Dronning Ingrids Hospital Research Articles

1223. Increasing Incidence of Methicillin-Resistant Staphylococcus aureus in Greenland

BackgroundThe first case of methicillin-resistant Staphylococcus aureus (MRSA) in Greenland was diagnosed in 2000 and led to the first guideline on screening and treatment for MRSA. Up to 2015 there were only 13 patients with MRSA but since then a nearly 4-fold increase in incidence has been seen. The objectives of this study were to analyze the reasons for this increase.MethodsMRSA data were collected from the laboratory surveillance database at Dronning Ingrids Hospital, typing results from the Reference Laboratory for Antimicrobial Resistance and Staphylococci at SSI, and the patient records.ResultsFrom 2000 to 2017, 48 patients (15 children and 33 adults) have been diagnosed with MRSA. Thirty patients were colonized with MRSA, predominantly in the nose and throat. Eighteen patients had infections: conjunctivitis, middle ear infections, wounds, skin abscesses, mastitis, surgical site infections, for example.The increase since 2015 was mainly due to three large outbreaks in three different cities: Aasiaat in 2014/2015 (seven persons with MRSA; three children and four adults), the capital Nuuk in 2016 (six persons with MRSA; two children and four adults) and Tasiilaq in 2017 (13 persons with MRSA; three children and ten adults). The first two outbreaks were community-acquired with transmission in families and the last one was community-acquired or community-onset hospital acquired. Each outbreak was caused by a specific MRSA-type: t902 CC22 in Aasiaat (unknown epidemiology), t3979 CC5 in Nuuk (probably from Australia), and t304 CC6 in Tasiilaq (probably from Denmark).MRSA was mainly imported from Denmark or abroad due to admission to hospital or due to traveling to high-endemic countries like Australia, but in some cases the epidemiology was unknown. Transmission occurred mainly in families with close contact.ConclusionThe increasing number of patients with MRSA in Greenland can be explained by factors such as import from Denmark or abroad due to admission to hospital or traveling, and transmission in Greenland. An ongoing surveillance, compliance to screening procedures (especially patients admitted to hospitals abroad) and guidelines for infection prevention and control are necessary in order to combat MRSA in Greenland in the future.Disclosures All authors: No reported disclosures.

Greenlandic patients with colorectal cancer: symptomatology, primary investigations and differences in diagnostic intervals between Nuuk and the rest of the country

ABSTRACTBackground: Colorectal cancer (CRC) is a potentially fatal disease, and expedited referral and treatment is needed to ensure early detection.Objective: We aimed to assess the symptomatology of Greenlandic patients with CRC and the primary investigations initiated before referral to Dronning Ingrids Hospital in Nuuk for further diagnostic workup. Primary care interval (first consultation until referral), hospital interval (referral until diagnosis) and diagnostic interval (first consultation until diagnosis) were calculated and compared between patients living in Nuuk and in other places in Greenland (“the Coast”).Design: This was a retrospective, register-based study of all patients in Greenland diagnosed with CRC from 2008 through 2011. Medical history was obtained and investigated by reviewing the primary care charts.Results: In total 113 patients were identified from the Greenlandic cancer database or pathology reports. About 80% of the patients were asked about blood in the stools and changes of bowel habits, and the majority responded positively to this. Abdominal examination was performed for 78%, 65% had a rectal examination performed, 22% a proctoscopy performed and 51% a haemoglobin level measured.The median primary care interval was 4 days in Nuuk vs. 55 days for patients from “the Coast” (p=0.01); the median diagnostic interval was 55 days in Nuuk vs. 95 days for patients from “the Coast” (p=0.04). Median hospital interval was similar for both groups (23 days vs 24 days; p=0.86). Women had a median primary care interval of 70 days vs. 15 days for men (p=0.06).Conclusions: Patients with CRC presented classic symptomatology of CRC. Primary care interval and diagnostic interval were significantly longer for patients from “the Coast” compared with Nuuk. Women tended to have longer primary care interval. A more standardised examination should be implemented and a national CRC screening programme should be considered to reduce the difference in diagnostic interval and ensure timely referral.

Reproductive history and dietary habits and breast cancer risk in Greenlandic Inuit: a case control study

BackgroundThe incidence of breast cancer in Greenland has increased considerably since 1970. It has been suggested that the previous low incidence is associated with the traditional lifestyle and marine food diet, and that the increase in breast cancer risk may be due to changes to a more westernized diet and lifestyle. ObjectiveTo investigate the relation between food intake, reproductive factors and the risk of breast cancer in Greenlandic Inuit women. DesignA case control study with participants from all regions of Greenland. The sampling was carried out at Dronning Ingrids Hospital in Nuuk, Greenland where all breast cancer cases are treated. The reproductive factors and dietary intake were assessed using a questionnaire completed at enrolment. Student t-test was used to compare group differences for continuous data. Fisher's exact test and Pearson's Chi-square were used to compare distribution frequency of data between groups. Odd ratios (ORs) were obtained using logistic regression. Estimates with a P-value ≤0.05 were considered significant. ResultsInformation on reproductive factors and dietary intake was available for 116 participants, 60 breast cancer cases and 56 controls. We found that the risk of having breast cancer was significantly reduced (OR: 0.24 [95% CI 0.09; 0.66]) for the group with ≥3 full-term pregnancies and breastfeeding duration of ≥6 months compared to the group with ≤2 full-term pregnancies and breastfeeding duration of <6 months. We found that intake of fruit and vegetables when analyzed together, significantly reduced breast cancer risk (OR: 0.22 [95% CI 0.05; 0.98]). ConclusionsHigher parity, longer breastfeeding duration and intake of fruit and vegetables were protective factors for breast cancer risk. No clear associations between breast cancer and traditional or other imported food were seen.

Air ambulance and hospital services for critically ill and injured in Greenland, Iceland and the Faroe Islands: how can we improve?

The Nordic Atlantic Cooperation (NORA) is an intergovernmental organization under the auspices of the Nordic Council of Ministers. The NORA region comprises Greenland, Iceland, Faroe Islands and western coastal areas of Norway. Historical, cultural and institutional links bind these nations together in multiple ways, and regional co-operation has in recent years become a focus of interest. This commentary addresses air medical services (AMSs) and available advanced hospital services in the 3 smallest NORA countries challenged sparse populations, hereafter referred to as the region. It seems likely that strengthened regional co-operation can help these countries to address common challenges within health care by exchanging know-how and best practices, pooling resources and improving the efficiency of care delivery. The 4 largest hospitals in the region, Dronning Ingrids Hospital in Nuuk (Greenland), Landspítali in Reykjavík and Sjúkrahúsið á Akureyri, (both in Iceland) and Landssjúkrahúsið Tórshavn on the Faroe Islands, have therefore undertaken the project Network for patient transport in the North-West Atlantic (in Danish: Netværk for patienttransport i Vest-Norden). The goal of the project, and of this article, is to exchange information and provide an overview of current AMSs and access to acute hospital care for severely ill or injured patients in the 3 participating countries. Of equal importance is the intention to highlight the need for increased regional co-operation to optimize use of limited resources in the provision of health care services.

High prevalence of medicine-induced attempted suicides among females in Nuuk, Greenland, 2008–2009

BackgroundThe suicide rate in Greenland, especially among men, is among the highest in the world. Attempted suicide rates may be high also. However, the rates of attempted suicide are unknown.ObjectiveWe aimed to estimate the age- and gender-specific incidence of attempted suicide using medicine in Nuuk in 2008–2009.DesignAn observational retrospective study of consecutive medical records on patients admitted to Dronning Ingrids Hospital in Nuuk in 2008–2009 with possible medicine intoxication.ResultsSeventy-four (60 females and 14 men) cases of attempted suicide using medicine were included. Of those, 43 used paracetamol alone or in combination with other medicine. The incidence of attempted suicide using medicine was higher among females than males (p<0.001). The highest incidence of attempted suicide with paracetamol was found among women aged 20–24 years (0.84%). The highest incidence of suicide with medication (1.31 per 100 inhabitants per year) was among women aged 15–19 years.ConclusionsThe incidence of attempted suicide using medicine was high in Nuuk, Greenland, especially among women. The highest incidence of suicide attempts with medication was observed among women in the age group 15–19 years (1.31%). This may reflect psychosocial vulnerability among young people in Greenland. Initiatives to improve living conditions for children and adolescents are highly recommended to be initiated immediately.

Acute respiratory distress in Maniitsoq, Greenland

Background Inhalation of aerosols of surface active substances is a known risk factor for development of acute respiratory distress syndrome (ARDS). A number of small case series are reported with exposure for aerosols from spraycans with textile or leather protecting agents. We report a series of cases with respiratory symptoms in a group of 39 persons exposed to a floor-sealing product, Anti Fleck Super(R) (AFS). Case: In 2010, a supermarket in the Greenlandic town Maniitsoq, was under renovation. A 300 m2 floor was sprayed with AFS. The spraying created a fog of aerosols of poly-fluorinated silicones. Craftsmen, employees, and customers inhaled the aerosols during a period of minutes to 3 hours. Within hours 39 persons developed cough, dyspnoea and fever in varying degrees. It was necessary to evacuate the 39 patients with progressive symptoms, by airplane from the small hospital in Maniitsoq, to the well-equipped Dronning Ingrids Hospital (DIH), Nuuk. Triage was used. Methods Symptoms were recorded in Maniitsoq and DIH. All patients had arterial blood analyses and chest x-rays taken on arrival to DIH. Two months after the incident, the patients were offered a thoroughly clinical follow-up with lung function test, oxygen-saturation working test and chest x-ray. The patients: male and female, mean age 33 years, mainly without earlier medical record. Almost all were smokers.

Cost analysis of establishing dialysis facilities for the treatment of chronic renal failure in Greenland

Objectives. At present there are no facilities offering treatment for chronic renal failure with dialysis in Greenland. Patients in need of treatment must go to Denmark. It has been proposed that treatment facilities should be established at Dronning Ingrids Hospital in Nuuk, Greenland. The objective of this study is to explore the costs of such an alternative compared with the situation today.Methods. The costs of establishing dialysis facilities in Nuuk, Greenland, and providing dialysis for Greenlandic patients were compared with the costs of the current way of managing dialysis for Greenlandic patients in need of treatment. Data for the study were collected from publicly available statistics, from Dronning Ingrids Hospital in Nuuk and from Rigshospitalet in Copenhagen.Results. The actual number of patients in dialysis was found to be lower than expected. Based on Danish prevalence statistics, it was expected that about 27 persons in Greenland would be in dialysis each year. Over a time horizon of 10 years, the additional costs of establishing and offering dialysis treatment in Nuuk were expected to amount to an average of 1.4 million Danish kroner (€190,000) per year compared with the current treatment costs. Results were sensitive to the demand for dialysis treatment among people in need of treatment. If all patients in need of dialysis were treated, the additional costs of establishing dialysis facilities and providing treatment in Nuuk were estimated to about 7 million Danish Kroner (€930,000) per year compared with the status quo.Conclusions. Changes in the demand for dialysis treatment may influence the cost of establishing treatment facilities in Nuuk.

Incidence of myocardial and cerebral infraction in Nuuk, Greenland

Introduction. Myocardial and cerebral infarction are held to be rare among the Inuit, whereas cerebral haemorrhage is thought to be frequent. Recent studies have questioned these beliefs. We report data form our institution. Method. Retrospective data collection and review of all charts from Greenlandic patients from the Nuuk area admitted to the city hospital, Dronning Ingrids Hospital, from 1999 to 2002. Results. A total of 8 patients with myocardial infarction were found, median age 70 years, 4 with ST elevation MI and 4 with non-ST elevation MI. Two of the former had thrombolysis. Thirty-five patients were admitted with stroke, excluding subarachnoid haemorrhage, median age 65 years. Of these, twentynine had a CT. Five scans were reported as being normal, one patient had an intracerebral haemorrhage and twenty-three had cerebral infarctions. Six had no CT. One of these was admitted comatose and died without regaining consciousness, the rest were minor strokes in patients over 70. Conclusion. Myocardial infarction is a rare disease in Greenlanders, whereas stroke is four times as frequent. The overwhelming majority of strokes are infarctions, whereas intracerebral haemorrhage seems to account only for a small minority.

Risk factors for ischaemic stroke in young Greenlanders

Introduction. Contrary to a widely held belief, ischaemic cerebral infarction is not a rare disease in Greenland, as shown recently by our institution. We report data on some of the known risk factors in patients below 60 years of age with ischaemic stroke. Method. Retrospective data collection and review of charts from Greenlandic patients from all of Greenland admitted to the central hospital, Dronning Ingrids Hospital in Nuuk, in the years 2001 and 2002. Results. A total of 37 patients below 60 years of age were discharged with a diagnosis of cerebral infarction. All had a CT, which showed infarction in 32. Five were reported normal, and the diagnosis of infarction rested on the absence of haemorrhage combined with long-standing, major neurological defect. Median age of the group was 54 years. Fifteen (40%) were women, thirty (81%) were smokers. Nine (24%) had hypertension. Two had diabetes, one had atrial fibrillation, and one had dilated cardiomyopathy. Two had significant carotid atherosclerosis diagnosed by duplex ultrasound. Of the rest, fifteen had transoesophageal echocardiography done, thirteen of which showed atherosclerotic changes. The cholesterol levels showed relatively high HDL levels. Conclusion. Ischaemic stroke is a common disease in young Greenlanders and seems to be associated with atherosclerosis with smoking as the only outstanding risk factor - though not more common than in the general population.

Invasive pneumococcal disease in Greenland

Introduction. The purpose of the present study was to evaluate the incidence and outcome of pneumococcal infections in Greenland with special reference to serotypes. Study design. Retrospective study of invasive pneumococcal infections in Greenland in the period 1996–2002. Methods. Cases were defined as patients with positive cultures of Streptococcus pneumoniae from blood and/or CSF received at the microbiological laboratory of Dronning Ingrids Hospital in Nuuk. Cultures were sent to Statens Serum Institut in Copenhagen for serotyping. Medical charts were reviewed. Results. Fifty-one cases were identified. Incidence among Inuit was 54 and among non-Inuit 17 per 100,000 per year. Twenty-one patients were in the age group 35-49 years and 20 in the age group 50-64 years. Twenty patients had meningitis (incidence 6 per 100,000). Seventeen patients died (33%). Most common serotypes were 1 (6 cases) and 12F (8 cases). Mortality rate was significantly higher among patients with 12F than among others (p<0.01). No patients with serotype 1 died. Conclusion. Like in Canada and Alaska, the incidence of invasive pneumococcal disease, especially meningitis, is high among the Inuit in Greenland. Young and middle-aged adults were most frequently affected. Serotype seems to be an important determinant of the outcome of invasive pneumococcal disease.