International Journal of Circumpolar Health最新文献

Seal finger is a rare zoonotic bacterial infection typically caused by Mycoplasma species, transmitted from seals (Pinnipedia suborder) to humans. First documented in 1907, this disease remains under-researched despite growing relevance as humans increasingly encroach on Arctic regions. We conducted a review of multiple databases to evaluate its history, prevalence, at-risk populations, and treatment options. The infection primarily affects individuals who have close contact with marine mammals, including fishers, hunters, sealers, and marine biologists. Seal finger usually presents similarly to panaritium, with localized swelling, erythema, and pain. Due to its rarity and limited awareness among healthcare providers, the infection is often unrecognized, leading to wounds going untreated or being managed with inappropriate antibiotics. This mismanagement allows the infection to progress, potentially involving joints or spreading further, which could have been effectively prevented with a course of tetracycline. Further research is essential to better understand the epidemiology of seal finger and improve timely diagnosis. To reduce complications, more education is needed for physicians working in coastal, Arctic, and aquarium settings about recognizing the disease and administering proper treatment. Enhanced awareness and research can improve patient outcomes and increase the safety of human interactions with seals.

Previous research has indicated that migrants risk facing inequities both internationally and in Sweden; integration policies are therefore important to study. How health is described in policies affects how health interventions are approached. Discourse analysis offers a way of understanding how health is framed within the integration policies affecting newly arrived migrants in Sweden. The aim was to analyse the health discourses used in Swedish and European Union (EU) integration policies. A discourse analysis, inspired by Fairclough, was performed on integration policies related to Sweden, at local, regional, national and EU levels. The policies of the Establishment Program, which focuses on newly arrived migrants (refugees, persons of subsidiary protection and their relatives who arrived through family reunification), were chosen for the analysis, and 17 documents were analysed in total. The analysis of the documents showed how the health discourses were expressed in the form of the medicalisation of health, the individualisation of health and the risk of ill health. A pathogenic approach to health was visible in the policies and individual disease prevention or rehabilitation was the main health focus. The results showed similarities to previous research highlighting how a particular understanding of health in a neoliberal context is formed.

During the COVID-19 pandemic, Sweden adopted a recommendation-based approach rather than strict lockdowns. This approach relies on public willingness to adhere to guidelines and motivations for prosocial behaviour. This study aimed to explore the motivations behind adherence or non-adherence to COVID-19 recommendations in Sweden. Semi-structured interviews were conducted in 2022 with 20 participants aged 26 to 63, all residing and working in Stockholm. The interviews were conducted via online platforms, Teams and Zoom, transcribed and analysed using content analysis. The analysis yielded two overarching themes that motivated adherence or non-adherence, Sacrificing comfort for collective wellbeing and A sense of being superior and able to handle national recommendations in your own way derived from six categories: (i) Social pressure and the desire to appear prosocial, (ii) Embracing a new reality as a means to return to normalcy, (iii) The absence of punitive measures for non-adherence, (iv) Creating safe environments and circumventing the system, (v) Negotiating which recommendations to follow and (vi) Diminished adherence over time. Adherence to public health recommendations was driven by social pressure and a desire to protect loved ones, often requiring personal sacrifices and behavioural adjustments. Conversely, non-adherence stemmed from a sense of autonomy, mental well-being preservation and tiredness, highlighting the challenges of sustaining compliance over time.

The Arctic region, characterised by its remote and geographically challenging environment, is home to predominantly Indigenous populations who experience significant healthcare disparities compared to urban counterparts. This paper synthesises evidence on the persistent challenges in delivering healthcare in the Arctic, including geographical remoteness, healthcare personnel shortages, and cultural and language barriers. Telehealth emerges as a crucial solution, offering a nuanced approach to overcoming physical and systemic barriers. We review current implementations of telehealth in the Arctic, highlighting successful adaptations to local cultural contexts and technological limitations. By integrating a patient-centred approach, infrastructure readiness, and relevant telehealth services, a holistic healthcare delivery model tailored for the Arctic environment is proposed. New type of technologies is also proposed to enhance remote care possibilities. This paper underscores the need for collaborative efforts in research, policy making, and healthcare provision to ensure the sustainability and effectiveness of health services in the Arctic, aiming to close the gap in health equity. Key references from seminal works and recent studies provide a foundation for the discussions and recommendations presented.

Direct-acting antiviral (DAA) hepatitis C treatment can reduce fibrosis and prevent cirrhosis and its sequelae. This study aims to evaluate changes in fibrosis and lab measurements from pre-treatment to post-treatment and over time following the end-of-treatment among Alaska Native and American Indian (AN/AI) peoples treated with sofosbuvir-based DAAs between 2014 and 2023. Study participants were predominantly male (53.9%) with a mean age of 54.4 years at start of treatment. Among the 290 (61.3%) participants with at least one pre- and one post-treatment Liver Stiffness Measurement (LSM), post-treatment LSM was significantly lower than pre-treatment LSM (p < 0.001). Median post-treatment LSM increased with increasing pre-treatment fibrosis stage (p < 0.001). Median values for ALT, AST, AFP, FIB-4 and APRI decreased significantly between pre- and post-treatment visits (p ≤ 0.002), while platelets remained stable (p = 0.827). The majority of AN/AI adults successfully treated with sofosbuvir-based DAAs experienced a reduction in LSM, with LSM subsequently remaining stable up to 4 years following end-of-treatment. Liver function and blood-based estimates of fibrosis also improved. The most important predictor of LSM improvement was pre-treatment fibrosis stage.

The Northwest Territories (NWT) experienced an unprecedented wildfire season in the summer of 2023, triggering a record number of evacuation orders across the territory. This review aims to improve understandings of the community-level impacts of the 2023 wildfire evacuations in the NWT, addressing a gap in research by analysing the impacts of the evacuations and offering insights to inform future emergency preparedness and targeted investigations. Using a grey literature review methodology, 96 sources - including news articles, community reports, and government reports were analysed to assess evacuation impacts. Through inductive thematic analysis, nine key themes emerged: mental health; equity-deserving populations; local businesses and economy; evacuee financial struggle; supply chains; healthcare; education; recreation and entertainment; and cross-cutting. While some sources reported that evacuation-related challenges stemmed directly from wildfire threats, many evacuee experiences were intensified by existing gaps in emergency response, communication breakdowns, and inadequate supports for equity-deserving groups. Findings suggest that the impacts of the 2023 NWT wildfire evacuations exacerbated pre-existing vulnerabilities, were marked by communication failures, and had cascading, interconnected, and long-term consequences. This review highlights the far-reaching consequences of wildfire evacuations in the NWT in 2023 and underscores the need for community-led and equity-oriented emergency planning that is responsive to the specific needs of Northern populations.

Brown adipose tissue (BAT) is essential for non-shivering thermogenesis, a key survival mechanism for Arctic populations exposed to chronic cold. As BAT dissipates energy as heat, it presents a potential target for improving cardiometabolic health and treating obesity. The Arctic Inuit represents a unique metabolic model due to distinct genetic and environmental adaptations. This study advances methods in cardiometabolic research by investigating BAT activation in Arctic Inuit and ethnic Danes under cold exposure. A comparative crossover study of 20 Inuit and Danes includes two sessions: (A) thermal comfort and (B) 2 hours of individualised cooling. Each session concludes with fat biopsies and [¹⁸F]FDG-PET/CT scans to quantify BAT activity and volume. Additional measures include blood sampling and infrared thermography (IRT). The cooling protocol and biological sampling are designed to capture key metabolic signatures of BAT activation, enabling detailed insight into thermogenic function and its cardiometabolic implications. PET/CT scans contribute valuable insights into metabolic processes and the ethical considerations balance the benefit of unique insight against radiation risk. Given limitations in accessibility and radiation exposure, this study also evaluates IRT as a low-risk, accessible alternative to PET/CT scans. This methodological advancement supported approval by the North Denmark Region ethics committee (N-20220042). As [¹⁸ F]FDG-PET/CT is not available in Arctic Greenland, data collection was conducted in Denmark with an accessible Inuit population. The study forms part of a broader study on climate and health, approved by the ethics committee for Greenland.

For young Indigenous people, suicide is among the leading causes of death. High rates in Arctic areas indicate serious health and societal concerns. More knowledge is needed about the suicidal process, as suicide attempts predict later death by suicide. This study aimed to look for associations between suicide attempts and ethnic identity factors and culturally specific factors in Sami adolescents, including possible gender-specific patterns of predictors. In the total group of 442 Sami (15-16-year-olds) in The Norwegian Arctic Adolescent Health Study (NAAHS), multivariable logistic regression analyses showed associations between suicide attempts and the female gender, living in a stepparent family, and a weak family economy. Sami females who reported weak identity exploration had eight times higher odds of reporting suicide attempts. Sami males who had experienced discrimination or showed a strong identity commitment had between six- and eight-times higher odds of reporting suicide attempts. Sami females were less affected by experiencing ethnic discrimination compared to males, as Sami females were more sensitive to family patterns. Public health programmes and prevention strategies targeting adolescent suicidal behaviour should consider gender differences in the association between ethnic identity, cultural and socio-demographic factors, and suicide attempts.

A population-based cross-sectional study was conducted in six towns in Greenland to establish normative data on refraction and visual acuity in preschool children and to develop a practical vision screening method suited to Greenlandic healthcare needs. We recruited 274 children born in 2017 through kindergartens in six towns. The only exclusion criterion was known eye disease under ophthalmological care. Vision screening was performed by an optometrist, assessing distance visual acuity with Kay Pictures, binocular near visual acuity with Lea Symbols, stereoacuity with the Lang II Test, and non-cycloplegic refraction using the Plusoptix A12R. An ophthalmologist conducted follow-up examinations, including cycloplegic refraction, within one week. Of 532 eligible children, 274 participated (144 boys, 133 girls; mean age 4.7 years). The mean visual acuity for the worse- and best-seeing eye was 0.05 (±0.16 SD) and 0.01 (±0.12 SD) logMAR, respectively. Cycloplegic myopia (≤-0.5 dioptres) was found in 5%, while 18% had hyperopia >+2.0 dioptres. Most preschool children in Greenland have good visual acuity and mild hyperopia. Vision screening combining the Plusoptix autorefractor and distance visual acuity demonstrated the highest sensitivity (89%) for identifying children needing further evaluation. Implementing this vision screening method in kindergartens is recommended to improve early detection and treatment outcomes.

Water safety planning is a risk management approach that accounts for quantitative and qualitative drinking water hazards and includes ongoing input from stakeholders. This approach has been applied in jurisdictions across the world including Canada. Rural and remote communities in Canada, impacted by water safety, stand to benefit most from holistic approaches to water safety risk management such as water safety planning. Unfortunately, these communities typically have limited resources to engage in this approach. Additionally, most remote communities rely on truck and cistern water systems, which have less understood hazards than communities in Canada with piped service. In this study, we report the results of an initial water safety planning case study in Cambridge Bay, Nunavut. We identified numerous water quality hazards including disinfection byproducts in trucks, manganese in the source water, and copper in tap water, as well as operational challenges that increase the risk of water emergencies in the community. We conclude that water safety planning has the potential to substantially improve water safety in Nunavut but current information gaps as well as complex stakeholder interactions are likely to hinder top-down attempts. A dynamic and inclusive approach is recommended that incorporates a targeted exploration of water safety hazards.