Possible risk factors for abnormal Papanicolaou smear were investigated in a population-based cross-sectional study. From Nuuk (Greenland) and Nykøbing Falster (Denmark), random samples of 800 women aged 20-39 years were drawn. Totals of 586 and 661 women were included in Greenland and Denmark, respectively. All women went through a personal interview, and had a gynecologic examination including a PAP smear and cervical swab for HPV analysis. A blood sample was taken for analysis of HSV type specific antibodies. Multiple sexual partners was the most important risk factor for abnormal cervical cytology (OR = 4.2). An infectious etiology was also indirectly supported by a relatively protective effect of barrier contraceptive methods (OR = 0.6). The simultaneous finding of HPV 16/18 as a significant risk factor (OR = 2.4) cannot be taken uncritically as support for a causal effect of this HPV type, since such a relationship between cytological changes of the cervix and HPV infection could also emerge if the positive PAP smear was not just a measure of intra-epithelial neoplasia but also an expression of the infection itself on the cervix.
This survey examines the age at onset of acute otitis media (AOM) in 591 unselected Greenlandic children aged 3, 4, 5 and 8 years from the two largest towns in Greenland. The attendance rate was 86%. Parental information about episodes of AOM was cross-checked in medical records, which were available for 95% of the children. AOM was defined as episodes with earache, otorrhoea or previous treatment for AOM, with written otoscopic evidence of AOM resulting in treatment with weak analgetics or antibiotics. Recurrent AOM (rAOM) was defined as > or = 5 AOM episodes since birth. In total, 66% of the children had experienced AOM at least once. Of all children, 40% had AOM during the first year of life. Median age of the first episode was 10 months (range: 1-84 months), and there was no sex difference. Children between 7 and 12 months of age were at highest risk of AOM. Children with rAOM had their first AOM episode at a significantly younger age than children with
OBJECTIVE: To describe the sociomedical risk factors associated with episodes of acute otitis media (AOM), recurrent AOM (rAOM), and chronic otitis media (COM) in Greenlandic children and especially to point out children at high risk of rAOM (defined as > 5 AOM episodes since birth) and COM which are prevalent among Inuit children all over the Arctic. METHODS: The study design was cross-sectional and included 740 unselected children, 3, 4, 5, and 8-years-old, living in two major Greenlandic towns, Nuuk and Sisimiut. All children were otologically examined and the parents answered a questionnaire containing sociomedical variables including ethnicity, family history of OM, housing, insulation, crowding, daycare, passive cigarette smoking, breast feeding, type of diet, allergy, and chronic diseases. Historical data were cross-checked in medical records which also formed the basis for the drop-out analyses. Statistical analyses included frequency tests, calculation of odds ratio (OR), and multiple logistic regression. RESULTS: The attendance rate was 86%. Former episode of AOM was reported by 2/3 of the children, rAOM by 20%, and COM by 9%. The following variables were found significantly more often in children with AOM by simple frequency testing: Parental (OR = 1.83), sibling (OR = 1.62), and parental plus sibling (OR = 2.56) history of OM, crowding (OR = 5.55), long period of exclusive breast feeding ( > 4 months) (OR = 2.47), and recent acute disease (P = 0.034). The following variables were found significantly more often in children with rAOM or COM by simple frequency testing: Parental history of OM (OR = 1.60; OR = 2.11, respectively) and no recall of breast feeding (P = 0.005; P = 0.003, respectively). Also, COM was found significantly more often in children with two Greenlandic parents (OR = 3.07). A multiple logistic regression test denoted only parental history of OM (OR = 1.82) and long period of exclusive breast feeding (OR = 1.14) as significant predictors of AOM. CONCLUSIONS: Many of the risk factors usually associated with AOM could not be confirmed as risk factors in this survey. Parental history of OM and long period of exclusive breast feeding were the strongest factors associated with AOM in Greenlandic children and ethnicity was associated with COM. However, the study confirms that AOM is a multifactorial disease determined by a number of genetic and environmental factors.
Contraceptive habits in relation to sexual activity were investigated in a population-based cross-sectional investigation. A total of 661 women from Nykøbing Falster and 586 women from Nuuk/Godthåb in Greenland participated. The women, who were in the age group 20-39 years, were selected at random from the census and all underwent a personal interview. Both in Godthåb and in Nykøbing Falster a "non-barrier" method of contraception was the commonest method employed, regardless of the number of sexual partners. In Godthåb, the majority had thus employed IUDs and in Nykøbing Falster, oral contraception was the method most employed. In Godthåb, 9-22% had employed condoms on one or other occasion and the prevalence of this was found to increase with the number of sexual contacts. In Nykøbing Falster 57-63% had employed condoms but no significant variation was observed between various categories of numbers of partners in this area. From the point of view of prevention of sexually transmitted disease, it is striking that among women with greater than or equal to 20 sexual partners, approximately 79% and approximately 40% in Godthåb and Nykøbing Falster, respectively, had never employed condoms or diaphragms. In future, it will be important to investigate the patterns of sexual behaviour in various cultures and their development during the course of time in order to advise a population on the basis of the norms found in the culture concerned.
As part of a study of risk factors for cervical cancer, the possible change was assessed in the use of condoms after AIDS campaigns. In 1986, samples of 800 women aged 20-39 years were drawn at random from Nuuk/Godthåb (Greenland) and Nykøbing Falster (Denmark). A total of 586 and 661 women were interviewed in Greenland and Denmark, respectively. In 1988, new random samples of 150 women were drawn from the same areas. Totally, 129 Greenlandic and 126 Danish women were included in the study. From 1986 to 1988 the prevalence of ever having used condoms increased significantly among Greenlandic women aged 20-29, whereas no statistically significant changes were observed in Denmark. This pattern was independent of the lifetime number of sexual partners. Neither in Greenland nor in Denmark did the mean lifetime number of sexual partners change from 1986 to 1988.
The prescription pattern to children living in an arctic environment (Nuuk, Greenland) is similar to the pattern seen in other countries e.g. Sweden, Norway or the US, but the prescription rate of both anti-infectives and the total number of drugs is 2-3 times larger. This may reflect differences both in socioeconomic factors, in disease patterns and in sickness rate in children living in the Arctic. Inuit children are known to have a disease pattern that partly differs from the one seen elsewhere. Most drugs were prescribed to the youngest children who also received less phenoxymethylpenicillin and more other anti-infectives. 2/3 of all drugs were prescribed during the winter (November to April). A small group of large scale consumers, 116 children or 7% of the children prescribed drugs, were prescribed anti-infective drugs 3 times or more and were prescribed more than 1/5 of all drugs to children in Nuuk in the year surveyed.
The study is a retrospective evaluation of audiometric screening tests and registration charts of 167 school children in the towns Sisimiut and Nuuk, Greenland. The children were from 5 to 14 years old. The test performed was pure tone air conduction audiometry at frequencies from 250 to 8000 Hz. In total 43% of the children had hearing thresholds exceeding hearing loss (HL) of 20 dB at one or more frequencies in either one or both ears. The threshold elevations were most common and more severe at the high frequencies (6000-8000 Hz). At the mid frequencies (500-2000 Hz) a HL greater than 20 dB was found in 32/166 (19%) of the children, seven (4%) of whom were bilaterally affected. Seventeen children (10%) had HL at two or all frequencies in the mid frequency range. HL was significantly more frequent in Sisimiut in total 95% CI = 11-40%; (p
In Greenland, the incidence of cervical cancer is 5.7 times higher than in Denmark among women aged 20-39. From Nuuk (Greenland) and Nykøbing Falster (Denmark) a sample of 800 women aged 20-39 years was drawn at random. A total of 586 and 661 women were investigated in Greenland and Denmark respectively. All women had a gynecological examination including a PAP-smear and cervical scrape for HPV-analysis (filter in situ hybridization). A blood sample was taken for analysis of HSV type-specific antibodies (ELISA). The percentage of normal smears was identical in the 2 areas (95%). The total HPV 16/18 infection rate was 13% in Denmark and 8.8% in Greenland, and the age-adjusted prevalence rate in Greenland was only 67% of that in Denmark (95% CI: 0.05-0.89). The proportion of HPV 6/11 positivity was the same in Greenland and in Denmark (6.7% vs. 7.5%). A significantly higher proportion of the Greenlandic women had HSV-2 antibodies (68.2%) in comparison with Danish women (30.9%) (p less than 0.01). The prevalence of HSV-1 was also higher in Greenland, especially in women aged 20 to 24. Our finding of a higher HPV infection rate in Denmark than in Greenland, opposed to cervical cancer rates, does not support a role for these viruses as determinants of cervical cancer incidence. In contrast, the rate of HSV-2 infection co-varies with the observed incidence of cervical cancer. This is in line with the notion that differences in cervical cancer incidence between Denmark and Greenland are determined by aspects of sexual behavior.
The prevalence of human papillomavirus (HPV) infection and other risk factors were studied in a high risk area for cervical cancer (Greenland) and in a low risk area (Denmark). From Nuuk (Greenland) and Nykøbing Falster (Denmark), random samples of 150 women aged 20-39 years were drawn. A total of 129 and 126 women were included in Greenland and Denmark, respectively. The proportion of HPV infected women assessed by ViraPap was similar in Denmark and Greenland (4.8 vs 3.9%). When type specific polymerase chain reaction (PCR) was used, the total HPV detection rate was 38.9% in the Danish population and 43.4% in the Greenlandic. A similar interrelationship between Greenland and Denmark applied to the HPV types 11, 16, 18 and 33. No relationship was observed between HPV detection and number of partners for any of the diagnostic methods. Significantly more Greenlandic than Danish women had antibodies to HSV 2, 76.0% and 26.2%, respectively. The prevalence of self-reported histories of selected venereal diseases was also highest among Greenlanders, except for genital warts where the prevalence was similar in the two areas. Greenlandic women had significantly more sexual partners, earlier age at first intercourse, more current smokers and less use of barrier contraceptives compared to the Danish women. This study confirms the results of our previous population-based cross-sectional comparison study in these areas, corroborating the conclusion that the prevalence of detectable HPV infection does not seem to be a determinant of cervical cancer incidence. However, by using DNA hybridisation techniques, temporal virus shedding is only measured at one point in time. Detectable virus shedding may not correlate with the risk of cervical cancer. In fact, HPV DNA detection may have different implications in different populations. In Denmark, HPV DNA detection may reflect transient, recently acquired infection, whereas in Greenland, it is more indicative of chronic persistent infection.
In an unselected survey in two Greenlandic towns, 591 children were examined to study the prevalence of otitis media (OM). The attendance rate in Nuuk was 80%, while 93% participated in Sisimiut. The children were three-, four-, five- and eight-years-old and represented 18% of children in these age groups in all Greenland. In total, 51.7% in Nuuk and 54.1% in Sisimiut presented pathologic middle ear affections ranging from slight to severe. The prevalence rates of chronic OM (COM) were 6.8% in Nuuk and 11.7% in Sisimiut (P = 0.055) but without significant age or sex difference. The acute OM point prevalence rate was between 1.5% and 0.4%. The prevalence rate of middle ear effusion (MEE) was between 23.0% and 28.2%. Secretory OM was significantly more prevalent in the younger age groups. The odds ratio of having COM was significantly higher in children with two Greenlandic born parents (3.07) than in children with only one Greenlandic born parent. A follow-up study after one year in Sisimiut revealed unchanged or aggravated middle ear disease in 56.8% of 82 children with middle ear pathology at the primary survey. Thus, OM persists as a major health problem among Greenlandic children, although the general socio-economic and medical conditions have improved during the last decades. Proposals are provided for increased otologic efforts.