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Helicobacter pylori is a bacterium that may colonise and proliferate in human stomachs, leading invariably to chronic inflammation and, to a lesser extent, to peptic ulcers and cancer. The main objective of this study is to describe the epidemiology surrounding H. pylori in Nunavik's Inuit population using the 2004 and 2017 Health Surveys. Estimated prevalences were 70.9% for bacterial colonisation using a stool antigens test (SAT), 72.5% for anti- H. pylori antibodies, 12.7% for faecal occult blood in participants aged ≥ 50 and respectively of 28.4%, 11.2% and 2.4% for a prior diagnosis of colonisation, gastritis and peptic ulcer in the medical charts, with under five cases of gastric cancer reported. Variables associated with higher SAT+ prevalence were the number of household members (prevalence ratio [PR] = 1.03) and age (quadratic relationship), whereas mainly drinking municipal (PR = 0.84) and natural water (PR = 0.72) compared to bottled water, and increasing alcohol consumption (PR = 0.96) were associated with reduced prevalence. Despite current regional guidelines targeting high risk individuals in the context of high prevalence, Nunavik's health authorities must remain vigilant by following gastric cancer incidence and the rapid evolution of guidelines, while considering local realities.

Setting: Consumption of raw game meats is important for Inuit health and well-being but may sometimes increase risk of exposure to parasites. In Nunavik, following trichinellosis outbreaks in the 1980s caused by raw walrus consumption, a diagnostic test was developed for the region and offered to all Inuit communities by 1997. Despite this prevention program, an important trichinellosis outbreak occurred in 2013, affecting 18 inhabitants of Inukjuak., Intervention: Because the classical outbreak investigation did not rapidly converge toward a common food source or specific event, a local response group, composed of four community members appointed by the Municipal Council as well as the regional public health physician, nurse and wildlife parasitologist, was created. Their objective was to investigate potential sources of infection related to the outbreak, hence the investigation of the types of meats consumed, the movement of meats between and within the community, and the local practices of processing game meat., Outcomes: Though the source of infection was not fully confirmed, this local investigation identified the distribution of transformed polar bear meat as the most probable source of infection. The creation of this unique, intersectoral and intercultural local response group fostered the use of local knowledge to better understand aspects of the modern food system, and is one of the most innovative outcomes of this investigation., Implications: Integrating multiple ways of knowing was critical for the management of this important public health issue and contributed to community members' mobilization and empowerment with respect to local food safety issues.

Objective: In 2002, a mass immunization campaign using the 23-valent pneumococcal polysaccharide vaccine (PPV23) was carried out in Nunavik to control an outbreak caused by a virulent clone of serotype 1 Streptococcus pneumoniae. At the same time, the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced for routine immunization of infants, replaced by the 10-valent vaccine (PCV10) in 2009, and the 13-valent vaccine (PCV13) in 2011. The objective of this study was to describe the epidemiology of invasive pneumococcal disease (IPD) in relation to pneumococcal vaccine use., Method: Retrospective analysis of IPD cases identified by the Quebec Public Health Laboratory during the period 1997-2016., Results: One hundred thirty-two IPD cases were identified during the study period. In adults, serotype 1 incidence decreased following the 2002 PPV23 mass campaign, but breakthrough cases occurred. Following PCV use, the incidence of vaccine-type IPD decreased markedly in children and also in adults but serotypes not covered by conjugate vaccines increased. The overall IPD rate was 43/100,000 person-years in the 1997-1999 pre-vaccine era and 58/100,000 person-years in 2010-2016., Conclusions: The 2002 PPV23 mass immunization campaign may have contributed to control the serotype 1 outbreaks in Nunavik, but its effect was short-lived as IPDs caused by serotypes included in this vaccine continued to occur after 2005. PCV use in children induced important modifications in the epidemiology of IPD, but most of the benefits were eroded by serotype replacement.

Nunavik, Québec suffers from epidemic tuberculosis (TB), with an incidence 50-fold higher than the Canadian average. Molecular studies in this region have documented limited bacterial genetic diversity among Mycobacterium tuberculosis isolates, consistent with a founder strain and/or ongoing spread. We have used whole-genome sequencing on 163 M. tuberculosis isolates from 11 geographically isolated villages to provide a high-resolution portrait of bacterial genetic diversity in this setting. All isolates were lineage 4 (Euro-American), with two sublineages present (major, n = 153; minor, n = 10). Among major sublineage isolates, there was a median of 46 pairwise single-nucleotide polymorphisms (SNPs), and the most recent common ancestor (MRCA) was in the early 20th century. Pairs of isolates within a village had significantly fewer SNPs than pairs from different villages (median: 6 vs. 47, P < 0.00005), indicating that most transmission occurs within villages. There was an excess of nonsynonymous SNPs after the diversification of M. tuberculosis within Nunavik: The ratio of nonsynonymous to synonymous substitution rates (dN/dS) was 0.534 before the MRCA but 0.777 subsequently (P = 0.010). Nonsynonymous SNPs were detected across all gene categories, arguing against positive selection and toward genetic drift with relaxation of purifying selection. Supporting the latter possibility, 28 genes were partially or completely deleted since the MRCA, including genes previously reported to be essential for M. tuberculosis growth. Our findings indicate that the epidemiologic success of M. tuberculosis in this region is more likely due to an environment conducive to TB transmission than a particularly well-adapted strain.

Background: Tuberculosis predominantly affects socioeconomically disadvantaged communities. The extent to which specific dietary and lifestyle factors contribute to tuberculosis susceptibility has not been established., Methods: A total of 200 residents of a village in Northern Quebec were investigated during a tuberculosis outbreak and identified to have active tuberculosis, latent tuberculosis infection, or neither. Participants completed questionnaires about their intake of food from traditional and commercial sources, and provided blood samples. Adults were asked about recent smoking and drug and alcohol intake. Nutritional adequacy was evaluated with reference to North American standards. Multiple dietary, lifestyle, and housing factors were combined in a logistic regression model evaluating the contributions of each to disease and infection., Findings: After adjusting for potential confounding, new infection was associated with inadequate intake of fruit and vegetables (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.03-4.3), carbohydrates (OR, 4.4; 95% CI, 1.2-16.3), and certain vitamins and minerals. A multivariable model, combining nutrition, housing, and lifestyle factors, found associations between new infection and inadequate fruit and vegetable intake (OR, 2.3; 95% CI, 1.0-5.1), living in the same house as a person with smear-positive tuberculosis (OR, 14.7; 95% CI, 1.6-137.3), and visiting a community gathering house (OR, 3.7; 95% CI, 1.7-8.3). Current smoking was associated with new infection (OR, 9.4; 95% CI, 1.2-72) among adults completing a detailed lifestyle survey., Interpretation: Inadequate nutrition was associated with increased susceptibility to infection, but not active tuberculosis. Interventions addressed at improving nutrition may reduce susceptibility to infection in settings where access to healthy foods is limited.

Rabies is endemic throughout arctic areas including the region of Nunavik, situated north of the 55th parallel of Québec, Canada, and raises public health concerns. The aim of this paper is to provide a descriptive overview of the temporal and regional distributions of three important components of arctic rabies in Nunavik from 1999 to 2012, following a "One Health" approach: animal rabies tests and confirmed cases, dog vaccination, and human consultations for potential rabies exposures. Forty-four cases of rabies, involving mainly arctic and red foxes, were confirmed in animals during this period. The mean number of dogs vaccinated per 1,000 inhabitants was highly variable and lower in the Hudson region than the Ungava region. 112 consultations for potential rabies exposure were analyzed, of which 24 were exposure to a laboratory confirmed rabid animal. Children less than 10 years of age were the age group most commonly exposed. The median time between potential exposure and administration of the first post-exposure prophylaxis dose was four days. This study confirms that the risk of human exposure to rabid animals in Nunavik is present and underlines the need to follow a "One Health" approach to prevent rabies in humans in similar contexts worldwide.

Background: In 2000, an outbreak of severe pneumonia caused by a virulent clone of serotype 1 Streptococcus pneumoniae was detected in the Nunavik region of Quebec. A mass immunization campaign was implemented in the spring of 2002, targeting persons ≥5 years of age and using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). At the same time, the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into the routine immunization programme of infants, with catch-up for children up to 4 years of age., Objectives: To describe the epidemiology of invasive pneumococcal disease (IPD) in relation to PPSV23 and PCV7 use., Study Design and Methods: Retrospective analysis of IPD cases identified by the Quebec public health laboratory during the period 1997-2010., Results: A total of 82 IPD cases were identified during the study period. In adults, serotype 1 incidence decreased following the 2002 PPSV23 mass campaign but breakthrough cases continued to occur. Following PCV7 use in children, there was a decrease in the incidence of vaccine-type IPD and replacement by other serotypes in adults. In children, a marked decrease in the annual incidence of serotypes included in PCV7 was observed following PCV7 introduction: 162/100,000 in 1997-2001 vs. 10/100,000 in 2004-2010 (p<0.01). Concomitantly, the incidence of IPD caused by serotypes not included in PCV7 increased from 29/100,000 to 109/100,000 (p=0.11)., Conclusion: The mass immunization campaign using the PPSV23 in 2002 and the introduction of PCV7 for the routine immunization of infants induced important modifications in the epidemiology of IPD. IPD rates in Nunavik remain much higher than in the southern part of the province both in children and adults. More effective pneumococcal vaccines are needed to eliminate geographic disparities in IPD risk.

Background: In 1999, the Government of Canada regulated the use of lead shot for hunting. Concurrently, the Nunavik Regional Board of Health and Social Services (NRBHSS) was informed of the results of an isotope study that pointed to lead ammunition as a likely source of lead exposure in Nunavik. Rapidly thereafter, a coalition for the banning of lead shot was implemented by the NRBHSS as well as by regional/local partners and by Inuit hunters in order to disseminate this information to the public., Objectives: The purpose of this article is to describe the intervention conducted in the winter of 1999 by the NRBHSS and to assess the combined impact of national legislation and an awareness campaign on blood lead levels in Nunavik., Study Design: Impact assessment of the intervention for the banning of lead shot conducted in 1999 in Nunavik using blood lead levels data before and after the intervention., Methods: Data on blood lead levels in Nunavik describing foetal exposure as well as during childhood and in adults published between 1992 and 2009 were compiled. Blood lead levels in Nunavik prior to and after the interventions were compared. To assess the current situation, the most recent blood lead levels were compared with those from surveys conducted during the same period in North America., Results: Analysis of blood samples collected from umbilical cord and from adults show that blood lead levels in Nunavik significantly declined between 1992 and 2004. Nevertheless, lead exposure in Nunavik still remains higher in comparison to that observed in other North American surveys., Conclusions: The current situation regarding lead exposure in Nunavik has significantly improved as a result of the implemented intervention. However, according to recent data, a gap still subsists relative to other North American populations.

Objectives: During the 1980s, walrus-meat consumption caused infections with the parasite Trichinella nativa in Nunavik inhabitants. In response to these events, stakeholders set up the community-based Nunavik Trichinellosis Prevention Program (NTPP). The objectives of the present communication are to review the NTPP, describe how science and action were interwoven in its development and identify its assets and limitations. Study design. Descriptive study., Methods: The NTPP relies on a pooled digestion assay of tongue samples taken from each harvested walrus. The public health recommendations depend on the results of the analyses: infected walrus meat should be destroyed; parasite-free meat may be eaten raw or cooked., Results: All communities involved in the walrus hunt participate in the NTPP and a high percentage of harvested walruses are included in the NTPP. Infected animals account for 2.9% of the walruses tested (20/694) since 1992. The NTPP permitted the early management of a trichinellosis event in 1997. Since then, it prevented the new occurrence of outbreaks related to walruses hunted by Nunavimmiut., Conclusions: The absence of recent major outbreaks of trichinellosis in Nunavik may reasonably be attributed to the NTPP. The success of the program stands on many facilitating factors such as the nature of the disease and its source, the existence of an efficient analytic method, the strong involvement of the different partners including direct resource users, as well as the comprehensive bidirectional science-to-action approach that has been followed.

This pilot study was aimed at documenting the presence of fecal indicators and enteric pathogens in blue mussels (Mytilus edulis) from 6 communities in Nunavik, Quebec. One to four 2 kg samples of mussels were collected at low tide in each community. Samples were investigated by enumeration methods for the fecal indicators enterococci, Escherichia coli, F-specific coliphages, Clostridium perfringens, and by molecular identification for the pathogens norovirus, Salmonella spp., Campylobacter jejuni, Campylobacter coli, and Campylobacter lari, verocytotoxin-producing E. coli (particularly serovar O157:H7), Shigella spp., and Yersinia enterocolitica. In 5 communities, the presence of Giardia duodenalis and Cryptosporidium spp. was also tested by microscopy and molecular methods and that of Toxoplasma gondii was tested by molecular methods. Apart from small quantities of Clostridium perfringens in 2 samples, no bacterial or viral pathogens were detected in the mussels. Toxoplasma gondii was also not detected. However, G. duodenalis and Cryptosporidium spp. were present in 18% and 73% of the samples investigated for these pathogens, respectively. When considering the indicators and the viral and bacterial pathogens investigated, the mussels examined were of good microbiological quality, but considering the presence of potentially zoonotic protozoa, it should be recommended that consumers cook the molluscs well before eating them.

This study analyzes sexual-preference profiles in a sample of 420 sexual aggressors who exhibited a valid profile during their initial phallometric assessment. The sexual stimuli used in the process were audiotapes describing sexual-offending scenarios. Two types of sexual stimuli sets were used: one developed for sexual aggressors against women and a second developed for sexual aggressors against children. Penile responses were recorded during stimulus presentation using a mercury-in-rubber strain gauge. Classification analyses (hierarchical and K-means clustering combination) were conducted separately for three groups of sexual aggressors: (a) sexual aggressors against children (n = 253), (b) sexual aggressors against women (n = 138), and (c) mixed sexual aggressors (n = 29). The sexual aggressors against children exhibited four penile-response profiles, the sexual aggressors against women two penile-response profiles, and the mixed sexual aggressors only one penile-response profile. In addition, analyses carried out on randomly split subsamples established that the generated profiles for sexual aggressors against children and sexual aggressors against women were stable.

Recent explanatory models of sexual aggression of women have emphasized the role of an antisocial tendency in explaining sexual aggression. If those models agree about the importance of an antisocial propensity, they disagree about the presence of a single or multiple pathways leading to sexual aggression. Currently, no empirical studies have examined within-individual changes of antisocial behavior in youth of sexual aggressors of women and whether those changes are related to the unfolding of the sexual and nonsexual criminal activity in adulthood. This study examines the presence of antisocial trajectories in childhood and adolescence using a sample of 209 convicted adult sexual aggressors of women. A dynamic classification procedure using cluster analyses yields five distinct antisocial trajectories, which are then compared using analysis of covariance on various parameters of criminal activity in adulthood. The results highlight the heterogeneity of antisocial development in youth of adult sexual aggressors of women. Patterns of initiation, persistence, and escalation in youth are related to the general, violent, and sexual offending in adulthood.

The amount of empirical research on men who commit sexual murders is scarce, and no distinction has been made between those who have victimized adults and those who have victimized children. Therefore, to better understand specifically sexual murderers of children (n = 11), comparisons were performed with a group of sexual murderers of adult women (n = 66) on developmental, precrime, crime, and postcrime factors. It appears that sexual murderers of children are more often victims of sexual abuse during childhood and present more often deviant sexual fantasies as compared to sexual murderers of women. The results show also that sexual murderers of children more often use pornography prior to crime, have contact with the victim prior to crime, and commit a crime more often characterized by premeditation, strangulation, the hiding of the body, and its dismemberment than the sexual murderers of women.

Objectives: In spring 2002, a mass immunization campaign using a 23-valent pneumococcal polysaccharide vaccine (23-PPV) was launched in order to control an outbreak of severe pneumonia caused by a virulent clone of serotype 1 Streptococcus pneumoniae in Nunavik, Quebec, Canada. The objective of the study was to evaluate the impact of this campaign on the incidence of invasive pneumococcal disease (IPD) and hospitalizations possibly associated with pneumococcal infections (HPAPI) in the mostly Inuit population aged 10 to 64 years., Study Design: Retrospective analysis of surveillance and administrative data., Methods: Multivariate Poisson model comparing the frequency rates of selected outcomes before the outbreak, during the outbreak, and after implementation of the mass immunization program., Results: The reported incidence of serotype 1 IPD decreased markedly after the implementation of the vaccination campaign (rate ratio = 0.16; p < 0.002). The frequency of HPAPI and the mean duration of hospital stay also decreased. However, vaccine failures were documented and the HPAPI rate remained higher than in the period prior to the outbreak., Conclusions: Although 23-PPV contributed to control the outbreak, better vaccines are needed for the prevention of infections caused by serotype 1 S. pneumoniae.

The aim of this study was to investigate the relationship between developmental factors and deviant sexual preferences in child molesters. In total, 146 adult males having committed a sexual offence against a child were included in the study. Three types of factors were investigated: negative experiences during childhood, behavior problems during adolescence, and sexual criminal activity in adulthood. Negative experiences and behavior problems were assessed through a semistructured interview. The sexual criminal activity was determined using police records. Sexual preferences towards children were assessed using phallometric assessment. Hierarchical regression analyses suggested the presence of two developmental pathways. The psychosocial deficits pathway is related to a sexual interest for nonviolent sexual stimuli involving children. The sexualization pathway is associated with a sexual interest for violent sexual stimuli involving children. These two pathways are discussed in light of previous empirical findings related to the development of deviant sexual preferences in child molesters.

This study evaluated the infectivity of Trichinella nativa in freshly frozen walrus meat and traditionally aged walrus meat (igunaq) associated with two human outbreaks of trichinellosis in the Canadian Arctic. Trichinella larvae recovered from walrus meat stored at -20 degrees C for up to 20 months remained infective for guinea pigs inoculated with 135 or 716 larval doses. However, none of the 4-5 and 10-month-old igunaq preparations contained infective T. nativa larvae as measured by bioassays using mice and guinea pigs at inoculation doses ranging from 6 to 500 larvae. This indicates that the degradation process that occurred in the field can be sufficient to either kill Trichinella larvae or render them non-infective for mice and guinea pigs. Further research is needed to evaluate the food safety risk of traditional walrus igunaq aged under different field conditions and storage times.

The aim of this study was to investigate developmental factors related to deviant sexual preferences in a sample of 118 sexual aggressors against women. For each subject, developmental factors were collected through a semistructured interview, whereas sexual preferences were assessed phallometrically using French translations of audiotaped stimuli developed by G. G. Abel, E. B. Blanchard, J. V. Becker, and A. Djenderedjian (1978). Using multiple regression analyses, our results showed that a sexually inappropriate family environment, use of pornography during childhood and adolescence, and deviant sexual fantasies during childhood and adolescence are related to the development of deviant sexual preferences. These results are in agreement with Knight and Sims-Knight's model of sexual aggression (R. A. Knight & J. E. Sims-Knight, in press).

Objectives: Hearing loss is highly prevalent among Inuit children in Canada. Hearing screening at kindergarten age has been carried out in Nunavik by trained Inuit technicians since 1986. In this study, we determined what percentage of children fail their initial hearing screening at age 5-6 years and compared this initial result with the last hearing test. We also report the type of hearing loss observed at the last test., Methods: Results compiled in a clinical database were analysed. At age 5-6 years, 524 children (born 1990-1994, 84% coverage) were tested and 515 children were retested at a later date. Screening failure was defined as >22 dB pure tone average (.5k, 1k, 2kHz) in either ear. Observations on ear condition at the last test were used to determine type of hearing loss., Results: Nineteen percent (101 children) failed the hearing screening at age 5-6 years and 12% failed on the later test. When those who failed the first test were retested, 58 had improved and 43 remained with a hearing loss. Twenty-one children who had initially passed the hearing screening were found to have a hearing loss at retest. The majority of the hearing losses were due to otitis media., Conclusion: Hearing screening and retesting remains necessary due to the high prevalence of hearing loss found in this population and the fluctuating nature of this problem.

Objectives: Chronic otitis media (COM) and associated hearing loss is a frequent problem for many Inuit children in Canada. In this study, we evaluated individuals aged 12-16 years living in Inukjuak, to determine the prevalence of middle ear disease and hearing loss, and the effect of hearing loss on academic performance., Methods: Otological examination, hearing test, medical and school file review were performed in November 1997. 88 individuals were seen., Results: Otological examination revealed maximal scarring in 1.8%, minimal scarring in 34.9%, normal eardrums in 49.1% and chronic otitis media in 16.9%. There were 62 individuals whose ear exams could be directly compared with a previous exam done in 1987. Of those, there were three ears that had developed COM and 4/13 ears with COM in 1987 that had healed. Hearing tests found bilateral normal hearing in 80% (PTA <20dB), unilateral loss in 15% and bilateral loss in 5%. Hearing loss was associated with poorer academic performance in Language (p<.05). A similar trend was found in Mathematics but not in Inuttitut., Conclusion: Chronic otitis media remains a significant problem among the Inuit, with a prevalence of 16.9% in individuals aged 12-16 years. One in five in this age group has hearing loss, and this hearing loss impacts on academic performance.

In low-incidence countries targeting tuberculosis (TB) elimination, TB remains a problem of a few high-risk groups. In Canada, Aboriginals, and particularly the Arctic Inuit communities, have witnessed dramatic decreases in TB during the 1960s to 1970s, but rates remain at least 10 to 20 times higher than the national average. We are describing the results of an integrated traditional and molecular epidemiology study of all culture-positive Mycobacterium tuberculosis cases in the Arctic Inuit communities of Quebec from 1990 until 2000. The demographic characteristics of the 46 TB cases included in the study were most notable for a bimodal age distribution (48% under 25 years). Genotyping analysis using multiple modalities (IS6110 restriction fragment length polymorphism, spoligotype, mycobacterial interspersed repetitive units-variable number tandem repeats) showed that 76% (35/46) of TB cases were clustered (six clusters, median size four cases) and estimated that at least 62.5% of TB cases were due to ongoing transmission. By integrating the epidemiologic and genotyping data, we observed that the genotyping clustering results were concordant with recognized epidemiologic links but most notably identified previously unrecognized intervillage transmission. This study demonstrates significant ongoing transmission in a geographically isolated, low-density population. In a resource-rich country such as Canada, these communities illustrate some of the persistent challenges of TB control and elimination.