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Ten year evaluation of a trial of chemoprophylaxis against tuberculosis in Frobisher Bay, Canada.

A trial of chemoprophylaxis to prevent tuberculosis in Canadian Inuit (Eskimos) was carried out in Frobisher Bay, Canada during 1971-1974. A completely supervised regimen of isoniazid and ethambutol thrice weekly for 18 months was administered. A 10-year evaluation of 370 treated persons and 217 control subjects demonstrates the sustained value of adequate chemoprophylaxis in reducing the risk of developing active tuberculosis in the 3 groups under study--1, those with a previous episode of active tuberculosis, 2, positive tuberculin reactors with normal chest X-ray and 3, BCG vaccinated individuals with large tuberculin reactions. There were 3 cases of active disease in the treated group, a risk of 0.1% per annum, and 13 cases among the controls, a risk of 1.0% per annum.

Adolescent↗

EBV strain variation: geographical distribution and relation to disease state.

The strains of Epstein-Barr virus (EBV) were characterized in epithelial and lymphoid malignancies from geographic regions with high or low incidence. The predominant strains in nasopharyngeal carcinoma (NPC) from regions with elevated incidence were EBV type 1 in southeast Asia and Mediterranean Africa. In Alaskan Eskimos, a distinct variant of EBV type 2 was found in NPC and carcinoma of the parotid gland. This strain contained polymorphisms characteristic of the Asian EBV type 1. The strains prevalent in southeast Asia and Mediterranean Africa were also found in NPC which developed in caucasian Americans. These variants were not detected in lymphomas which developed in central Africa, Mediterranean Africa, or continental United States. These results suggest that distinct EBV strains predominate in geographic areas with elevated incidence of NPC. The detection of these distinct strains in epithelial tumors from areas of low incidence may reflect an epithelial cell tropism or pathogenicity.

Animals↗

Human umbilical blood vessel converts all cis-5, 8, 11, 14, 17 eicosapentaenoic acid to prostaglandin I3.

All cis-5, 8, 11, 14, 17 eicosapentaenoic acid (EPA) is presently being evaluated for dietary prophylactic use in thrombo-embolic disorders. EPA inhibits the production of TXA2 and platelet aggregation. We here present results demonstrating that human umbilical arteries convert 14c-EPA to a substance that in aqueous solutions decomposes to 14C-delta 17-6-keto-PGF1 alpha . The conversion rate in rat aortic tissue was found substantially lower. These results in combination with earlier data indicating that EPA does not influence the conversion of arachidonic acid (AA) into PGI2 in human vascular tissue, encourage further research along the lines initiated by the findings of high EPA/AA ratio and low incidence of myocardial infarction in Greenland Eskimos.

6-Ketoprostaglandin F1 alpha↗

Evaluation of an Alaskan streptococcal control program: importance of the program's intensity and duration.

Prospective follow-up information from the throat culturing results of 1,653 Eskimo children in 12 Alaskan villages was used to evaluate the effect of duration and intensity of a streptococcal control program begun in 1971 while controlling for several other risk factors related to streptococcal colonization. Relative risks of colonization for each of the subsequent study years relative to the first year indicate that the risk of colonization decreased over the duration of the study by 42% in Year 2 to 55% in Year 4 (P less than 0.0001). Cost-cutting measures such as lengthening the time interval between routine throat cultures led to a 37% increase in the risk of colonization (P = 0.0002). A comparison of the number of cases of acute rheumatic fever during the 5-year period before the streptococcal control program with the number of cases during the 5-year program period showed that cases in villages with the program decreased from 11 to 0. In a similar group of comparison villages without the program, the number of cases decreased from 7 to 4. A benefit-cost study of the program indicates that benefit exceeds cost. These findings and the changes in the carriage of streptococcal organisms during the control program underscore the importance of such long-term programs with regularly scheduled culturing in high-risk populations of children.

Acute Disease↗

Dietary linolenic acid in man--an overview.

Small amounts of linolenic acid are ubiquitous in human food but only a few foodstuffs contain sizable amounts, namely some plant oils, butter and fish; in marine fish, linolenic acid is accomplished by eicosapaentaenoic acid, highly exceeding linolenic acid in quantity. Of the linolenic acid ingested, some is incorporated into phospholipids and cholesteryl esters, very little is elongated and eventually converted to prostaglandins; probably most linolenic acid is used as fuel. Polyunsaturated fatty acids of the (n-3)-series should no longer be considered to be similar with respect to their metabolic fate and their effects. In particular, results from experiments with "eskimo diets" may not be applied to considerations of linolenic acid. There may be a small dietary requirement for linolenic acid, possibly only for growing children; yet it is prudent to recommend diets which are not devoid of linolenic acid, especially in formula diets or parenteral nutrition. Some experiments suggest that high doses of linolenic acid exert untoward effects by inhibiting prostaglandin synthesis of the 1- and 2-series. The ratio between linoleic and linolenic acid in relevant experiments was such that only excessive use of linseed oil could produce them under conventional dietary conditions. Still it must be considered prudent to keep the linolenic acid content of foods well below that of linoleic acid.

Dietary Fats, Unsaturated↗

Viral oncogenesis: Epstein-Barr virus.

The Epstein-Barr virus (EBV) is a common herpesvirus that has been linked to several human neoplasms. It has been found in over 90% of cases of Burkitt's lymphoma in endemic regions, although only 15% of cases in nonendemic regions show evidence of infection. The virus has been found in malignant lymphomas in immunocompromised states, including the acquired immunodeficiency syndrome, iatrogenic immunosuppression, such as in posttransplantation patients, and congenital immunodeficiencies. Recently, EBV genomes have been found in approximately 25% of cases of Hodgkin's disease, where it has been found in the Reed-Sternberg cells. Epstein-Barr virus genomes are found in over 90% of cases of undifferentiated nasopharyngeal carcinoma. In addition, EBV has been identified in undifferentiated carcinomas in other sites in Asians, such as carcinomas of the parotid in Chinese individuals and Eskimos.

Burkitt Lymphoma↗

Long-term antibody response after measles vaccination in an isolated arctic society in Greenland.

Scoresbysund is an isolated district on the east coast of Greenland with 500 inhabitants, mainly Polar Eskimos, which had never been exposed to natural measles. In 1968 more than 90% of the population were vaccinated with the Schwarz live further-attenuated measles vaccine and subsequently children born after 1968 likewise received the measles vaccination. Upon the initial measles vaccination no clinical cases of measles have been observed. The immunity status of the isolated population has been followed for 16 years after vaccination by IgM, IgA, and IgG ELISA tests and by HI test on a series of serum samples taken at intervals. Immunoblotting was performed on sera obtained 16 years after the vaccination. In general, antibody studies have demonstrated some decline in antibody titres after the initial measles vaccination. However, a temporary moderate increase in measles antibodies occurred in some individuals 2-4 years after vaccination, probably due to a reinfection of vaccinees. Most of these individuals did not have demonstrable IgA antibodies prior to the supposed reinfection.

Antibodies, Viral↗

World-wide epidemiology of Haemophilus influenzae meningitis; industrialized versus non-industrialized countries.

The epidemiology of Haemophilus influenzae meningitis in non-industrialized areas shows considerable differences from that in the industrialized world. The incidence rates among Alaskan Eskimos, Navaho and White Mountain Indians, Australian Aboriginals and among populations in Africa such as Gambians and Senegalese are three- to fourfold higher than those in the USA and up to ten times higher than those in Europe. The peak age in populations with a high incidence is around 5 to 6 months of age compared to 9 months of age in other countries. The case fatality rate (CFR) is not related to the state of industrialization but seems to be more dependent on the accessibility of health care facilities. Africa the CFR is about ten times higher than that seen elsewhere. Apart from other dissimilarities such as the pattern of serotypes causing disease and the transmission rate, the epidemiology of Hib disease is sufficiently different from industrialized areas that it demands a thorough testing of a conjugated Hib vaccine before it can be introduced on a large scale in populations in non-industralized areas.

Age Factors↗

Secular trends and the pattern of growth in arctic populations.

Examinations of growth patterns in Arctic populations suggest that Inuit/Inupiat (Eskimo) children display a unique pattern relative to European or continental U.S. children. This pattern--high weight for height--becomes established early in life and it has existed for as long as researchers have Inuit or Inupiat data. This paper will examine the growth pattern relative to the NCHS reference standard, using recent data from the Arctic and several indices combining height and weight. Of particular concern will be the persistence of this pattern in the face of secular trends in growth that have occurred over the past 50 years. Trends for height increase have been greater than those for weight but weight for height still remains well above the 50th percentile of the U.S. reference for these Arctic groups.

Anthropometry↗

Geographical distribution of diabetes among the native population of Canada: a national survey.

The prevalence of diagnosed diabetes was determined for 76% of the registered Indian and Inuit (Eskimo) population of Canada from case registers maintained by the federal agency responsible for Indian health services. A total of 5324 cases were ascertained. The age-sex adjusted rate varied among the Indians from a low of 0.8% in the Northwest Territories to a high of 8.7% in the Atlantic region. Among Inuit, the prevalence was 0.4%. Most cases occur in middle-aged or older individuals, with a higher prevalence among Indian (but not Inuit) females. An ecologic analysis was performed with the crude prevalence of individual communities regressed upon independent variables that included longitude, latitude, geographic isolation, culture area, and language family. Stepwise regressions were also carried out within the Algonkian, Athapaskan, and Eskimoan language families. For the national sample, composite language phylum-culture area predictors were used. The results in the national sample confirmed most findings in the individual language family analysis. Six predictors: latitude, Northeast-Algonkian, Northeast-Iroquoian, Subarctic-Algonkian, Plains-Siouan, and Plains-Algonkian, ranked here in decreasing order of importance, explained 48.4% of the variation in diabetes prevalence. All the named groups had rates significantly greater than found in the reference group of Arctic-Eskimoans. We conclude that the distribution of diabetes among Canadian natives is determined by both genetic and environmental factors.

Aged↗

One person's 'spoiling' is another's freedom to become: overcoming ethnocentric views about parental control.

Gaining cultural self-awareness by health and human services professionals in areas that are bastions of conservatism like childrearing is particularly difficult to achieve. It is argued that polarized ideas about parental control dominate the Anglo Dominant Culture's value orientations, reflected in both popular and scientific literature. Parental permissiveness is cast into an opposing category of 'noncontrol', imbuing it with negativism. Prejudice against Eskimo childrearing is examined in that context and a method is offered to 'loosen' the grip of Anglo beliefs about parenting.

Attitude of Health Personnel↗

Is cancer communicable?

Recent developments in cancer epidemiology have led to the possibility of an exceedingly complex communicable factor(s) in cancer etiology. The transmission of such an agent(s) may require a susceptible genotype and/or other promotional events. Likely candidates which support this supposition include: Epstein-Barr virus (nasopharyngeal carcinoma, Burkitt's lymphoma, salivary gland tumor among Eskimos, X-linked lymphoproliferative syndrome of Purtilo); human T-cell leukemia virus (adult T-cell leukemia); acquired immune deficiency syndrome (AIDS), complicated by Kaposi's sarcoma (etiologic agent remains elusive, though epidemiology suggests possible infectious transmission); abnormal immune phenomena in households of Hodgkin's disease patients; and clustering of various types of cancer in spouses, the general population, and families. We have selectively reviewed the literature and evolved an etiologic hypothesis which integrates a communicable agent(s) in concert with genetic and/or environmental carcinogenic interaction which could conceivably explain a significant fraction of the total cancer burden.

Epidemiologic Methods↗

Atherogenesis. An epidemiological model based on the presence of unnatural trans and cis isomers of unsaturated fatty acids in the maternal diet and in mothers milk.

The hypothesis that the presence of unnatural trans and cis isomers of unsaturated fatty acids in the maternal diet and in human mothers milk could be responsible for initiating atherosclerosis in utero or in infants is proposed. It is suggested that the key etiological factor involved in the formation of atherosclerotic plaques could be uncontrolled division of smooth muscle cells of the intima resulting from the intracellular excess of linoleic acid and deficiency of its metabolites gamma-linolenic acid and dihomogamma-linolenic acid. This imbalance is brought about by competitive inhibition of the enzyme delta-6-desaturase by unnatural trans and cis unsaturated fatty acids. Delta-6-desaturase is the enzyme responsible for converting linoleic acid to dihomogamma-linolenic acid. The cellular presence of unnatural trans and cis isomers of unsaturated fatty acids would therefore enhance increased levels of linoleic acid and deficiency of its metabolites gamma-linolenic acid and dihomogamma-linolenic acid. It is proposed that prophylaxis against the effects of delta-6-desaturase inhibition could be achieved by the adoption of an Eskimo-like diet containing the essential fatty acid metabolites gamma-linolenic acid and/or dihomogamma-linolenic acid and eicosapentaenoic acid per se in high concentrations.

Arteriosclerosis↗

The role of omega 3 fatty acids on insulin secretion and insulin sensitivity.

Carbohydrate intolerance is positively correlated with animal fat consumption and is more common in beef eating populations. In contrast, individuals consuming diets comprised of polyunsaturated fats have a lower incidence of diabetes mellitus. This is especially apparent in the Eskimos living in Alaska and Greenland whose diet is highly enriched with omega 3 fatty acids. It is hypothesized that dietary enrichment with omega 3 fatty acids increases the incorporation of these fatty acids into the beta cell phospholipid membrane thus enhancing insulin secretion. It is also proposed that similar changes occur in the phospholipid membrane composition of peripheral cells. These changes in the membrane phospholipids would then theoretically increase both insulin receptor binding affinity and sensitivity, thus enhancing glucose transport across their membranes. Augmented insulin secretion and increased insulin sensitivity induced by chronic omega 3 fatty acid ingestion would positively influence carbohydrate metabolism and improve glucose homeostasis.

Diabetes Mellitus↗

Long-chain n-3 fatty acids in breast milk of Inuit women consuming traditional foods.

The fatty acid composition of mature breast milk total lipids was analysed in milk from Inuit women living in a small Arctic community. Long-chain n-3 fatty acids were higher than in comparable samples from Vancouver residents. The data suggest that secretion of n-3 fatty acids in milk is influenced by the dietary intake of the lactating woman. The levels of these fatty acids in Inuit milk approximate those reported for the diet fat of adult Eskimo, and which have been associated with reduced plasma cholesterol levels and death from coronary heart disease.

British Columbia↗

Fish oil: a panacea?

Since the first report by Bang and Dyerberg regarding the apparent beneficial effects of a fish oil-enriched diet on the incidence of atherosclerotic heart disease in Greenland eskimos, a considerable number of studies have been performed regarding the effects of omega-3 polyunsaturated fatty acids on the prevention and treatment of a variety of disease states not necessarily related to atherosclerosis. Studies have been performed on healthy volunteers and in patients with hyperlipidaemia, atherosclerotic vascular disease, diabetes, asthma, psoriasis and chronic renal insufficiency, amongst others. Positive effects on platelet activity, lipid profile, blood rheology and blood pressure--all factors which are presumably of importance in the pathogenesis of atherosclerotic disease have been noted in these studies, albeit with a wide range of variability. Some negative effects also appear to exist. However, some general conclusions can be made regarding the effects of a fish oil-enriched diet.

Arteriosclerosis↗

Adipose tissue triglyceride fatty acids and atherosclerosis in Alaska Natives and non-Natives.

Essential polyunsaturated fatty acids (PUFA) of the omega-3 family are believed to protect against cardiovascular disease. A rich source of omega-3 PUFA is found in fish and marine mammals (seal, walrus, whale), which are a large part of the traditional diet of Alaska Natives (Eskimo, American Indians, Aleuts), a group that has been reported to have a lower mortality rate from cardiovascular disease than non-Natives. An autopsy study using standardized methods to evaluate the extent of atherosclerosis and its risk factors, and analyses of stored triglyceride fatty acids was conducted in a sample of Alaska Native subjects and non-Native subjects living in Alaska. Findings indicate that Alaska Natives had less advanced atherosclerosis in coronary arteries, along with higher proportions of omega-3 and lower proportions of omega-6 PUFA in adipose tissue, than did non-Natives. We conclude that high dietary intake of omega-3 PUFA may account for the lower extent of coronary artery atherosclerosis, contributing to the reported lower heart disease mortality among Alaska Natives.

Adipose Tissue↗

Selective brain cooling seems to be a mechanism leading to human craniofacial diversity observed in different geographical regions.

Selective brain cooling (SBC) can occur in hyperthermic humans despite the fact that humans have no carotid rete, a vascular structure that facilitates countercurrent heat exchange located at the base of the skull in some mammals. Emissary and angular veins, upper respiratory tract, tympanic cavity and cerebrospinal fluid are major components of SBC system in humans. The efficiency of SBC is increased by evaporation of sweat on the head and by ventilation through the nose, but it is surprising to find out that mammals do not display SBC during exercise hyperthermia. What is the explanation then for the SBC at high body temperatures? Our hypothesis is that selective brain cooling protects the brain from thermal damage in a long-standing manner by allowing adaptive mechanisms to change the craniofacial morphology appropriate for different environmental conditions. Since the brain can only be as big that can cool, it is not surprising to find a lower (below 1300 cm(3)) cranial volume in Australian Aborigines with respect to the one (over 1450 cm(3)) in Eskimos. In addition to lower brain volume, other craniofacial features such as thick everted lips, broader nasal cavity and bigger paranasal sinuses that provide more evaporating surfaces seem to be anatomical variations developed in time for an effective SBC in hot climates. It was reported previously that these biological adaptations result from the tissues of neural crest origin. Among the crest derivatives, leptomeninges (pia and arachnoid mater), skeletal and connective tissues of the face and much of the skull seem to be structures upon which environment operates to produce more convenient craniofacial morphology for an effective SBC. In conclusion, selective brain cooling seems to be a mechanism leading to adaptive craniofacial diversity observed in different geographical regions. Thus, SBC is necessary for long-term biological adaptation, not for protecting the brain from acute thermal damage.

Adaptation, Physiological↗