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Soborg B.,Statens Serum Institute | Koch A.,Statens Serum Institute | Thomsen V.O.,Statens Serum Institute | Ladefoged K.,Queen Ingrids Hospital | And 4 more authors.
European Respiratory Journal | Year: 2010

Inuit in the Arctic are experiencing an increase in tuberculosis cases, reaching levels in Greenland comparable to high-incidence countries. This prompted us to study the level of tuberculosis transmission to Greenlandic children. Specifically, we estimated the current prevalence of Mycobacterium tuberculosis infection (MTI) and the underlying annual risk of MTI. 2,231 Greenlandic school children aged 5-17 yrs (∼25% of the Greenlandic population in the relevant age group) were tested for MTI using the tuberculin skin test and the QuantiFERON®-TB Gold in-tube test. Subjects with dual-positive results were considered infected and subjects with dual-negative results uninfected. The children with discordant test results were classified as probably having MTI and analysed separately. 8.1% of the children had dual-positive test results. The annual risk of MTI was estimated as 0.80% (95% CI 0.67-0.92%) giving a cumulative risk at the 18th birthday of 13.4%. The annual risk of MTI varied substantially by ethnicity (0.87% in Inuit children, 0.02% in non-Inuit children; p<0.001) and by location (0.13% on the west coast, 1.68% on the south coast; p<0.001). M. tuberculosis transmission occurs at a very high level in Inuit children with pronounced geographic differences emphasising the need for immediate public health interventions. Copyright©ERS 2010. Source


Ladefoged K.,Queen Ingrids Hospital
International journal of circumpolar health | Year: 2012

Despite a high level of sexually transmitted infections, HIV incidence has remained quite stable in Greenland with 5-6 new cases per year (approximately 10 per 100,000). However, disease control is suboptimal and mortality is relatively high. The aim of the present study was to determine associations between adherence to treatment and treatment outcome, living conditions and quality of life among HIV patients in Greenland. Cross-sectional questionnaire-based cohort study of HIV patients in Greenland during 2008-2009. Data regarding treatment, viral load, CD4 count, etc. were obtained from a central HIV-database. Forty-six persons, 17 women and 29 men, of the 60 registered HIV-positive patients (77%) were included. Eighty percent were heterosexually infected and 17% by men having sex with men (MSM) activity. Median age at the time of diagnosis was 48 years (range 20-63). Eighty-nine percent received highly active antiretroviral therapy (HAART). Sixty-seven percent were adherent as defined by a combination of adherence to appointments and to treatment. Ninety-seven percent of adherent and 17% non-adherent patients on HAART had HIV-RNA less than 200 copies per ml (RR=24.2, p<0.0001). Poor adherence was associated with younger age (<50 years) (adjusted RR=7.95, p=0.005) and living in remote areas with no direct contact with skilled personnel (adjusted RR=6.75, p=0.01). Unsafe sex was also more frequent among non-adherent patients (RR=4.12, p=0.026), but due to few answers this topic was not included in the multivariate model. The HIV population in Greenland is peculiar since most patients are heterosexually infected and middle-aged at diagnosis. A relatively poor adherence and consequently inferior treatment outcome is related to young age and living in remote areas. Source


Nielsen N.O.,Statens Serum Institute | Skifte T.,National Board of Health in Greenland | Andersson M.,Statens Serum Institute | Wohlfahrt J.,Statens Serum Institute | And 4 more authors.
British Journal of Nutrition | Year: 2010

Vitamin D deficiency has been associated with increased risk of tuberculosis (TB). Changes from a traditional to a Westernised diet among Greenlanders have resulted in reduced serum vitamin D, leading to considerations of whether preventive vitamin D supplementation should be introduced. The association between vitamin D status and TB was examined to assess the feasibility of vitamin D supplementation in Greenland. This was examined in a case-control study involving seventy-two matched pairs of TB patients (cases) and controls aged 8-74 years. Cases were diagnosed with TB during 2004-6 based on clinical findings in combination with either (1) positive Mycobacterium tuberculosis culture, (2) characteristic X-ray abnormalities together with a positive tuberculin skin test or a positive interferon- release assay or (3) characteristic histology. Controls were individually matched on age (±5 years), sex and district. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured and OR of TB were the outcome. Compared with individuals with 25(OH)D concentrations between 75 and 140nmol/l, individuals with concentrations<75nmol/l (OR 65; 95% CI 18, 235) or>140nmol/l (OR 65; 95% CI 19, 222) had higher risks of active TB (P=0003; adjustment for alcohol and ethnicity). Supplementing individuals with low vitamin D to normalise serum 25(OH)D concentrations was estimated to result in a 29% reduction in the number of TB cases. The study indicated that vitamin D supplementation may be beneficial to individuals with insufficient vitamin D concentrations but may increase the risk of TB among individuals with normal or high concentrations. © The Authors 2010. Source


Andersen S.,Queen Ingrids Hospital | Andersen S.,University of Aalborg | Kjaergaard M.,Queen Ingrids Hospital | Jorgensen M.E.,Queen Ingrids Hospital | And 2 more authors.
Atherosclerosis | Year: 2011

Background: Elevated blood pressure is a risk factor for cardiovascular disease and may be detected by left ventricular hypertrophy (LVH) in electrocardiogram (ECG). Pre-western Inuit had frequent signs of LVH in ECG predominantly in the 3rd decade while a low occurrence of ischemic heart disease. Methods: We evaluated the association between blood pressures and ECG signs of LVH, cardiac auscultation, and symptoms related to heart disease in the recently recovered data from the survey of 1851 Inuit conducted in 1962-1964 in East Greenland. Results: The participation rate was 97%. Among the 812 Inuit aged 18. years or above blood pressure was unaltered until the age of 39. years (systolic, p= 76; diastolic, p= 0.36) and increased subsequently (both, p< 0.001). Systolic blood pressure >140. mm. Hg was more frequent when aged >40. years (p< 0.001) and diastolic blood pressure >90. mm. Hg was more common in men (p< 0.001) and in men and women aged >40. years (p< 0.001). ECG signs of LVH were more frequent in men (p< 0.01) but the occurrence decreased from the age of 40. years (p< 0.01), and were not influenced by systolic (p= 0.97), diastolic (p= 0.87) or pulse pressure (p= 0.69). Conclusions: Blood pressure rose only after the age of 40. years in pre-western Inuit. Left ventricular hypertrophy peaked among 30-year olds and was independent of elevated blood pressure. It may be speculated that the common left ventricular hypertrophy was due to marked physical activity that contributed to the low occurrence of ischemic heart disease among pre-western Inuit. © 2011 Elsevier Ireland Ltd. Source


Bjorn-Mortensen K.,Queen Ingrids Hospital | Ladefoged K.,Queen Ingrids Hospital | Obel N.,Copenhagen University | Helleberg M.,Copenhagen University
International Journal of Circumpolar Health | Year: 2013

Introduction. We aimed to characterise the HIV epidemic in Greenland and to determine incidence, prevalence, mortality rates (MR) and specific causes of deaths. Study design. The study design used was population-based nationwide cohort study. Methods. We included all patients diagnosed with HIV in Greenland before 2011. Data were obtained from patient files, death certificates and the mandatory reports of HIV cases. Incidence and prevalence were estimated as cases/100,000 adults/year and MR as deaths/1,000 person-years (PYR). MRs were estimated for the pre-HAART (≤1996), early-HAART (1997-2004) and late-HAART (≥2005) periods. Deaths were considered AIDS related, if CD4 count <6 months before death was <200 cells/μL and/or an AIDS-related event occurred <12 months of death. Results. We identified 171 cases of HIV among adult Greenlanders. Of these, 133 (78%) were infected in Greenland, 17 (10%) in Denmark and 21 (12%) in other places. The majority was infected through heterosexual contact [127 (74%)], 30 (18%) through homosexual contact, 3 (2%) through intravenous drug use and 11 (6%) through other or unknown routes of transmission. The median age at HIV diagnosis was 46 years (interquartile range 34-56). The incidence increased from 3.8 before 1989 to 29.7 cases/100,000 adults/year in the late 1990s. The incidence has slowly declined to approximately eight cases/100,000 adults/year. Prevalence increased to a maximum in 2009 (174.9/100,000 inhabitants), and slowly declined since then. A total of 79 have died and 25 have emigrated. MRs were high in the pre- and early-HAART periods, 65.3 [95% confidence intervals (CI) 40.0-106.6] and 87.0 [95% CI 63.5-119.0], and a large fraction of deaths were AIDS related. In the late-HAART period, MR has declined markedly to 53.4 (95% CI 35.8-79.7) with a substantial decline in AIDS-related MR. Conclusion. Heterosexual contact is the main route of HIV infection and the patients are diagnosed at a median age of 46. The incidence of newly diagnosed HIV patients has decreased markedly since year 2000. Mortality is high although declining in recent years. © 2013 Karen Bjorn-Mortensen et al. Source

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