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Retina fundus images conducted in Greenland are telemedically assessed for diabetic retinopathy by ophthalmological nurses in Denmark. Applying an AI grading solution, in a Greenlandic setting, could potentially improve the efficiency and cost-effectiveness of DR screening. We developed an AI model using retina fundus photos, performed on persons registered with diabetes in Greenland and Denmark, using Optos® ultra wide-field scanning laser ophthalmoscope, graded according to ICDR.Using the ResNet50 network we compared the model's ability to distinguish between different images of ICDR severity levels in a confusion matrix. Comparing images with ICDR level 0 to images of ICDR level 4 resulted in an accuracy of 0.9655, AUC of 0.9905, sensitivity and specificity of 96.6%.Comparing ICDR levels 0,1,2 with ICDR levels 3,4, we achieved a performance with an accuracy of 0.8077, an AUC of 0.8728, a sensitivity of 84.6% and a specificity of 78.8%. For the other comparisons, we achieved a modest performance. We developed an AI model using Greenlandic data, to automatically detect DR on Optos retina fundus images. The sensitivity and specificity were too low for our model to be applied directly in a clinical setting, thus optimising the model should be prioritised.

This cross-sectional study sought to assess the prevalence of atrial fibrillation (AF) diagnosis in Greenland among various age groups and examine the corresponding quality of care. We collected data from Greenland's electronic medical records and evaluated the quality of care using six internationally recommended indicators, which are: percentage of AF patients with an assessment of smoking status within the previous year, an assessment of body mass index within the previous year, assessment of blood pressure within the previous year, measurement of thyroid stimulating hormone (TSH), treatment with an anticoagulant and percentage of patients with a measurement of serum-creatinine. We found the prevalence of AF among patients aged 20 years or older in Greenland to be 1.75% (95% CI 1.62-1.88). We found an increasing prevalence of AF with age and a greater proportion of men than women until the age of 74 years. Our study suggests that the associated quality of care could be higher as the requirement of only one of the six quality indicators was met. A lack of registration may partly explain this, and initiatives to improve the quality of care are recommended.

The aim of this study was to evaluate the activity within the primary health care (PHC) in Greenland by identifying the patterns of all registered contacts made by patients in 2021, and to compare the most frequently used types of contacts and diagnostic codes in Nuuk to the rest of Greenland. The study was designed as a cross-sectional register study using data from the national electronic medical records (EMR) and diagnostic codes from the ICPC-2-system. In 2021, 83.7% (46,522) of the Greenlandic population were in contact with the PHC, resulting in 335,494 registered contacts. The majority of the contacts with PHC was made by females (61.3%). On average, females were in contact with PHC 8.4 times per patient per year, while males were in contact with PHC 5.9 times per patient per year. The most frequently used diagnostic group was \"General and unspecified\", followed by \"Musculoskeletal\" and \"Skin\". The results are in line with studies from other northern countries and indicate an easily accessible PHC system, with a predominance of female contacts.

Diabetes used to be a rare condition among Inuit in Greenland. However, research in recent decades has shown a high prevalence of undiagnosed diabetes. Addressing diabetes in the geographically dispersed population of Greenland presents a challenge to the health care system. In 2008, a new model of diabetes care was introduced in Greenland that included continual monitoring, analysis, and adjustment of initiatives taken. The overall aim of this review was to review the feasibility of the monitoring of an ongoing national diabetes care programme. After ten years of observation it was clear that monitoring of such a programme based on information in electronic medical records in Greenland was feasible. It was found that the majority of the population in Greenland was in contact with the health care system. Increased diagnostic activity resulted in an increased prevalence of diagnosed diabetes. The quality of diabetes care in Greenland and the testing effectiveness of gestational diabetes were improved. Microvascular complications were frequently observed among Greenlandic diabetic patients, except for retinopathy that was as an exception. In summary, this model may improve diabetes care and potentially care for other chronic conditions in Greenland, and may also be helpful in other remote settings where chronic disease care is difficult. Abbreviations: AD: Anno Domini; ADA: American Diabetes Association; BC: Before Christ; BMI: Body Mass Index; BP: Blood Pressure; CWB: Capillary Whole Blood; EMR: Electronic Medical Record; EASD: European Association for Study of Diabetes; GA: Gestational Age; GDM: Gestational Diabetes Mellitus; FIGO: The International Federation of Gynaecology and Obstetrics; HbA1c: Glycosylated haemoglobin; IDF: International Diabetes Federation; LDL: Low density lipoprotein; NDQIA: National Diabetes Quality Improvement Alliancel; NICE: National Institute for Health and Care Excellence; OECD: Organisation for Economic Co-operation and Development; OGTT: Oral Glucose Tolerance Test; QIH: Queen Ingrid Hospital; RCT: Randomised Controlled Tria;l T1D: Type 1 Diabetes; T2D: Type 2 Diabetes; UACR: Urine Albumin Creatinine Ratio; WHO: World Health Organisation

Greenland's geography and dispersed settlements impede equitable access to care. To address this, Steno Diabetes Center Greenland (SDCG) implemented a telemedicine programme (2021-2024) comprising client-to-provider video (VC), client-to-provider mail, and provider-to-provider Medical Assistance Requests (MAR). The aim of this study was to describe utilization of the newly implemented telemedicine modalities at SDCG from 2021 to 2024. The study was conducted as a cross-sectional, register-based study using electronic medical record data extracted January 15, 2025. All SDCG contacts from January 1, 2021, to December 31, 2024, were included. Consultations were classified as face-to-face, administrative, telephone, mail, or video. Total telemedicine comprised all non-face-to-face modalities. In total, 43,190 consultations were registered. Overall activity increased by 56% from 2021 to 2024. In 2024, telemedicine constituted 70% of all consultations. The newly implemented modalities accounted for 40% of all consultations in 2024. VC rose by >2,000% during the period to around 7% in 2024; mail increased from zero to 14% in 2024. Administrative consultations grew by 57%, driven by an increase in MAR. In conclusion, the newly implemented telemedicine modalities were rapidly and sustainably integrated into SDCG, enhancing access and continuity. The swift toward video, mail, and MAR supports further scale-up across the Greenlandic Health System. Client and providers experiences as a well as effect on clinical quality in Greenland needs to be addressed in future research.

Background Health literacy plays an important role in self-management of non-communicable diseases. To lay the groundwork for development of a patient education intervention for people with chronic obstructive pulmonary disease (COPD) or type 2 diabetes (T2D), this study investigates health literacy and self-management of people with COPD or T2D in Greenland. Methods Individual, semi-structured interviews about the experiences of living with COPD or T2D in Greenland were conducted at the National Hospital in Nuuk and at the four regional hospitals. Informants ( n  = 24) were selected by purposeful sampling. Interviews were audio-recorded. During the analyses, we applied the results using the qualitative methodology Interpretive Description, alongside Osborne’s Health Literacy Questionnaire (HLQ) and the Precaution Adoption Process Model (PAPM) as theoretical frameworks. Results Three themes emerged: Gaining knowledge of one’s disease; Understanding how to apply knowledge in everyday life, and Integrating knowledge to perform self-management. We created a model to illustrate how the three themes could be related to the seven stages in PAPM and with the nine health literacy domains in the HLQ. We found varying levels of knowledge about disease and health literacy among the informants. Furthermore, the informants’ experiences were situated at different places in our model. Depending on their position in the model, they needed certain kinds of knowledge related to their disease, such as bio-medical knowledge or experience-based knowledge. Social support from society, peers, and health care professionals was essential at all places in the model. The ability to perform self-management required several skills and competences, which had to be supported to some extent to be able to change lifestyle behaviours and perform self-management. Conclusions There was a great desire for more knowledge about COPD and T2D and for information in Greenlandic. The study showed considerable individual variation in knowledge about disease and health literacy, and involving the informants’ network in management of the disease was found essential. The study’s results can support the development of a culturally adapted patient education intervention. The intervention must be multifaceted, accessible to all citizens in Greenland, targeted to the individuals’ situations, prioritised, and quality assured as an integrated part of overall care.

The aim was to test the internal consistency of the Greenlandic version of the COPD Assessment Test (CAT) questionnaire and to estimate the symptom burden in patients with chronic obstructive pulmonary disease (COPD) in Greenland using the CAT questionnaire. A Greenlandic version of the CAT questionnaire was developed including forward translation, reconciliation, backwards translation, and pilot test. Afterwards, a cross-sectional study of patients with COPD was conducted. The internal consistency assessed by the Cronbach α coefficient was 0.823 for the Greenlandic version of the questionnaire (n = 103). The CAT was negatively correlated to spirometry values and current smoking. In the cross-sectional study (n = 250), 81.1% of the patients experienced a high symptom burden (≥10). The main CAT score was 17 (range 0-38). The CAT was used in 9 out of 17 towns in Greenland. The Greenlandic version of the CAT questionnaire demonstrated a good internal consistency. We observed a high burden of symptoms associated with reduced lung function and active smoking status among patient diagnosed with COPD in Greenland. The questionnaire can be used in clinical practice for assessment of symptom burden in patients with COPD in Greenland and may help to increase focus on symptom control and quality of care.

To investigate the prevalence of overweight and obesity among children aged 3 to 10 years in Greenland. Further, to describe the prevalence of overweight and obesity according to sex, place of residence and age, including change over time. In a cross-sectional study, we included 4715 children aged 3-10 years, using data from the national electronic medical records. BMI was calculated and children were categorised into age and sex-specific weight classes according to cut-off values established by the International Obesity Task Force. In 2023, 37.1% of children in Greenland aged 3-10 years were classified as overweight or obese (12.6% obese). The proportion of children with normal weight was 61.1%. We saw no noticeable differences in the distribution of weight classes according to place of residence and sex. Further, our study illustrates a significant rise in the prevalence of overweight and obesity at the time of school entry, increasing from 7.5% in 1980 to 33.4% in 2023. This study demonstrates a high prevalence of overweight and obesity among children in Greenland, and further highlights a striking increase at school entry over recent decades. These findings underscore the urgent need for early prevention efforts and continued nationwide surveillance.

Subarachnoid haemorrhages (SAH) caused by rupture of intracranial aneurysms (IA) are a severe condition. Earlier studies found a higher incidence of SAH in Greenlandic patients compared to Danish patients, with familial aggregation also higher in Greenland. However, updated data is lacking. To investigate the contemporary incidence, outcome, and familial disposition of SAH/IA in Greenlandic patients in 2018-2021. Greenlandic patients diagnosed with ruptured or unruptured IA (UIA) during 2018-2021 were included. Data was obtained from patient files, x-ray department, and discharge registry. Incidence rates were estimated as cases/100,000/year. Direct age-standardised incidence rates were calculated using WHO 2000-2025 as standards. Of 30 SAH patients, 20 (66.7%) were females, 10 (33.3%) males. Of 36 UIA patients, 27 (75.0%) were females, 9 (25.0%) males. For SAH, crude incidence was 13.4/100,000/year, age-standardised incidence was 10.8/100,000/year. Familial history was observed in 30.0% of SAH patients. 5 patients (16.7%) died before treatment, 28-day case-fatality rate (CFR) for all patients was 23.3%. Overall and age-standardised incidence rates were similar to previous studies but higher among females and compared to neighbouring countries. A high occurrence of familial history was reported. SAH remains a serious condition in Greenland, as evidenced by five fatalities before treatment was administered.

This study aimed to estimate the age- and sex specific prevalence of patients using antihypertensive medication in Greenland, and compared the quality of care between patients with and without a diagnosis for hypertension. The study was a cross-sectional study comparing patients using antihypertensive medication in 2020 (6,629 patients) and 2021 (7,008 patients), respectively. For data from 2021, patients with a medical diagnosis code were identified. Data was obtained from the Greenlandic electronic medical record. The population of Greenland was used as background population. Quality of care was evaluated based on suggested indicators by international guidelines and goals from Steno Diabetes Centre Greenland. The prevalence of patients aged ≥20 years using antihypertensive medication had increased from 16.7% in 2020 to 17.5% in 2021. The prevalence increased by age and was higher among women compared to men. In 2021, the prevalence of patients aged ≥20 years with a medical diagnosis code for hypertension was 7.9%. The use of antihypertensive medication in Greenland is common. The associated quality of care was low. However, process indicators were significantly improved when patients had a medical diagnosis code. Future focus must be on initiating initiatives ensuring that more patients are registered with a medical diagnosis code.