Low prevalence of iron-deficiency anaemia among Inuit preschool children: Nunavut Inuit Child Health Survey, 2007-2008.

OBJECTIVE: To report the prevalence rates and correlates for anaemia, iron deficiency (ID) and iron-deficiency anaemia (IDA) among Inuit preschool-aged children. DESIGN: A cross-sectional study assessed iron intake, demographic information, medical history, anthropometrics, Hb, ferritin, C-reactive protein and antibodies to Helicobacter pylori. SETTING: Sixteen selected Inuit communities in Nunavut Territory, Canada. SUBJECTS: Inuit (n 388) aged 3-5 years randomly recruited from communities. RESULTS: Anaemia (3-4 years: Hb < 110 g/l; 5 years: Hb < 115 g/l) was prevalent in 16·8 % of children. The prevalence of ID (ferritin < 12 µg/l) was 18·0 % and that of IDA was 5·4 %. When ID was defined as ferritin <10 µg/l, 10·8 % of children were iron deficient and 3·3 % had IDA. In multiple logistic regression, boys were more likely to be iron deficient (OR = 2·28, 95 % CI 1·17, 8·25), but no other risk factor emerged for ID. Three- to 4-year-olds were less likely than 5-year-olds to have anaemia from causes other than ID (OR = 0·11, 95 % CI 0·08, 0·58). Anaemia from other causes was more common among children residing in crowded homes (OR = 2·30, 95 % CI 1·37, 12·31) and those treated for past-year ear infection (OR = 1·35, 95 % CI 1·05, 7·21). CONCLUSIONS: The low prevalence of ID and IDA is encouraging, but efforts are still needed to reduce rates as they continue to be higher than general population rates. Household crowding and infections may contribute to anaemia and warrant further research.

Prevalence and risk factors for parental-reported oral health of Inuit preschoolers: Nunavut Inuit Child Health Survey, 2007-2008.

INTRODUCTION: Studies from the early 20th Century suggest that Inuit had a low prevalence of dental caries. However, Inuit children now experience a high prevalence of tooth decay and dental caries. The main objectives of this study were to provide an estimate of the prevalence and correlates of parental-reported oral health among Inuit preschool-aged children in Nunavut. METHODS: Inuit preschool-aged children aged 3 to 5 years from 16 of Nunavut's 25 communities were randomly selected to participate in the Nunavut Inuit Child Health Survey conducted in 2007 and 2008. The parent/primary caregiver was asked to give written informed consent for their child's participation. Caregivers were asked to rate their child's oral and dental health and if their child had any 'decayed, extracted or filled baby teeth': an affirmative response designated a child as having reported-caries experience (RCE). Interviewer administered questionnaires included household characteristics, nutritional supplements, past-month qualitative food frequency questionnaire (FFQ), and a 24 hour dietary recall with repeat 24 hour recalls on a 20% sub-sample. RESULTS: The overall participation rate was 72.3% (388 children). Among the participating children, 53% percent were female and the mean age was 4.4 +/- 0.9 years. The weighted prevalence of RCE was 69.1% (95% CI: 63.7-74.4%). Caregivers rated their child's oral and dental health as: 'very good' (9.5%), 'good' (44.5%), 'fair' (29.5%) and 'poor' (16.6%). Very few children were taking a fluoride supplement (4.6%, 95% CI: 2.3-6.9%) or a vitamin D supplement (4.9%, 95% CI: 2.4-7.4%). Sixteen percent of children (95% CI: 12.3.-20.1) were taking a multivitamin and multimineral supplement containing vitamin D and calcium but not fluoride. In univariate analyses using data from the qualitative FFQ, children with RCE drank milk less often than children without RCE (1.6 +/- 0.1 vs 2.2 +/- 0.2 times per day, respectively, t-test p

Food insecurity among Inuit preschoolers: Nunavut Inuit Child Health Survey, 2007-2008.

BACKGROUND: Food security (i.e., a condition in which all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life) has been noted to be lower in indigenous communities in Canada. We investigated the prevalence of inadequate food security, or food insecurity, among Inuit households with preschool children. METHODS: We conducted a cross-sectional survey of the health status of 388 randomly selected Inuit children aged three to five years in 16 Nunavut communities during the period from 2007 to 2008. From the survey data, we classified levels of food insecurity specifically among children. We also classified levels of overall food insecurity of the household of each child. We calculated the weighted prevalence of levels of child food insecurity and of household food insecurity. RESULTS: Nearly 70% of Inuit preschoolers resided in households rated as food insecure (69.6%; 95% confidence interval [CI] 64.7%-74.6%). Overall, 31.0% of children were moderately food insecure, and 25.1% were severely food insecure, with a weighted prevalence of child food insecurity of 56.1% (95% CI 51.0%-61.3%). Primary care-givers in households in which children were severely food insecure reported experiencing times in the past year when their children skipped meals (75.8%), went hungry (90.4%) or did not eat for a whole day (60.1%). Primary caregivers in households in which children were moderately food insecure reported experiencing times in the past year when they worried food would run out (85.1%), when they fed their children less expensive food (95.1%) and when their children did not eat enough because there was no money for food (64.3%). INTERPRETATION: We observed a high prevalence of household food insecurity, with a substantial proportion of children with severely food insecure status. Interventions are needed to ensure a healthy start in life for Inuit preschoolers.

Protein modulator of multidrug efflux gene expression in Pseudomonas aeruginosa.

nalC multidrug-resistant mutants of Pseudomonas aeruginosa show enhanced expression of the mexAB-oprM multidrug efflux system as a direct result of the production of a ca. 6,100-Da protein, PA3719, in these mutants. Using a bacterial two-hybrid system, PA3719 was shown to interact in vivo with MexR, a repressor of mexAB-oprM expression. Isothermal titration calorimetry (ITC) studies confirmed a high-affinity interaction (equilibrium dissociation constant [K(D)], 158.0 +/- 18.1 nM) of PA3719 with MexR in vitro. PA3719 binding to and formation of a complex with MexR obviated repressor binding to its operator, which overlaps the efflux operon promoter, suggesting that mexAB-oprM hyperexpression in nalC mutants results from PA3719 modulation of MexR repressor activity. Consistent with this, MexR repression of mexA transcription in an in vitro transcription assay was alleviated by PA3719. Mutations in MexR compromising its interaction with PA3719 in vivo were isolated and shown to be located internally and distributed throughout the protein, suggesting that they impacted PA3719 binding by altering MexR structure or conformation rather than by having residues interacting specifically with PA3719. Four of six mutant MexR proteins studied retained repressor activity even in a nalC strain producing PA3719. Again, this is consistent with a PA3719 interaction with MexR being necessary to obviate MexR repressor activity. The gene encoding PA3719 has thus been renamed armR (antirepressor for MexR). A representative "noninteracting" mutant MexR protein, MexR(I104F), was purified, and ITC confirmed that it bound PA3719 with reduced affinity (5.4-fold reduced; K(D), 853.2 +/- 151.1 nM). Consistent with this, MexR(I104F) repressor activity, as assessed using the in vitro transcription assay, was only weakly compromised by PA3719. Finally, two mutations (L36P and W45A) in ArmR compromising its interaction with MexR have been isolated and mapped to a putative C-terminal alpha-helix of the protein that alone is sufficient for interaction with MexR.