Oral aspiration, type 1 laryngeal cleft, and respiratory tract infections in canadian inuit children

Farrow, Sarah; Agarwal, Amisha; Saban, Jeremy; Scott, Darcy; Barrowman, Nicholas J.; Kovesi, Tom

doi:10.1002/ppul.24447

Cited by 6 publications

(7 citation statements)

References 19 publications

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“…All subjects completed both Pedi‐EAT‐10 and I‐GERQ‐R questionnaires. Subjects had mean I‐GERQ‐R score of 13.01 ± 0.63 with 36% (39) having abnormal scores. Subjects had mean Pedi‐EAT‐10 score of 8.7 ± 0.80 with 30% (32) having abnormal scores.…”

Section: Resultsmentioning

confidence: 99%

“…A subset of subjects had a clinically indicated VFSS performed and were classified as having aspiration or normal swallow function. VFSS showing aspiration or penetration were considered abnormal based on prior studies (36)(37)(38)(39). Medical records were reviewed for demographics and additional clinical data including medications and diagnostic study results.…”

Section: Methodsmentioning

confidence: 99%

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Overlapping Symptoms of Gastroesophageal Reflux and Aspiration Highlight the Limitations of Validated Questionnaires

Duncan

DiFilippo²,

Kane³

et al. 2020

J. pediatr. gastroenterol. nutr.

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Objectives: Infants frequently present with feeding difficulties and respiratory symptoms, which are often attributed to gastroesophageal reflux but may be because of oropharyngeal dysphagia with aspiration. The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) is a clinical measure of gastroesophageal reflux disease but now there is greater understanding of dysphagia as a reflux mimic. We aimed to determine the degree of overlap between I-GERQ-R and evidence of dysphagia, measured by Pediatric Eating Assessment Tool-10 (Pedi-EAT-10) and videofluoroscopic swallow study (VFSS). Methods: We performed a prospective study of subjects <18 months old with feeding difficulties. All parents completed Pedi-EAT-10 and I-GERQ-R as a quality initiative to address parental feeding concerns. I-GERQ-R results were compared with Pedi-EAT-10 and, whenever available, results of prior VFSS. Pearson correlation coefficients were calculated to determine the relationship between scores. Groups were compared with 1-way ANOVA and Fisher exact test. ROC analysis was completed to compare scores with VFSS results. Results: One hundred eight subjects with mean age 7.1 ± 0.5 months were included. Pedi-EAT-10 and I-GERQ-R were correlated (r = 0.218, P = 0.023) in all subjects and highly correlated in the 77 subjects who had prior VFSS (r = 0.369, P = 0.001). The blue spell questions on I-GERQ-R had relative risk 1.148 (95% confidence interval [CI] 1.043–1.264, P = 0.142) for predicting aspiration/penetration on VFSS, with 100% specificity. Scores on the question regarding crying during/after feedings were also higher in subjects with abnormal VFSS (1.1 ± 0.15 vs 0.53 ± 0.22, P = 0.04). Conclusions: I-GERQ-R and the Pedi-EAT-10 are highly correlated. I-GERQ-R results may actually reflect oropharyngeal dysphagia and not just gastroesophageal reflux disease in infants.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Overlapping Symptoms of Gastroesophageal Reflux and Aspiration Highlight the Limitations of Validated Questionnaires

Duncan

DiFilippo²,

Kane³

et al. 2020

J. pediatr. gastroenterol. nutr.

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“…The authors emphasised the relevance of focusing on the environmental contaminant 24. Apart from some tuberculosis research, respiratory health research viewed health outcomes through a clinical lens 25–27. Nutrition and chronic diseases studies situated health in a nutrition transition paradigm, reporting a shift from traditional Inuit lifestyle to western diets and physical activity 28–31.…”

Section: Resultsmentioning

confidence: 99%

“…24 Apart from some tuberculosis research, respiratory health research viewed health outcomes through a clinical lens. [25][26][27] Nutrition and chronic diseases studies situated health in a nutrition transition paradigm, reporting a shift from traditional Inuit lifestyle to western diets and physical activity. [28][29][30][31] Studies on childbirth outcomes and infant health addressed health about maternal health risk behaviours (smoking, alcohol).…”

Section: Framing Health Issues and Justificationmentioning

confidence: 99%

Shifting paradigm from biomedical to decolonised methods in Inuit public health research in Canada: a scoping review

et al. 2022

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BackgroundThe National Inuit Strategy on Research focuses on advancing Inuit governance in research, increasing ownership over data and building capacity. Responding to this call for Inuit self-determination in research, academic researchers should consider cultural safety in research and ways to promote Inuit-led methods.MethodsThis scoping review collated academic literature on public health research in Inuit communities in Canada between 2010 and 2022. A critical assessment of methods used in public health research in Inuit communities examined cultural safety and the use of Inuit-attuned methods. Descriptive and analytical data were summarised in tables and figures. Knowledge user engagement in the research process was analysed with thematic analysis.Results356 articles met the inclusion criteria. Much of the published research was in nutrition and mental health, and few initiatives reported translation into promotion programmes. Almost all published research was disease or deficit focused and based on a biomedical paradigm, especially in toxicology, maternal health and chronic diseases. Recent years saw an increased number of participatory studies using a decolonial lens and focusing on resilience. While some qualitative research referred to Inuit methodologies and engaged communities in the research process, most quantitative research was not culturally safe. Overall, community engagement remained in early stages of co-designing research protocols and interventions. Discussion on governance and data ownership was limited. Recent years saw emerging discussions on these issues. Knowledge user capacity-building was limited to brief training on conventional data collection methods.ConclusionsThe last decade of published public health research has not responded to the National Inuit Strategy on Research. Participatory research is gaining ground, but has not reached its full potential. A shift from biomedical to decolonised methods is slowly taking place, and public health researchers who have not yet embraced this paradigm shift should do so.

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“…This recognition of PCD in Inuit is particularly important since the Indigenous population of Canada experiences a higher frequency of chronic respiratory disease and pulmonary infections compared to the nonindigenous community, particularly in infancy 23 . In Inuit children, bronchiectasis is common with most cases appearing to follow severe viral respiratory infections occurring early in life, such as respiratory syncytial virus or adenovirus, 5,6 although a recent case series describes a group of Inuit infants primarily from the west Qikiqtaaluk region with idiopathic oral aspiration, 24 which may be another significant cause of bronchiectasis in this population. Social determinants of health in Inuit communities, such as overcrowding and reduced ventilation in houses, play an important role in the development of severe lower respiratory tract infection early in life; however, our study demonstrates that genetic conditions also need to be considered as a cause of chronic respiratory disease in Inuit patients 25 …”

Section: Discussionmentioning

confidence: 99%

First reports of primary ciliary dyskinesia caused by a shared DNAH11 allele in Canadian Inuit

Hunter-Schouela

Geraghty

Hegele

et al. 2023

Pediatric Pulmonology

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Background Primary ciliary dyskinesia (PCD) is typically an autosomal recessive disease characterized by recurrent infections of the lower respiratory tract, frequent and severe otitis media, chronic rhinosinusitis, neonatal respiratory distress, and organ laterality defects. While severe lower respiratory tract infections and bronchiectasis are common in Inuit, PCD has not been recognized in this population. Methods We report a case series of seven Inuit patients with PCD identified by genetic testing in three Canadian PCD centers. Results Patients ranged from 4 to 59 years of age (at time of last evaluation) and originated in the Qikiqtaaluk region (Baffin Island, n = 5), Nunavut, or Nunavik (northern Quebec, n = 2), Canada. They had typical features of PCD, including neonatal respiratory distress (five patients), situs inversus totalis (four patients), bronchiectasis (four patients), chronic atelectasis (six patients), and chronic otitis media (six patients). Most had chronic rhinitis. Genetic evaluation demonstrated that all had homozygous pathogenic variants in DNAH11 at NM_001277115.1:c.4095+2C>A. Conclusions The discovery of this homozygous DNAH11 variant in widely disparate parts of the Nunangat (Inuit homelands) suggests this is a founder mutation that may be widespread in Inuit. Thus, PCD may be an important cause of chronic lung, sinus, and middle ear disease in this population. Inuit with chronic lung disease, including bronchiectasis or laterality defects, should undergo genetic testing for PCD. Consideration of including PCD genetic analysis in routine newborn screening should be considered in Inuit regions.

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Oral aspiration, type 1 laryngeal cleft, and respiratory tract infections in canadian inuit children

Cited by 6 publications

References 19 publications

Overlapping Symptoms of Gastroesophageal Reflux and Aspiration Highlight the Limitations of Validated Questionnaires

Overlapping Symptoms of Gastroesophageal Reflux and Aspiration Highlight the Limitations of Validated Questionnaires

Shifting paradigm from biomedical to decolonised methods in Inuit public health research in Canada: a scoping review

First reports of primary ciliary dyskinesia caused by a shared DNAH11 allele in Canadian Inuit

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