International Journal of Circumpolar Health最新文献

Vitamin D is vital for physiological functions and is obtained primarily through sunlight and a few dietary sources. With limited sunlight exposure, the Faroe Islands face challenges in maintaining sufficient levels of vitamin D, while the Faroese population has documented the highest incidence and prevalence of inflammatory bowel disease worldwide. This study investigates vitamin D status among Faroese adults and its association with inflammatory bowel disease as well as other self-reported diseases in a subset of the Faroe Genome Project 2. Cross-sectional study including 1,748 participants aged 18-86 years. Among participants, 74.3% maintained sufficient vitamin D levels, while 25.7% were insufficient (<50 nmol/l). Individuals with conditions like hypertension, type 2 diabetes, and inflammatory bowel disease showed significantly higher rates of vitamin D sufficiency compared to those without these conditions. Notably, 83% of participants with inflammatory bowel disease had sufficient vitamin D. Our data reveal higher vitamin D levels compared to previous studies in the Faroe Islands. Furthermore, contrary to our hypothesis, our data shows higher vitamin D levels for participants reporting diseases including inflammatory bowel disease, indicating patients with inflammatory bowel disease can attain high vitamin D levels, which is of considerable clinical importance.

The Northwest Territories, Canada, has high rates of alcohol- and drug-related hospitalisations and deaths. There is considerable debate over how to provide substance use recovery services in this region, due to its small, culturally diverse population. The aim of this study was to examine demographic differences in ethnicity, gender and sex for individuals in the barriers to accessing services, supports to stay in recovery, and reasons they struggled to stay in recovery. A total of 439 respondents completed online and paper-based surveys on their experiences accessing recovery services in the Northwest Territories. A mixed methods approach was applied, in which Fisher's exact test was applied to test for statistically significant demographic differences in quantitative responses, and themed analysis was performed using deductive coding using written survey responses. Several statistically significant demographic differences were identified in barriers to services, supports to recovery, and barriers to staying in recovery. Cultural incongruity, and the importance of social support to substance use disorder recovery, were identified as key themes that emerged in qualitative analysis. There is a need for community-based, culturally safe, and family-inclusive holistic supports at the community level to address substance use issues in the NT, including more informal confidential supports and efforts to reduce stigma and normalise and celebrate recovery.

Inuit are a distinct ethnic group living in an environment likely to influence calcium metabolism and skeletal health. Bone mineral content (BMC) is a marker of skeletal health and fracture risk. Age is a dominant risk factor for osteoporosis, emphasising the importance of skeletal health in the ageing Inuit populations. This systematic review aims to provide an overview of data on BMC among Inuit. We performed a systematic search for data on BMC among Inuit guided by an experienced librarian. The search identified 211 studies, of which six provided data on BMC among Inuit living in Alaska or Canada. In men/women, BMC peaked around the age of 25 years in distal radius at 1.55/1.07 g/cm2 and in distal ulna at 0.81/0.54 g/cm2. Diaphysis of ulna, humerus, and tibia peaked around 10 years later. The 23% to 30% sex differences in BMC were similar across studies. Age related changes were parallel to other populations. In conclusion, BMC in Inuit is presented for easy viewing and comparison. BMC was similar between Inuit populations, and sex and age-related differences were comparable to other populations. New scientific studies should update data, include spine and hip, describe bone structure, and consider fracture risk beyond BMC.

Palliative care policies worldwide support people's wishes to spend their final days at home with family caregivers playing a vital role. In Norway, 16% of the population lives in rural areas where palliative end-of-life care is especially challenging due to geographical barriers and limited access to healthcare resources. Research on rural family end-of-life care for people with cancer is sparse. Therefore, the purpose of this study was to investigate what resources are needed for rural family caregivers when providing end-of-life care and preparing for home death for a person with cancer. Thirteen semi-structured in-depth interviews with family caregivers in seven rural municipalities in Northern Norway were conducted from February to April 2023. The thematic analysis revealed three key themes supporting caregivers' resilience: end-of-life care and home death require available resources in family caregivers; the availability of reliable professional follow-up services for end-of-life care; support from family and social networks compensate for lacking healthcare resources. Holistic healthcare for rural populations should consider aspects like distance and cost while involving the entire family and their social network. Local palliative care beds and telehealth services should be available to support rural family caregivers.

A programme evaluation was conducted of a vision screening programme, in an urban elementary school in Saskatchewan, with 26 kindergarten and grade one students. The vision screening was completed by students in their fourth year of a Bachelor of Science in nursing programme and the teacher for visually impaired students using the Lea Symbol Assessment charts. The elementary students were assessed for both near and distant vision, at 40 cm and 3 m, respectively. Of the 26 students assessed, 42% of kindergarten students and 29% of grade one students required a referral to an optometrist based on the visual acuity standards. Building capacity for a school-based vision screening and referral process requires collaboration across health and education sectors including relationship building with students and families. Recommendations for future practice include capacity building and recognising disparities in Indigenous health and improving access to healthcare resources for Indigenous families.

Brown adipose tissue (BAT) is crucial for non-shivering thermogenesis, a key adaptation for humans in Arctic environments. The discovery of BAT presence in human adults has ignited curiosity due to its potential role in combating obesity, type II diabetes and cardiovascular diseases. Following PRISMA guidelines and preregistration (PROSPERO CRD42023444511) this systematic review aims to describe the evidence of BAT activity among adults living in the Arctic with habitual cold exposure. Systematic searches were conducted in PubMed, Embase, and Scopus as of November 2024. In addition, trial registration searches, manual screening of reference lists, and requests to experts were performed. No restrictions were made regarding study selection. Each study was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Of 429 studies screened, 21 full texts were included for eligibility assessment, and eight studies qualified for inclusion. Due to the heterogeneity of the included studies, a meta-analysis was not pursued. Results indicate high BAT activity in Arctic populations, as supported by increased supraclavicular skin temperatures after cold exposure, thyroid hormone dynamics, and genetic markers linked to BAT. Findings highlight BAT's role in cold adaptation among adults residing in Arctic regions, though methodological limitations remain, necessitating further research.

Indigenous-informed food security initiatives are gaining global recognition for their potential to foster sustainable, community-minded solutions, while centering environmental stewardship, and the preservation of culturally significant foodways. Despite this growing aknowledgement, Indigenous involvement in decision-making related to improved food security in Canada remains underexplored. This review aims to contribute to deepened understandings of how Indigenous inputs are guiding current food security decision-making processes, and how these approaches are being applied in the context of mixed food systems throughout Canada. A systematic search of five online databases was conducted to examine the existing literature on Indigenous-informed food security efforts in Canada, exploring key themes, gaps and recommendations. Yielding a total of 1916 results, 39 of which were retained for further analysis, this search highlighted a broad swath of initiatives, programs, policies and strategies, developed by, in partnership with, or centering the perspectives of Indigenous communities. These existing initiatives frame how Indigenous groups are already guiding food security action in Canada, and what factors need to be considered to ensure on-going effectiveness. Findings highlight the need for more collaborative, cross-sectoral, community-minded food security initiatives, which integrate both support for Indigenous self-determination and recognize the validity of traditional knowledges within decision-making processes at all levels.

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.

Patients in Nunavut rely exclusively on airplane to access medical care beyond the nursing stations in communities. This can take the form of scheduled flights for chronic and non-urgent issues or dedicated medevacs for emergencies. Each community is routinely visited by family physicians (FP) who provide in-person primary care. The frequency and duration of FP visits depends on the community size, with larger communities having longer and more frequent visits. During their visits, FPs can be called upon to assist in emergencies. This study provides a detailed portrait of the territory's medical travels between 2012 and 2018. Contrary to our initial hypothesis, we show that the presence or absence of an FP in the community did not have a significant impact on the rates of medevacs. However, we found that the rates of non-urgent scheduled flights increased. Our findings provide in-depth information on the rates of medevacs and non-urgent travel in Nunavut. They also raise important questions for primary care in remote areas by demonstrating an increase in routine travel requirements when physicians are present in those communities. As health outcomes were not assessed, further studies are required before recommendations can be made to change the rate of FP visits.