International Journal of Circumpolar Health最新文献

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.

Hearing disability constitutes a major health care issue especially among indigenous populations and in low- and middle-income countries (LMIC). The authors are engaged in organising audiological services in Greenland, where the geographical challenges highlight the potential of tele-audiology. The search strategy was created in the PubMed database combining keywords and MeSH Terms with "OR" in each domain: "Hearing" and "Telemedicine" and then combined using "AND". Telerehabilitation was defined as: Rehabilitation of patients with hearing loss enabled by one or more consultations with a specialist over a remote connection. The search was reproduced in Cochrane. The final search resulted in a total of 2,273 articles. After screening, 32 articles were reviewed. The included studies cover a broad variety of study designs, age groups, and countries. All included studies were analysed and summarised according to themes of relevance to an arctic setting. The review concludes that the technological development in tele-audiology has come far. Importantly, none of the studies reviewed provided clear evidence that tele-audiology delivers an inferior service, though further high-quality research is needed to confirm this. However, the evidence level in the studies was generally low. The usability of tele-audiology in cross-cultural settings and LMICstill need further investigation.

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.

Ketchikan, Alaska is home to 13,754 residents and located on an island, presenting unique challenges of access and availability. Limited published research exists regarding traditional foods or food security in Alaska, and primary research on food security in Ketchikan is nonexistent. This study measured food security and analysed related variables in Ketchikan, Alaska using a retrospective cross-sectional study design. A total of 108 participants completed the surveys, all of whom were residents. Chi-square analyses determined significant associations between food security status and variables in the community. The food insecurity rate of the convenience sample was 49.1%. Facilitators of food security included receiving foods from others, culinary literacy, and adequate money to purchase food. Barriers to food security included the expense of food, government assistance ran out, availability of certain foods in the area, and transportation challenges. The study is the first known primary research measuring prevalence of food insecurity in the region and the corresponding factors that act as facilitators or barriers. These data help inform programme development to tackle key findings from a community needs assessment. Future work should include prevalence of food insecurity, and barriers and facilitators, of a representative sample in the region.

This article explores the challenges and opportunities for nursing students during clinical placements in rural areas with Indigenous and minority populations, specifically focusing on the Sami and Kven communities in Northern Norway. It highlights the importance of cultural sensitivity and competence in nursing education, as emphasised by the National Framework for Nursing and Health Professional Education. The Arctic Samprax project, utilising an action research approach, aims to develop sustainable practice models that integrate cultural sensitivity into nursing students' learning experiences. The study reveals that explicit supervision and reflective dialogue are crucial for students to understand and address cultural aspects in healthcare. Challenges such as staff shortages, inconsistent supervision, and lack of continuity hinder the learning process. The article emphasises the need for collaboration between educational institutions and rural practice sites to enhance students' cultural competence. Recommendations include developing preparatory programs focusing on the learning outcomes relevant for rural practice placements, as well as increasing practice placements in Indigenous areas. The study underscores the responsibility of educational institutions in circumpolar regions to contribute to inclusive and equitable healthcare services for diverse populations. We suggest a greater focus on cultural humility in the curriculum to align with the ethical guidelines for nurses.

Statistics Canada uses two self-report measures - Ancestry and Identity - in the Canadian Census to identify First Nations, Inuit and Métis (FNIM) peoples. How these measures are employed alone or in combination to assess definitional impact on the reporting of health conditions has not been investigated. To illustrate, we assessed how these measures, alone or in combination, estimate colorectal cancer rates. A working group comprised of Indigenous and non-Indigenous academics assessed the response patterns to the Identity and Ancestry questions in the 2006 Canadian Census Health and Environment Cohort and categorised the responses into groups: A) Identity only; B) Ancestry only; C) any Ancestry or Identity; D) both Ancestry and Identity. We then assessed concordance, and subsequently examined the way these groupings may impact the reporting of colorectal cancer rates (2010-2015). FNIM responses varied across the different combinations of the Ancestry and Identity questions. Concordance for FNIM was 76%, 81%, and 18% respectively for single responses, which impacted the estimation of colorectal cancer rates. To improve health reporting, it is essential that research teams choose the most appropriate definition in partnership with FNIM and urban Indigenous organisations to ensure the right data are analysed to align with community priorities.

There is an association between local cold injuries and Raynaud's phenomenon (RP) in the scientific literature, but the time relation and anatomical correlation have not been established. During military training in an Arctic setting, a previously healthy man in his early twenties sustained a freezing cold injury affecting mainly his right index finger. He subsequently developed Raynaud's phenomenon limited to only the part of the index finger that was originally affected by the cold injury. Medical investigation also revealed findings suggestive of subclinical peripheral neuropathy. This case demonstrates that Raynaud's phenomenon can develop secondary to local cold injury affecting the hand. It also suggests that cold exposure could be related to peripheral neuropathy.