International Journal of Circumpolar Health最新文献

As the prevalence of type 2 diabetes increases in Iceland, more nurse-led diabetes clinics have been established in primary health. This study aimed to evaluate treatment outcomes in patients with type 2 diabetes at two rural nurse-led diabetes clinics and compare these outcomes with guidelines. A retrospective cohort study was conducted in primary care settings in Northern Iceland using secondary data from medical recording systems. The sample (n = 88) included patients with two glycated haemoglobin (HbA1c) measurements taken at least 6 months apart (Time 1 and 2). Between Time 1 and 2, HbA1c levels (p = 0.049), body mass index (p = 0.013), and systolic blood pressure (p = 0.040) decreased. At time 2, approximately 70% of patients reached clinical goals for HbA1c levels, 33% for body mass index, 56% for systolic blood pressure, and 49% for diastolic blood pressure. This finding is consistent with those of other European studies in diabetes care. Assessing healthcare outcomes is beneficial for small rural clinics, where work is often conducted in isolation. This programme evaluation study conducted in two nurse-led clinics in Iceland demonstrated improved diabetes outcomes with care aligned with clinical guidelines and provided a baseline for measuring future outcomes.

This study describes the development of the Asthma Symptom Score (ASS) and evaluates its accuracy and internal consistency in Greenlandic and Danish, using clinical interviews based on Global Initiative for Asthma guidelines as the gold standard. A cross-sectional study was conducted across all regions of Greenland, targeting citizens aged 12+, using data from the electronic medical record. The ASS (n = 94) was validated against clinical interviews using a receiver operating characteristic curve, yielding an area under the curve estimate of 0.91, indicating strong agreement. The ASS demonstrated a sensitivity of 83%, a specificity of 93%, and an overall agreement of 87%. Patients scoring 0-5 points were categorised as having controlled asthma, while those scoring 6-20 points were categorised as non-controlled. Among participants completing both the ASS and the clinical interview, 57% were classified as having non-controlled asthma. The ASS demonstrated acceptable internal consistency in both Greenlandic and Danish. These findings underscore the need for improved management of asthma in Greenland. The strong correlation between the ASS and clinical interviews suggests that the ASS may be a valuable tool in clinical practice for assessing asthma control among patients with a confirmed diagnosis. However, further validation including a larger study group, and test - retest reliability is recommended.

This paper examines the development and implementation of the Inuit Holistic Service Delivery Model, designed by Qaujigiartiit Health Research Centre and currently being piloted through the Inuusirvik Community Wellness Hub in Iqaluit, Nunavut. The model represents a paradigm shift away from siloed Western service delivery frameworks towards an integrated approach grounded in Inuit epistemology, language, and cultural practices. Drawing on Indigenous methodologies and community-based approaches, this paper articulates how the model's eight interconnected components create a comprehensive wellness system that honours Inuit Qaujimajatuqangit (Inuit knowledge) while addressing contemporary community needs. The innovative approach offers valuable insights for other jurisdictions seeking to decolonise service delivery systems and develop culturally responsive alternatives. This paper contributes to growing scholarship on Arctic Indigenous health and wellness frameworks by demonstrating how the Inuit Holistic Service Delivery Model deserves recognition in academic discourse as a unique and innovative approach to community wellbeing.

Shared decision-making supports person-centred care. Our team of Inuit-led and/or -focused organizations and researchers field-tested a strategy called Not Deciding Alone to support health decision-making. Guided by aajiiqatigiingniq, a principle of collective decision-making and consensus-building, we co-produced a mixed-methods study to: (1) train Qikiqtani region community health representatives (CHRs) with a workshop, (2) develop a radio show and survey, and (3) assess the radio show with Inuit community members in the health system. We evaluated participant experiences using forms, case studies, and an online survey. The workshop was delivered to 13 CHRs; seven (54%) provided evaluation data. All (100%) reported positive experiences with the content, activities, and facilitation. One (14%) said the workshop was too short; four (57%) agreed there was enough discussion time. Six (86%) reported new learning. Three radio show events were held with 33 survey respondents, the majority women (n = 25, 76%). Most found the show informative (n = 29, 88%) and helpful for future decision-making (n = 27, 82%), and said it would improve their confidence (n = 27, 82%). Not Deciding Alone was found to be an acceptable, useful, and relevant strategy for supporting health decision-making among Inuit community members.

Accelerated climate warming in the Arctic threatens the food security of Indigenous peoples, including the Sámi in Finland. As temperatures rise nearly four times faster than the global average, ecosystems that support traditional Sámi practices, such as reindeer herding, fishing, hunting, and gathering, are increasingly disrupted. These practices are central to Sámi identity, knowledge systems, and social cohesion. However, despite these predictive narratives, the question of how these changes will affect overall food security among the Sámi remains unclear. This study aimed to: 1) investigate how climate change affects Sámi food security, 2) map concerns about anticipated impacts, and 3) assess the effectiveness of Finnish national policies. We addressed four dimensions of food security: availability, access, utilisation, and stability. Data were gathered through semi-structured interviews (N = 10), alongside a policy analysis. Findings indicate that climate change compromises the stability of the Sámi food systems and has broad implications on food security in terms of availability, accessibility, and utilisation. Current policy responses lack sufficient attention to the Sámi's cultural-ecological ties and offer limited support for Arctic-specific adaptation. These results underscore the urgency of culturally responsive and place-based policy action to strengthen Sámi food security in a rapidly changing climate.

Community-based participatory research (CBPR) is a framework to improve social equity by engaging communities as equal partners in research design, conduct, and knowledge creation. While CBPR has seen increasing application in Arctic regions, its use in Greenland has been limited by logistical, linguistic, and historical challenges, including community fatigue from extractive research practices. This manuscript details a CBPR-informed approach used to conduct an exploratory study on fertility, reproductive health, and climate adaptation in the Kalaallit community of Paamiut. The study aimed to understand the socio-environmental factors influencing fertility decisions amid economic and environmental changes. We report on nine strategies used to conduct equitable health and socio-ecological research in Greenland guided by the principles of CBPR. Using CBPR principles improved trust, participant recruitment, and the creation of community-valued research products in Paamiut. While time and funding limitations constrained full implementation of CBPR best practices, this study highlights the potential of CBPR to improve equity in Greenlandic research. Using CBPR principles to guide community-engaged research in Greenland provides a concrete and actionable way for students or early-career researchers to promote equitable relationships despite resource limitations. The methods described can be applied across other research disciplines to continue building trust and sustainability in international research partnerships in Greenland.

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.

Seal finger is a rare zoonotic bacterial infection typically caused by Mycoplasma species, transmitted from seals (Pinnipedia suborder) to humans. First documented in 1907, this disease remains under-researched despite growing relevance as humans increasingly encroach on Arctic regions. We conducted a review of multiple databases to evaluate its history, prevalence, at-risk populations, and treatment options. The infection primarily affects individuals who have close contact with marine mammals, including fishers, hunters, sealers, and marine biologists. Seal finger usually presents similarly to panaritium, with localized swelling, erythema, and pain. Due to its rarity and limited awareness among healthcare providers, the infection is often unrecognized, leading to wounds going untreated or being managed with inappropriate antibiotics. This mismanagement allows the infection to progress, potentially involving joints or spreading further, which could have been effectively prevented with a course of tetracycline. Further research is essential to better understand the epidemiology of seal finger and improve timely diagnosis. To reduce complications, more education is needed for physicians working in coastal, Arctic, and aquarium settings about recognizing the disease and administering proper treatment. Enhanced awareness and research can improve patient outcomes and increase the safety of human interactions with seals.

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.

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.