International Journal of Circumpolar Health最新文献

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.

The Northwest Territories, Canada, has high rates of alcohol- and drug-related hospitalisations and deaths. There is considerable debate over how to provide substance use recovery services in this region, due to its small, culturally diverse population. The aim of this study was to examine demographic differences in ethnicity, gender and sex for individuals in the barriers to accessing services, supports to stay in recovery, and reasons they struggled to stay in recovery. A total of 439 respondents completed online and paper-based surveys on their experiences accessing recovery services in the Northwest Territories. A mixed methods approach was applied, in which Fisher's exact test was applied to test for statistically significant demographic differences in quantitative responses, and themed analysis was performed using deductive coding using written survey responses. Several statistically significant demographic differences were identified in barriers to services, supports to recovery, and barriers to staying in recovery. Cultural incongruity, and the importance of social support to substance use disorder recovery, were identified as key themes that emerged in qualitative analysis. There is a need for community-based, culturally safe, and family-inclusive holistic supports at the community level to address substance use issues in the NT, including more informal confidential supports and efforts to reduce stigma and normalise and celebrate recovery.

Inuit are a distinct ethnic group living in an environment likely to influence calcium metabolism and skeletal health. Bone mineral content (BMC) is a marker of skeletal health and fracture risk. Age is a dominant risk factor for osteoporosis, emphasising the importance of skeletal health in the ageing Inuit populations. This systematic review aims to provide an overview of data on BMC among Inuit. We performed a systematic search for data on BMC among Inuit guided by an experienced librarian. The search identified 211 studies, of which six provided data on BMC among Inuit living in Alaska or Canada. In men/women, BMC peaked around the age of 25 years in distal radius at 1.55/1.07 g/cm2 and in distal ulna at 0.81/0.54 g/cm2. Diaphysis of ulna, humerus, and tibia peaked around 10 years later. The 23% to 30% sex differences in BMC were similar across studies. Age related changes were parallel to other populations. In conclusion, BMC in Inuit is presented for easy viewing and comparison. BMC was similar between Inuit populations, and sex and age-related differences were comparable to other populations. New scientific studies should update data, include spine and hip, describe bone structure, and consider fracture risk beyond BMC.

Palliative care policies worldwide support people's wishes to spend their final days at home with family caregivers playing a vital role. In Norway, 16% of the population lives in rural areas where palliative end-of-life care is especially challenging due to geographical barriers and limited access to healthcare resources. Research on rural family end-of-life care for people with cancer is sparse. Therefore, the purpose of this study was to investigate what resources are needed for rural family caregivers when providing end-of-life care and preparing for home death for a person with cancer. Thirteen semi-structured in-depth interviews with family caregivers in seven rural municipalities in Northern Norway were conducted from February to April 2023. The thematic analysis revealed three key themes supporting caregivers' resilience: end-of-life care and home death require available resources in family caregivers; the availability of reliable professional follow-up services for end-of-life care; support from family and social networks compensate for lacking healthcare resources. Holistic healthcare for rural populations should consider aspects like distance and cost while involving the entire family and their social network. Local palliative care beds and telehealth services should be available to support rural family caregivers.