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ABSTRACTThe rate of cervical cancer among Canadian Inuit women is higher than the national average. To date, early detection remains the best strategy for reducing the incidence of cervical cancer and its consequences. Thus, the aim of this study was to explore the barriers and facilitators in implementing human papillomavirus (HPV) self-sampling as a primary screening strategy for cervical cancer among Inuit women of Nunavik in Northern Quebec. A focused ethnographic approach was adopted. Inuit women of Nunavik participated in individual or group interviews during which a semi-structured interview guide was used to determine their perceptions of the barriers and facilitators to implementing HPV self-sampling as a primary screening strategy for cervical cancer. The data were analysed based on Paillé’s grounded theory of qualitative analysis. Twenty-eight Inuit women participated in this study. Analysis revealed five subcategories of facilitators and four barriers. Inuit women may embrace the self-sampling method. Importantly, in order to be effective, these strategies must be culturally sensitive and adapted to women’s preferences so as to increase sustainability. The results of this study provide the means for integrating the perspectives of Inuit women in implementing HPV self-sampling as a primary screening strategy for cervical cancer in Nunavik. Consideration of these facilitators and barriers might maximise the chance of success and optimise the screening participation rate.

ABSTRACTIntratypic DNA polymorphism has been described for human papillomavirus (HPV) types infecting Inuit women in Nunavik, Quebec, a high-risk population for HPV infection and cervical cancer, but there is no previous research on the association between HPV polymorphism and infection persistence in Inuit women. Polymorphism of HPV types 16, 18 and 52 was described in a subset of 64 participants with multiple clinic visits within a cohort of 677 Nunavik Inuit women aged 15–69 recruited in 2002–2010 with testing results. Logistic regression and Cox proportional hazards models were used to assess the association between HPV variants and infection persistence and clearance. Infections with HPV16 lineage A3 variants cleared 3.13 times faster (95% CI: 1.10–8.97) than those with lineage A1 variants. HPV52 lineage C variants cleared slower than lineage A variants (HR = 0.28, 95% CI: 0.08–0.98). HPV polymorphism may be associated with viral persistence for certain HPV types in this population.

ABSTRACTBackground:Inuit interpreters are key players in end-of-life (EOL) care for Nunavik patients and families. This emotionally intensive work requires expertise in French, English and Inuit dialects to negotiate linguistic and cultural challenges. Cultural differences among medical institutions and Inuit communities can lead to value conflicts and moral dilemmas as interpreters navigate how best to transmit messages of care at EOL.Objectives:Our goal was to understand the experience of Inuit interpreters in the context of EOL care in Nunavik in order to identify training needs.Design:In the context of a larger ethnographic project on EOL care in Nunavik, we met with 24 current and former interpreters from local health centres and Montreal tertiary care contexts. Data included informal and formal interviews focusing on linguistic resources, experiences concerning EOL care, and suggestions for the development of interpretation training.Results:Inuit working as interpreters in Nunavik are hired to provide multiple services of which interpretation plays only a part. Many have no formal training and have few resources (e.g. visual aids, dictionaries) to draw upon during medical consultations. Given the small size of communities, many interpreters personally know their clients and often feel overwhelmed by moral dilemmas when translating EOL information for patients and families. The concept of moral distress is a helpful lens to make sense of their experience, including personal and professional repercussions.Conclusions:Inuit interpreters in Nunavik are working with little training yet in context with multiple linguistic and cultural challenges. Linguistic and cultural resources and focused training on moral dilemmas unique to circumpolar contexts could contribute to improved work conditions and ultimately to patient care.​​​​

BackgroundInuit communities in northern Quebec have high rates of human papillomavirus (HPV) infection, cervical cancer and cervical cancer–related mortality as compared to the Canadian population. HPV types can be further classified as intratypic variants based on the extent of homology in their nucleotide sequences. There is limited information on the distribution of intratypic variants in circumpolar areas.ObjectiveOur goal was to describe the HPV intratypic variants and associated baseline characteristics.DesignWe collected cervical cell samples in 2002–2006 from 676 Inuit women between the ages of 15 and 69 years in Nunavik. DNA isolates from high-risk HPVs were sequenced to determine the intratypic variant.ResultsThere were 149 women that were positive for HPVs 16, 18, 31, 33, 35, 45, 52, 56 or 58 during follow-up. There were 5 different HPV16 variants, all of European lineage, among the 57 women positive for this type. There were 8 different variants of HPV18 present and all were of European lineage (n=21). The majority of samples of HPV31 (n=52) were of lineage B. The number of isolates and diversity of the other HPV types was low. Age was the only covariate associated with HPV16 variant category.ConclusionsThese frequencies are similar to what was seen in another circumpolar region of Canada, although there appears to be less diversity as only European variants were detected. This study shows that most variants were clustered in one lineage for each HPV type.

Background. A higher incidence of cervical cancer and human papillomavirus (HPV) infection has been reported in northern Canada and in First Nation, Métis and Inuit women, with some evidence to suggest that the HPV type distribution in these populations may be different from the rest of Canada.Objective. The objective of this study was to measure the HPV type prevalence in Labrador women to determine if significant differences in HPV types could reduce the effectiveness of HPV vaccination.Design. The prevalence of HPV types was determined in 1,370 women presenting for routine pap screening in Labrador between February and November 2010. Cervical cytology and HPV genotyping were performed on the same liquid-based cytology specimens.Results. The overall prevalence of HPV was 21.4%; cytological abnormalities were found in 8.8% of the participants. HPV 16 and 18 were the most common high-risk HPV types. These two types were found in 52.4% of high-grade lesions. The prevalence in HPV infections was comparable across the Labrador regions.Conclusions. The present results support the potential effectiveness of the HPV immunization program in Labrador.

BackgroundHuman leukocyte antigen (HLA) alleles code for proteins that are involved in the recognition of foreign antigens and activation of the immune system. The frequency of HLA alleles varies across different populations.ObjectiveTo describe the frequency of HLA alleles in a population of Inuit women of Nunavik, Quebec, Canada.DesignA cohort of women was recruited from 4 different communities between January 2002 and December 2007. HLA-B*07, HLA-DQB1*03, DQB1*06:02, DRB1*13 and DRB1*15:01 alleles were typed by PCR sequence-specific primers (PCR-SSP) and HLA-E and G alleles were type by DNA-sequencing procedures.ResultsWe obtained data on 524 participants. The most frequent HLA alleles in this population were HLA-E*01:03, HLA-G*01:04:01 and HLA-DQB1*03, and they were found in 89, 75 and 94% of the population, respectively.ConclusionsThe distribution of HLA alleles in Nunavik, Quebec is unique when compared to other populations in Canada or around the world.

Objectives:To describe the attitudes about and experiences with cervical cancer, Pap smear screenings and the HPV vaccine among a sample of Inuit women from Nunavik, Quebec, Canada. We also evaluated demographic and social predictors of maternal interest in HPV vaccination.Study design:A mixed method design was used with a cross-sectional survey and focus group interviews.Methods:Women were recruited through convenience sampling at 2 recruitment sites in Nunavik from March 2008 to June 2009. Differences in women's responses by age, education, and marital status were assessed. Unconditional logistic regression was used to determine predictors of women's interest in HPV vaccination for their children.Results:Questionnaires were completed by 175 women aged 18–63, and of these women a total of 6 women aged 31–55 participated in 2 focus groups. Almost half the survey participants had heard of cervical cancer. Women often reported feelings of embarrassment and pain during the Pap smear and older women were more likely to feel embarrassed than younger women. Only 27% of women had heard of the HPV vaccine, and 72% of these women were interested in vaccinating their child for HPV. No statistically significant predictors of maternal interest in HPV vaccination were found.Conclusions:Our findings indicate that health service planners and providers in Nunavik should be aware of potential barriers to Pap smear attendance, especially in the older age groups. Given the low awareness of cervical cancer, the Pap smear and the HPV vaccine, education on cervical cancer and prevention strategies may be beneficial.1Published ‘ahead-of-print’ 26 October 2011 (at www.ijch.fi) in accordance with previous publisher's routines.