International Journal of Circumpolar Health最新文献

Northern regions of Canada have the highest reported incidence of childhood rickets in the country, yet this public health problem remains poorly described. The goal of this research was to explore the food and vitamin D supplementation experiences in pregnancy and infancy and examine associations with rickets diagnosis. Data were collected systematically through a retrospective chart review of Inuit children from 18 communities in Nunavut born from 2010-2013. Although most pregnant people reported consuming country food daily or weekly, one in three pregnant people reported being food insecure. Fewer than half of infants were reported to have received daily vitamin D supplement at two months of age, and frequency of supplement use declined with age. Rickets diagnosis was present in 1.63% of children (95% CI = 1.20%-2.20%). The odds of rickets diagnosis were higher for children whose mothers experienced food insecurity during pregnancy than for those whose mothers had never experienced food insecurity (OR = 5.279; 95% CI = 1.248-16.191). Enhanced support for food security, breastfeeding and vitamin D supplementation in early life is needed. In the context of social determinants of health, this study highlights the far-reaching and negative impacts of food insecurity on the health of Inuit children in Nunavut.

Challenges persist in delivering good-quality and safe health care to the Norwegian Sámi population. This cross-sectional study explored system-level factors affecting healthcare services for Sámi people. Specifically, it assessed (1) the extent to which Norwegian municipalities provided good and safe health and care services to Sámi users, as reported by managers, and (2) whether good and safe service provision was associated with selected municipal characteristics. An online survey was conducted in 2019 across 135 municipalities in the four northernmost counties, and 77 responded (57% response rate). Service quality was measured using a single five-point ordinal-scale question, and proportional odds regression models were used to analyse associations with municipal characteristics. Overall, 40% of municipalities reported offering good and safe services to a 'large' or 'very large' extent to Sámi users. More favourable assessments were observed among municipalities located within the Sámi language area and among those with higher net operating surplus. The results suggest that while certain contextual factors may support service provision, there remains considerable potential for improvement across municipalities. Continued policy attention and resource allocation, combined with initiatives to strengthen cultural and linguistic competence, are needed to enhance equitable access to health care for Sámi communities.

Cancer screening is a high priority within the Métis community in Alberta. Despite comparable cancer incidence rates to non-Métis Albertans, Métis people face barriers to accessing cancer screening programs. This study used community-based research approaches informed by Métis ways of knowing to engage 31 individuals across Alberta about their experiences with accessing cancer screening services. Data collection was completed through two in-person Métis gatherings and six telephone interviews. Gatherings included talking circles and cultural activities, with discussions lasting approximately three hours. Topics discussed included experiences with accessing screening services, the quality of care received during appointments, and the supports needed to improve access to screening programs. Discussions were audio-recorded, transcribed, de-identified, and thematically analyzed using NVivo Software. Four prominent themes emerged from this study: (1) the impact of patient-provider communications on cancer experiences, (2) a broken healthcare system and access to care, (3) a need for support and safety, and (4) health promotion behaviours. An overarching theme of discrimination as a social determinant of health emerged throughout the findings. Tangible barriers, including geographical, transportation, and financial, were also identified by study participants. This study provides an increased understanding of Métis experiences related to cancer screening and offers direction for improvements.

Despite overall improvements in general health, the prevalence of mental illness continues to rise, underscoring the need for innovative approaches to health promotion. This study examines how purpose-driven small and medium-sized enterprises (SMEs) design and develop nature-based interventions (NBIs) as social innovations to promote mental health. Using a case study approach, the research draws on data from workshops, semi-structured interviews, and expert stakeholder discussions involving 28 SME practitioners, eight public actors from social and healthcare sectors, nine entrepreneurs, and four experienced stakeholders. The analysis reveals that the successful development of NBIs depends on five core dimensions: accessibility, acceptance, affordability, meaningfulness, and knowledge. In addition, the study identifies a range of strengths, weaknesses, opportunities, and threats that SMEs encounter when navigating the complex landscape of NBI implementation. The findings highlight the potential of NBIs to complement traditional healthcare by fostering empowerment and supporting tailored recovery, while also offering strategic insights into the collaboration required for sustainable social innovation.

Maritime medical fitness is vital for safety in high-risk and medically isolated environments, yet current international policies remain inconsistent, opaque, and weakly evidence-based. This paper presents the Integrated EBM-Policy Framework (IEPF), a three-tier model integrating systematic clinical evidence appraisal, a maritime-specific risk stratification matrix, and adaptive regulatory feedback. Developed via a mixed-methods study of 112 maritime health professionals across nine jurisdictions, the IEPF increases clarity, defensibility, and international harmonization of fitness-to-embark decisions, especially for cardiovascular and mental health risks. It reduces unnecessary exclusions and strengthens applicability in circumpolar and remote operations, positioning IEPF as a scalable benchmark for global maritime health governance and high-risk occupational policy.

Chronic obstructive pulmonary disease (COPD) presents a significant health burden in Greenland. Pulmonary telerehabilitation (PTR) provides an evidence-based, feasible approach to deliver care to the geographically dispersed population. This mixed-method study evaluates the feasibility and acceptability of PTR for individuals with COPD in Greenland, combining quantitative evaluation of adherence, satisfaction, and clinical outcomes with qualitative interviews and a field log. Seven participants were enrolled in the 10-week program; four completed it. Satisfaction was high and clinical outcomes improved. Participants reported increased self-efficacy and perceived the intervention as effective for disease management. However, dropout rate was high, technical issues were frequent, and some found online sessions less engaging, expressing a desire for more peer support and structural incentives to sustain motivation beyond the program. In this small sample, PTR appeared to be an acceptable and valuable addition to COPD care in Greenland. However, questions remain about the suitability of this approach for the broader population, given Greenland's telehealth infrastructure and digital readiness. Future efforts should focus on strengthening peer support and sustained engagement beyond programs. Considering digital health literacy and user readiness is essential for telerehabilitation efforts in Greenland.

Nunavik (Québec, Canada) has been inhabited by Inuit for over 4,000 years. Inuit midwives assisted in childbirth for centuries before colonization removed birth from our communities. In the 1980s, after years of evacuation for birth to southern hospitals, local women and Inuit leaders brought birth back to our remote Hudson Coast and Hudson Strait villages. As Inuit midwives, we have continuously offered local midwifery care to the population since that time, supported by southern midwives and an interprofessional team. Our midwifery service is nationally and internationally recognized as a model for returning childbirth to remote communities and reclaiming Indigenous midwifery. Inuulitsivik midwifery demonstrates that birth services and midwifery education can be integrated into health care systems in remote communities with safe outcomes. To understand the factors that contribute to our success and sustainability, we brought together experienced midwives and student midwives and met in person, by teleconference and online. Themes that emerged include Inuit values and language; Inuit leadership; local midwifery education; an adapted role for midwives in remote communities; flexibility in the organization and implementation of practice; midwifery-led interdisciplinary care and strategic collaboration with southern Canadian and international allies. We explore these themes and use common frameworks for policy analysis to consider effectiveness; impacts on the experience of pregnant women and families; health equity and access to services; costs; feasibility and acceptability. Our local midwifery service makes an important contribution to meeting the calls to Action of the Truth and Reconciliation Commission of Canada.

Chronic back pain (CBP) is a widespread public health issue. There is a lack of community-based care options for Indigenous Peoples with CBP. A virtual care clinic co-designed with community was implemented in the Cree Community of Pelican Narrows using remote presence (RPR) technology. Methods We used a community-based participatory action framework and pre-post design to evaluate this intervention. Pain, quality of life and experience outcomes were measured. An assessment was provided by a local nurse practitioner and a physical therapist joining over RPR. The physical therapist provided jp to four follow-up treatments per participant using RPR. Results Thirty-eight participants were assessed, and 78 follow-up treatments delivered. No significant differences between pre- and post- pain or quality of life were found. Thirteen patient participants and five health providers completed interviews. Patient themes included: (1) community and healthcare context, (2) community preferences for back pain care, and (3) experience with virtual back pain clinic. Health care provider themes included: (1) getting people to clinic, (2) experience with virtual back pain clinic, and (3) ways to enhance care. Conclusion Virtual CBP clinic enhanced access to therapy and was experienced positively. Participants suggested ways to address challenges, including a hybrid model of care.