University

This research explored whether personal qualities of students could be identified that may act as protective factors against being bullied or victimized by other students. It is possible for instance, that some personal strengths possessed by the victim may help him or her surmount the risk factors associated with being bullied. Thus, the role of psychological strengths in protecting students against different forms of bullying was explored in a survey of grade 7 & 8 students from a provincial northern city. The students were randomly selected to participate and responded to a series of questionnaires on strengths (SAI and BERS-II) and bullying. Gender analysis was included in the Results: The results showed that specific strengths, namely, school functioning in boys and strengths in personality functioning for both genders appeared to serve as protective factors against different forms of perceived bullying and victimization. Good school functioning was associated with lower frequencies of bullying experienced by boys. This association was not found to hold for girls. Contrary to expectation, both boys and girls indicated that strengths related to an increased involvement with spirituality and cultural identification was associated with greater victimization. A tentative explanation for these findings is offered, but additional research on this topic is also indicated. The significant implications for anti-bullying programming in the school system are also discussed. Contact: Edward Rawana ([email protected])

THE ASSOCIATION BETWEEN PSYCHOLOGICAL STRENGTHS AND THERAPEUTIC OUTCOME AMONG ADOLESCENTS RECEIVING RESIDENTIAL TREATMENT FOR SUBSTANCE ABUSE AT PROGRAM COMPLETION AND THREE MONTH FOLLOW-UP

E. Rawana, K. Brownlee, J. Brazeau, J. Rawana, N. Black, J. Franks

Lakehead University

There is an evolving body of literature that suggests that strength based interventions are an important predictor of treatment outcome, however, further information on the role of strengths in treatment for adolescent with co-morbid conditions of mental health and substance abuse problems is very much needed. This study examined the relationship between individual strengths and treatment outcomes for adolescents in a residential substance abuse treatment program. The program is offered by the Sister Margaret Centre as part of St. Joseph’s Care Group, Thunder Bay, Ontario and has a strong northern focus. This centre provides a five week residential treatment program for adolescents between the ages of 13 to 18 years of age with serious substance abuse and mental health issues. About forty percent of the

clients are First Nations youth. Every six weeks a new cohort of adolescents is admitted to the program. The data for this study comprised of individual strengths assessed at admission, file reviews of treatment summaries and discharge reports. The data was collected from multiple cohorts upon program completion. Data was gathered at three months follow-up by telephone interview. The results showed that increased individual strengths were associated with increased goal accomplishment and enhanced program participation. A relationship was also found between increased strengths and positive attitudes towards the self as well as positive interpersonal relationships at the conclusion of treatment. These results offer support for the use of a strength-based approach in the treatment of substance abusing adolescents who are experiencing mental health problems. Contact: Edward Rawana ([email protected])

A JOURNEY TO THE TEACHINGS: A COMMUNITY APPROACH TO INJURY PREVENTION (2009)

L. Richardson

Health Canada, First Nations & Inuit Health Branch

Purpose: A Journey to the Teachings (JTT) is a culturally sensitive injury prevention manual that has been created for use by service providers and practitioners in First Nations and Inuit communities. The manual, which includes ready-to-use presentation materials (slides, hand-outs), has been developed to incorporate both First Nations and Inuit perspectives.

JTT is organized according to the “four life cycle and stages of learning” approach:

- Awareness: Looking at the Problem - Understanding: Identifying Risk and Protective Factors - Knowledge: Identifying Injury Patterns and Prevention

Strategies - Wisdom: Using Prevention Strategies to Act

Methods: This resource was developed using internationally recognized theories and principles of injury prevention that are based on public health and epidemiological approaches. JTT is based on the resource, A Journey: Strengthening Aboriginal Communities through injury prevention, 2001 by the Alberta Centre for Injury Control and Research. It was developed through a consultative process with Aboriginal communities and educators and incorporates traditional and local knowledge.

Results: JTT is a new resource with release in early 2009. Health Canada will conduct ongoing program evaluations and report on progress.

Conclusions: Health Canada will be supporting training sessions for community practitioners and service providers to enable them to conduct local JTT workshops. Contact: Lynda Richardson ([email protected])

USING A DVD TO ADMINISTER INFORMED CONSENT: IPY CHILD INUIT HEALTH SURVEY

R. Rosol1,2, G.M. Egeland1, Qanuippitali Steering Committee (Nunavut)3 1Centre for Indigenous Peoples’ Nutrition and Environment (CINE), McGill University, 2Simon Fraser University, Faculty of Health Sciences, Government of Nunavut DHSS, Nunavut Tunngavik Inc., Nunavut Association of Municipalities, McGill University, University of Toronto

The ethical requirements for the administration of informed consent forms for potential participants in research has resulted in lengthy consent forms that represent a barrier to effective communication especially in cross-cultural and diverse linguistic settings. In order to facilitate recruitment into the International Polar Year Child Inuit Health Survey of Nunavut, a DVD was developed.

A multilingual informed consent DVD was developed and followed word-for-word the content of the written informed consent document


that was approved by the McGill Ethics Review Committee. Revisions were made in consultations with steering committee members and then translated into 3 Inuit dialects (Inuktitut, Innuinaqtun and Netsilik) found in the 16 Nunavut communities that participated in the child health survey. The traveling child health survey team included nurses, bilingual interviewers, nutritionist, and a lab technician/graduate student and involved local community research assistants. Inuit children aged 3-5 years were identified by the community health centre and parents or guardians were invited to have their child participate. In larger communities, children were randomly selected using random digit numbers while in smaller communities all appropriately aged children were eligible for participation. After viewing the DVD informed consent information and agreeing to participate, guardians signed informed consent forms.

A total of 384 children participated in the health survey. The DVD was a helpful tool in explaining the child health survey and what the participation involved for children and their parents.

Research practice standards are evolving and media approaches to enhancing communication with potential participants in health research will likely become more widespread. DVD communication can improve participants’ understanding of research while simultaneously fulfilling the lengthy requirements of ethical review boards. Contact: Grace Egeland ([email protected])

FOOD SECURITY IN NUNAVUT: PRELIMINARY RESULTS FROM THE IPY ADULT INUIT HEALTH SURVEY

R. Rosol1,2, G.M. Egeland1, C. Huet1, L.H. Malcoe2, Qanuippitali Steering Committee (Nunavut)3 1Centre for Indigenous Peoples’ Nutrition and Environment (CINE), McGill University, 2Simon Fraser University, Faculty of Health Sciences, 3Government of Nunavut DHSS, Nunavut Tunngavik Inc., Nunavut Association of Municipalities, McGill University, University of Toronto

Food security is a social determinant of health and a public health priority for the Inuit. Traditionally sustained by nutrient-dense country foods such as caribou, fish, and seal, the current trend among Inuit is an increased consumption of market foods. While Inuit continue to undergo changes in their lifestyle and cultural practices, diets that emphasize a diverse array of traditional/country foods and nutritious market foods will be essential to sustaining good health.

Limited data exist on food insecurity, and on the availability of and access to country foods among Indigenous Peoples in Canada. The IPY Inuit Health Survey: “Qanuippitali? How about us, how are we?” was conducted across the Canadian Arctic and collected vital information on health and household characteristics. Homes were randomly selected and one adult per home answered a household questionnaire which contained items on home characteristics, food security, and family’s access to country food. The questionnaire was administered by trained bilingual land-team members. The prevalence and severity of food insecurity were calculated using a modified version of the USDA Food Security Survey Module Questionnaire.

The Inuit-specific data carries important implications for Inuit in terms of developing effective responses to mitigate the negative health effects of food insecurity, and to help guide future policy and program interventions. Information collected on the availability, food sharing practices, accessibility and harvesting methods of country food will provide additional level of food security relevant to northern communities. Preliminary results will be presented at a student session on the 20 communities surveyed in the Baffin and Kivalliq regions of Nunavut. Caveats of the USDA approach will be discussed as it relates to assessing food security among Indigenous Peoples. Contact: Renata Rosol ([email protected])

A DAY IN THE LIFE OF THE IPY INUIT HEALTH SURVEY SHIP TEAM: PARTICIPANTS VISITING THE CCGS AMUNDSEN

H. Saudny-Unterberger, H. Angootealuk, E. Elias, S. Chatwood, A. Nicholson, K. Young, Qanuippitali Steering Committee (Inuvialuit),

Qanuippitali Steering Committee (Nunatsiavut), Qanuippitali Steering Committee (Nunavut)

McGill University / C.I.N.E.

The IPY Inuit Health Survey was developed to better understand the factors contributing to Inuit health and spirit of thriving in the face of changes. Because of the vast distances involved, the CCGS Amundsen was used to visit the 33 coastal communities in the Inuvialuit Settlement Region, Nunatsiavut, and Nunavut Territory in 2007 and 2008. Members of the ship survey team included interviewers, nurses, laboratory technicians, and specialists. A greeter welcomed participants onboard and Coast Guard personnel ensured safe transportation to and from the ship. Once participants were on board, nurses took fasting blood samples, administered a glucose tolerance test, measured blood pressure and pulse, and took body composition measurements. Participants over 40 years of age underwent specialty tests.

Participants also met with bilingual interviewers to answer questions about diet, general health and well-being, tobacco use, mental health, alcohol and drug use, physical activity and social support. Lab technicians prepared all blood samples on board the Amundsen. Participants received some of their results (height, weight, waist circumference, blood pressure and hemoglobin readings) while on board the ship. The fieldwork took place over 2 years. A total of 2,100 participants, ranging in age from 18 to 90 years from 33 coastal and 3 non-coastal communities in Inuvialuit Settlement Region, Nunavut, and Nunatsiavut participated.

The Inuit Health Survey will provide Inuit specific information that will aid Inuit in making informed choices about their health. It also provides an analytically rich database for researchers exploring determinants of health, and for those developing health policies and interventions. Nearly all participants agreed to a 7-year follow-up forming the International Inuit Cohort Study in collaboration with plans for a Nunavik, Quebec and Greenlandic follow-up evaluation. The successful work onboard the Amundsen is a testimony to capable individuals working together for a common goal. Contact: Helga Saudny-Unterberger ([email protected])

THE PARTICIPATORY APPROACH TO THE IPY INUIT HEALTH SURVEY 2007/2008

H. Saudny-Unterberger, C. Lennie, M. Wood, N. Obed, I. Sobol, K. Young, G.M. Egeland, Qanuippitali Steering Committee (Inuvialuit), Qanuippitali Steering Committee (Nunatsiavut), Qanuippitali Steering Committee (Nunavut)

McGill University / C.I.N.E.

Inuit have expressed a desire to have health information that is Inuit specific and of practical relevance so that informed decisions can be made in the face of the rapid changes that are affecting all dimensions of life in Arctic communities. In response to these concerns, a multifaceted participatory health research project for those 18 years of age and above was developed and undertaken in the Inuvialuit Settlement Region, Nunatsiavut, and Nunavut over a 2 year period. The survey was designed to be compatible with a similar survey in Nunavik of Northern Québec in 2004 and with an ongoing health survey in Greenland.

All work was developed in full partnership with steering committees, advisory committees and working groups representing the 3 jurisdictions and University researchers. Plans took into account the different traditional foods, languages and cultural identity of the 3 regions yet sought consistency in methods and approaches for a unified Inuit Health Survey. Memoranda of Agreement, containing precise language regarding roles and responsibilities of steering committee members, committees and researchers, short and long-term storage of the data and information dissemination, were developed with each steering committee. In addition, each community decided whether they wanted to be included in the survey by signing a community-university research agreement. Community corporations


and steering committee members were indispensable in identifying bilingual individuals for land and ship teams. Face-to-face meetings and telephone conference calls with steering committees and hamlets ensured a successful completion of the survey.

The health survey will provide the most comprehensive look at community and personal health of Inuit, and will assist health professionals and policy makers at the regional, provincial, territorial and national level in formulating priorities and strategies for health policies. Contact: Helga Saudny-Unterberger ([email protected])

DECLINE IN THE PREVALENCE OF NEURAL TUBE BIRTH DEFECTS, ALASKA, 1996-2004

K.J. Schoellhorn

State of Alaska Division of Public Health

Introduction: All women who are capable of becoming pregnant should consume 400mg of folic acid per day in order to reduce the number of neural tube birth defects (NTDs). In 1996, the USFDA published a requirement that all commercial grain products be fortified with folic acid, effective January 1998.

Methods: We analyzed Alaska Birth Defects Registry (ABDR) data for children born in 1996-2004 to examine post-fortification trends in NTD birth prevalence.

Results: At the beginning of the study period, ABDR data indicated three-year average (1996-1998) NTD prevalences of 22.2 per 10,000 for Alaska Native infants and 5.7 per 10,000 for non-Natives. Statewide NTD birth prevalence declined 50% between 1996 and 2004, from 7.9 to 3.9 cases per 10,000 live births (p<.05). The five year average NTD birth prevalence declined 66% for the Alaska Native population and 33% for non-Natives.

Discussion: Folic acid fortification of packaged grain products likely resulted in a 50% decline in NTD prevalence in Alaska during 1996-2004, meeting the CDC estimate of a 50% reduction in NTDs if all women of reproductive age consume the recommended dosage of folic acid. We found high pre-fortification NTD rates for Alaska Native, compared to non-Native, infants. The almost four fold excess risk of an NTD-affected birth for Alaska Natives was virtually eliminated by 2004. Single-year data show that most of the decline in NTD prevalence among Alaska Natives occurred between 1998 and 1999, corresponding temporally with the FDA fortification mandate. These data provide support for improving nutritional education and support among Alaska Native women and implementing nutritional intervention in the pre-conception settting. Contact: K. Janine Schoellhorn ([email protected])

INCREASED RISK OF HIRSCHPRUNG’S DISEASE AMONG ALASKA NATIVES IDENTIFIED FOLLOWING VERIFICATION OF REPORTED CASES, 1996-2006

K.J. Schoellhorn, S.A. Collins

State of Alaska Division of Public Health

Background: Hirschsprung’s disease (HSCR) is a potentially fatal neonatal intestinal obstruction syndrome. During birth years 1996-2002, reported HSCR birth prevalence in Alaska was 13.3 per 10,000 live births, approximately six times higher than national estimates, with no significant disparities by race, maternal age, Alaska Native status or maternal residence. Case verification sample surveys, initiated at major hospitals in 2002 and 2004, reported high positive predictive value (PVP) for reports of HSCR to the Alaska Birth Defects Registry (ABDR), lending support to the validity of elevated HSCR prevalence estimates. As preparatory work for a study of genetic and environmental HSCR risk factors, we a complete case verification study of reported HSCR.

Methods: The ABDR is a statewide population-based birth defects registry utilizing passive surveillance and multiple source reporting

methodology. We reviewed medical records for all children identified with HSCR with birth years 1996-2007. HSCR was confirmed when a child’s medical chart documented positive diagnostic testing by rectal biopsy. Reported HSCR was ruled out when the chart indicated that diagnostic tests were negative or when an alternate diagnosis was confirmed.

Results: HSCR prevalence fell from 9.8 per 10,000 live births before case verification to 3.0 per 10,000 live births after case verification Alaska Native infants had confirmed HSCR rates three times that of non-Native infants PVP was highest for Alaska’s largest neonatology practice (ANA) and lowest for reports received through Medicaid (DMA).

Conclusions: A case-verification study demonstrated that Alaska does not have an increased risk of HSCR overall but that the Alaska Native population has a three-fold increase in risk compared to the non-Native population. These findings have important implications for development of etiologic hypotheses yet were not apparent during evaluation of pre-verification reports. Contact: K. Janine Schoellhorn ([email protected])

THE EPIDEMIOLOGY OF TUBERCULOSIS IN THE CIRCUMPOLAR REGION OF CANADA, 1997 TO 2006

D. Scholten1, V. Gallant1, C. Case2, J.F. Proulx3, E. Randell4, P. Rivest5, C. Stannard6, M. Yetman7 1Public Health Agency of Canada, 2Department of Health and Social Services, Yellowknife, 3Direction de santé publique du Nunavik, Quebec, 4Department of Health and Social Services, Government of Nunavut, 5Direction de la Protection de la Santé Publique, Ministère de la Santé et des Services Sociaux, Montreal, Quebec, 6Yukon Communicable Disease Control, Whitehorse, Yukon, 7Department of Health and Community Services, St. John’s, Newfoundland and Labrador

Background: The circumpolar region of Canada includes Yukon, Northwest Territories, Nunavut, Nunavik (the northern region of Quebec) and the northern region of Labrador in Newfoundland-Labrador. In 2006, Canada helped to establish the TB Working Group of the International Circumpolar Surveillance (ICS-TB) network. The purpose of this poster is to advance the work of the ICS-TB working group by presenting an historical review of the epidemiology of TB in the circumpolar region of Canada.

Methods: Cases of new or relapsed active TB reported from 1997 to 2006 were categorized as “circumpolar” or “non-circumpolar” based on place of residence at the time of diagnosis. Descriptive analysis compared the groups on demographic and clinical characteristics. Preliminary results include cases from Yukon, Northwest Territories and Nunavut only.

Results: From 1997 to 2006, 17,324 cases of TB were reported; 430 (3%) in the circumpolar region and 16,894 (97%) in the rest of Canada. The average annual incidence rate in the circumpolar region (42.7 per 100,000) was almost eight times higher than the rest of Canada (5.4 per 100,000). Circumpolar cases tended to be younger (30 vs. 43 median years) and most (96%) were of Aboriginal origin (Inuit 75.2%, Métis 0.2% and Status Indian 23.4%). Circumpolar cases were more likely to be identified through contact tracing (38.6% vs. 5.8%) and to be diagnosed with primary TB (17.2% vs. 6.1%). However, the rate of drug resistance remains markedly lower in circumpolar cases (0.9 % vs. 11.7%).

Conclusion: The epidemiology of TB in the circumpolar region of Canada shows higher rates of disease and a profile suggestive of ongoing transmission in the community, while low rates of drug resistance remain encouraging. Ongoing, targeted surveillance of TB in the circumpolar region of Canada will provide important information to reduce disease rates and maintain low levels of drug resistance. Contact: Derek Scholten ([email protected])


WHAT’S IN YOUR FREEZER? TRADITIONAL FOOD USE IN TWO FIRST NATIONS COMMUNITIES IN YUKON, CANADA

R. Schuster, L.H.M. Chan, C. Dickson


Traditional foods are at the center of culture and health for Aboriginal Peoples across Canada. With increased environmental, social and economic pressures, the diet of many First Nations communities has shifted from one largely comprised of traditional foods to one including increasing quantities of market foods. An improperly balanced diet of market foods can result in nutritional deficits and raises health concerns for chronic diseases. This project intends to create a record of traditional food consumption in two Yukon First Nations communities, the Vuntut Gwitchin of Old Crow, located above the Arctic Circle, and the Teslin Tlingit, located southeast of Whitehorse along the Alaska Highway.

Frequency of traditional food consumption per season from summer 2007-winter 2008 along with average portion size was documented in interviews with 29 and 33 community members in Old Crow and Teslin, respectively. This information was compared with data collected in the early 1990s to illustrate changes in food use over the past fifteen years. The comparison, though limited by only two time points and differences in methodologies, may provide a snapshot of general trends of changes in traditional food use.

The frequency of consumption of traditional foods was not shown to decrease in Old Crow over the past fifteen years. Although the frequency of consumption of mammals decreased, frequency of consumption of fish, berries and other plants was reported to increase. In Teslin, frequency of traditional food use decreased overall, with plants other than berries being the only group to show an increase in frequency of use. The changes in traditional food use can be attributed to changes in environment, food availability, and perhaps cultural sensitivities. We are working with the communities to develop specific adaptation plans to minimize impact on their quality of diet. Contact: Roseanne Schuster ([email protected])

DYNAMICS OF HEMATOLOGICAL INDICATORS AS CLINICO-DIAGNOSTIC TEST SPORTSMEN’S ADAPTATION OF YAKUTIA TO PHYSICAL EXERCISES

E.I. Semenova, E.D. Okhlopkova, A.I. Yakovleva


The most important element in learning to adapt to the restructuring of the organism athletes intense physical strain in the extreme climatic conditions of Yakutia is the evaluation of morphological blood. The aim of our research was to study the physiological state champions qualified shifts hematological indices of blood in different periods of the training process. We examined 10 qualified and the most efficient free-style wrestlers in age from 17 to 20 years who participated in the championship of Russia among juniors. The concentration of hemoglobin, the number of erythrocytes, leukocytes and differential leukocyte formula was studied in the dynamics of 7 days before and after the competition.

Obtained showed that the athletes before and after the competition the number of red blood cells fluctuated within the limits of the rules: up to competition - 4,39 +/- 0,07, after - 4,42 +/- 0,09 million ml of blood. The concentration of hemoglobin to the competition in line with the average of 153,29 +/- 2,74 g / l. The concentration of hemoglobin above 160 g / l found in the three athletes. As a result, the average value of color index was higher standards. After the competition tended to normalize the concentration of hemoglobin - 135,4 +/- 3,49 g / l and a color indicator - 0913. The total number of leukocytes before and after the competition changed slightly 5,74 +/- 0,37 Thousands and thousands of 7,19 +/- 0,47 respectively. Differential counting of leukocytes revealed the presence of monocytosis (11,04 +/- 1,65%). The monocytosis detected in 80% of the athletes, the absolute - 40% of the athletes. After the tournament there was a gradual

normalization, and the number of monocytosis fell to 8,26 +/- 0,91%, however, the absolute monocytosis was still at 2 athletes. Saving monocyitosis after the competition, we think, is a sign of tiredness and dysadaptation of body. In this case, they need a development and application of rehab measures.

Thus, changes in hematological parameters in athletes before competition: increasing the concentration of hemoglobin, a color indicator of conserning monocytosis possibly linked to the violation of water-salt metabolism and dysadaptation of body also it will a clinical-diagnostic indicator of physical fatigue athletes. Contact: Evgenia Semenova ([email protected])

COLLABORATION AND CONSULTATION IN INFECTIOUS DISEASE SURVEILLANCE AND PREVENTION IN CANADA’S NORTH

S. Shaw, E. du Plessis, L. Thompson, C. Sevenhuysen, M. Fast

National Collaborating Centre for Infectious Diseases

Introduction: Designing and implementing infectious disease prevention programs is complicated by an evolving body of research, and an expanding range of intervention options. In northern Canadian, where rates of reportable infectious diseases have historically been among the highest nationally, program and policy planning also faces other unique and significant challenges. Access to health services, infrastructure limitations, geographic and environmental considerations, resource allocation, and social structures influence both clinical and public health strategies to reduce the impact of infectious diseases.

The mandate of the National Collaborating Centre for Infectious Diseases (NCCID) is to help bridge the gap between evidence and action. In fulfilling this role, NCCID has consulted with northern Canadian practitioners to identify public health priorities.

Results: Drawing from NCCID’s consultation in June 2008 and Forum in March 2009, this presentation will focus on identified gaps and priorities for strengthening public health’s response to infectious diseases in the Canadian north. This presentation will briefly outline NCCID’s process for involving multiple parties in knowledge exchange. The remainder of the session will outline critical gaps constraining the strategic planning of prevention programs, as well as significant issues affecting the prevention and control of infectious diseases in the Canadian north.

Conclusion: The identification and discussion of gaps, issues, and opportunities for infectious disease prevention in northern Canada will accelerate the development and implementation of effective programming strategies. Contact: Souradet Shaw ([email protected])

PHYSICAL DEVELOPMENT AS A FACTOR OF CHILDREN’S HEALTH IN THE FAR NORTH (RUSSIA)

N.N. Shim


Physical development is one of the most important criteria which reflects not only health status in a man but social welfare in population. Aim of a study was to define a level of physical development in schoolchildren living in the Far North (Tarko-Sale village and Nadym city) in comparison with other regions (town of Shatura, Central Russia). When comparing physical development of Nadym boys and Tarko-Sale boys, significant increase in the following indices was stated: height – by 5,7% (149,3±7,8 vs. 141,0±6,2, p<0,001), body mass – by 16,6% (43,4±9,6 vs. 36,2±5,4, p<0,001), lung vital capacity (LVC) – by 16,4% (2400±500 vs. 2006±290, p<0,001). Significant decrease in dynamometry of a right hand – by 2,8% and a left hand – by 6,9% (p<0,001) was also present. In Nadym and Tarko-Sale girls, the same tendencies were revealed. There was stated significant increase in height – by 2,9% (149,4±6,2 vs. 145,1±6,3, p<0,001), body mass – by


13,5% (39,9±5,9 vs. 34,5±5,1, p< 0,001), LVC – by 13,9% (2300±400 vs. 1980±320, p<0,001). Decrease in dynamometry of a right hand reached 15% and a left hand – 18,9% (p<0,001). Comparative analysis of Nadym children and Shatura children showed that Nadym boys had significantly higher height – by 3,8% (149,3±7,8 vs. 143,9±7,5, p<0,001), body mass – by 18,4% (43,4±9,6 vs. 33,7±7,1, p<0,001), LVC – by 27,0% (2400±500 vs. 1811±310, p<0,001). Indices of dynamometry of a right hand in Nadym boys were also higher by 23,5% and a left hand – by 41,2% (p<0,001). We found out that only 42,9% of Nadym schoolchildren had harmonious physical development. So, physical development of Nadym schoolchildren was characterized by higher indices but was quite disharmonious mainly due to excessive body mass. The fact can be explained both by more calorific nutrition of Nadym children and by extreme climato-geographic conditions of living and, as a result, by different intensity of metabolic processes. Contact: N.N. Shim ([email protected])

ASSESSMENT OF INTELLECTUAL DEVELOPMENT IN NATIVE CHILDREN OF YAMALO-NENETS AUTONOMOUS OKRUG (RUSSIA)

T.Ya. Shipulina, T.V. Maltseva, S.A. Tokarev


Children of indigenous population of the Far North often come across difficulties during school study because of their intellectual insufficiency. This problem is considered to be quite important. Aim of research was to study prevalence of mental and psychic retardation in younger schoolchildren of native residents taking into account gender and place of their residing (tundra, village). 112 native children who studied in the 1st-4th forms of boarding school in Nyda village (Nadym region) took part in the study on condition of written parents’ agreement. Among them 24 boys and 21 girls were tundra residents, 29 boys and 38 girls – village residents. Analysis of medical, psychological and pedagogical charts, results of a children psychiatrist’s examination allowed to reveal in tundra children 18 boys and 13 girls and in village residents – 11 boys and 12 girls – suffering intellectual insufficiency. In tundra children intellectual insufficiency (mental and psychic retardation) was revealed twice more often when compared to village children (68,9% vs. 34,3%, p=0,0003). In the same groups we defined statistically significant differences in prevalence of mental retardation (24,4 vs. 8,9%, p=0,0354) and psychic retardation (44,4% vs. 25,4, p=0,0487). Gender differences in prevalence of intellectual insufficiency were not revealed – 75,0% (boys) and 61,9% (girls), p=05327 in tundra children and 37,9% (boys) and 31,6% (girls), p=0,5874 in village children. Psychic retardation also did not differ in village boys and girls (20,7% and 28,9%, p=0,6268). The same situation was stated for tundra children – 50,0% (boys) and 38,1% (girls), p=0,6163. Gender differences were not also revealed for mental retardation – 17,2% and 2,6%, p=0,0776 – in village boys and girls; 25,0% and 23,8%, p=1,0 – in tundra boys and girls. Conclusion: Native children, residing in tundra, suffer intellectual insufficiency twice more often in comparison to children who live in villages. This fact demands thorough study of a problem. Contact: T. Ya. Shipulina ([email protected])

THE SÁMI PSYCHIATRIC YOUTH TEAM: A CULTURAL SENSITIVE TREATMENT APPROACH OF SUICIDAL BEHAVIOUR PROBLEMS AND SUBSTANCE ABUSE IN INDIGENOUS SÁMI

A. Silviken

The Sámi Psychiatric Youth Team (PUT), The Sámi National Centre for Mental Health, Helse-Finnmark

Objective: To present The Sámi Psychiatric Youth Team (The Sámi National Centre for Mental Health (SANKS)). The Team was opened in 1990 and the main office is located in Karasjok municipality, in Northern Norway. The Team’s catchment’s area is the five largest

indigenous Sámi municipalities located in the inland area of Finnmark County. The municipalities are all included in The Saami Language Act of Norway. The Team serves adolescents and young adults aged 15 to 30 years. The Team’s main issues are prevention and treatment of suicidal behaviour problems and substance abuse.

Methods: The Team emphasizes a cultural sensitivity approach. First, a) the Team staffs are cross professional including psychologists, social workers and a medical doctor, and b) the staffs have either indigenous heredity or native Sámi language competence themselves, or formal education in Sámi culture competence. Secondly, a) the clients/adolescents have easy access to the treatment facilities as they are able to admit themselves for treatment (not only school nurses, social workers etc.), b) the adolescents are able to receive treatment in their local communities, and c) there is an extensively use for short message services (SMS) — both for arranging appointments and as part of clinical intervention.

Results: One fifth of the clients have admitted themselves for treatment. Extensively uses of SMS have increased the Teams accessibility for communicating with indigenous Sámi adolescents. SMS have been especially useful in cases of intervention with adolescents who report self-harming, suicidal thoughts and attempts. There has also been a declined the dropouts’ rates due to SMS.

Conclusion: When working in a clinical setting with indigenous adolescents with mental health problems it is important to emphasize both a cultural sensitivity approach and easy access to the treatment facilities. Contact: Anne Silviken ([email protected])

PRIMARY BIRTHING ATTENDANTS AND BIRTH OUTCOMES IN REMOTE INUIT COMMUNITIES - A NATURAL “EXPERIMENT” IN NUNAVIK, CANADA

F. Simonet1, R. Wilkins2, E. Labranche3, J. Smylie4, M. Heaman5, P.J. Martens6, W. Fraser1, K. Minich7, Y. Wu1, C. Carry8, Z.-C. Luo1 1Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Montreal, 2Health Information and Research Division, Statistics Canada, 3Nunavik Regional Board of Health and Social Services, Canada, 4Department of Public Health Sciences, University of Toronto, Centre for Research on Inner City Health, 5Faculty of Nursing, University of Manitoba, 6Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, 7Department of Community Health Sciences, University of Toronto, 8Ajunnginiq (Inuit) Center, National Aboriginal Health Organization, Ottawa, Canada

Objectives: There is a lack of data on the safety of midwife-led maternity care in remote or Indigenous communities. In a de facto natural “experiment”, we assessed birth outcomes by primary birthing attendant in two sets of remote Inuit communities.

Methods: A geocoding-based retrospective birth cohort study in 14 Inuit communities of Nunavik, Canada, 1989-2000: primary birth attendants were Inuit midwives in the Hudson Bay (1,529 Inuit births) versus Western physicians in Ungava Bay communities (1,197 Inuit births). The primary outcome was perinatal death. Secondary outcomes included stillbirth, neonatal death, postneonatal death, preterm, small-for-gestational-age and low birth weight birth. Multi-level logistic regression was used to obtain the adjusted odds ratios (aOR) controlling for maternal age, marital status, parity, education, infant sex and plurality, community size and community-level random effects.

Results: The aOR (95% confidence interval) for perinatal death comparing the Hudson Bay versus Ungava Bay communities were 1.29 (0.63, 2.64) for all Inuit births, and 1.13 (0.48, 2.47) for Inuit births at ~28 weeks of gestation. There were no statistically significant differences in the crude or adjusted risks of any of the outcomes examined.

Conclusions: Risks of perinatal death were not significantly different in the Hudson Bay communities with midwife-led maternity care as

154 POSTER SESSIONS: T U V W X Y Z

compared to the Ungava Bay communities with physician-led maternity care. Our findings are inconclusive, although the results excluding extremely preterm births are more reassuring concerning the safety of midwife-led maternity care in remote Indigenous communities. Contact: Fabienne Simonet ([email protected])

ACTUAL NUTRITION AND CARDIOVASCULAR RISK FACTORS IN SIBERIA (1985-2005)

G.I. Simonova, O.M. Bragina, Yu.B. Parlyuk, Yu.P. Nikitin


Purpose: To study twenty years dynamics of actual nutrition of adult Siberian population and to estimate its correlation with cardiovascular risk factors (cohort analysis for the period 1985-2005).

Methods: Two representative samples of men and women 25-64 years old were investigated. We used data of Novosibirsk center in WHO MONICA project and HAPIEE study. Screenings were carried out in 1984-1985, 1988-1989, 1994-1995 and 2002-2005 years. Total number of subjects was 11670. Endpoints were taken from total mortality register database.

Results: The structure of urban Siberian population nutrition is highly unbalanced: the large part of total fat from meat and dairy products is 39-46%, and the small part of polyunsaturated fatty acids from fish ~ 1%. We also registered high consumption of sugar (up to 70-75g daily) and starch saturated products alongside with low consumption of compound carbohydrates, vitamins and cellulose. In 1995 and 2005 daily consumption of fruits was 290 and 437g per day respectively.

The prevalence of obesity in men increased by 2005 to 21%, that is for about 10% higher than in 1995. Average total cholesterol level increased from 5.3 to 6.0 mmol/l. The prevalence of obesity in women was 45%. Average total cholesterol level increased from 5.7 to 6.4 mmol/l. The frequency of metabolic syndrome was 18% in men and 33% in women.

Conclusion: Changes in actual nutrition of the population is associated with the dynamics of major cardiovascular risk factors. Contact: Galina Simonova ([email protected])

SYSTEMATIC REVIEW OF EDUCATIONAL INTERVENTIONS TO INCREASE HIGH SCHOOL GRADUATION AMONG INDIGENOUS HIGH SCHOOL STUDENTS

A. Stepushyn

University of Toronto - Community Health and Epidemiology

Background: Aboriginal populations in Canada are younger than then non-Aboriginal population and Aboriginal children and youth are making up a larger proportion of the school population. Education is an important determinant of health and Aboriginal populations have lower educational attainment than the non-Aboriginal population. Larger school-age population, the lower levels of educational attainment among Aboriginal youth and the importance of education for future well-being has made it critical to identify strategies and programs that are effective in increasing high school completion among Aboriginal youth.

Objectives: To evaluate educational interventions effective at increasing high school completion among Aboriginal high school students in Canada and Indigenous students internationally.

Methods: A systematic overview was conducted in February 2009. Articles, reports and program evaluations were identified through a systematic search of five electronic databases (MEDLINE, PsycInfo, ERIC, CBCA Education, and the Bibliography of Native North Americans). Reference lists of articles and reviews as well as websites of international organizations (governmental, non-profit and research) were reviewed for relevant studies and reports.

Studies that were included examined a program, intervention, or educational strategy that focused on improving retention and

graduation among a student population of predominantly (>50%) Indigenous high school students. Only English language studies available through the University of Toronto library system were reviewed. No restrictions were made based on study design, dates or location of publication.

Results: Over 1,700 abstracts were identified and a total of five articles that met the inclusion criteria and were available through the University of Toronto library system were reviewed. All reports were from Canada (N=2) or the United States (N=3). Reports focused on either individually-targeted programs for high risk students (N=2) or population-level interventions for an entire class, school or school division (N=3). The most common intervention was the integration of Indigenous knowledge and pedagogical styles into school curriculum (N=2). Other strategies included an alternative high school, an intensive academic summer program and a program aimed at developing creative problem skills and work experience. Although all projects reported positive outcomes there was insufficient homogeneity in terms of populations, interventions, study design or study quality to calculate a single measure of effect.

No exclusions were made based on study design because of the small number of applicable studies. As such, the quality of the studies varied significantly but was generally low. Three of the five studies lacked comparison groups. Papers generally lacked structure and detail that would allow judgments of potential biases. No randomized control trials, or well designed quasi-experimental designs, were located.

The identification of only five studies, despite a rigourous search (1738 seemingly relevant abstracts were studied, and other efforts were made to find relevant studies without abstracts) suggests that this is an underdeveloped area of research.

Conclusion: Additional methodologically-sound research in this area is required to capture and evaluate strategies and programs that maximize the ability of Aboriginal youth and communities to succeed academically. Contact: Megan Stepushyn ([email protected])

T U V W X Y Z

SOME DEMOGRAPHIC PECULIARITIES OF LONGEVITY IN THE INDIGENOUS MINORITIES OF RUSSIA NORTH-EAST REGIONS

O.V. Tatarinova, Yu.P. Nikitin


Purpose: We analyzed contemporary levels and dynamic tendencies of longevity in the Indigenous Minorities (IM) of Siberia and the Far East.

Methods: Using the results of all-Russia censuses of enumeration 1989 and 2002 we studied the dynamic of absolute number of long-livers and census longevity indexes (correlation between subjects older than 90 to the number of subjects older than 60 (LI-2)) in 21 Indigenous Minorities of Asian North in 1989, and in 2002 — similar data concerning 37 ethnicities.

Results: The total number of Asian north aborigines in 1989 was 181517, in 2002, 243982 (+34%). During the same period the absolute number of long-livers decreased for 12%.

In 1989 the number of representatives of some IM (all ages) was from 170 (Orokes) to 34190 (Nenets); in 2002 from 8 (Kereks) to 41302 (Nenets). The number of long-livers in indigenous ethnicities was from 1 to 40 in 1989 and from 1 to 37 in 2002.

In 1989 there were no long-livers older than 90 in 6 IM from 21 (29%). In 2002 this index increased to 35%. Centenary long-livers in 1989 was in 7 ethnicities, in 2002, in just 4.

According to LI-2 estimations, some ethnicities had high indexes in 1989: Ulichs, Nenets, Evens and Evenkis; in 2002, Nenets and Ulichs.


In 1989 men long-livers were represented in 15 from 21 IM (71%), in 2002, in 17 (73 %). IL-2 indexes prevailed in women in all ethnicities.

Conclusion: Despite the increase in total number of aboriginals in Russia north-east regions in 1989-2002, the absolute number of long-livers older than 90 decreased. During the same period LI-2 in most ethnicities also decreased. Long-livers were registered mostly in women. Contact: Yuri Nikitin ([email protected])

THE CAREGIVER’S JOURNEY

A. Timmins

Artico Biota Studio

The “Caregiver’s Journey” is an exhibition of original paintings that explores the emotional and physical journey of care giving and recovery. I was the primary care giver during my daughter’s cancer recovery. Later I realized that my personal resources were depleted, I needed to find my healing process, which led me back to self expression and healing through art.

There are many shared aspects of care giving from a northern community:

- traveling from a small community to a large city with a small child or sick person is stressful & lonely

- seeing other families looking after their loved one, northerner caregivers need family support but often find that family bonds are being stretched

- learning how to communicate with nurses and doctors, so that one doesn’t feel diminished

- I found that it helps to reach out and share common experiences in the hospital environment

- lifting the spirits of a loved one in distress by taking their thoughts away from their pain or worry

- to overcome boredom during long periods of waiting it helps to play a game or draw, even dreaming about good times in the past or in the future

- there are difficulties when a caregiver’s livelihood, routines and their own personal lives are interrupted for an extended period of time

- this show will attempt to show through imagery that caregivers can access art and experience art in the midst of care giving to relieve their anxiety

Contact: Ann Timmins ([email protected])

FEATURES OF THE CORONARY ARTERIES ATHEROSCLEROSIS AND ITS EVOLUTION IN INHABITANTS OF YAKUTIA FOR 40-YEAR PERIOD

M. Tomskiy, V.A. Argunov

SB RAMS

Purpose: to estimate dynamics of atherosclerotic process in coronary arteries in the men living in Yakutia for the 40-year period by comparison of results of three stages of pathologic-anatomical epidemiological researches.

Methods: For three stages of pathologic-anatomical epidemiological researches coronary arteries in 1030 [1st stage-1962-65 (423), 2nd stage - 1985-88 (443), 3rd stage-2001-03 (167)] practically healthy men of indigenous and non-indigenous nationality in the age of 20-59 years, died by a violent death and not had any chronic diseases were investigated by visually- planometric method. After total painting by sudan in vessels the stenosis degree, the area of elevated lesions which was combined from the sum of the fibrous plagues areas, complicated lesions and calcinosis were defined.

Results and Discussion: It is established, that for the 40-year period evolution of an atherosclerosis has undergone the essential changes that is worsening of atherosclerotic process current in coronary arteries, both in native, and non-native population due to increase in the area of elevated lesions. It is necessary to note, that distinctions

have been more expressed in the age of 40 years, and between the first stage and the subsequent investigation phases. Thus, distinctions in the area of elevated lesions in a descending branch of the left coronary artery between the second and third stages of researches in persons of non-indigenous nationality were less significant, than between the first and the second, that testifies to some stabilization of atherosclerotic process in the given population. For the native population rates of growth of the area of elevated atherosclerotic lesions remain stably high at all investigation phases. So, if in men of indigenous population in the age of 50-59 years the area of elevated lesions in a descending branch of the left coronary artery made at 1st stage 15,4±0,9 %, on 2nd and 3rd stages has increased accordingly up to 20,8±1,2 % and 27,8±0,6 % of the area of vessel. For the last period frequency of stenoses of coronary arteries with prevalence of multiple stenosing sites has essentially increased. Preservation of rates of growth and prevalence of heavy kinds of atherosclerotic lesions in coronary arteries of aboriginals of Yakutia for last decades are the influence of the urbanization, accompanied by changes of the life way, a traditional feed and ecology of northern territories.

Conclusion: Results of three stages of researches of an atherosclerosis testify to its proceeding burdening in persons of indigenous nationality and some stabilization for the last 20 years of an atherosclerosis heaviness parameters in the non-indigenous population of Yakutia. However, despite of progressive heavining of atherosclerosis, for indigenous population the law consisting to a lesser degree of an atherosclerosis in vessels that is caused by genetic features of a structure of a vascular wall, namely, smaller thickness of arteries intimas, in comparison with non-indigenous ones, is still kept. Contact: Mikhail Tomskiy ([email protected])

INFLUENCE OF MIGRATION AND DURATION OF RESIDING IN CONDITIONS OF THE NORTH ON ATHEROSCLEROTIC PROCESS CURRENT

M. Tomskiy, V.A. Argunov

SB RAMS

During intensive industrial development of northern territories, there came migrants to Yakutia, mainly, from the European part of Russia and Siberia that sharply differed on the climatic conditions. In this connection, revealing distinctions in rates of development of an atherosclerosis in migrants from different regions of the country represents doubtless interest.

Aorta and coronary arteries in 770 men of non - indigenous nationality in the age of 20-59 years which have arrived to Yakutia from the European part of Russia and from Siberia are investigated by visually- planometric method. Frequency and the fibrous plagues area, the complicated lesions, calcinosis, and also frequency of CA stenoses were defined.

It is revealed, that, despite lacking essential distinctions in frequency and the area of various kinds of atherosclerotic lesions in vessels in migrants from various regions of Russia, frequency of stenoses of coronary arteries was almost in 2 times more in migrants from the European part of Russia. So, stenoses of a descending branch of the left coronary artery in migrants from the European part of Russia were registered twice more often (20,0 %), than in natives of Siberia (10,3 %).

The comparative analysis of influence of northern experience on the area of atherosclerotic lesions in CA has shown, that in the men who have lived in the North more than 10 years, the area of an atherosclerosis was essentially larger, than in persons with smaller northern experience. Significant distinctions are revealed in frequency of CA stenoses in persons with various northern experiences. So, in right CA stenoses are met more than in 2 times often (18,2 %) in northerners - old residents, than in persons with the 5 and 5-10 yrs experience (8,6 %). Similarly, DLCA stenoses are more often registered in northerners - old residents (in 36,5 % of cases), than in persons with northern experience of 5-10 years (23,4 %) and till 5 years (20,7 %).


Thus, acceleration of development rates of coronary arteries atherosclerosis with greater frequency of stenoses in migrants from the European part of Russia, in comparison with migrants from Siberia, testifies to the best adaptation of Siberians to extreme conditions of the Far North. Frequency and the CA atherosclerosis area in migrants is directly proportional to duration of residing in conditions of the Far North. Contact: Mikhail Tomskiy ([email protected])

THE BASIC DIRECTIONS OF WORK OF THE YAKUT SCIENCE CENTRE OF COMPLEX MEDICAL PROBLEMS SB RAMS

M. Tomskiy, T.E. Burtseva

SB RAMS

The staff of Yakut Research center of CMP SB RAMS is 69 employees. The given centre consolidates scientific potential of Republic and coordinates the organization and carrying out of basic researches in the field of medicine in Republic. From the moment of creation of the centre in 2001 employees have defended 5 theses for a doctor’s degree, 22 master’s theses, 19 monographies on actual problems of person health in the North, 263 articles in the Russian press and 22 articles in a foreign press have been published, 1 patent for the invention was obtained. There are 3 departments: a department of molecular genetics, a department of adaptation mechanisms, a department of chronic non-infectional diseases epidemiology. The basic directions of our centre are: studying of atherosclerosis, oncologic pathology, a hereditary pathology, cold traumas in inhabitants of Republic, and studying of children’s health state.

In the Centre the population of Republic DNA bank is created, the profound researches of prevalence of a hereditary pathology are carried out, the register of a hereditary and congenital pathology is conducted, genes candidates of multifactorial diseases for populations are investigated.

It is scientifically proved, that for the 40-year period evolution of an atherosclerosis has undergone the essential changes that is worsening of atherosclerotic process current in coronary arteries, both in native, and non-native population due to increase in the area of elevated lesions.

Studying of physical development, the hormonal status of children of native small in numbers people of the North of Yakutia has revealed essential regional and ethnic features, thus growth and weight of children of small in numbers people of the North are in the bottom corridor of nomograms (p<0,05), arterial pressure is higher, than in children of the alien population, parameters of the hormonal status essentially do not differ.

Medical expeditions to places of compact residing of native small in numbers people of the North of Yakutia, to the regions of Republic for the profound studying of a health state of the indigenous and alien population are annually carried out.

YRC CMP SB RAMS closely communicates with large centres of science: Scientific research institute of therapy SB RAMS (Novosibirsk), Tomsk centre of science of medical genetics SB RAMS, Institute of biochemistry and genetics of the Ufa centre of science of the Russian Academy of Science, and also with the foreign centres, including scientific research institute of brain (Niigata, Japan), the Estonian Biocentre (Tartu, Estonia), clinic Maunt-Sinaj (New York, USA). Contact: Mikhail Tomskiy ([email protected])

WAY OF DEFINITION OF DEEP TISSUES TEMPERATURE AFTER COLD IMPACT IN PRE-REACTIVE PERIOD

M. Tomskiy, J.R. Alexeev, R.Z. Alexeev

SB RAMS

The problem of conservative treatment of frostbites in pre-reactive period and furthermore with a congelation of tissues until now contains a significant amount of debatable questions and still is topical. A relative rarity of patients in pre-reactive period, especially with a

congelation of tissues, difficulties of diagnostics and absence of objective methods of supervision over a condition of blood circulation and efficiency of treatment, this problem remains to be vital and the most important.

Thermography is a valuable method of definition of efficiency of this or that method of treatment. The attractive side of this method of inspection of patients is its absolute harmlessness, an opportunity of multiple, repeated, dynamic researches and relative simplicity in interpretation of the received results.

In particular, detailed studying of temperature changes in tissues of the cooled segment, enables to diagnose presence of congelations of tissues. Definition of superficial temperature cannot show temperature in depth.

We offer to define interstitial temperature for diagnostics. For this purpose, we apply the original thermometer with the gauge on a tip of injection needle. The method is approved in more than 2000 patients. In 96 patients admitted in pre-reactive period on depth of 3-4 mm the temperature in tissues was from 2 to 23 below zero, thus the superficial temperature was from 3 to 5-6 degrees above zero. In 34 patients at admittance superficial temperature was from 14 to 16 degrees above zero, but in depth of 4 mm the temperature was from 3 to 6 degrees below zero.

Thus, the true picture of depth of freezing of tissues can be defined only by measurement of temperature on depth of 4-6 mm. By leaving a needle with the thermocouple on depth, it is possible to determine efficiency of infusion therapy. Contact: Mikhail Tomskiy ([email protected])

HEALTH STATE OF SMALL IN NUMBERS PEOPLE CHILDREN OF THE NORTH OF YAKUTIA

M. Tomskiy, T.E. Burtseva, G.G. Dranaeva

SB RAMS

Burtseva T.E., Dranaeva G.G. 25154 representatives of small in numbers people of the North (snpN), including 10373 Evens, 12729 Evenks, 961 Dolgans, 483 Chukchi, 608 Yukagirs live in Republic Sakha (Yakutia) on the end of 2008. Number of the children’s population of radical small in numbers people from 0 till 17 years inclusive for January, 1st 2008 has made 9414 children. On rank structure of morbidity of children of aboriginals respiratory illnesses are in the lead, which relative density has made 54,5 % (2006-53,4 %), on the second place - digestive illnesses, relative density has made 9,9 % (2006-11, 5 %), on the third place - illnesses of skin and hypodermic fat- 6,7 % (2006-6,6 %). The profound inspection of children has revealed the following tendency: each 2nd child has disease of eyes and adnexal apparatus and caries, each 4th child: gastrointestinal tract pathology, endocrine system, a pathology of ear, throat and nose, illness of nervous system and noise in heart.

Studying of the hormonal status has revealed, that in girls Sakha and small in numbers people of the North from 10-14 years follicle-stimulating hormone (FCH) and luteinizing hormone (LH) contents authentically differ (FSH: girls Sakha 11,13 mIU/ml; girls- snpN 7,39 mIU/ml; LH: girls Sakha 14,47 mIU/ml; girls- snpN 6,95 mIU/ml), and in girls Sakha both FSH, and LH are higher, than in girls snpN. Comparison of the received results of the hormonal status to development of secondary sexual attributes has confirmed that girls Sakha advance in sexual development girls snpN. In boys Sakha FSH and progesterone are higher, than in boys snpN in this age group (FSH: boys Sakha 8,01 mIU/ml; boys- snpN 5,53 mIU/ml; progesterone: boys Sakha 1,28 ng/ml; boys- snpN 0,60 ng/ml). Comparison of the received results of the hormonal status to development of secondary sexual attributes has confirmed that teenagers Sakha advance in sexual development teenagers snpN.

With the purpose of studying of a hereditary pathology load 315 children on two loci are surveyed: intron 2 (a marker of the classical form dhj; ltyyjq dysfunction of adrenal cortex (CDAC) and exon 7 (a marker of nonclassical form CDAC). Results of research have appeared


to be unexpected. Mutation V281L causing occurrence of the nonclassical form of congenital adrenal hyperplasia: in Chikchi - 2:39 (5,1:100), in Yukagirs - 2:40 (5:100), in Evens - 2:48 (4,2:100), in Sakha - 1:49 (2:100), in Evenks - 2:106 (1,9:100). Thus, the mutation frequency of a marker of CDAC nonclassical form revealed by us is comparable to the data received earlier (in Yupik Eskimos 1,7:100 (Pang S., Wallace M.A .and al, 1998)).

Thus, studying of a health state of children of small in numbers people of the North of Yakutia is one of priority directions of YSC CMP SB RAMS. Contact: Mikhail Tomskiy ([email protected])

THE POPULATION HISTORY OF SAKHA (YAKUTS) IN CONNECTION WITH PREVALENCE OF SOME HEREDITARY DISEASES

M. Tomskiy, S.A. Fedorova, E.K. Khusnutdinova, R. Villems

SB RAMS

We have characterized, at high phylogenetic resolution, mtDNA variation (n=694) and Y chromosome haplotypes diversity (n=318) in populations of the Republic Sakha (Yakutia) in the northeastern part of Russian Federation (Sakha or Yakuts, Evenks, Evens, Yukaghirs, Dolgans) and analyzed our results in a broader context of the Eurasian mtDNA and Y-chromosomal variability. The genetic portraits of studied ethnic groups were obtained and scenarios of ethnogenesis of different nations suggested by historians and archaeologists were compared with genetic reconstructions

Sakha (Yakuts) differ from other Siberian populations by the striking prevalence of hg N3. The median-joining network of N3 lineages have very strongly pronounced star-like phylogeny in Yakuts, that specifies on founder effect characteristic for the whole gene pool of this nation. The coalescence time of N3-haplotypes in Yakut population is 1540±580. Thus, one can propose that the specific peculiarities of Yakut gene pool have been formed at least during 20 centuries in isolated conditions. The mitochondrial gene pool of Yakuts differs from other populations of Yakutia by high level of diversity of western Eurasian lineages that consists 10% and by significantly high frequency of cluster D5a2 (18%). The low level of lineages diversity in Yakuts in comparison with other populations indicates to the small size of ancestral population with subsequent significant expansion. We considered our results in connection with some epidemiologic and molecular genetic researches of hereditary diseases characterized by a high prevalence among Yakuts such as spinocerebellar ataxia type 1 (1:2590) (Platonov, 2003), myotonic dystrophy (1:4690) (Sukhomyasova, 2005), 3-M syndrome (1:8775) (Maksimova et al., 2007). Contact: Mikhail Tomskiy ([email protected])

FEATURES OF CLINICAL -FUNCTIONAL CHANGES IN ABORIGINALS OF YAKUTIA WITH THE VERIFIED CORONARY ATHEROSCLEROSIS

M. Tomskiy, N.V. Maharova, R.V. Jakovlev

SB RAMS

Purpose: To reveal clinical -functional features in aboriginals of Yakutia with the verified coronary atherosclerosis.

Methods: Results of inspection of 238 native and 244 alien inhabitants of Yakutia with verified coronary sclerosis have been included in the analysis. The analysis of rhythm infringements was made by results of Cholter monitoring. Echocardiographic research was held by the standard technique. Electrocardiographic research was made in rest in 12 standard assignments with a speed of 25 mm/sec. Selective coronary angiography (SCAG) was held on angiographic installation “Axiom. Artis BA” (Siemens, Germany) by Judkins standard technique, the quantity and a degree of coronary arteries (CA) lesions was defined. A multispiral computer tomography (MSCT) was held on the

4-spiral computer tomograph Somaton Sensation-4 (Siemens, Germany); calcium index (CI) was calculated on Agatston.

Results: According to SCAG in indigenous people, stenoses up to 50 % were found unlike alien which had stenoses of 50-75 % and occlusions (p=0,002). According to CI mean value in aboriginals has made 238,8±83,3 units, in alien-545,6 ±98,6 un. (p=0,000). Q - myocardial infarction is revealed in 54,9 % with identical frequency both in natives and in alien, more often in natives CAD began with AMI (78,6 %) whereas in alien with AMI began in 54,7 % (p=0,000). In natives more often overventricular infringements of rhythm came to light unlike alien in which more often ventricular infringements of rhythm, and of a high gradation took place. The fraction of emission less than 45 % met more often in alien (22,3 %), than in natives (10,6 %) (p=0,002).

Conclusions: The analysis of clinical-functional parameters has shown, that in aboriginals of Yakutia an atherosclerosis of coronary arteries is expressed more weakly, than in alien, thus the Q - myocardial infarction is revealed in 54,9 % with identical frequency both in natives and in alien. In natives CAD painless forms were revealed more often, on heaviness of a clinical picture in natives lighter current of disease was noted. Contact: Mikhail Tomskiy ([email protected])

IMPLEMENTING A NUTRITION INTERVENTION PROGRAM AMONG THE INUIT IN NUNAVUT: STORE-CENTERED ACTIVITIES OF HEALTHY FOODS NORTH

M. Ugyuk, R. Rosol, A.J. Brunetti, E. Mead, C. Roache, R. Reid, J. Gittelsohn, S. Sharma

The Hamlet of Taloyoak, Taloyoak, NU

Objective: To describe how Healthy Foods North (HFN) implemented store-centered activities to increase the availability and accessibility of healthy store-bought foods, and to influence dietary choices among the Inuit.

Setting: Two remote communities in Nunavut, Canada.

Design: Fourteen month, seven-phase, multi-institutional, community-based nutritional intervention program aimed at Inuit men and women, 19 years of age and older. This poster outlines activities related to the store component of Healthy Foods North.

Results: Store-based activities, which included interactive sessions such as food tasting, end-of-aisle displays, shelf labels, and posters, were an effective strategy to influence and inform community members at the point-of-purchase. One-on-one encounters between shoppers and locally trained community interventionists were reinforced through giveaways, recipe cards and handouts throughout the program. Partnering with local store managers was essential to the implementation of the HFN at the community level, and to ensure the availability of healthier food alternatives.

Conclusions: This novel multi-institutional nutritional intervention, Healthy Foods North, benefits communities through these partnerships as well as through locally trained interventionists who conduct the project activities.

Acknowledgements: The research was supported by the American Diabetes Association Clinical Research Award Grant # 1-08-CR-57. Contact: Mary Ugyuk ([email protected])

ETHICAL ASPECTS IN THE ENVIRONMENTAL HEALTH RESEARCH

K. Vähäkangas1, A. Rautio2, A.M. Pietilä3

Departments of 1Pharmacology and Toxicology and 3Nursing Science, University of Kuopio; and 2Centre for Arctic Medicine, Thule Institute, University of Oulu, Finland

At the moment in the Northern societies there is a huge change on-going not only in climate, ecosystems, but also in socio-economic and cultural issues. Environmental research is always multidisciplinary and thus we need to consider research ethics also from multidisciplinary


point of view. Our aim is to find good practices in a multidisciplinary approach. This is challenging because different research fields/disciplines have their own paradigms, methodologies, and research traditions. By listening, understanding, and finally working together we can understand more deeply the complexity of environmental health problems. To start our collaboration it is important first to analyze the existing literature and review the views of different disciplines.

Basic concepts in good research ethics are always the same: pursue of truth, scientifically sound research methodologies and respect for research participants and collaborators. Additional recognized ethical aspects in environmental health research are global: unequality of resources and in means to influence the environment and take actions accordingly. The research training should be planned taking on account also ethical aspects of research. Mandatory courses for understanding research ethics in various disciplines may be advisable. Education and training of young scientists in issues of environmental changes and environmental health is naturally the prerequisite for the future research. The multidisciplinary research team has to discuss at a very early phase such ethical issues, not only concerning the patients, but also the whole process from setting the aims of the studies through the working phases to the publishing of data.

This is also essential to justify the projects, especially when dealing with other stakeholders in society. Contact: Arja Rautio ([email protected])

THE CLINICAL-MORPHOLOGICAL PECULIARITIES OF GASTRODUODENAL PATHOLOGY IN EVENKIAY CHILDREN

M. Valery, T. Polivanova

State Scientific Research Institute of Medical Problems of the North

The aim of our investigation was to study the clinical-morphological peculi-arities in schoolchildren of native and strange population of Evenkiay. 1204 children of strange and 299 children of native (evenks) population in age 7-16 years were examined. Esophageal gastro duodenal scope and morphological research of stomach mucous membrane were made in representative children groups of each population with dyspepsia syndrome. We revealed that dyspepsia was very often in evenks. Dyspepsia had func-tional character in the biggest part of children of native and strange population. The erosion-ulcer defects of stomach and duodenum mucous membrane were diagnosed in evenks in two times seldom. The evenks children with erosion-ulcer de-fects of gastro duodenal zone complicated on abdominal pain rarely; besides, the pathology in evenks was determined after prolonged dyspepsia syndrome. The erosion-ulcer defects of gastro duodenal mucous membrane in children of strange population were associated with high activity of antral gastritis. We revealed the high infection of H.pylori in the children of both population and especially who had erosion-ulcer defects of gastro duodenal zone. We observed the increase of H.pylori contaminating area in children of Evenkiay strange population with gastro duodenal pathology, possible as a result of immune reactivity decrease.

Conclusion: there are the determined ethnic peculiarities of clinical-morphological appearances of gastro duodenal pathology in children of Evenkiay, with most unfavorable course in strange population. Contact: Valery Manchuk ([email protected])

THE REASONS OF SUICIDAL BEHAVIOUR OF SIBERIA NATIVE POPULATION

M. Valery, N. Semenova

State Scientific Research Institute of Medical Problems of the North

The highest indicators of mortality from suicide in Siberia are registered in Tyva. The frequency of completed suicide in this region exceed All-Russia indicator in 1,6 times, and average world index more then 4 times. The aim of the present investigation was the study of the reasons of suicidal behaviour of tuvinian, native population. 1634

adolescents and 286 families were examined. We revealed the unfavourable influence of social reasons, including ethno-political and social-economic changes, happened during last 50 years. The change of ethno-political conditions, the assimilation of western culture in mentality of tuvinian led to losing them former valuable orientation (the value of family attitude, religious and ethnic identity), with revaluation on another social values. The consequence of this was disbalance between external manifestation of tuvinian life and their internal world; they could not realized affiliate need, one of the main requirements, which was very important for orient culture. The change of social-economic formation for short period of time, the disturbances in system of life; the use of not typical cultural and domestic elements became excessive stress factors for native population, who had low dynamic adaptation because of ethnic peculiarities of psychical processes. The suicidal behaviour of tuvinian was the result of psychical adaptation disturbances and was the sign of psychical nervous breakdown because of highest requirements to adaptative mechanisms in disbalance of human-environment system. For prevention the disadaptive behaviour they need in complex of measures, directed on improvement in the value of family attitude, ethnic mentality and creation of viability in children and adolescents of Tyva in modern social-economic conditions. Contact: Valery Manchuk ([email protected])

CREATING MODELS FOR MOTHER’S WELLNESS THROUGH PARTNERSHIP RESEARCH: A COMMUNITY PARTNER EXPERIENCE

M. Van Bibber

Inter Tribal Health Authority

Purpose: The purpose of the Healthy Community Mothers and Children Research Project was to develop respectful and culturally appropriate models of supporting the health and well-being of mothers at risk and ultimately promote the birth of healthy babies. Inter Tribal Health Authority is committed to developing its capacity for community based research as a way of promoting family and individual well-being amongst its 29 member First Nations. The poster will profile one of four innovative models developed through collaboration between researchers and four community partners in Canada. The models are designed to assist post partum mothers with risky drinking behaviours, in their journey to wellness.

Process/Approach: The research process incorporated both community and university based expertise to modify a model of brief alcohol intervention to better fit the unique aspects of the partner communities. Aboriginal community members in four communities developed community-specific interventions utilizing local knowledge and expertise. University-based researchers provided examples of research tools and a structured approach which supported community-based researchers in conducting the research. These models can be useful to front line workers and others who are working with women in preventing maternal alcohol consumption during future pregnancies.

Findings: A community model of brief alcohol intervention profiled in this poster has incorporated local/indigenous knowledge and preliminary results indicate the models are both acceptable and effective.

Results: The community participation increased awareness of FASD and the importance of supporting prospective mothers. As a result of the HCMC research, ITHA successfully developed a proposal for an FASD mentor program to provide supportive services to women in five First Nation communities on Vancouver Island. The research process and partnership has raised awareness of the value of research as an important tool for improving health status in Aboriginal communities. Contact: Marilyn Van Bibber ([email protected])

NORTHERN BREASTFEEDING VIDEO

S. Wadowska1, A. Godfreyson2


1Yellowknife Health and Social Services Authority, 2Beaufort-Delta Health and Social Services Authority, Canada

Objectives: The aim of this video is to promote breastfeeding to pre and postnatal women by providing a current, northern focused breastfeeding video for distribution to and use by Canada Prenatal Nutrition Programs (CPNP) and other appropriate health programs. The reason for initiating such a project is the belief it would be valuable to CPNP projects and other organizations across the territory to have access to a video that discusses breastfeeding within a northern population. The videos currently available for promotion of breastfeeding are not culturally appropriate for women in the Northwest Territories (NWT). This statement has been made by many CPNP Workers and participants in the NWT. The videos currently available are southern-based, depicting non-Aboriginal women or women of southern-based Aboriginal groups. Women from the North have a difficult time relating to the women in these videos and therefore the promotion of breastfeeding through the use of southern-based videos is severely impaired and arguably culturally insensitive. The video is narrated by a young aboriginal woman who is pregnant for the first time and is looking to find out more information about breastfeeding. She meets with various people throughout the video, such as an elder who speaks about breastfeeding as traditionally being the best way to feed a baby. The video is seen as her journey in discovering breastfeeding through the experiences of other women.

Methods: The video is currently being filmed using northern women as actors. A local production company has been hired to film, edit and produce the video.

Results: We hope that this video will increase initiation and duration rates of breastfeeding in Northern women. We will launch the video at our annual CPNP workshop and do informal surveys with participants of the CPNP programs to measure the effectiveness of the video. Contact: Sophia Wadowska ([email protected])

IMPACTS OF CLIMATE CHANGE ON INUIT DIET IN THE WESTERN ARCTIC: LINKS BETWEEN CLIMATE CHANGE, FOOD SECURITY AND NUTRITIONAL HEALTH

S. Wesche, L.H.M. Chan


There is a nutrition transition occurring among Indigenous peoples globally. Similar trends are being observed in Inuit in the Arctic. While market foods now make up more than half of Inuit dietary intake, the consumption of traditional foods remains key for dietary quality and central to local identity and livelihoods. Traditional foods provide important nutrients, vitamins and minerals, and help restrict the intake of the saturated fats, sucrose and excess carbohydrates often found in store-bought alternatives. The access to, availability of, and condition of traditional food species in the western part of Canadian Arctic are affected by changing climatic conditions, with implications for food security and human health. This study examines critical impacts of climate change on Inuit diet and nutritional health in four communities in the western Canadian Arctic to identify both community-based and regional trends. The vulnerability of each community to changing food security is differentially influenced by a range of factors, including current harvesting trends, levels of reliance on individual species, opportunities for food substitution, and exposure to climate change hazards. At a regional scale, declining harvests of caribou are of common concern, as this species is a primary meat source for all communities in both summer and winter. Nutritional implications of lower traditional food use include likely reductions in iron, zinc, protein, vitamin D and omega-3 fatty acids, among others. Understanding linkages between climate change and traditional food security provides a basis for strengthening adaptive capacity and determining effective adaptation strategies to respond to future change. Contact: Sonia Wesche ([email protected])

ETHICAL AND CULTURAL IMPLICATIONS OF SPECIMEN BANKING AMONG ALASKA NATIVE PEOPLE: HISTORICAL PROJECT.

A. Willetto Wolfe

Southcentral Foundation

Background: The use of human biological specimens in research studies has occurred in Alaska since the 1950s. Approximately 532,500 serum specimen aliquots from 91,500 individuals are currently housed at the Arctic Investigations Program of the Centers for Disease Control (AIP CDC) located in Anchorage, Alaska. Specimens from Alaska Native people make up 79% of the bank, 17% of the samples are from non-Native people, and 4% are unknown. The historical project focuses on when and how the AASB was created and how it has been used and governed over time. This includes changes in consent for collection, storage and use. This chronology is important as a historical context for discussions regarding policy and procedures for the AASB.

Purpose: To describe initial findings about the inception, use, management and documentation for collection and storage of the Alaska Area Specimen Bank (AASB) over time. Some members of the Alaska Native community have expressed concern about the use and storage of specimens.

Methods: Medical researchers were interviewed about their knowledge and use of the AASB. They were specifically queried about research approval processes and consent. Archived periodicals were used to cross reference information shared by informants and contemporary documentation.

Results: The AASB was created around 1960, but no informants involved at inception have been interviewed to date. In 1973, management was transferred from the Arctic Health Research Center (a university-based site) to the Artic Investigation Program at the Centers for Disease Control and Prevention (CDC) in Anchorage, Alaska. Research since 1973 has predominantly involved immunizations or improved screening for a pressing public health issues. Consent processes have become increasingly detailed with more regulations and reviews by Tribal Health Organizations, village councils, and institutional review boards. Management of the AASB is now the joint responsibility of the CDC and a group of Alaska Native leaders from across the state.

Conclusions: Accounts of the early years of the serum bank are less defined than more recent years. Preliminary information gathered does not reveal evidence of inappropriate access or use of the AASB. Future work will focus on obtaining additional information about the early years of AASB. Contact: Abbie Willetto Wolfe ([email protected])

160 Presenters’ Index: By Initials & Surname

Presenters’ Index

By Initials & Surname

A

A. Abel, 48 A. Apicyn, 24 A. Baker, 61 A. Banerji, 36 A. Binzer, 25, 65, 87 A. Brockman, 48 A. Bult-Ito, 67 A. Corriveau, 27, 44, 76, 97 A. Cortinois, 52 A. Daniels, 43, 120 A. Demers, 124 A. Donnison, 131 A. Doraty, 124 A. Ducas, 89, 132 A. Dudarev, 132 A. Edin-Liljegren, 118 A. Ferland, 102 A. Gafarova, 33, 58, 119, 135,

136 A. George, 26, 110, 111 A. Geraghty, 106 A. Giles, 61 A. Godfreyson, 161 A. Hache, 51, 81, 120 A. Hoechmann, 49, 50 A. Ing, 146 A. Johns, 23 A. Kimiksana, 101 A. Koch, 25, 32, 35, 55, 65,

67, 77, 87, 108, 114, 143 A. Kronstal, 63 A. Kumar, 121, 144 A. Kushwaha, 57 A. MacLeod, 34, 125 A. Manning, 37, 57 A. Manyguns, 106 A. Moses, 101 A. Nahwegahbow, 38 A. Neimanis, 138 A. Nicholson, 152 A. Niittyvuopio, 146 A. Pacey, 57, 127, 147, 149 A. Porter-Chapman, 51 A. Pronovost, 150 A. Rautio, 146, 151, 160 A. Reeves, 42, 120 A. Ritchie, 41 A. Robitaille, 31, 145 A. Salmon, 74, 110 A. Severini, 44, 45 A. Silverman, 91 A. Silviken, 72, 155 A. Stepushyn, 156 A. Thio, 120 A. Timmins, 157 A. Trofimov, 57

A. Tumchewics, 91 A. Tzemis, 31 A. Vaktskjold, 97, 98 A. Willetto Wolfe, 161 A. Woods, 53 A.A. Buganov, 122, 126 A.A. Kovalenko, 111 A.A. Maadi, 109 A.A. Rivellese, 92 A.A. Roussin, 52 A.A. Savchenko, 122 A.B. Kjeldsen, 107 A.B. Salmina, 109 A.B.M. Andersen, 55 A.B.S. Nielson, 59 A.C. Hegeman, 140 A.D. Neverov, 79 A.G. Borisov, 122 A.G. Comuzzie, 67, 91, 92,

102 A.G. Romashchenko, 68 A.I. Yakovleva, 148, 154 A.J. Brunetti, 160 A.J. Parkinson, 78, 90, 113 A.K. Palmer, 31, 109, 121 A.L. Morse, 108 A.M. Mayer, 101 A.M. Pietilä, 160 A.N. Romanova, 35, 58, 137 A.O. Ondar, 145 A.R. Spein, 94 A.S. Golderova, 58, 133, 137 A.S. Iakovleva, 93 A.S. Savalas, 117 A.V. Efremova, 133 A.V. Kiklevich, 141 A.V. Struchkova, 133 A-Track Working Group, 36

B

B. Adlard, 57 B. Armstrong, 110 B. Boyer, 24, 25 B. Cameron, 117 B. Denning, 131 B. Dieter, 62 B. Downey, 117 B. Elias, 44, 99, 124 B. Elkin, 138 B. Erasmus, 46 B. Farrell, 49 B. Green, 119 B. Grimwood, 37, 57 B. Grueger, 75 B. Hanley, 44, 62, 97 B. Hopping, 140 B. Hughson, 141 B. Jeffery, 127

B. Kristensen, 32 B. Larke, 77 B. Martin, 54, 82 B. McMahon, 78 B. Niclasen, 126 B. Olsen, 98 B. Parlee, 118 B. Revich, 70, 71 B. Roos, 60 B. Søborg, 55 B. Tallio, 46 B. Tetso, 140 B. Walberg, 22 B. Young, 31, 145 B.D. Roebuck, 38 B.J. McMahon, 78 B.K. Poulsen, 26 B.L. Cameron, 108 B.V. Howard, 67, 91, 92, 102

C

C. Alton, 91 C. Anderson, 151 C. Betker, 34, 125 C. Burchill, 124 C. Carry, 40, 72, 101, 104,

156 C. Case, 69, 137, 153 C. Christensen, 78 C. Cook, 52 C. Dallas, 30 C. DeByle, 87 C. Dickson, 46, 56, 154 C. Fletcher, 26, 91 C. Furgal, 38, 75 C. Graham, 42 C. Greenberg, 25 C. Gregson, 61 C. Hamilton, 127 C. Homan, 78 C. Huet, 57, 152 C. Jardine, 48 C. Jeppesen, 75, 76, 102 C. Kasper, 124 C. Kehler, 48 C. Kirby, 52 C. Knotsch, 41, 82 C. Laviolette, 120 C. Lennie, 86, 153 C. Lopez, 54, 69, 92 C. Loppie, 109 C. Lys, 64 C. Miller, 121 C. Moniz, 76 C. Orlaw, 97, 112 C. Osiowy, 77 C. Palacios, 88 C. Penney, 33

C. Roache, 27, 39, 56, 76, 140, 160

C. Sarin, 106 C. Schraer, 101 C. Sevenhuysen, 132, 154 C. Sikora, 61 C. Southcott, 34 C. Stannard, 153 C. Sy, 97 C. Tait, 23 C. Van Waes, 40 C. Wallace, 138 C. Werk, 126 C. Wild, 48 C. Zanis, 78 C. Zhirong, 57 C.B. Christiansen, 143 C.B. Svendsen, 143 C.D. Efremova, 58, 137 C.G. Himsworth, 88 C.N. Da Silva, 37 C.P. Archibald, 36 C.P. Pedersen, 72 C.R. Wenger, 91, 92, 102 C.V.L. Larsen, 73 C.Y. Jean, 91 Canadian Red Cross, 62 CANHelp Working Group,

27, 108

D

D. Allman, 25 D. Anderson, 115 D. Badry, 75 D. Ballard, 52 D. Boon, 76 D. Boulos, 36 D. Bruden, 78, 87, 113, 114 D. Carlino, 62 D. Chichakhov, 125 D. Ciliska, 89, 98 D. Dedam-Montour, 101 D. Dell, 119, 131 D. Desaulniers, 29 D. Dieter, 62 D. Dupont, 100 D. Gesink-Law, 25, 65, 87 D. Gravel, 88 D. Gretch, 78 D. Hurlburt, 78, 87, 113, 114 D. Kinnon, 34 D. Koeller, 24, 25 D. Kurszewski, 37 D. Leavitt, 24 D. Littlejohn, 109 D. Martin, 46, 100 D. Menzies, 129 D. Nibgoarsi, 88


D. Panov, 136 D. Parks, 113, 114 D. Perkins, 66 D. Priestly, 90 D. Reid, 74 D. Rousell, 61 D. Santrapinsky, 33, 119, 135 D. Scholten, 35, 153 D. Simeon, 41 D. Sullivan, 78 D. Tagornak, 118 D. Turner, 124 D. Tzemis, 22 D.M. Biktimirova, 141 D.M. Sparks, 124 D.P. Charette, 37, 57

E

E. Affleck, 51, 52, 55 E. Anda, 111 E. Asay, 101, 142 E. Bojko, 96, 105 E. Counil, 102 E. Coutle, 45 E. De Roose, 76, 128, 131,

134, 144 E. DeRoose, 103 E. Dewailly, 75, 102 E. Ding, 121 E. Du Plessis, 132 E. Dunaway, 78 E. Elias, 152 E. Erasmus, 48 E. Erber, 103, 128, 134, 140 E. Freeland-Ballantyne, 37 E. Giles, 77 E. Gromova, 33, 58, 135, 136 E. Guimond, 125 E. Jenkins, 88 E. Kliewer, 124 E. Koop, 143 E. Labranche, 111, 156 E. Lund, 63 E. Mead, 27, 39, 56, 140,

142, 160 E. Myers, 37 E. Näkkäläjärvi, 146 E. Nieboer, 111 E. Nowgesic, 86 E. Olofsson, 53 E. Randell, 153 E. Rawana, 95, 129, 151 E. Rink, 25, 65, 87 E. Rubinstein, 82, 89 E. Skifte, 107 E. Sock, 86 E. Stewart, 47 E. Throassie, 127 E.A. Alexeeva, 137 E.A. Lexeeva, 58 E.B. Kudryashova, 28 E.C. Bonefeld-Jørgensen,

123 E.D. Okhlopkova, 148, 154 E.F. Druyts, 22 E.F. Teslya, 141 E.G. Samsonova, 28 E.I. Semenova, 148, 154

E.J. Virginia, 38 E.K. Brandson, 22, 31, 109,

120, 121 E.K. Khusnutdinova, 159 E.L. Franco, 45 E.P. Bronnikova, 58, 59, 110 E.R. Mirdaleeva, 28 E.V. Fast, 79 E.V. Lukicheva, 58, 59 E.V. Moshkova, 93 E.V. Shakhtshneider, 35, 68 E.Y. Kupershtein, 58, 59

F

F. Balbi, 128 F. Benoit, 89, 98 F. Christensen, 106 F. Michayluk, 127 F. Simonet, 111, 156 F. Stenz, 87 F. Sussman, 120 F. Tarrant, 35, 99 F. Tester, 83 F.A. Leighton, 138 F.A. Platonov, 141

G

G. Annuzzi, 92 G. Aubé, 116 G. Baikie, 22 G. Becker, 85, 112 G. Bergenholtz, 95 G. Brown, 96 G. Cobra, 95 G. Degteva, 96 G. Dow, 32 G. Edwards, 140 G. Egeland, 57 G. Gibson, 86 G. Gordon, 26 G. Hua-Xio, 29 G. Jayaraman, 45 G. Johnson, 44, 45 G. Mironova, 123 G. Mulvad, 25, 65, 87, 94 G. Ohno, 147 G. Osborne, 33, 61, 97, 98,

112, 114, 127, 142, 149, 150

G. Pootoogook, 37 G. Rees, 76 G. Riccardi, 92 G. Stadig, 61 G. Thomas, 80 G. Thunem, 33 G. Turner, 107 G. Vivian, 76 G. Vrakas, 31 G. Wurtak, 44 G.E. Mironova, 133, 143, 148 G.G. Dranaeva, 159 G.I. Ievleva, 141 G.I. Simonova, 156 G.K. Healey, 42, 83, 112, 130,

139, 145 G.K. Heatha, 52

G.M. Egeland, 26, 33, 38, 112, 124, 127, 139, 142, 147, 149, 150, 152, 153

H

H. Angootealuk, 152 H. Beanlands, 34, 89, 98, 125 H. Durrani, 81 H. Dyson, 89 H. Eiberg, 67, 146 H. El-Gabalawy, 66 H. Fikowski, 108 H. Harder, 73 H. Krarup, 77 H. Kuhnlein, 46 H. Leslie, 69 H. Moeller, 107 H. Nakimayak, 26 H. Rosen, 78 H. Saudny-Unterberger, 26,

152, 153 H. Vallance, 24, 25 H. Wang, 91, 92 H. Weiler, 139, 147, 150 H.H.H. Garing, 67 H.V. Kuhnlein, 33, 146

I

I. Fleischer, 102 I. Gagulin, 33, 58, 135, 136 I. Grant, 76 I. Gromova, 119 I. Kleist, 68 I. Nielsen, 67 I. Njålstad, 142 I. Partridge, 53 I. Pike, 61 I. Sobol, 33, 44, 45, 88, 97,

98, 112, 127, 142, 149, 153 I. Tensen, 26 I.A. Ignatova, 123 I.A. Pinigina, 60 I.M. Nielsen, 146 I.M. Ponomareva, 110 I.R. Petrova, 59 I.V. Karandashova, 79 I.V. Kulikov, 68 I.V. Osokina, 27, 141, 148 International Circumpolar

Surveillance Working Group, 87, 136, 137

J

J. Boffa, 69 J. Brazeau, 151 J. Brewster, 112 J. Bull, 22 J. Butler Walker, 42, 43, 62,

139 J. Caines, 47 J. Cheechoo, 38, 45 J. Chen, 29 J. Cheung, 27 J. Christensen, 82, 91, 110,

115, 143 J. Cowan, 97, 98

J. De Luce, 63 J. Edwards, 48 J. Eibl, 133 J. Eskes, 102 J. Franks, 129, 151 J. Friborg, 40 J. Gittelsohn, 27, 39, 56, 76,

103, 128, 131, 134, 140, 144, 160

J. Gordon, 35, 99, 101 J. Hassi, 96 J. Hayek, 139 J. Huntington, 26, 27 J. Jaud, 49 J. Johnson, 65 J. Jokelainen, 96 J. Jones, 99 J. Klejka, 114 J. Kornelsen, 83, 137 J. Lamba, 126 J. Leston, 64 J. Linton, 89, 132 J. Lys, 116 J. MacKinnon, 69 J. Martin, 129 J. Mignone, 99 J. Mike, 145 J. Muller, 91 J. Naedzo, 43, 120 J. Ogina, 27, 56, 101 J. Pereira, 149, 150 J. Poliquin, 145 J. Polisena, 105 J. Rawana, 129, 151 J. Reade, 65 J. Reading, 80, 94, 104 J. Rempel, 78 J. Robbins, 21, 86 J. Rossiter, 79 J. Rouleau, 97 J. Shoveller, 65 J. Smylie, 111, 156 J. Soon, 65 J. Spika, 88 J. Van Oostdam, 37, 57 J. Whitley, 129, 151 J. Williams, 78 J. Wolfe, 130 J. Wortman, 60 J.A. Jamieson, 33 J.C. Catholique, 23 J.C. Lopez-Alvarenga, 92 J.D. Ford, 56 J.D. Martin, 100 J.D. Otvos, 92 J.D. Wenger, 113, 114 J.E. Smith, 86 J.F. Proulx, 153 J.G. Petrova, 97 J.I. Forrest, 22 J.J. Christensen, 143 J.L. Tonkikh, 110 J.M. Buck, 130 J.N. Larsen, 141 J.O. Odland, 132 J.P. McGhie, 144 J.R. Alexeev, 158 J.S. Jensen, 87 J.S. Johnson, 142


J.S.G. Montaner, 22, 31, 109, 120, 121

J.W. MacCluer, 67, 91, 92, 102

J.W. Morse, 108 J.Y. Odland, 111

K

K. Boyd-Hummel, 78 K. Brownlee, 95, 129, 151 K. Clement, 109 K. Colbourne, 130 K. Edwards, 43 K. Friendship, 38 K. Gray, 52 K. Haack, 67 K. Kandola, 39 K. Kleinshmidt, 106 K. Knapp, 76 K. Koller, 101 K. Ladefoged, 35, 55, 64, 68 K. Machalek, 112 K. McMullin, 69 K. Minich, 111, 156 K. Mitchell, 41 K. Morgan, 91, 104 K. Murray, 128 K. Nielsen, 138 K. Nisbet, 30 K. Nystad, 147 K. Rudolph, 87, 113, 114 K. Schreiner, 126 K. Schwartzman, 129 K. Thorsen, 95 K. Vähäkangas, 151, 160 K. Verdecchia, 29 K. Watanabe, 147 K. Winters, 75 K. Young, 33, 52, 71, 89, 112,

127, 132, 142, 149, 150, 152, 153

K.A. Fernandes, 22, 109, 120, 121

K.C. Duncan, 109 K.E. McIsaac, 112 K.G. Nozdrachev, 58 K.J. Goodman, 26, 27, 108 K.J. Schoellhorn, 153 K.K. Anderson, 129 K.L. Hansen, 63

L

L. Abryutina, 24 L. Amagoalik, 128 L. Angalik, 88 L. Arbour, 24, 25, 66, 97, 98,

111, 112 L. Bartlett, 128 L. Beck, 103, 128, 134 L. Bulkow, 78, 114 L. Clearsky, 124 L. Daerga, 118 L. Day, 49 L. Dean, 39 L. Duffy, 40 L. Duncan, 43 L. Dunfield, 133

L. Edge, 54, 138 L. Eichelberger, 82 L. Fournier, 31 L. Friesen, 89, 132 L. Grøtvedt, 94 L. Gulliver, 62 L. Gushue, 130 L. Gyrgolkau, 137 L. Harms, 48 L. Harrison, 91 L. Jacobsson, 118 L. Jette, 113 L. Johnson-Down, 127, 142 L. Kreuger, 141 L. Kuptana, 101 L. Lafferty, 43, 120 L. Larcombe, 54, 81 L. Lochhead, 95 L. Lynge, 125 L. Menominee-Batise, 100 L. Murawski, 62 L. Nicholas-Figueroa, 40 L. Ogilvie, 100 L. Okalik, 26, 30, 46 L. Panaro, 88 L. Parton, 79 L. Patti, 92 L. Paulette, 85, 112 L. Piper, 53 L. Richardson, 151 L. Schwarzburg, 84 L. Shah, 88 L. Specht, 40 L. Svenson, 124 L. Thompson, 132, 154 L. Tranebjærg, 67 L. Van Pelt, 38 L. Vindfeld, 143 L. Wexler, 24 L. Whitbeck, 64 L. Yuan, 100 L. Zubov, 24, 29 L.A. Butler, 114 L.A. Gyrgolkau, 35 L.A. Huisman, 66 L.C. Ragus, 106 L.D. Olesova, 148 L.G. Goldfarb, 141 L.H. Malcoe, 152 L.H.M. Chan, 38, 46, 56, 154,

161 L.L. Alekseeva, 141 L.L. Harrigan, 104 L.O. Reiersen, 132 L.O.E. Ebbesson, 92, 102 L.P. Nielsen, 114 L.V. Cox, 74 L.V. Salamatina, 134, 135 L.V. Tarabukina, 59

M

M. Allan, 112 M. Andersson, 32, 35, 55, 114 M. Ar-Rushdi, 89 M. Aslam, 36 M. Beaumier, 56 M. Bell, 79 M. Bruce, 78, 87, 113, 137

M. Buell, 71, 86 M. Bzdell, 130, 145 M. Campbell, 138 M. Dyck, 85 M. Eriksson, 118 M. Fast, 89, 98, 132, 154 M. Fournier, 47 M. Garner, 87, 113, 136 M. Ghisari, 123 M. Greenwood, 80, 89, 98,

117, 125 M. Grey, 43 M. Guyot, 38 M. Hall, 99, 124, 138 M. Hammond, 101 M. Heaman, 111, 156 M. Helferty, 136, 137 M. Horton, 115 M. Ip, 37, 57 M. Jong, 52, 106 M. Kelly, 94, 104 M. Kemp, 143 M. King, 108, 117 M. Kratsmann, 27 M. Kratzmann, 56 M. Kumar, 34, 144 M. Lee, 96 M. Lindegger, 88 M. Lodahl, 67 M. Long, 123 M. Lovgren, 113, 137 M. Masulli, 92 M. Mayan, 69 M. Mayoh, 99 M. Melbye, 35, 55, 114 M. Melhus, 63, 94 M. Nsungu, 88 M. Ofner, 88 M. Pedersen, 102 M. Petit, 21 M. Porter, 86 M. Potyrala, 112 M. Probizanski, 129 M. Ramesh, 101 M. Roger, 45 M. Routledge, 143 M. Rydbacken, 64 M. Shapran, 148 M. Shum, 83 M. Snowball, 78 M. Tjepkema, 125 M. Tomskiy, 157, 158, 159 M. Tyndall, 120 M. Ugyuk, 160 M. Valery, 160 M. Van Bibber, 110, 115, 161 M. Voevoda, 50 M. Wideman, 47, 48 M. Williams, 46 M. Wood, 153 M. Yetman, 153 M. Young, 36 M.A. Buyack, 28 M.A. Mackenzie, 86 M.A. Romanyuk, 92, 93 M.E. Kelm, 65 M.E. Macdonald, 129 M.E. Moffatt, 48 M.E. Tejero, 67, 92, 102 M.G. Bruce, 113, 114

M.H. Therkildsen, 40 M.I. Tomskii, 35 M.I. Voevoda, 35, 68 M.J. Kral, 30 M.J. Ogarkov, 68 M.J. Roman, 92 M.K. Mau, 42 M.K. Sharma, 130 M.L. Kelly, 31 M.R. Mulvey, 88 M.S. Cheranova, 30 M.T.S. Jenssen, 142

N

N. Beauvais, 101 N. Black, 151 N. Edgecombe, 43 N. Enuaraq, 30 N. Eseva, 96 N. Faraj, 112 N. Hanlon, 65 N. Kassi, 43, 45, 110, 115 N. Lachance, 34 N. Lauster, 83 N. McCullough, 127 N. Murphy, 44 N. Nielsen, 35, 55 N. Obed, 153 N. Poole, 116 N. Potolitsyna, 96 N. Reynolds, 126 N. Schuurman, 137 N. Semenova, 160 N. Sheikh, 124 N. Sibileva, 29 N. Trotter, 69 N. Wedzin, 86 N.A. Pashina, 122, 123 N.C. Agnew, 84 N.C. Doubleday, 37, 57 N.C. Larter, 39 N.D. Rendtorff, 67 N.G.L. McHugh, 111 N.J. Harms, 138 N.J. Weissman, 91, 92 N.K. Larsen, 59 N.N. Butorin, 109 N.N. Shim, 155 N.S. Polovodova, 122, 150 N.S. Yudin, 68 N.V. Golubeva, 67 N.V. Maharova, 159 N.V. Makcharova, 35

O

O. Anoee, 88 O. Grishin, 93 O. Ketkina, 105 O. Vaccaro, 92 O.A. Mirolyubova, 93 O.L. Barbarash, 68 O.M. Bragina, 156 O.S. Amelchugova, 109, 110 O.V. Shtygasheva, 109, 110 O.V. Smirnova, 122 O.V. Tatarinova, 157 O.V. Yanchenko, 35


P

P. Anderson, 61 P. Bjerregaard, 59, 72, 73, 75,

76, 102, 117 P. Brassard, 44, 45, 129 P. Hayward, 82 P. Hazelton, 82 P. Hjelmborg, 123 P. Homøe, 40, 67, 140 P. Jousilahti, 96 P. Kern, 146 P. Lubov, 73 P. Lyta, 99 P. Macmillan, 95 P. Maez, 128 P. Marquis, 76 P. McNicoll, 83 P. Moffitt, 85 P. Myllynen, 151 P. Nicherson, 54 P. Orr, 54, 69, 81, 82, 86, 130 P. Peters, 101 P. Rivest, 153 P. Sj’lander, 32, 118 P. Tchouaffi, 61 P. Tobin, 56 P. Vlahos, 49 P. Zizman, 47 P.C. Tremblay, 86 P.I. Sidorov, 29 P.J. Martens, 99, 111, 124,

156 P.K. Wiebe, 30 P.M. Ignatyev, 141 P.M. Okin, 92 Pauktuutit Inuit Women of

Canada, 57, 65, 74, 84, 85, 118

Q

Qanuippitali Steering Committee (Inuvialuit), 26, 38, 152, 153

Qanuippitali Steering Committee (Nunatsiavut), 26, 38, 152, 153

Qanuippitali Steering Committee (Nunavut), 26, 33, 38, 57, 112, 127, 139, 142, 147, 149, 150, 152, 153

R

R. Bennett, 45 R. Collins, 101 R. Copes, 89, 98 R. Dieter, 62 R. Drybones, 43, 120 R. Fedina, 28, 135 R. Goodwin, 90 R. Hegele, 24, 25 R. Jackson, 31 R. Johnson, 24 R. Kristiansen, 94 R. Link, 94, 104 R. Long, 69

R. Magga, 146 R. Martial, 117 R. Masching, 99 R. McCormick, 21, 66 R. Montgomery-Andersen,

25, 65, 87 R. Morales, 24 R. Munday, 26, 27, 108 R. Obomsawin, 53, 86 R. Pearce, 57 R. Peterson, 127 R. Plaetke, 128 R. Platonova, 69 R. Rawat, 81 R. Reid, 27, 39, 56, 76, 140,

160 R. Rosol, 152, 160 R. Salokangas, 118 R. Schroth, 48 R. Schuster, 154 R. Singleton, 78, 114 R. Timmins, 29 R. Tsang, 87, 137 R. Villems, 159 R. Wilkins, 111, 125, 156 R.A. Blake, 48 R.A. Dieter Jr., 62 R.B. Devereux, 67, 91, 92,

102 R.C.A. Thompson, 88 R.E. Scott, 81 R.G. Jensen, 40, 140 R.L. Bourque-Bearskin, 108,

117 R.R. Fabsitz, 67, 91, 92, 102 R.S. Hogg, 22, 31, 109, 120,

121 R.V. Jakovlev, 159 R.Z. Alexeev, 158

S

S. Abonyi, 69, 127 S. Andersen, 67 S. Bauhaus, 86 S. Bernier, 75 S. Biggs, 103, 128, 134, 144 S. Brofeldt, 40, 140 S. Chatwood, 37, 42, 44, 52,

57, 80, 112, 139, 152 S. Christianson, 130 S. Clarren, 110 S. Collins, 24, 25 S. Coulter, 120 S. Cross, 76 S. Déry, 145 S. Desai, 87, 136, 137 S. Duke, 48 S. Ebbesson, 102 S. Gryzbowski, 83 S. Grzybowski, 137 S. Harper, 138 S. Hassler, 32 S. Hatjó, 47 S. Irlbacher-Fox, 24, 141 S. Keefe, 89 S. Kelley, 91 S. Khoja, 81 S. Kvernmo, 72, 94

S. Laston, 67, 91, 92, 102 S. Lauson, 112 S. Law, 52 S. Livingston, 78 S. MacLeod, 110, 127 S. McIntosh, 112 S. Mitchell, 43 S. Moller, 31 S. Møllersen, 119 S. Montgomery-Andersen,

25, 65, 87 S. Morin, 145, 150 S. Näyhä, 96 S. Negus, 78 S. Nickels, 41 S. O’Hara, 147 S. Ogunnaike-Cooke, 36 S. Peters, 98 S. Reaburn, 103, 128, 134,

144 S. Rognerud, 142 S. Salavat, 28 S. Samanani, 124 S. Senécal, 125 S. Sharma, 27, 39, 56, 76,

103, 128, 131, 134, 140, 142, 144, 160

S. Shaw, 132, 154 S. Skinner, 88 S. Skov-Jensen, 65 S. Smith, 54, 90 S. Suleymanov, 28 S. Totten, 45 S. Tough, 126 S. Valeriy, 122 S. van Zanten, 27 S. Verhille, 83 S. Villumsen, 143 S. Vyacheslav, 71 S. Wadowska, 110, 115, 161 S. Wesche, 46, 161 S.A. Cole, 67 S.A. Collins, 153 S.A. Dogadin, 58 S.A. Fedorova, 159 S.A. McEwen, 138 S.A. Rolin, 90 S.A. Tokarev, 126, 155 S.G. Donaldson, 37, 57 S.G. Kriroschekov, 60 S.I. Braslavskaya, 79 S.K. Clarren, 74 S.O.E. Ebbesson, 67, 91, 92 S.V. Smirnova, 122, 123 Steffanson Arctic Institute,

141

T

T. Andersen, 67 T. Antone, 100 T. Axtell, 80 T. Bliss, 29 T. Galloway, 127 T. Greenland, 101 T. Haldorsen, 72 T. Heale, 47 T. Hennessy, 44, 78, 113, 114 T. Holton, 53

T. Korolenko, 30 T. Kosatsky, 70 T. Kovesi, 114 T. Krüger, 123 T. Laatikainen, 96 T. Larssen, 142 T. Leech, 37 T. Leung, 136 T. Lidguerre, 127 T. Loginova, 105 T. Mala, 24, 25 T. Malzeva, 122 T. Marsden, 83 T. McKinnon, 106 T. Moore, 43, 120 T. Myers, 25 T. Nancarrow, 37, 146 T. Neily, 61 T. Polivanova, 160 T. Rendal, 68 T. Ritter, 114 T. Sato, 29 T. Skifte, 55, 68 T. Starosotskaya, 148 T. Vlasova, 57 T. White, 124 T. Wilsgaard, 111 T. Wong, 44, 45 T. Wuerz, 32 T. Zulz, 35, 87, 113, 114, 137 T.A. Mala, 42 T.A. Romanova, 35, 59 T.E. Burtseva, 158, 159 T.G. Komlyagina, 145 T.K. Erdakova, 134, 135 T.K. Young, 112, 127 T.L. Stuart, 88 T.M. Mäkinen, 71, 96 T.R. Orchard, 22 T.V. Maltseva, 150, 155 T.Ya. Shipulina, 155

U

U. Poppel, 25, 65, 87

V

V. Chashchin, 70, 132 V. Chupakhin, 132 V. Dekabrina, 77 V. Douglas, 85 V. Faria, 108 V. Gafarov, 33, 58, 119, 135,

136 V. Gallant, 153 V. Goleski, 45 V. Illisiak, 37 V. Kamper, 32 V. Maud, 56 V. Melnikov, 98 V. Napoleon, 118 V. Peskov, 24 V. Stordahl, 21 V. Sunnari, 105 V. Van Wagner, 111 V. Van Zanten, 108 V.A. Argunov, 157, 158 V.A. Baum, 68


V.A. Dolgin, 79 V.D. Lima, 109, 120 V.L. Edge, 138 V.L. Osayueskiy, 141 V.N. Melnikov, 145 V.Ø. Thomsen, 55 V.P. Chulanov, 79 V.S. Voruganti, 67 V.T. Manchuk, 27, 122, 123 V.V. Antipina, 59 V.V. Tsukanov, 58, 59, 109,

110

W

W. Burke, 24, 25 W. Fraser, 156 W. Hogg, 83 W. Lahey, 105 W. Martin, 26, 111 W. Mason, 116 W. White, 88 W. Zhang, 22, 31 W.A. MacDonald, 50, 83,

100, 139 W.J. Howard, 91, 92, 102 W.S. Harris, 92, 102

W-L. Yu, 138

X

X. Cao, 76, 131, 142 X. Cui, 126

Y

Y. Kabanov, 33, 58, 119, 135, 136

Y. Mao, 44, 45 Y. Nikitin, 93 Y. Wu, 156

Y.A. Li, 44 Y.L. Tonkikh, 58, 59 Y.V. Vorobyova, 28 Yu.B. Parlyuk, 156 Yu.P. Nikitin, 156, 157

Z

Z. Chen, 40 Z. Todd, 43 Z.-C. Luo, 111, 156 Z.N. Krivoshapkina, 143 Z-C. Luo, 111, 156

International Union forCircumpolar Health

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Canadian Society forCircumpolar Health

www.csch.ca

ICCH14 Secretariatc/o Institute for Circumpolar Health Research

PO Box 11050 • Yellowknife, Northwest Territories • X1A 3X7 • CanadaTel: +1.867.873.9337 • Fax: +1.867.873.9338 • Email: [email protected]

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Documents

ICCH14 Abstract Book