Ambulance services in sparsely populated circumpolar regions operate over large distances with limited access to alternative care, potentially expanding their role beyond transport to assessment, decision-making, and healthcare navigation. In such settings, conveyance decisions involving children and young people (CYP) may be complex for ambulance clinicians. This retrospective study examined factors associated with non-conveyance and subsequent healthcare contacts among CYP assessed by ambulance clinicians in northern Sweden and compared characteristics of conveyed and non-conveyed patients. Assessments of patients aged 0-17 during 2020-2023 were included. Logistic regression identified factors associated with non-conveyance, and unscheduled healthcare contacts within 72 hours were examined. Non-conveyance occurred in 39% of assignments. Non-conveyed patients were younger and more often assessed for respiratory conditions and infections, whereas conveyed patients more commonly presented with trauma and neurological conditions. Younger age, assignments outside office hours, and rural location were associated with non-conveyance. One quarter of non-conveyed patients had an unscheduled healthcare contact within 72 hours. The findings suggest that non-conveyance is part of a broader healthcare pathway rather than solely the end of an ambulance assignment. Child-specific guidance for assessment, referral, and follow-up, alongside strengthened decision support for ambulance clinicians, may contribute to safe non-conveyance decision-making in remote regions.
Small and geographically isolated societies face distinct challenges during a pandemic but may also possess advantages. This narrative literature review presents epidemiological, immunological and psychological studies conducted in the Faroe Islands during the SARS-CoV-2 pandemic, examining its effects on individuals in the Faroe Islands. The COVID-19 pandemic hit the Faroe Islands early in March 2020. With only around 55,000 inhabitants, the Faroe Islands' isolated, well-documented population enabled extensive epidemiological research and close monitoring of infection patterns. This resulted in studies on transmission, immunity, mental health and long COVID. Overall, the Faroese studies demonstrate how small, cohesive societies with robust infrastructure can conduct high-quality research during a crisis, contributing to both local and global knowledge.
Pilot whale has for centuries been part of the traditional diet in the Faroe Islands; however, since the late 1970s, concerns about contamination have resulted in ongoing dietary advisories. This cross-sectional survey examines consumption frequency, cultural importance, risk perception and awareness of contaminants and advisories related to pilot whale in the Faroese population among residents aged 18-70 years randomly selected from the Faroese Population Registry. In all 1,492 respondents were included in the final analysis. The results indicate that most participants consume pilot whale meat to some extent, with 78% consuming dried and 65% consuming cooked pilot whale meat, although consumption patterns vary across demographic characteristics. Older age groups demonstrated significantly higher awareness of official dietary advisories and contaminants compared to the youngest age group (2008 advisory: 97% vs. 60%; 2011 advisory: 85% vs. 52%; contaminants: 100% vs. 89%), while the youngest age group expressed more positive attitudes toward the cultural importance of pilot whale (80% vs. 68%). These findings provide important insights into dietary behaviour and contaminant-related risks associated with pilot whale consumption in the Faroe Islands and highlight the need for risk communication and public health messaging that account for demographic differences and cultural importance.
Emotional and behavioural problems in Indigenous Sámi and non-Sámi preschool children in Norway were examined in a sample, including 332 Sámi children and 4,777 non-Sámi children, from the Norwegian Mother, Father and Child Cohort Study (MoBa). Problems at 1.5, 3 and 5 years of age were measured by an abbreviated version of the Child Behaviour Checklist (CBCL). Linear mixed models were used to analyse differences in internalising and externalising symptoms over time with a focus on the influence of ethnicity, Sámi parental background and local community context. Overall, no significant differences in emotional and behavioural problems were found between Sámi and non-Sámi children. Minority/majority status and parental practices are discussed as possible explanations for the interaction effect of gender, Sámi parental background and community context on externalising problems. The results indicate the need for culturally sensitive interventions in health services, prevention strategies and further research in Indigenous children.
Supporting maternal mental health is a priority in circumpolar settings, where seasonality and constrained service availability can limit psychosocial support. This qualitative study explored pregnant women's and healthcare providers' experiences of a postpartum depression prevention programme and perspectives on integrating it into routine antenatal care in Arkhangelsk, Northwest Russia. Four focus group discussions with pregnant women (n = 17) and individual interviews with four healthcare providers were analysed using reflexive thematic analysis. Participants described the programme as providing trusting spaces for sharing, expert-led preparation for childbirth and the postpartum period, and brief individual follow-up after birth. Women reported greater confidence in identifying signs of vulnerability, articulating needs, and accessing support. Providers highlighted that these benefits depended on feasible scheduling, group formats, reusable materials, and coordinated delivery across professionals to avoid fragmentation. System-level factors (reach, retention, and cross-provider coordination) were seen as central for sustained uptake and routine integration. The findings suggest that the programme's contribution lies in the interaction between participant experiences of support and the organisational conditions needeed to sustain them in routine antenatal care. Preventive perinatal mental health programmes in circumpolar contexts can strengthen preparedness and help-seeking when designed for relational participation and supported by coordinated service structures.
In Nunavut, public health management of tuberculosis (TB) remains a challenge due to social and economic inequities, geographic isolation, TB-related stigma, and distrust in healthcare linked to a history of colonialism. A TB outbreak was declared in Naujaat, Nunavut following an increase in reported cases starting in January 2023. In response to this outbreak, the Naujaat community-wide TB screening (CWS) clinic was held from April 15th to May 29th, 2024, with support from the Nunavut Tunavik Incorporated (NTI) leadership and community engagement teams. This article outlines the steps taken in the coordination and implementation of a large public health intervention in this remote, northern community. Despite significant logistical challenges, the CWS clinic screened 89.2% of the 1000-person target consisting of all previously unscreened individuals residing in the community. As a result, 31 individuals with latent TB infection and <5 active TB cases were diagnosed and offered treatment, representing nearly 4% of those undergoing 2-step testing. Although the screening outcomes suggested that community transmission was low at the time of community-wide screening, it nonetheless exceeded the WHO threshold of 0.5% prevalence for community-wide screening. Lessons learned through the Naujaat CWS can help inform future public health actions towards TB elimination in Nunavut and other circumpolar jurisdictions.
Necrotizing soft tissue infection (NSTI) caused by Haemophilus influenzae type B (Hib) is rare and life-threatening. We report severe monomicrobial Hib NSTI in a 16-month-old Inuit child who had received 3 doses of the Hib vaccine, highlighting vaccine failure and host susceptibility. The child sustained a minor fall to the left thigh without skin breakdown and developed fever the same day, initially treated with amoxicillin for presumed acute otitis media. He re-presented with persistent fever, progressive leg pain, swelling, ecchymosis, and refusal to weight-bear, prompting air transfer to the regional hospital and the initiation of ceftriaxone. Investigations showed C-reactive protein >90 mg/L, a white blood cell count of 13.6 ×10⁹/L, normal creatine kinase, and unremarkable radiographs. Owing to concern for necrotizing infection, the patient was transferred to a tertiary pediatric intensive care unit. Antimicrobials were escalated to piperacillin-tazobactam, vancomycin, and clindamycin, and intravenous immunoglobulin was administered. Emergent surgical debridement demonstrated extensive dermal and subcutaneous necrosis with preserved fascia and muscle. Blood and tissue cultures grew Hib. He required mechanical ventilation, inotropic support, and multiple additional debridements prior to skin grafting. Household contacts received chemoprophylaxis. Immunologic evaluation was unremarkable; genetic testing was non-diagnostic. NSTI requires prompt recognition, surgical debridement, and targeted antimicrobial therapy. While most cases are due to group A Streptococcus or polymicrobial infections, Hib is rare, with few pediatric cases reported. Vaccine failures occur, particularly before the 18-month booster, reflecting waning immunity. Indigenous populations remain disproportionately affected. Invasive Hib disease despite vaccination warrants evaluation for underlying immunodeficiency. Invasive Hib infection should be considered even in fully vaccinated children. Continued surveillance, prompt surgical management, public health response and investigations of host susceptibility remain essential.
The Canadian Frailty Network commissioned this study to gather feedback on the AVOID Frailty model from Indigenous Elders and older adults in the Yukon. Grounded in Indigenous research methodologies, Two-Eyed Seeing, and guided by an Elder co-author this study involved guide conversations to engage 42 participants aged 55 and older across four Yukon communities. Participants raised Activity, Interaction, and Diet spontaneously as central to healthy aging, while Vaccinate and Optimize medications typically required prompting. However, participants reframed these domains in relational and place-based terms, locating wellness in connection to land, traditional foods, intergenerational responsibility, and community. The AVOID model's emphasis on disease prevention and individual behaviour change does not account for the collective, relational, and cultural dimensions that shape Indigenous health and wellness. A strengths-based adaptation, grounded in Indigenous ways of knowing, doing, and being, is needed.
A population-based study has reported a higher prevalence of self-reported asthma among the Sámi compared with the general Swedish population. However, it remains unclear whether this reflects a true difference or reporting bias. This study aimed to estimate asthma incidence among the Sámi and compare it with that of the non-Sámi population using register-based data from 1993 to 2018. We conducted a retrospective cohort study using the Sámi electoral roll and the reindeer ownership register to identify Sámi individuals. Each Sámi participant was matched with four non-Sámi controls by age, sex and municipality. Asthma cases were identified through the National Patient Register, covering inpatient and specialist outpatient care. Incidence rate ratios (IRRs) were estimated using sex-stratified Poisson regression models. The study included 13,311 Sámi individuals and 53,219 controls. Sámi men (IRR = 1.19, 95% CI = 1.00-1.41) and women (IRR = 1.23, 95% CI = 1.04-1.45) had higher rates of specialist asthma diagnoses than controls. Sámi men, but not women, also had a higher risk of asthma-related hospitalisation (IRR = 1.43, 95% CI = 1.07-1.90). These findings suggest a higher asthma burden among the Sámi. Further research is needed to clarify underlying risk factors and inform targeted public health interventions.
Mental health disparities have been reported among Indigenous populations worldwide. It remains unclear how different dimensions of Sámi affiliation, such as heritage, identity, and language are related to mental health outcomes. We aimed to examine mental health in the Sámi population according to different forms of Sámi affiliation (heritage, identity, and language affiliation). Furthermore, we examined changes in mental health from 2004 to 2012. Data were derived from two cross-sectional population-based studies conducted in 2004 and 2012. Both surveys included information on Sámi heritage, Sámi identity, linguistic background, and mental health assessed by the Hopkins Symptom Checklist-10 (HSCL-10). Slightly higher levels of psychological distress were observed in most Sámi groups compared to the non-Sámi population, with the exception of Sámi-speaking women. Differences over time were generally small, although men with Sámi heritage showed a modest increase in distress. In adjusted analyses, Sámi affiliation remained associated with psychological distress after controlling for age, education, and household income. Psychological distress was slightly higher in the Sámi population compared to the non-Sámi population, although differences were modest. Sámi affiliation appears to be associated with psychological distress beyond socioeconomic factors, potentially reflecting a complex interplay of social, cultural, and historical influences.
The prevalence of obesity has increased among Inuit populations across the Arctic, although some studies indicate stabilisation. The Greenlandic Inuit may exhibit distinct obesity patterns due to unique genetic factors and rapid societal transitions. We investigated temporal trends in obesity prevalence among adults in Greenland from 1999 to 2018 by age, sex and place of residence. We analysed data from serial cross-sectional Greenland Population Health Surveys conducted in 1999-2001 (N = 1,004), 2005-2010 (N = 3,031), 2014 (N = 511), and 2018 (N = 859). Obesity was defined as a body mass index ≥ 30 kg/m². The prevalence of obesity increased among all groups. Among women, the prevalence rose from 20.0% (95% CI 16.6, 23.4) in 1999 to 29.6% (95% CI 25.0, 34.2) in 2018; among men, it rose from 14.4% (95% CI 11.2, 17.6) to 22.2% (95% CI 18.5, 26.0). Women maintained a higher prevalence than men across all surveys. Age-specific patterns showed increases up to age 40, then plateaued in both sexes. Geographic differences among women diminished by 2018, whereas men in settlements consistently showed the lowest prevalence. The persistent rise across all demographic groups, combined with geographic convergence among women but not men, highlights the need for targeted, culturally appropriate public health strategies.
Kalaallit Nunaat (Greenland) continues to experience a very high burden of suicide, while knowledge about culturally meaningful recovery processes remains limited. This qualitative pilot study explores how Inuit individuals with lived experience of suicide attempts describe coping, turning points, and pathways toward thriving lives. Six participants who had experienced suicide attempts in childhood, adolescence or early adulthood, took part in semi-structured interviews conducted in Kalaallisut. Data were analyzed using systematic text condensation. Findings show that recovery was not experienced as an individual trait but as a relational and culturally embedded process. Supportive relationships, cultural grounding, connections to nature and land based practices, language-accessible services, and opportunities for belonging and contribution functioned as key protective resources. Inuit worldviews, including understandings of Sila and Inua, and engagement with land-based practices supported emotional regulation, meaning-making, and hope.
This proceedings paper describes the work done with communicating scientific research and knowledge in and from the Arctic about pregnancy, birth, and child-rearing in the AMAUTI Podcasts series. The podcast series consists of 5 episodes in English and one in Kalaallisut (Greenlandic), and all episodes consists of one interview with a researcher or knowledge-holder.
Exposure to ice water, despite its growing popularity and documented health benefits, is limited by the risk of distressing physiological reactions. The aim of this study was to evaluate the relationships between individual, environmental factors and acute tympanic temperature changes during cold exposure. A total of 90 individuals either practicing cold water immersion (CWI) or winter swimming (WS) were enrolled in the study. They were divided into 4 subgroups according to the distance swum (200 m or 450 m) and immersion time (5 or 9 min). The tympanic temperature of all participants was measured, and BMI was calculated. This study found significant pre-post exposure changes in temperature [°C] (p>0.05) in all the subgroups, except for the group immersed for 5 min. In winter swimmers, a significant negative correlation between BMI and tympanic membrane temperature was found p = 0.006) for both females and males. The greatest change in tympanic temperature occurred in participants with 3 years of experience in practicing those activities. A five-minute immersion in water below 1°C did not allow for the observation of a significant body response to ice water. The results indicate that a higher BMI was associated with a smaller decrease in tympanic membrane temperature in the winter swimming subgroup.
Artificial intelligence and machine learning (AI/ML) utilisation in Alaska Native and American Indian (AN/AI) healthcare presents an opportunity to address persistent health disparities and improve the well-being of Alaska Native communities. The 2025 Artificial Intelligence in Alaska Native Health Care Systems symposium occurred in Anchorage, Alaska, with 31 individuals participating in facilitated conversations between various stakeholders and specialists at the Alaska Native Tribal Health Consortium, Southcentral Foundation, Maniilaq Association and Stanford University. The overarching goal of the symposium was to bring together partners within the Alaska Tribal Health System (ATHS) to promote: (1) AN/AI peoples' guidance in support of Tribal sovereignty for AI/ML implementation within the ATHS, (2) expanded technical capacity and (3) centralised guidance and expertise to lead future AI/ML research and implementation with community-defined benefits. During the event, small group discussions focused on the following topics: (1) common AI/ML applications, (2) concerns surrounding AI/ML, (3) current or potential policies guiding AI/ML use and (4) how to build trust in AI/ML models. Themes discussed were data democratisation, AI/ML development and use needs to occur under the principles of data sovereignty, and AI/ML quality improvement and research are needed and distinct. The symposium was an important step in considering how to use AI/ML to optimise AN/AI health and well-being through collaborative partnerships and services.
To investigate the prevalence of overweight and obesity among children aged 3 to 10 years in Greenland. Further, to describe the prevalence of overweight and obesity according to sex, place of residence and age, including change over time. In a cross-sectional study, we included 4715 children aged 3-10 years, using data from the national electronic medical records. BMI was calculated and children were categorised into age and sex-specific weight classes according to cut-off values established by the International Obesity Task Force. In 2023, 37.1% of children in Greenland aged 3-10 years were classified as overweight or obese (12.6% obese). The proportion of children with normal weight was 61.1%. We saw no noticeable differences in the distribution of weight classes according to place of residence and sex. Further, our study illustrates a significant rise in the prevalence of overweight and obesity at the time of school entry, increasing from 7.5% in 1980 to 33.4% in 2023. This study demonstrates a high prevalence of overweight and obesity among children in Greenland, and further highlights a striking increase at school entry over recent decades. These findings underscore the urgent need for early prevention efforts and continued nationwide surveillance.
This study examines community participation in a research project on health issues at the human-dog interface conducted in seven Northern Canadian Indigenous communities. Using a realist evaluation, we analyzed the mechanisms underlying participatory successes and failures in eleven projects derived from an ecosystem approach to health. This qualitative evaluation revealed that the researchers' concerns about collaborators’ participation were largely unfounded. Experienced collaborators demonstrated resilience in the face of previous negative experiences and appreciated the participatory approach. However, over-solicitation of the same stakeholders and mistrust of researchers from the South limited wider community participation. Organizational collaborators played a crucial, but ambivalent role as intermediaries—both facilitating access to communities (boundary-spanning) and, at times, restricting researchers' contact with broader community members (gatekeeping). Although the “dog problem” was recognized as important, it was not a priority in the face of more pressing local or regional challenges. This evaluation highlights the importance of trust, realistic expectations and an understanding of cultural dynamics in optimizing participation in participatory research in Indigenous contexts.
Mental health problems are increasing among adolescents, where stress, screen time, social media and sleep deprivation are contributing factors. The aim of this study was to explore adolescents’ understanding and self-reporting of health for further development of the screening tool HEILUNG. Mixed-method study design based on qualitative (focus groups) and quantitative data (cross-sectional study) was used. The participants in both studies were adolescents in upper secondary schools across Iceland. The framework method was used in the data analysis for the focus groups and descriptive statistics for the cross-sectional study (CSS). The focus groups included 31 participants, and the CSS 648. The focus groups showed that mental health was important and dependent on physical and social health. Almost 56%, 45% and 27% of the participants (CSS) were stressed, anxious and depressed often/daily, respectively. Mental well-being was affected by sleep deprivation and social media. More than half of the participants (CSS) did not get enough sleep, and approximately 38% had seven hours or more of screen time daily. Mental health was of great concern to adolescents in both studies affected by many influential factors. Making health decisions regularly was difficult for them. They needed opportunities to discuss health issues and health promotion, which could be provided by school nurses.
Physical literacy is a critical component of children's overall wellness and academic success. While it has been discussed in Indigenous contexts, no published research has yet systematically measured physical literacy among Indigenous children in Canada. This study provides the first baseline measurements of physical literacy in Indigenous/Mi'kmaw students aged 9-12 attending schools within Mi'kmaw Kina'matnewey (MK), a unified Indigenous education authority in Mi'kma'ki-the ancestral and unceded territory of the Mi'kmaq people in Nova Scotia, Canada. Using the Canadian Assessment of Physical Literacy, Second Edition (CAPL-2), researchers evaluated 81 students across four physical literacy domains: motivation and confidence, daily behaviour, knowledge and understanding, and physical competence. Analyses examined patterns by age and gender. Results showed that more than 90% of students scored within the beginning or progressing categories for physical competence and overall physical literacy, mirroring but falling below national CAPL-2 trends. Significant age-related differences emerged, with 11- and 12-year-olds outperforming younger peers on movement skills, knowledge, and overall physical literacy. No significant gender differences were observed. These findings establish the first empirical snapshot of Indigenous/Mi'kmaw students' physical literacy and highlight opportunities for culturally grounded, community-driven interventions to support Indigenous/Mi'kmaw children's movement development, holistic well-being, and lifelong physical activity.
Antarctic scientific expeditions operate under extreme environmental constraints with severely limited medical evacuation capabilities, yet epidemiological data on expedition personnel remain sparse. This study aims to characterise the disease spectrum and healthcare utilisation patterns during a 208-day Antarctic scientific expedition aboard RV Xue Long 2 and provide evidence-based support for polar healthcare. Retrospective analysis of 586 medical consultations (632 diagnoses) from 206 expedition members aboard RV Xue Long 2 (November 2024-May 2025). Primary diagnoses and affected systems were categorised according to the International Classification of Diseases, 10th Revision (ICD-10). Among 206 personnel (mean age 37.9 ± 9.0 years; 89.8% male), 144 individuals (69.9%) yielded 586 consultation records. Among these individuals, 79.1% required ≤4 visits. Consultations peaked initially (129 encounters/month) after departure. No emergency medical evacuations occurred. Acute upper respiratory infection (12.7%), dermatitis (5.9%) and muscle strain (5.1%) were the predominant diagnoses. Systemically, respiratory (18.0%), digestive (16.6%) and dermatological diseases (15.2%) predominated. Motion sickness and trauma incidence remained modest. The polysystemic morbidity profile reflects the dual stressors of prolonged oceanic isolation and extreme polar environments. These findings mandate expedition-specific medical protocols, mandatory pre-deployment health screening and comprehensive cross-training for shipboard physicians to optimise remote polar healthcare delivery.
