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Epidemiology of Haemophilus influenzae type B disease among Navajo Indians.

During a 7-year period ending June 30, 1980, the annual incidence of all Haemophilus influenzae type b disease among Navajo children less than 5 years old was 214 per 100,000, and that of H. influenzae meningitis was 152 per 100,000. Eighty-one percent of H. influenzae meningitis occurred in children 12 months of age or younger, and 64 percent clustered in children ages 4 through 8 months. Meningitis accounted for 70 percent of all invasive disease. No epiglottitis was observed. The epidemiology is similar to that in Yupik Eskimos, who have an even higher rate of H. influenzae type b disease than Navajos but are a much smaller population. Mortality from H. influenzae meningitis was low (4 percent) among Navajo children, but neurological sequelae were observed in at least 16 percent of the survivors. This high rate of sequelae may be due in part to clustering of cases in infancy. Among normal Navajo neonates, 79 percent had maternal capsular type b antibody titers greater than or equal to 0.15 micrograms per deciliter (microgram per dl), and the whole group had a geometric mean titer of 0.51 micrograms per dl. By age 4 months, when meningitis cases became frequent, only 14 percent of Navajo infants had antibody titers greater than or equal to 0.15 micrograms per dl. Twelve of 67 asymptomatic infants (18 percent), each monitored every 2 months, had H. influenzae type b or a cross-reacting organism isolated from the pharynx on at least one occasion before they were 9 months old. Active immunization would be theoretically indicated in this population with high H.influenzae type b exposure and disease, but a vaccine would have to confer substantial immunity in very young infants.

Adolescent↗

[The potential clinical significance of the isoniazid acetylator phenotype in the treatment of pulmonary tuberculosis].

The most important factor determining the speed with which isoniazid is eliminated from the body is the rate of its acetylation in the liver. There are large differences between individuals in the rates at which isoniazid is acetylated. Over 98% of subjects can be clearly characterized as being either rapid of slow acetylators. Among the many satisfactory procedures for determining the acetylator phenotype of subjects, the simple sulphamethazine method is probably the most convenient. The proportions of rapid acetylators among different populations vary from about 40% among those of European and South Indian descent to over 85% among Japanese and Eskimos. The isoniazid acetylator phenotype of tuberculosis patients treated with isoniazid-containing regimens is without prognostic significance when treatment is given daily and only of doubtful importance when weak twice-weekly regimens are employed. However if treatment is given on a once-weekly basis, the response of rapid acetylators is generally much less satisfactory than that of slow acetylators. Since isoniazid is eliminated from the body predominantly by metabolism its clearance is not greatly diminished in the event of renal failure. As a consequence there are no grounds for reducing the dosage of isoniazid given to patients with impaired renal function. The incidence of the commonly encountered asymptomatic increases in serum transaminases associated with isoniazid treatment is similar in rapid and slow acetylators. Clinically important hepatic toxicity manifested by jaundice only occurs in 1-2% of patients treated with isoniazid-containing regimens. Despite earlier suggestions to the contrary, it is no more common in rapid than among slow acetylators. Since all patients can be treated effectively and safely with standard isoniazid dosages, determining patients' isoniazid serum/plasma levels or acetylator phenotype is hardly ever worthwhile. By contrast, since poor patient compliance is a major cause of therapeutic failure, monitoring the regularity with which patients self-administer their prescribed isoniazid treatment using simple urine-test methods can be of considerable value.

Acetylation↗

Malignant lympho-epithelial lesion--the Manitoba experience.

A retrospective study was carried out utilizing the Records Department of the Health Sciences Centre, St. Boniface General Hospital, and the Manitoba Cancer Treatment and Research Foundation. Seventeen cases of malignant lympho-epithelial lesion were found. The pathology of all cases was reviewed. There were 12 females and five males. Sixteen cases involved the parotid gland and one the submandibular gland. The ages ranged from 17-65 years with the peak incidence in the fourth decade of life. Fifteen of the patients were Eskimos, all residing in the Northwest Territories; two patients were Caucasian. Most patients were treated with a combined modality of surgery with postoperative radiation. The clinical features, pathology, treatment, and final outcome are reviewed.

Adolescent↗

Spontaneous gastric squamous cell carcinomas and other neoplasms in Greenland collared lemmings (Dicrostonyx groenlandicus).

Malignant neoplasms were present in 39/66 Dicrostonyx groenlandicus of varying ages, examined from a laboratory colony. The presence of multiple neoplasms in some resulted in an overall average of 1.15 tumors/affected animal. Gastric squamous papillomas were present in nine, and locally invasive or metastatic gastric squamous cell carcinomas in a further 36 animals. Three mammary adenocarcinomas, one pancreatic islet cell tumor, one probable pancreatic adenocarcinoma and one adrenal cortical adenoma were also seen in lemmings with gastric tumors. Two others had mammary adenocarcinoma alone, and one animal had bilateral Harderian gland adenocarcinoma. Lesions resembling glomerulonephrosis of rats were seen in 23/51 animals whose kidneys were examined. These findings were not considered artefacts of captivity since concurrent gastric squamous cell carcinoma, mammary adenocarcinoma and glomerulonephrosis were present in the single animal examined directly from the wild at Eskimo Point, Northwest Territories.

Adenocarcinoma↗

Focal epithelial hyperplasia of the oral mucosa.

Focal epithelial hyperplasia (FEH) of the oral mucosa has been reported mainly among American Indians, Eskimos, and south Africans. Our investigation is the first among Canadian Indians and combines an epidemiological study of FEH in a Cree Indian population living in Fort Georges. P.Q., and a description of its histologic and ultrastructural features. The sample consists of 150 individuals divided into six age groups. The prevalence rate for all groups is 18.6%. Clinically the lesions are nodular, sessile, and tend to merge with the adjoining mucosa upon stretching. Histologically the hyperplasia is limited to the epithelium. E.M. shows papova-virus-like particles. Otolaryngologists' awareness of this lesion could possibly lead to its recognition on a larger scale.

Adolescent↗

Factors affecting streptococcal colonization among children in selected areas of Alaska.

The epidemiology of streptococcal disease affecting 706 Alaskan Eskimo children was investigated by analysis of data on throat cultures obtained during a long-term surveillance program begun in 1971. A binary variable multiple-regression model was used to study the association between streptococcal colonization of these children and six potential risk factors: age, sex, number of children in household, region, health-aide rating, and colonization rate for each child the previous year. Factors found to be significantly associated with streptococcal colonization included age, past colonization, competence of local health-aide in providing care, and health-care region. Age varied most in the standardized colonization ratio (percentage of corresponding adjusted rate to overall crude colonization rate), ranging from 122 percent for children 3--6 years old to 67 percent for children 13--18 years old. The number of children in over-crowded homes and a child's sex were not apparently important. The method of analysis can be used to provide health-care planners with a simple means of identifying potentially important areas of concern for planning effective and economical health-care strategy.

Adolescent↗

Nasopharyngeal carcinoma: epidemiology, histopathology and aetiology.

The highest incidence of nasopharyngeal carcinoma (around 20 per 100,000 per year) is found in Chinese populations in many countries. Elevated rates (5--15) are found in Eskimos, and in several racial groups in South-East Asia. The incidence rates in Malta and in some parts of Northern Africa are also moderately elevated. The incidence rates are low (less than 1) in virtually all other parts of the world. In Singapore, the incidence rates are high in Chinese (18.4), intermediate in Malays (4.7) and low in Indians (less than 1). Among the various Chinese communities, the incidence rates in Cantonese (29.1 and 11.0 for males and females respectively) are significantly higher than those in Hokkiens (14.1 and 4.7), Teochews (18.3 and 6.2), Hainanese (14.2 and 3.3) and Hakkas (12.6 and 4.8). The tumour has a male preponderance (2--3 times) and a peak incidence in the 5th and 6th decades. Nasopharyngeal carcinoma (NPC) is the commonest form of nasopharyngeal cancer in man. All histological types of NPC have consistently shown ultrastructural evidence of squamous differentiation and may be regarded as variants of a homogeneous group of tumours. The development of the neoplasm is attributable to the action of environmental factors in genetically susceptible persons. There is growing evidence that nitrosamine compounds and the Epstein-Barr virus may be involved in the aetiology of this neoplasm.

Asia, Southeastern↗

The effects of dietary omega 3 fatty acids on platelet composition and function in man: a prospective, controlled study.

The rarity of atherosclerotic vascular disease and a mild bruising tendency in Greenland Eskimos has been linked to their ingestion of omega 3 fatty acids contained in foods obtained from the sea. Previous studies have shown that feeding salmon oil to normal volunteers resulted in reductions of plasma cholesterol and triglycerides. We wished to learn whether salmon oil feeding would result in the incorporation of omega 3 fatty acids into platelets and whether platelet function or platelet-vessel interaction would be altered. Diets containing salmon oils led to the incorporation of eicosapentaenoic acid (C20:5 omega 3) into platelets (6.1%) with a reduction in arachidonic acid (C20:4 omega 6). The ratio of C20:5/C20:4 increased from 0.0045 on the control diet to 0.3 on the salmon diet. Bleeding times were prolonged (from 6.75 to 10 min, p less than 0.005), platelet retention on glass beads was mildly reduced (from 89% to 78%, p less than 0.0005), and platelet aggregation in response to dilute concentrations of ADP was inhibited in the subjects ingesting the salmon oil. We conclude that in normal subjects dietary omega 2 fatty acids derived from salmon oil are incorporated into platelet phospholipids and that these changes are accompanied by alterations in bleeding time and platelet function.

Adenosine Diphosphate↗

Detection of genetic variation with radioactive ligands. II. Genetic variants of vitamin D-labeled group-specific component (Gc) proteins.

A novel technique for detecting electrophoretic and quantitative variants of group-specific component (Gc) proteins is described. The technique, in vitro labeling with radioactive vitamin D followed by polyacrylamide gel electrophoresis and autoradiography (PAGE autoradiography), permits sensitive, high resolution detection of Gc variants by virtue of a physiologically significant property: the ability of Gc to bind vitamin D and 25-hydroxyvitamin D. Using this procedure, anodal Gc variants, with mobility similar to Gc Aborigine and Gc Eskimo, were observed in Chinese, Japanese, African Pygmies, and American Blacks. The gene frequency of these variants ranges from 2.6% to 15%; they were not previously known to be polymorphic in these populations. In addition to qualitative variants, individual variation in Gc band density ratios is documented and discussed. These studies not only illustrate the utility of PAGE autoradiography in screening Gc, but also confirm that a major functional role of Gc in man and other animals is the transport of vitamin D and vitamin D metabolites.

Adult↗

[Polymorphism of mitochondrial DNA region V in native and migrant inhabitants of Northeast Asia].

Data on polymorphism of the V region of mitochondrial DNA (mtDNA) in eastern Slavs from Magadan (N = 108), Asian Eskimos (N = 21), and coastal Chukchi (N = 10) are presented. The region V insertion-deletion polymorphism was shown to be absent in the samples of native and immigrant population of northeastern Asia. The Hae III-Ava II restriction polymorphism of the 8249-8254 bp part of this mtDNA region was found only in eastern Slavs. In them, the variant Hae III(-)/Ava II(+) and the novel type of polymorphism Hae III(-)/Ava II(-) were recorded at frequencies 2.8% and 1.85%, respectively. The low level of diversity of mtDNA types in Arctic populations of the world is discussed. A hypothesis is advanced that the low level of mtDNA diversity in Arctic population of humans is determined by several factors. These include an initially low number of mtDNA types in forming ancestral populations, genetic drift, isolation, and continuous adaptation of the populations. The latter is associated with selection of genotypes optimal for living in the extreme climatic and geographic conditions of the North; some of these genotypes control a low level of free oxygen radicals in the cell.

Adaptation, Physiological↗

Dental evidence for the peopling of the New World: some methodological considerations.

Turner (1985b) and Greenberg et al. (1986) proposed that New World populations originated in northern Asia and entered the Americas in three migratory waves: Macro-Indian, Aleut-Eskimo, and Na-Dene. Biological support for this model comes from Turner's unweighted pair group (UPGMA) cluster analysis of discrete dental traits in world populations. Unfortunately, UPGMA analysis often creates suspect clusters and may not be valid as a method for displaying evolutionary relationships because it assumes that rates of evolution are equal among all populations. To test whether Turner's results are an artifact of his analytical method, I analyzed his published data (Turner 1985b) using two alternative techniques that do not assume homogeneous rates of change: a Wagner distance algorithm employing the Fitch-Margoliash criterion for goodness of fit and a maximum parsimony analysis using segment-coded dental trait frequencies. Both alternative methods produce trees that are similar to the UPGMA analysis results, supporting Turner's original results and basic conclusions. Comparisons of tree topology demonstrate that there is strong congruence between trees produced by all three methods, although the placement of certain populations, such as Na-Dene, depends on the method of analysis employed.

Algorithms↗

[Rationale for alcohol consumption and mitochondrial aldehyde dehydrogenase genotype in the native male population of Chukotka].

To study the alcohol consumption pattern and mitochondrial aldehyde dehydrogenase (ALDH2) genotype, a random sample consisting of 170 native males (Chukchee and the Eskimo), residents of 4 Chukotka settlements, was studied. According to interviews, most residents (68%) consumed alcohol once or twice a month; however during an alcohol uptake episode they consumed very high (intoxicating) doses exceeding 150 g of pure alcohol. The rates of control loss, alcohol amnesia and withdrawal syndrome were more than 50%. Twelve per cent reported inconsistent facial flushing after drinking and positive ethanol-patch test was found only in 2% of cases. Direct genotyping, using specific oligonucleotide probes, showed no atypical oriental type ALDH2. The normal genotype (ALDH2-1) was present in all the examinees from Chukotka natives (n = 87). These results explain the ability of Chukotka natives to consume high amounts of alcohol per occasion and they are in disagreement with the hypothesis that the drinking pattern among the natives is explained by specific features of alcohol-metabolising enzymes.

Adult↗

Founder mitochondrial haplotypes in Amerindian populations.

It had been proposed that the colonization of the New World took place by three successive migrations from northeastern Asia. The first one gave rise to Amerindians (Paleo-Indians), the second and third ones to Nadene and Aleut-Eskimo, respectively. Variation in mtDNA has been used to infer the demographic structure of the Amerindian ancestors. The study of RFLP all along the mtDNA and the analysis of nucleotide substitutions in the D-loop region of the mitochondrial genome apparently indicate that most or all full-blooded Amerindians cluster in one of four different mitochondrial haplotypes that are considered to represent the founder maternal lineages of Paleo-Indians. We have studied the mtDNA diversity in 109 Amerindians belonging to 3 different tribes, and we have reanalyzed the published data on 482 individuals from 18 other tribes. Our study confirms the existence of four major Amerindian haplotypes. However, we also found evidence supporting the existence of several other potential founder haplotypes or haplotype subsets in addition to the four ancestral lineages reported. Confirmation of a relatively high number of founder haplotypes would indicate that early migration into America was not accompanied by a severe genetic bottleneck.

Americas↗

Human genetic diversity (immunoglobulin GM allotypes), linguistic data, and migrations of Amerindian tribes.

GM haplotype frequencies were examined in 49 Amerindian tribes (from North, Central, and South America) to investigate the congruence of genetic variation with that observed in language and geography. We used two approaches: (1) the mobile site method, which allows a two-dimensional representation of genetic variation where the distances between reference points (i.e., the locations of the populations in the geographic map after displacements) are close to the genetic distances, and (2) a multivariate analysis (factorial correspondence analysis), which permits a visual interpretation of the geographic distribution of GM haplotypes on a map, completed by a cluster analysis. The results show a strong gradient from the Bering Strait to South America. The Eskimo and Na-Dene are genetically different from all other Amerindians, reflecting their more recent migrations. The orientation of most trajectories of the tribes from Central and South America can be interpreted as earlier migrations along the Pacific and Atlantic coasts. We conclude that geographic and linguistic factors played a part in the genetic diversity of Amerindian tribes.

American Indian or Alaska Native↗

Discrepancies between patient recall and the medical record. Potential impact on diagnosis and clinical assessment of chronic disease.

BACKGROUND: During a case-control study, data necessary for fulfilling diagnostic and classification criteria for spondyloarthropathy were collected from 121 patients. OBJECTIVE: To study the potential impact of differences between patient recall and the medical record on diagnosis and clinical characterization of spondyloarthropathy as a model of chronic disease. METHODS: The study was conducted among four Alaskan Eskimo populations served by the Alaska Native Health Service. Two sets of historical data were compiled for each subject, one acquired during the interview and the other derived from the medical record. Paired items from the interview and the medical record were analyzed to determine discrepancies and consequent effects on diagnosis, classification, and disease characterization. RESULTS: Significant differences were observed in the reporting of genitourinary or diarrheal illnesses preceding or associated with arthritis, the occurrence of eye inflammation in association with joint pain, the occurrence of joint pain and back pain together, and the age at onset of back pain all of which are important to the diagnosis and classification of spondyloarthropathy. In contrast, for information needed to establish the probable inflammatory nature of back pain, patient interview was more helpful than the medical records, which did not provide adequate details to differentiate inflammatory from mechanical back pain. CONCLUSIONS: Patient recall bias can substantially affect diagnosis and clinical assessment of chronic disease, as exemplified by spondyloarthropathy. Reliance on records alone, however, may lead to underestimation of features that require subjective appraisal by the patient.

Arthritis↗

[Preservation of cutaneous structures of egyptian mummies. An ultrastructural study].

INTRODUCTION: The recent development of studies applied to ancient materials may be explained by the application of molecular biology techniques on the extracted ancient DNA mainly the polymerase chain reaction (PCR), the ultrasensitive DNA-amplification technique that hit the headlines in the late 1980s. PCR was used to amplify human immunodeficiency virus (HIV), genetic material in stored tissue specimens and to document people who died in 1976. In addition, recent discoveries of mummified bodies in ice of the Tyrolean Alps or Greenland allowed a new approach in archeological studies. Mummies are a good material for investigations of ancient tissues. The studies concern the techniques of embalming, tissue preservation and palepathological aspects. In cutaneous paleopathology, mummies from Egypt, South or North America and Europe were considered. Various skin lesions were characterized: histiocytoma, Chagas' disease, smallpox, syphilis. Recently drugs (cocaine, hashish and nicotine) were extracted from skin and head hair of Egyptian mummies. Only a few studies were concerned with the ultrastructure of the skin of such mummies. MATERIAL AND METHODS: We had the opportunity to obtain skin samples of two Egyptian mummies. One of them was embalmed between 150 BC-90 AC. The skin was studied by transmission electron microscopy. As the mummified materials had dried out and shrunk, it was necessary to rehydrate them for ultrastructural observation. Skin samples were fragmented into small pieces before fixation with 2 p. 100 glutaraldehyde in sodium cacodylate buffer for 10 days (allowing for removal of the materials used for embalming). The samples were then washed in the same buffer for 10 days. After washing the pieces were post-fixed with 1 p. 100 osmium tetroxyde, dehydrated and embedded in Epoxy medium. RESULTS: With this process, it was possible to observe the excellent preservation of the cutaneous structures. The epidermis was well preserved. It was possible to observe the different cell layers and mainly the upper layers. The nuclei and the desmosomes of keratinocytes were recognized. Intercellular spaces were narrow. Desmosomes showed dense thickenings of the cell membrane on both sides and an intercellular band with narrow lucent spaces adjacent to the dense cell membrane. The nuclei showed dense spots of chromatin and in the cytoplasm recognizable tonofilament bundles were identified. Langerhans cells and melanocytes were not observed. In the dermis, the collagen fibrils formed thick bundles and showed the characteristic axial periodicity. Elastic fibers were also recognized showing two main components: the amorphous substance and the fibrils. Throughout the dermis, a number of round or oval structures were found. They had the typical appearance of spores of bacteria. In the centre, they had an electron dense and granular core surrounded by an inner membrane and a spore coat. DISCUSSION: Only a few investigations were performed on the ultrastructure of the skin of the Egyptian mummies. In the majority of cases, the epidermis was not preserved. The present work demonstrates the good preservation of epidermal structures and specially desmosomes and intercellular connections. The presence of spores of bacteria was previously reported. These spores enter a highly resistant resting phase in order to survive in a dormant state for a long period of starvation or other adverse environmental conditions. Similar investigations were performed on skin obtained from Eskimo mummies preserved by the extremely cold and dry polar weather. In these conditions, the authors reported the observation of melanocytes, vessels and nerves. Additionally, biochemical investigations demonstrated the very good preservation of collagen and glycosaminoglycans of the dermal extracellular matrix.

Collagen↗

Malocclusion in Labrador Inuit youth: a psychosocial, dental and cephalometric evaluation.

Epidemiological studies of malocclusion of world populations have been previously limited to dental parameters. This cross-sectional study examined the prevalence of malocclusion in the dentitions of Inuit (Eskimo) youth aged between 5-22 years from Labrador, Canada, using psychosocial, dental and skeletal (radiographic) parameters. Data were obtained from two communities, Nain (population 1079) and Hopedale (population 534). About 82% (n = 363) of the Inuit youth and 50% (n = 222) of their parents responded to the psychosocial questionnaires. In total, 78% (n = 348) of the Inuit youth were examined intraorally to determine the prevalence of malocclusion using the Treatment Priority Index (TPI), and 23% (n = 100) had cephalometric radiographs taken using a portable cephalometer. The results indicated that 95% of the Labrador Inuit youth examined had some degree of malocclusion, 10-16% were aware of their occlusal disharmonies, 55-65% wanted to have their teeth straightened, and 5% were teased by others because of their malocclusions. In addition, 63% of the parents seemed to be aware of their child's occlusal problems and 70% wished their children to wear orthodontic appliances if they were needed. Prevalence and awareness to malocclusion were positively correlated. According to the TPI, 18% had "severely handicapping" and 20% had "very severely handicapping" malocclusions. The TPI score increased with age from 5.25 in the young group to 8.05 in the older age group (mean 6.7). There were high prevalences of crowded anterior teeth, upper lingual posterior crossbites, and open or edge to edge bites. A prevalence of 35% Angle Class I, 49% Angle Class II and 16% Angle Class III molar relationships were observed. Cephalometric analysis demonstrated a mean wits measurement of -2.0 mm, a mean ANB angle of 4.7, a mean lower face height of 68.3 mm, a mean interincisal angle of 125 degrees and a mean frankfort mandibular plane angle of 31.3 degrees. A need for orthodontic care and further education were clearly indicated and highly recommended.

Adolescent↗

Ethics in human experimentation: historical perspectives.

Ethics has received renewed attention recently as evidenced by recent revelations of experimentation on Eskimos during the 1950s and a new President vowing to raise ethical standards of conduct within government. There is also an ongoing, intense scrutiny of past radiation-exposure experiments with all of its possible ethical violations. This paper is a modest attempt to familiarize the reader with some of the historical development of ethics in human-use research. Debate concerning the use of humans as subjects of medical and behavioral experimentation has a long and distinguished history going back at least 2,000 years. A short historical review reveals that ethical behavior exhibits a pendulum action between the extremes of protection of humans at all costs and the attainment of scientific knowledge at all costs. Only by knowing the historical foundation of ethics can one understand the current issues surrounding human experimentation.

Ethics, Medical↗