International Journal of Circumpolar Health最新文献

Indigenous food sovereignty (IFS) has the potential to reconnect Indigenous peoples in Canada to their food systems, reduce health problems and improve food security. Using PRISMA-ScR guidelines to search Medline, Web of Science, Embase and Cabi databases, this review sought to explore the characteristics of IFS promotion and the food environments involved through food and nutrition interventions in Indigenous communities in Canada. Data from 30 relevant studies published between 2004 and 2022 were included, analysed and synthesised using a thematic approach based on key IFS principles and a food environment typology. Most studies were conducted in urban contexts, mainly in provinces with the largest Indigenous populations. Local descriptions of IFS showed conceptual and operational similarities. Among the four key principles of IFS, the principle of participation was the most reported. Gardening, farming, hunting, fishing and gathering were the main food activities used to operationalise IFS in traditional and cultivated food environments. Several IFS facilitators and barriers were identified. The IFS movement that emerged from the literature in Canada advocates for a healthy and sustainable food system based on traditional beliefs and controlled by communities to ensure wellbeing and food security. This review provides evidence of converging visions for food autonomy despite the heterogeneity of Indigenous nations in Canada.

In northern Canada, medical travel - the movement of patients to a larger centre to access healthcare services outside their home community - is a dominant feature of the healthcare system. This qualitative study explored the medical travel experiences of Gwich'in living above the Arctic Circle in the Gwich'in Settlement Area in Northwest Territories (NT). Data collection in 2020 comprised storytelling sessions with 10 Gwich'in medical travellers (6 female, 4 male). Using inductive and deductive methods with continual critical reflexivity, and guided by Gwich'in values, concerns about access to healthcare were found to be at the heart of each story. A broad conceptualisation of access was applied to understand and interpret the results according to six dimensions: accessibility, availability, affordability, adequacy, acceptability, and awareness. Situated within a context of colonialism, structural inequities and other factors relevant across the Circumpolar North, the results suggest that the NT medical travel policy framework provides only partial access to care. This article illustrates a need for healthcare and other government systems to think about policy and programmes in a more wholistic, equitable and relationship-centred way, which would help not only to bridge distances across geography, but also between peoples.

Background: Sensory impairments, including hearing and vision loss, are common in older adults and can affect quality of life. This study examines the integration of hearing and vision assessments in preventive home visits (PHVs) for older adults in the Faroe Islands, comparing outcomes between urban and rural settings.Aim: To evaluate the feasibility of including sensory assessments in PHVs and compare sensory measurements between Tórshavn (urban) and rural districts.Methods: A cross-sectional study with 175 participants aged 76 was conducted in Tórshavn and five rural areas. Data included demographics, self-assessments, and clinical evaluations using standardized tools.Results: Visual impairments were slightly more prevalent in rural areas, while hearing impairments showed no significant differences. Discrepancies between self-reported and measured impairments emphasized the importance of objective assessments. Sensory acreenings during PHVs improved early detection and highlighted inequities in access to specialized services.Conclusion: Integrating sensory assessments in PHVs is feasible and beneficial, adressing disparities between urban and rural areas. These screenings support equitable healthcare and early intervention, promoting better quality of life for older adults across diverse settings.

Rates of respiratory tract infections for children living in remote First Nations communities in the Sioux Lookout Zone in Northwestern Ontario are elevated and associated with poor indoor environmental quality including high exposures to endotoxin and serious dampness and mould damage. The studies also revealed a high prevalence of cigarette smoking and most houses have wood stoves, of variable quality. Depending on structure, polycyclic aromatic hydrocarbons (PAH) are carcinogens, immunotoxins and/or inflammatory mediators that are byproducts of the incomplete combustion of organic materials. Indoor sources of PAHs include tobacco smoke, cooking, and burning wood and/or fossil fuels for house heating. Twelve PAHs were measured in the <300 µm fraction of settled house dust by GC-MS in 59 houses. Nine PAHs were detected in all 59 houses, and median concentrations of individual PAHs measured ranged from 66 to 804 ng/g. PAHs associated with environmental tobacco smoke and with wood smoke dominated the PAH profile. Limiting tobacco smoking indoors and upgrading to low emission airtight wood stoves would improve indoor air quality and the respiratory health of children in this remote region of Ontario.

During the COVID-19 pandemic, Sweden adopted a recommendation-based approach rather than strict lockdowns. This approach relies on public willingness to adhere to guidelines and motivations for prosocial behaviour. This study aimed to explore the motivations behind adherence or non-adherence to COVID-19 recommendations in Sweden. Semi-structured interviews were conducted in 2022 with 20 participants aged 26 to 63, all residing and working in Stockholm. The interviews were conducted via online platforms, Teams and Zoom, transcribed and analysed using content analysis. The analysis yielded two overarching themes that motivated adherence or non-adherence, Sacrificing comfort for collective wellbeing and A sense of being superior and able to handle national recommendations in your own way derived from six categories: (i) Social pressure and the desire to appear prosocial, (ii) Embracing a new reality as a means to return to normalcy, (iii) The absence of punitive measures for non-adherence, (iv) Creating safe environments and circumventing the system, (v) Negotiating which recommendations to follow and (vi) Diminished adherence over time. Adherence to public health recommendations was driven by social pressure and a desire to protect loved ones, often requiring personal sacrifices and behavioural adjustments. Conversely, non-adherence stemmed from a sense of autonomy, mental well-being preservation and tiredness, highlighting the challenges of sustaining compliance over time.

The Arctic region, characterised by its remote and geographically challenging environment, is home to predominantly Indigenous populations who experience significant healthcare disparities compared to urban counterparts. This paper synthesises evidence on the persistent challenges in delivering healthcare in the Arctic, including geographical remoteness, healthcare personnel shortages, and cultural and language barriers. Telehealth emerges as a crucial solution, offering a nuanced approach to overcoming physical and systemic barriers. We review current implementations of telehealth in the Arctic, highlighting successful adaptations to local cultural contexts and technological limitations. By integrating a patient-centred approach, infrastructure readiness, and relevant telehealth services, a holistic healthcare delivery model tailored for the Arctic environment is proposed. New type of technologies is also proposed to enhance remote care possibilities. This paper underscores the need for collaborative efforts in research, policy making, and healthcare provision to ensure the sustainability and effectiveness of health services in the Arctic, aiming to close the gap in health equity. Key references from seminal works and recent studies provide a foundation for the discussions and recommendations presented.

Previous research has indicated that migrants risk facing inequities both internationally and in Sweden; integration policies are therefore important to study. How health is described in policies affects how health interventions are approached. Discourse analysis offers a way of understanding how health is framed within the integration policies affecting newly arrived migrants in Sweden. The aim was to analyse the health discourses used in Swedish and European Union (EU) integration policies. A discourse analysis, inspired by Fairclough, was performed on integration policies related to Sweden, at local, regional, national and EU levels. The policies of the Establishment Program, which focuses on newly arrived migrants (refugees, persons of subsidiary protection and their relatives who arrived through family reunification), were chosen for the analysis, and 17 documents were analysed in total. The analysis of the documents showed how the health discourses were expressed in the form of the medicalisation of health, the individualisation of health and the risk of ill health. A pathogenic approach to health was visible in the policies and individual disease prevention or rehabilitation was the main health focus. The results showed similarities to previous research highlighting how a particular understanding of health in a neoliberal context is formed.

The perspectives of Yukon's nurses and physicians can determine what might mitigate burnout and strengthen the response to the COVID-19 pandemic and/or future health emergencies. The study was conducted in the Yukon Territory, Canada in two phases: completion of the Copenhagen Burnout Inventory (CBI), and in-depth oral interviews. This paper will discuss the results of the interviews. A hybrid thematic analysis of 38 interviews revealed five primary themes: personal impacts; work-related effects; client effects/patient care; perceptions of the territorial response to COVID-19; and recommendations for future pandemics. The loss of social connection and burden of childcare contributed to personal burnout. Stressful work environments, increased workload, limited resources and feeling undervalued contributed to job stress and work-related burnout. Healthcare workers ascribed meaning to their roles in improving community health , which may have mitigated client-related burnout. Systemic change is needed to ensure the healthcare workforce can maintain service delivery and respond to future pandemics. The response to COVID-19 was mounted on the backs of frontline healthcare workers who made personal sacrifices and worked to exhaustion to serve their patients. As the healthcare system and its workforce recover from the pandemic, the calls to support healthcare workers must be answered.

Task shifting can improve access, availability, efficiency, and quality of health services in under resourced settings. Task shifting can occur formally or informally within health professions, between health professions, between support staff and health professions, or between lay community members and health professionals. There are currently thousands of Indigenous peoples in Canada's high Arctic, living in remote communities, north of the 60^th parallel with limited access to basic medical services. In Nunavut, 25 remote fly-in communities exist in some of the most sparsely populated and harshest conditions on earth. Diminished access to or absence of basic health services such as diagnostic imaging and staff resources in remote communities can have a detrimental effect on patient care, and health outcomes. The existence of a community based diagnostic x-ray training program using a task shifting model addresses a gap in quality and access to services and subsequent treatment for community residents in this region.

Country foods (i.e. wild traditional food) are associated with improved nutrition for northern populations. In response to community concerns, a project was implemented from 2019 to 2021 in the Sahtú region, Northwest Territories, Canada, to: 1) analyse nutrition biomarkers (vitamins A, B1, B2, B6, B12, D, E, folate, P, Na) in blood samples, in order to assess nutritional status and identify nutrient deficiencies, and 2) use a survey to document how access to country foods may improve food security in the community of Tulı́t'a. Findings from the nutritional biomarker assessments (n = 128) indicated that 94% of participants experienced clinical vitamin D deficiency (<20 ng/L of plasma 25-hydroxy-vitamin D3) and 9% had folate deficiency (<8.7 nmol/L total folate). In the previous 12 months, 71% of participants did not always have money to get more food when needed, but 92% of participants said they were not left hungry. Country foods were used to increase the quality or quantity of the diet. Increasing country food consumption, such as fatty fish and large game meat and organs could mitigate the vitamin D and folate deficiencies. Policies should be implemented to improve food security in the North by facilitating access to country food.