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Tremblay M, Sydora BC, Listener LJ, Kung JY, Lightning R, Rabbit C, Oster RT, Kruschke Z, Ross S. Indigenous gender and wellness: a scoping review of Canadian research. Int J Circumpolar Health 2023; 82:2177240. [PMID: 36803328 PMCID: PMC9946324 DOI: 10.1080/22423982.2023.2177240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
This scoping review examined research publications related to health and/or wellness along with gender among Canadian Indigenous populations. The intent was to explore the range of articles on this topic and to identify methods for improving gender-related health and wellness research among Indigenous peoples. Six research databases were searched up to 1 February 2021. The final selection of 155 publications represented empirical research conducted in Canada, included Indigenous populations, investigated health and/or wellness topics and focused on gender. Among the diverse range of health and wellness topics, most publications focused on physical health issues, primarily regarding perinatal care and HIV- and HPV-related issues. Gender diverse people were seldom included in the reviewed publications. Sex and gender were typically used interchangeably. Most authors recommended that Indigenous knowledge and culture be integrated into health programmes and further research. More health research with Indigenous peoples must be conducted in ways that discern sex from gender, uplift the strengths of Indigenous peoples and communities, privilege community perspectives, and attend to gender diversity; using methods that avoid replicating colonialism, promote action, change stories of deficit, and build on what we already know about gender as a critical social determinant of health.
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Affiliation(s)
- Melissa Tremblay
- Department of Educational Psychology, University of Alberta, 5-127 Education North, University of Alberta, Edmonton, Alberta, Canada,CONTACT Melissa Tremblay Department of Educational Psychology, University of Alberta, 5-127 Education North, University of Alberta, Edmonton, AB T6G 2G5, Canada
| | - Beate C. Sydora
- Department of Obstetrics & Gynecology, University of Alberta, Position: Research Associate, 626-1 Community Service Centre, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Luwana Joyce Listener
- Department of Obstetrics & Gynecology, University of Alberta, Position: Research Assistant, 5S141 Lois Hole Hospital for Women, Robbins Pavilion, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Janice Y. Kung
- University of Alberta, Position: Librarian, John W. Scott Health Sciences Library, 2K3.28 Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
| | | | - Chevi Rabbit
- Community member, Position: Human rights advocate
| | - Richard T. Oster
- Indigenous Wellness Core, Alberta Health Services, Edmonton, Alberta, Canada
| | - Zoë Kruschke
- Department of Educational Psychology, University of Alberta, Position: Research Coordinator, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Ross
- Departments of Obstetrics and Gynecology, and Women and Children’s Health Research Institute (WCHRI) University of Alberta, Position: Professor and Cavarzan Chair of Mature Women’s Health Research, 5S141 Lois Hole Hospital for Women, Robbins Pavilion, Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Bowker SL, Williams K, Volk A, Auger L, Lafontaine A, Dumont P, Wingert A, Davis A, Bialy L, Wright E, Oster RT, Bagshaw SM. Incidence and outcomes of critical illness in indigenous peoples: a systematic review and meta-analysis. Crit Care 2023; 27:285. [PMID: 37443118 PMCID: PMC10339531 DOI: 10.1186/s13054-023-04570-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/07/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Indigenous Peoples experience health inequities and racism across the continuum of health services. We performed a systematic review and meta-analysis of the incidence and outcomes of critical illness among Indigenous Peoples. METHODS We searched Ovid MEDLINE/PubMed, Ovid EMBASE, Google Scholar, and Cochrane Central Register of Controlled Trials (inception to October 2022). Observational studies, case series of > 100 patients, clinical trial arms, and grey literature reports of Indigenous adults were eligible. We assessed risk of bias using the Newcastle-Ottawa Scale and appraised research quality from an Indigenous perspective using the Aboriginal and Torres Strait Islander Quality Assessment Tool. ICU mortality, ICU length of stay, and invasive mechanical ventilation (IMV) were compared using risk ratios and mean difference (MD) for dichotomous and continuous outcomes, respectively. ICU admission was synthesized descriptively. RESULTS Fifteen studies (Australia and/or New Zealand [n = 12] and Canada [n = 3]) were included. Risk of bias was low in 10 studies and moderate in 5, and included studies had minimal incorporation of Indigenous perspectives or consultation. There was no difference in ICU mortality between Indigenous and non-Indigenous (RR 1.14, 95%CI 0.98 to 1.34, I2 = 87%). We observed a shorter ICU length of stay among Indigenous (MD - 0.25; 95%CI, - 0.49 to - 0.00; I2 = 95%) and a higher use for IMV among non-Indigenous (RR 1.10; 95%CI, 1.06 to 1.15; I2 = 81%). CONCLUSION Research on Indigenous Peoples experience with critical care is poorly characterized and has rarely included Indigenous perspectives. ICU mortality between Indigenous and non-Indigenous populations was similar, while there was a shorter ICU length of stay and less mechanical ventilation use among Indigenous patients. Systematic Review Registration PROSPERO CRD42021254661; Registered: 12 June, 2021.
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Affiliation(s)
- Samantha L. Bowker
- Critical Care Strategic Clinical Network™, Alberta Health Services, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124E Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Kienan Williams
- Indigenous Wellness Core, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7 Canada
| | - Auriele Volk
- Indigenous Medical and Dental Students Association, Faculty of Medicine and Dentistry, University of Alberta, Katz Group Centre for Pharmacy and Health Research, 1-002, Edmonton, AB T6G 2E1 Canada
- Indigenous Peoples and Critical Care in Alberta Advisory Committee, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Leonard Auger
- Indigenous Peoples and Critical Care in Alberta Advisory Committee, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Alika Lafontaine
- Indigenous Peoples and Critical Care in Alberta Advisory Committee, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Paige Dumont
- Indigenous Peoples and Critical Care in Alberta Advisory Committee, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
| | - Aireen Wingert
- Alberta Research Centre for Health Evidence, University of Alberta, Room 4-496A, Edmonton Clinic Health Academic, 11405 – 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Amanda Davis
- Indigenous Wellness Core, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7 Canada
| | - Liza Bialy
- Alberta Research Centre for Health Evidence, University of Alberta, Room 4-496A, Edmonton Clinic Health Academic, 11405 – 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Erica Wright
- Alberta Research Centre for Health Evidence, University of Alberta, Room 4-496A, Edmonton Clinic Health Academic, 11405 – 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Richard T. Oster
- Indigenous Wellness Core, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB T2W 1S7 Canada
| | - Sean M. Bagshaw
- Critical Care Strategic Clinical Network™, Alberta Health Services, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, 2-124E Clinical Science Building, 8440-112 Street NW, Edmonton, AB T6G 2B7 Canada
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Oster RT, Roach P, Clement F, Tailfeathers E, Healy B, Meckelborg L, Gladue J, McLane P. Action, Accountability and Transparency for Indigenous Health Systems Safety. Healthc Pap 2023; 21:28-34. [PMID: 37417347 DOI: 10.12927/hcpap.2023.27108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Anti-Indigenous racism is prevalent in Canada, especially within healthcare systems. Consequences are catastrophic, including deaths of Indigenous patients. Systems change and critical education guided by the Indigenous Peoples and research into how racism operates within healthcare settings are needed. In Alberta, promising initiatives are under way, including a First Nations-led initiative identifying racism and colonialism as key health determinants, novel experiential education, transformative education for senior health leaders and reframing health system measures to reflect Indigenous Peoples' perspectives. The time is now for comprehensive action toward eliminating racism within healthcare systems and fostering Indigenous health systems safety. Indigenous lives depend on it.
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Affiliation(s)
- Richard T Oster
- Scientific Director, Indigenous Wellness Core, Alberta Health Services, Adjunct Assistant Professor, Faculty of Agricultural, Life and Environmental Sciences, College of Natural and Applied Sciences, University of Alberta, Adjunct Assistant Professor, Faculty of Community Health Sciences, Cummings School of Medicine, University of Calgary, Edmonton, AB
| | - Pamela Roach
- Assistant Professor and Director of Indigenous Health Education, Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Fiona Clement
- Professor and Department Head, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Esther Tailfeathers
- Senior Medical Director, Indigenous Wellness Core, Alberta Health Services, Kainai Nation, AB
| | - Bonnie Healy
- Health Director, Blackfoot Confederacy Tribal Council Kainai Nation, Stand Off, AB
| | - Lori Meckelborg
- Director of Performance, Impact and Measurement, Indigenous Wellness Core, Alberta Health Services, Airdrie, AB
| | - Joanna Gladue
- Health Promotion Facilitator, Indigenous Wellness Core, Alberta Health Services, Edmonton, AB
| | - Patrick McLane
- Assistant Scientific Director, Emergency Strategic Clinical Network, Alberta Health Services, Adjunct Associate Professor, Department of Emergency Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB
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Dunn KPR, Oster RT, Williams KP, Egan CE, Letendre A, Crowshoe H, Potestio ML, Lee SS. Addressing inequities in access to care among Indigenous peoples with chronic hepatitis C in Alberta, Canada. Lancet Gastroenterol Hepatol 2022; 7:590-592. [PMID: 35709816 DOI: 10.1016/s2468-1253(22)00129-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Kate P R Dunn
- Cumming School of Medicine Indigenous, Local and Global Health Office, Calgary, AB, Canada; Indigenous Wellness Core, Alberta Health Services, Calgary, AB, Canada
| | - Richard T Oster
- Indigenous Wellness Core, Alberta Health Services, Calgary, AB, Canada
| | - Kienan P Williams
- Indigenous Wellness Core, Alberta Health Services, Calgary, AB, Canada
| | - Cari E Egan
- Indigenous Wellness Core, Alberta Health Services, Calgary, AB, Canada
| | - Angeline Letendre
- Public Health Evidence & Innovation, Alberta Health Services, Calgary, AB, Canada; Alberta Cancer Prevention Legacy Fund, Calgary, AB, Canada
| | | | | | - Samuel S Lee
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Sydora BC, Graham B, Oster RT, Ross S. Menopause experience in First Nations women and initiatives for menopause symptom awareness; a community-based participatory research approach. BMC Womens Health 2021; 21:179. [PMID: 33902542 PMCID: PMC8077762 DOI: 10.1186/s12905-021-01303-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Little research has been conducted about menopause in First Nations women. In response to the wishes of Cree women living in Maskwacis, Alberta, to start a dialogue on menopause, we undertook community-based participatory research (CBPR) to explore menopause experience and raise awareness of menopause symptoms in the community. METHODS The research adhered to the principles of Ownership, Control, Access and Possession (OCAP™) and was guided by the interest of the participating women. Local women (target age 40-65 years) were invited to participate in workshops using word-of-mouth and community posters in health centers. Five research workshops were held in community settings, attended by experienced women's health researchers and consenting women. The participants guided the informal discussions. They also completed questionnaires which included menopause-related quality of life. The researchers used extensive hand-written field notes to record data; qualitative content analysis was applied to identify themes. Simple descriptive analysis was used for the questionnaire results. The findings were discussed at a community feedback session and laid the basis for further knowledge translation initiatives. RESULTS The five workshops included a total of 37, mostly post-menopausal women with 6-11 women/workshop. The main discussion themes were: "experiences of menopause symptoms" including their impact on quality of life; "menopause knowledge prior to their own experience" with most women feeling that they had insufficient information before menopause; "menopause symptom management" which mainly included practical strategies; "impact of menopause on family members" which was of prime concern with uncontrollable mood changes affecting the whole family and sometimes causing matrimonial disharmony. Questionnaire responses corroborated the workshop discussions. Knowledge translation of the research findings produced two information pamphlets specifically for the Maskwacis community: one for husband/partner, the other for women and family members. These pamphlets have been distributed in all areas of the community. CONCLUSION This CBPR project addressed a topic identified by the community as being important. Community members developed informative pamphlets in response to the women's concern of lack of understanding for menopause symptoms among families. This simple solution has been widely accepted by community members, opening the possibility of wider discussion about menopause.
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Affiliation(s)
- Beate C Sydora
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, 626-1 Community Service Centre, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, T5H-3V9, Canada.
| | - Bonny Graham
- Maskwacis Health Services, Maskwacis, Alberta, Canada
| | - Richard T Oster
- Department of Agricultural, Food and Nutritional Sciences, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Canada
| | - Sue Ross
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, 626-1 Community Service Centre, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, T5H-3V9, Canada
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Mackenzie ML, Yuan Y, Shen Y, Toth EL, Bell RC, Oster RT. Pregnancy and development of diabetes in First Nations and non-First Nations women in Alberta, Canada. Diabet Med 2021; 38:e14372. [PMID: 32745272 DOI: 10.1111/dme.14372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/26/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Abstract
AIM To conduct a retrospective population-based study to examine the risk of developing diabetes after delivery in First Nations and non-First Nations women in Alberta. METHODS Delivery records (1999-2014) were linked to provincial administrative data, which allowed for a maximum follow-up of 16 years after delivery. Prevalence of pregnancy risk factors were compared by First Nations status. Hazard ratios for diabetes after delivery by First Nations status, high pre-pregnancy body weight (≥91 kg) and gestational diabetes status were estimated using the Cox proportional hazards model. RESULTS Age-adjusted prevalence of gestational diabetes (7.9% vs 4.6%; P<0.0001), high pre-pregnancy body weight (18.8% vs 10.2%; P<0.0001) and diabetes after delivery (3.9% vs 1.1%; P<0.0001) were higher in First Nations women than in non-First Nations women. Development of diabetes after delivery was higher with First Nations status (hazard ratio 3.0, 95% CI 2.6-3.4), high pre-pregnancy body weight (hazard ratio 3.6, 95% CI 3.3-4.0) and gestational diabetes status (hazard ratio 19.2, 95% CI 17.9-20.6). The highest risk was within First Nations women with high pre-pregnancy body weight and gestational diabetes (hazard ratio 54.8, 95% CI 45.2-66.5) compared to women without these three risk factors. Reduced prenatal visits per pregnancy (8.4 vs 10.7; P<0.0001) and delayed first prenatal visit (time to delivery 23.7 vs 26.7 weeks; P<0.0001) were observed in First Nations women compared to non-First Nations women. CONCLUSION First Nations women are at greater risk of developing diabetes after pregnancy, with gestational diabetes being the strongest predictor. Strategies that target the specific needs of First Nations women before, during and after pregnancy are required.
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Affiliation(s)
- M L Mackenzie
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Y Yuan
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Y Shen
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - E L Toth
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - R C Bell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - R T Oster
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Oster RT, Toth EL, Bell RC. Wîcohkamakew ("S/he Helps Someone"): A Qualitative Description of Experiences with a Community-derived Elders Mentoring Program for Indigenous Parents-to-be. Prog Community Health Partnersh 2021; 15:145-146. [PMID: 34248058 DOI: 10.1353/cpr.2021.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Oster RT, Toth EL, Bell RC. Wîcohkamakew ("S/he Helps Someone"): A Qualitative Description of Experiences with a Community-derived Elders Mentoring Program for Indigenous Parents-to-be. Prog Community Health Partnersh 2021; 15:177-187. [PMID: 34248062 DOI: 10.1353/cpr.2021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Responding to concerns about perinatal health risks and adverse outcomes, we established a community-based participatory research (CBPR) partnership between a Nêhiyawi (Cree) community and university-based researchers. We designed and implemented a community-derived Elders Mentoring Program (EMP) to provide additional support for pregnant women and their partners. Our objective was to understand the collective experiences of those involved in the Program. METHODS We conducted a qualitative description with the principles of CBPR as an overarching framework. We carried out 14 qualitative interviews with parents, perinatal clinic staff, and mentor Elders involved in the Program. We also used detailed notes from Community Advisory Committee (CAC) meetings as data. All qualitative data were analyzed with content analysis. RESULTS The Program helped pregnant women and their partners by fostering enhanced and multi-generational support networks. It also improved cultural security within the clinical environment and learning among health care staff. A sense of intergenerational fulfillment and enjoyment among those involved was common and was underpinned by genuine, collaborative relationships. CONCLUSIONS A community-derived prenatal EMP, designed in partnership with those who have intimate knowledge of the community, is a major step toward ensuring multi-generational and culturally secure care in pregnancy for women and families.
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Anand SS, Abonyi S, Arbour L, Balasubramanian K, Brook J, Castleden H, Chrisjohn V, Cornelius I, Davis AD, Desai D, de Souza RJ, Friedrich MG, Harris S, Irvine J, L'Hommecourt J, Littlechild R, Mayotte L, McIntosh S, Morrison J, Oster RT, Picard M, Poirier P, Schulze KM, Toth EL. Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study. Lancet Planet Health 2019; 3:e511-e520. [PMID: 31868600 DOI: 10.1016/s2542-5196(19)30237-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Historical, colonial, and racist policies continue to influence the health of Indigenous people, and they continue to have higher rates of chronic diseases and reduced life expectancy compared with non-Indigenous people. We determined factors accounting for variations in cardiovascular risk factors among First Nations communities in Canada. METHODS Men and women (n=1302) aged 18 years or older from eight First Nations communities participated in a population-based study. Questionnaires, physical measures, blood samples, MRI of preclinical vascular disease, and community audits were collected. In this cross-sectional analysis, the main outcome was the INTERHEART risk score, a measure of cardiovascular risk factor burden. A multivariable model was developed to explain the variations in INTERHEART risk score among communities. The secondary outcome was MRI-detected carotid wall volume, a measure of subclinical atherosclerosis. FINDINGS The mean INTERHEART risk score of all communities was 17·2 (SE 0·2), and more than 85% of individuals had a risk score in the moderate to high risk range. Subclinical atherosclerosis increased significantly across risk score categories (p<0·0001). Socioeconomic advantage (-1·4 score, 95% CI -2·5 to -0·3; p=0·01), trust between neighbours (-0·7, -1·2 to -0·3; p=0·003), higher education level (-1·9, -2·9 to -0·8, p<0·001), and higher social support (-1·1, -2·0 to -0·2; p=0·02) were independently associated with a lower INTERHEART risk score; difficulty accessing routine health care (2·2, 0·3 to 4·1, p=0·02), taking prescription medication (3·5, 2·8 to 4·3; p<0·001), and inability to afford prescription medications (1·5, 0·5 to 2·6; p=0·003) were associated with a higher INTERHEART risk score. Collectively, these factors explained 28% variation in the cardiac risk score among communities. Communities with higher socioeconomic advantage and greater trust, and individuals with higher education and social support, had a lower INTERHEART risk score. Communities with difficulty accessing health care, and individuals taking or unable to afford prescription medications, had a higher INTERHEART risk score. INTERPRETATION Cardiac risk factors are lower in communities with high socioeconomic advantage, greater trust, social support and educational opportunities, and higher where it is difficult to access health care or afford prescription medications. Strategies to optimise the protective factors and reduce barriers to health care in First Nations communities might contribute to improved health and wellbeing. FUNDING Heart and Stroke Foundation of Canada, Canadian Partnership Against Cancer, Canadian Institutes for Health Research.
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Affiliation(s)
- Sonia S Anand
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Health Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada.
| | - Sylvia Abonyi
- Faculty of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada; Division of Biomedical Sciences, University of Victoria, Victoria, BC, Canada
| | - Kumar Balasubramanian
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada
| | - Jeffrey Brook
- Dalla Lana School of Public Health and Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON, Canada
| | - Heather Castleden
- Department of Geogrophy and Planning, Queens University, Kingston, ON, Canada
| | - Vicky Chrisjohn
- Oneida Health Centre, Oneida Nation of the Thames, Southwold, ON, Canada
| | - Ida Cornelius
- Oneida Health Centre, Oneida Nation of the Thames, Southwold, ON, Canada
| | | | - Dipika Desai
- Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada
| | - Russell J de Souza
- Department of Health Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada
| | - Matthias G Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, Montréal, QC, Canada
| | - Stewart Harris
- Department of Family Medicine, Western University, London, ON, Canada
| | - James Irvine
- Department of Family Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Randy Littlechild
- Maskwacis Health Services, Maskwacis First Nation, Maskwacis, AB, Canada
| | - Lisa Mayotte
- Health Services, Lac La Ronge Indian Band, La Ronge, SK, Canada
| | - Sarah McIntosh
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | | | - Richard T Oster
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Manon Picard
- Health Services, Wendake Reserve, Wendake, QC, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Quebec, Université Laval, QC, Canada
| | - Karleen M Schulze
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada
| | - Ellen L Toth
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Oster RT, Bruno G, Mayan MJ, Toth EL, Bell RC. Peyakohewamak-Needs of Involved Nehiyaw (Cree) Fathers Supporting Their Partners During Pregnancy: Findings From the ENRICH Study. Qual Health Res 2018; 28:2208-2219. [PMID: 30160198 DOI: 10.1177/1049732318794205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We sought to understand the needs of involved Nehiyaw (Cree) fathers who supported their partners during pregnancy. We used qualitative description and a community-based participatory research approach. We carried out in-depth semi-structured interviews with six Nehiyaw fathers. Four also participated in photovoice and follow-up interviews. All data were content analyzed qualitatively. Fathers felt they had to support their partners and overcome challenges resulting from intergenerational colonial impacts (residential schools particularly) by reclaiming their roles and acknowledging the pregnancy as a positive change. Providing support was possible through their own strong support system stemming from family, faith, culture, and a stable upbringing with positive male role models and intact Nehiyaw kinships. Perinatal programming did little to include fathers. Attempts to improve perinatal care and outcomes should allow more inclusion of and support for Indigenous fathers through genuinely incorporating into care traditional culture and Elders, families, flexibility, cultural understanding, and reconciliation.
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Affiliation(s)
| | - Grant Bruno
- 1 University of Alberta, Edmonton, Alberta, Canada
- 2 Samson Cree Nation, Maskwacis, Alberta, Canada
| | | | - Ellen L Toth
- 1 University of Alberta, Edmonton, Alberta, Canada
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Anand SS, Abonyi S, Arbour L, Brook J, Bruce S, Castleden H, Desai D, de Souza RJ, Harris S, Irvine J, Lai C, Lewis D, Oster RT, Poirier P, Toth EL, Bannon K, Chrisjohn V, Davis AD, L'Hommecourt J, Littlechild R, McMullin K, McIntosh S, Morrison J, Picard M, Landing First Nation P, M. Thomas M, Tusevljak N, Friedrich MG, Tu JV. Canadian Alliance for Healthy Hearts and Minds: First Nations Cohort Study Rationale and Design. ACTA ACUST UNITED AC 2018; 12:55-64. [DOI: 10.1353/cpr.2018.0006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Toth EL, Keith KL, Littlechild R, Meneen K, Myskiw J, Buckreus K, Oster RT. Inaccuracies in Diagnosing Diabetes Complicating Pregnancy and High Frequency of Pre-Existing Type 2 Diabetes in a Large Canadian Indigenous Community. Can J Diabetes 2016. [DOI: 10.1016/j.jcjd.2016.08.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Oster RT, Bruno G, Montour M, Roasting M, Lightning R, Rain P, Graham B, Mayan MJ, Toth EL, Bell RC. Kikiskawâwasow - prenatal healthcare provider perceptions of effective care for First Nations women: an ethnographic community-based participatory research study. BMC Pregnancy Childbirth 2016; 16:216. [PMID: 27514523 PMCID: PMC4982262 DOI: 10.1186/s12884-016-1013-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnant Indigenous women suffer a disproportionate burden of risk and adverse outcomes relative to non-Indigenous women. Although there has been a call for improved prenatal care, examples are scarce. Therefore, we explored the characteristics of effective care with First Nations women from the perspective of prenatal healthcare providers (HCPs). METHODS We conducted an ethnographic community-based participatory research study in collaboration with a large Cree First Nations community in Alberta, Canada. We carried out semi-structured interviews with 12 prenatal healthcare providers (HCPs) that were recorded, transcribed, and subjected to qualitative content analysis. RESULTS According to the participants, relationships and trust, cultural understanding, and context-specific care were key features of effective prenatal care and challenge the typical healthcare model. HCPs that are able to foster sincere, non-judgmental, and enjoyable interactions with patients may be more effective in treating pregnant First Nations women, and better able to express empathy and understanding. Ongoing HCP cultural understanding specific to the community served is crucial to trusting relationships, and arises from real experiences and learning from patients over and above relying only on formal cultural sensitivity training. Consequently, HCPs report being better able to adapt a more flexible, all-inclusive, and accessible approach that meets specific needs of patients. CONCLUSIONS Aligned with the recommendations of the Truth and Reconciliation Commission of Canada, improving prenatal care for First Nations women needs to allow for genuine relationship building with patients, with enhanced and authentic cultural understanding by HCPs, and care approaches tailored to women's needs, culture, and context.
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Affiliation(s)
- Richard T Oster
- Department of Medicine, Research Transition Facility, University of Alberta, Edmonton, AB, T6G 2V2, Canada.
| | - Grant Bruno
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2R3, Canada.,Samson Cree Nation, Maskwacis, AB, T0C 1N0, Canada
| | | | | | | | | | - Bonny Graham
- Maskwacis Health Services, Maskwacis, AB, T0C 1N0, Canada
| | - Maria J Mayan
- Faculty of Extension, Enterprise Square, University of Alberta, Edmonton, AB, T5J 4P6, Canada
| | - Ellen L Toth
- Department of Medicine, Research Transition Facility, University of Alberta, Edmonton, AB, T6G 2V2, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2R3, Canada
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Toth EL, Keith KL, Littlechild R, Myskiw J, Meneen K, Buckreus K, Oster RT. High Frequency of Pre-Existing Type 2 Diabetes in a Series of Pregnant Women Referred for "Gestational Diabetes" in a Large Canadian Indigenous Community. Can J Diabetes 2016; 40:487-489. [PMID: 27427413 DOI: 10.1016/j.jcjd.2016.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
Abstract
We examined the referral processes and true diagnostic classifications for diabetes complicating pregnancy in a series of 62 pregnant women consecutively referred to a diabetes education and treatment centre in a large Indigenous community in Alberta, Canada. The referrals were made over a 5-year period (2010 to 2015). The main findings of this analysis were the high frequency (38.7%) of pre-existing type 2 diabetes and previously undiagnosed or unrecognized overt diabetes and the deficiencies in early testing and recognition.
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Affiliation(s)
- Ellen L Toth
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kristin-Lee Keith
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Randy Littlechild
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Joy Myskiw
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kari Meneen
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kelli Buckreus
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Richard T Oster
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Abstract
We conducted a focused ethnography with 12 First Nations women who had had diabetes in pregnancy to understand their real-life experiences and find ways to improve care for those with diabetes in pregnancy. We carried out unstructured interviews that were recorded, transcribed, and subject to qualitative content analysis. The experience of diabetes in pregnancy is one wrought with difficulties but balanced to some degree by positive lifestyle changes. Having a strong support system (family, health care, cultural/community, and internal support) and the necessary resources (primarily awareness/education) allows women to take some control of their health. Efforts to improve pregnancy care for First Nations women should take a more patient-centered care approach and strive to enhance the support systems of these women, increase their sense of autonomy, and raise awareness of diabetes in pregnancy and its accompanying challenges.
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Affiliation(s)
| | | | - Ellen L Toth
- University of Alberta, Edmonton, Alberta, Canada
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Oster RT, Grier A, Lightning R, Mayan MJ, Toth EL. Cultural continuity, traditional Indigenous language, and diabetes in Alberta First Nations: a mixed methods study. Int J Equity Health 2014; 13:92. [PMID: 25326227 PMCID: PMC4210509 DOI: 10.1186/s12939-014-0092-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/03/2014] [Indexed: 11/12/2022] Open
Abstract
Introduction We used an exploratory sequential mixed methods approach to study the association between cultural continuity, self-determination, and diabetes prevalence in First Nations in Alberta, Canada. Methods We conducted a qualitative description where we interviewed 10 Cree and Blackfoot leaders (members of Chief and Council) from across the province to understand cultural continuity, self-determination, and their relationship to health and diabetes, in the Alberta First Nations context. Based on the qualitative findings, we then conducted a cross-sectional analysis using provincial administrative data and publically available data for 31 First Nations communities to quantitatively examine any relationship between cultural continuity and diabetes prevalence. Results Cultural continuity, or “being who we are”, is foundational to health in successful First Nations. Self-determination, or “being a self-sufficient Nation”, stems from cultural continuity and is seriously compromised in today’s Alberta Cree and Blackfoot Nations. Unfortunately, First Nations are in a continuous struggle with government policy. The intergenerational effects of colonization continue to impact the culture, which undermines the sense of self-determination, and contributes to diabetes and ill health. Crude diabetes prevalence varied dramatically among First Nations with values as low as 1.2% and as high as 18.3%. Those First Nations that appeared to have more cultural continuity (measured by traditional Indigenous language knowledge) had significantly lower diabetes prevalence after adjustment for socio-economic factors (p =0.007). Conclusions First Nations that have been better able to preserve their culture may be relatively protected from diabetes.
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Affiliation(s)
- Richard T Oster
- Department of Medicine, University of Alberta, 4100 Research Transition Facility, 8308 114 Street, Edmonton T6G 2V2, AB, Canada.
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Oster RT, King M, Morrish DW, Mayan MJ, Toth EL. Diabetes in pregnancy among First Nations women in Alberta, Canada: a retrospective analysis. BMC Pregnancy Childbirth 2014; 14:136. [PMID: 24716718 PMCID: PMC4021202 DOI: 10.1186/1471-2393-14-136] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 04/07/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In addition to increasing the risk of adverse birth outcomes, diabetes in pregnancy is thought to be an important driver of the epidemic of type 2 diabetes affecting Canada's First Nations population. The relative contributions of gestational diabetes mellitus (GDM) and pre-existing diabetes are not well understood. We generated a comprehensive epidemiological profile of diabetes in pregnancy over a 10-year period among the First Nations population of Alberta, Canada. METHODS De-identified administrative data for 427,058 delivery records were obtained for the years 2000-2009. Pregnancy risk factors and delivery outcomes were described and compared by ethnicity (First Nations vs. non-First Nations) and diabetes status. Age-adjusted prevalence values for GDM and pre-existing diabetes were calculated and were compared by ethnicity. Longitudinal changes over time were also examined. Predictors were explored using logistic regression analysis. RESULTS First Nations women had more antenatal risk factors and adverse infant outcomes that were compounded by diabetes. First Nations descent was an independent predictor of diabetes in pregnancy (p < 0.001). GDM prevalence was significantly higher among First Nations (6.1%) compared to non-First Nations women (3.8%; p < 0.001), but prevalence values increased significantly over time only in non-First Nations women (4.5 average annual percent change; p < 0.05). The prevalence of pre-existing diabetes was stable over time in both groups, but First Nations women experienced a 2.5-fold higher overall prevalence compared with non-First Nations women (1.5% vs. 0.6%, respectively; p < 0.001). CONCLUSIONS Although First Nations women experience a higher overall prevalence of diabetes in pregnancy, the lack of increase in the prevalence over time is encouraging. However, because high-risk pregnancies and poor outcomes are more common among First Nations women, particularly those with diabetes, strategies to improve perinatal care must be implemented.
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Affiliation(s)
- Richard T Oster
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, 4-030 Research Transition Facility, University of Alberta, Edmonton, Alberta T6G 2V2, Canada
| | - Malcolm King
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Donald W Morrish
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maria J Mayan
- Faculty of Extension, University of Alberta, Edmonton, Alberta, Canada
| | - Ellen L Toth
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Oster RT, Toth EL. An Epidemiological Profile of Diabetes in Pregnancy Among First Nations and Non-First Nations Women in Alberta. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.08.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oster RT, Toth EL. The Diabetes-related Health of Aboriginal Women with a History of Gestational Diabetes. Can J Diabetes 2012. [DOI: 10.1016/j.jcjd.2012.07.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Oster RT, Johnson JA, Balko SU, Svenson LW, Toth EL. Increasing rates of diabetes amongst status Aboriginal youth in Alberta, Canada. Int J Circumpolar Health 2012; 71:1-7. [PMID: 22584517 PMCID: PMC3417716 DOI: 10.3402/ijch.v71i0.18501] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/07/2012] [Accepted: 03/13/2012] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To track and compare trends in diabetes rates from 1995 to 2007 for Status Aboriginal and general population youth. STUDY DESIGN Longitudinal observational research study (quantitative) using provincial administrative data. METHODS De-identified data was obtained from Alberta Health and Wellness administrative databases for Status Aboriginal (First Nations and Inuit people with Treaty status) and general population youth (<20 years). Diabetes cases were identified using the National Diabetes Surveillance System algorithm. Crude annual diabetes prevalence and incidence rates were calculated. The likelihood of being a prevalent case and incident case of diabetes for the 2 populations was compared for the year 2007. Average Annual Percent Changes (AAPC) in prevalence and incidence from 1995 to 2007 were determined and compared between the 2 groups to examine trends over time. RESULTS While the prevalence of diabetes was higher in the general population in 1995, by 2007 there were no between group differences, reflected in the significantly higher AAPC of 6.98 for Status Aboriginal youth. Status Aboriginal males had a lower diabetes risk in 1995 compared with females, and experienced a greater increase in prevalence over the 13 years (AAPC 9.18) so that by 2007 their rates were equivalent to those of the females. Differences in diabetes incidence trends were only observed among male youth, where increases in incidence were greater for Status Aboriginal (AAPC 11.65) compared to general population males (AAPC 4.62) (p = 0.03). CONCLUSION Youth-onset diabetes is an increasing problem in Alberta, especially among young Status Aboriginal males.
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Affiliation(s)
- Richard T Oster
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Oster RT, Johnson JA, Hemmelgarn BR, King M, Balko SU, Svenson LW, Crowshoe L, Toth EL. Recent epidemiologic trends of diabetes mellitus among status Aboriginal adults. CMAJ 2011; 183:E803-8. [PMID: 21788417 PMCID: PMC3168663 DOI: 10.1503/cmaj.101882] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Little is known about longitudinal trends in diabetes mellitus among Aboriginal people in Canada. We compared the incidence and prevalence of diabetes, and its impact on mortality, among status Aboriginal adults and adults in the general population between 1995 and 2007. METHODS We examined de-identified data from Alberta Health and Wellness administrative databases for status Aboriginal people (First Nations and Inuit people with treaty status) and members of the general public aged 20 years and older who received a diagnosis of diabetes mellitus from Apr. 1, 1995, to Mar. 31, 2007. We calculated the incidence and prevalence of diabetes and mortality rate ratios by sex and ethnicity in 2007. We examined the average relative changes per year for longitudinal trends. RESULTS The average relative change per year in the prevalence of diabetes showed a smaller increase over time in the Aboriginal population than in the general population (2.39 v. 4.09, p < 0.001). A similar finding was observed for the incidence of diabetes. In the Aboriginal population, we found that the increase in the average relative change per year was greater among men than among women (3.13 v. 1.88 for prevalence, p < 0.001; 2.60 v. 0.02 for incidence, p = 0.001). Mortality among people with diabetes decreased over time to a similar extent in both populations. Among people without diabetes, mortality decreased in the general population but was unchanged in the Aboriginal population (-1.92 v. 0.11, p = 0.04). Overall, mortality was higher in the Aboriginal population than in the general population regardless of diabetes status. INTERPRETATION The increases in the incidence and prevalence of diabetes over the study period appeared to be slower in the status Aboriginal population than in the general population in Alberta, although the overall rates were higher in the Aboriginal population. Mortality decreased among people with diabetes in both populations but was higher overall in the Aboriginal population regardless of diabetes status.
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Affiliation(s)
- Richard T Oster
- Department of Medicine, University of Alberta, Edmonton, Alta.
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Ralph-Campbell K, Oster RT, Connor T, Toth EL. Emerging longitudinal trends in health indicators for rural residents participating in a diabetes and cardiovascular screening program in northern Alberta, Canada. Int J Family Med 2011; 2011:596475. [PMID: 22295188 PMCID: PMC3263841 DOI: 10.1155/2011/596475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 02/10/2011] [Accepted: 02/14/2011] [Indexed: 05/31/2023]
Abstract
Background. Geographic isolation, poverty, and loss of culture/tradition contribute to "epidemic" rates of diabetes amongst indigenous Canadians. The Mobile Diabetes Screening Initiative travels to rural indigenous and other remote communities in Alberta to screen for diabetes and cardiovascular risk. We sought to examine risk factors longitudinally. Methods. Clinical and anthropometric measurements were undertaken for 809 adults (aged 20-91) between November 2003 and December 2009. For those who had more than one MDSi visit, trend estimates (actual changes) were calculated for body mass index (BMI), weight, waist circumference, hemoglobin A1c (A1c), total cholesterol, and blood pressure. Results. Among those without diabetes (N = 629), BMI and weight increased (P < .01) and blood pressure decreased (P < .05). For those with diabetes (N = 180), significant improvements (P < .05) were observed for all indicators except waist circumference. Conclusion. Improvements observed suggest that MDSi's model may effectively mediate some barriers and support subjects in managing their health.
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Affiliation(s)
- Kelli Ralph-Campbell
- BRAID Research Group, University of Alberta, 8308 114 Street, Suite 1055, Edmonton, AB, Canada T6G 2V2
| | - Richard T. Oster
- BRAID Research Group, University of Alberta, 8308 114 Street, Suite 1055, Edmonton, AB, Canada T6G 2V2
| | - Tracy Connor
- BRAID Research Group, University of Alberta, 8308 114 Street, Suite 1055, Edmonton, AB, Canada T6G 2V2
| | - Ellen L. Toth
- BRAID Research Group, University of Alberta, 8308 114 Street, Suite 1055, Edmonton, AB, Canada T6G 2V2
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Oster RT, Shade S, Strong D, Toth EL. Improvements in indicators of diabetes-related health status among first nations individuals enrolled in a community-driven diabetes complications mobile screening program in Alberta, Canada. Can J Public Health 2011. [PMID: 21214058 DOI: 10.1007/bf03404863] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The goal of Screening for Limb, I-Eye, Cardiovascular, and Kidney complications of diabetes (SLICK) is to reduce the burden of diabetes among Alberta First Nations individuals. By analyzing the longitudinal results of SLICK over a six-year time span, our purpose was to examine both baseline diabetes-related health status and whether subsequent improvements occurred. METHODS Diabetes complications screening, diabetes education, and community-based care were provided by mobile clinics which traveled to 43 Alberta First Nations communities biannually. Body mass index (BMI), waist circumference, hemoglobin A1c (HbA1c), total cholesterol and blood pressure, as well as the presence of foot and kidney abnormalities were assessed among 2102 unique subjects with diabetes. Mean values of diabetes health indicators at baseline and subsequent visits for returning subjects were compared. Secular trends were sought by examining trends in mean baseline health indicators per year. RESULTS High baseline rates of obesity, poor HbAlc concentrations, hypercholesterolemia, hypertension, foot abnormalities and kidney damage were observed. Significant improvements in BMI, blood pressure, total cholesterol and HbA1c concentrations were identified (p < 0.01) in returning subjects. Similarly, significant decreasing secular trends in total cholesterol and HbA1c concentrations were observed (p < 0.01). At baseline, females had a higher prevalence of obesity and abnormal waist circumference (p < 0.05); however, males had more inadequate HbA1c concentrations (>8.4%), hypercholesterolemia, hypertension, foot abnormalities and kidney damage (p < 0.05). DISCUSSION Despite worrisome baseline clinical characteristics, diabetes-related health appears to be improving modestly in Alberta First Nations individuals.
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Oster RT, Tishinsky JM, Yuan Z, Robinson LE. Docosahexaenoic acid increases cellular adiponectin mRNA and secreted adiponectin protein, as well as PPARγ mRNA, in 3T3-L1 adipocytes. Appl Physiol Nutr Metab 2010; 35:783-9. [DOI: 10.1139/h10-076] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adiponectin, a protein secreted from adipose tissue, has been shown to have anti-diabetic and anti-inflammatory effects, but its regulation is not completely understood. Long-chain n-3 fatty acids eicosapentaenoic acid (20:5n-3; EPA) and docosahexaenoic acid (22:6n-3; DHA) may be involved in adiponectin regulation as they are potential ligands for peroxisome proliferator-activated receptor-γ (PPARγ), a key transcription factor for the adiponectin gene. To examine this, 3T3-L1 adipocytes were incubated with 125 µmol·L–1 EPA, DHA, palmitic, or oleic acids complexed to albumin, or with albumin alone (control) for 24 h. Adipocytes were also incubated for 24 h with EPA and DHA plus bisphenol-A-diglycidyl ether (BADGE), a PPARγ antagonist. Both EPA and DHA increased (p < 0.05) secreted adiponectin concentration compared with the control (44% and 102%, respectively), but did not affect cellular adiponectin protein content. Incubation with BADGE and DHA inhibited increases in secreted adiponectin protein, suggesting that DHA may act through a PPARγ-dependent mechanism. However, BADGE had no effect on EPA-induced increases in secreted adiponectin protein. Only DHA enhanced (p < 0.05) PPARγ and adiponectin mRNA expression compared wtih the control. Our results demonstrate that DHA increases cellular adiponectin mRNA and secreted adiponectin protein in 3T3-L1 adipocytes, possibly by a mechanism involving PPARγ. Moreover, DHA increased adiponectin concentration to a greater extent (40% more, p < 0.05) compared with EPA, emphasizing the need to consider the independent actions of EPA and DHA in adipocytes.
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Affiliation(s)
- Richard T. Oster
- Department of Human Health and Nutritional Sciences, Animal Science and Nutrition Building, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Justine M. Tishinsky
- Department of Human Health and Nutritional Sciences, Animal Science and Nutrition Building, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Zongfei Yuan
- Department of Human Health and Nutritional Sciences, Animal Science and Nutrition Building, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Lindsay E. Robinson
- Department of Human Health and Nutritional Sciences, Animal Science and Nutrition Building, University of Guelph, Guelph, ON N1G 2W1, Canada
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Oster RT, Shade S, Strong D, Toth EL. Improvements in indicators of diabetes-related health status among first nations individuals enrolled in a community-driven diabetes complications mobile screening program in Alberta, Canada. Can J Public Health 2010; 101:410-4. [PMID: 21214058 PMCID: PMC6973552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 05/09/2010] [Indexed: 11/14/2023]
Abstract
OBJECTIVE The goal of Screening for Limb, I-Eye, Cardiovascular, and Kidney complications of diabetes (SLICK) is to reduce the burden of diabetes among Alberta First Nations individuals. By analyzing the longitudinal results of SLICK over a six-year time span, our purpose was to examine both baseline diabetes-related health status and whether subsequent improvements occurred. METHODS Diabetes complications screening, diabetes education, and community-based care were provided by mobile clinics which traveled to 43 Alberta First Nations communities biannually. Body mass index (BMI), waist circumference, hemoglobin A1c (HbA1c), total cholesterol and blood pressure, as well as the presence of foot and kidney abnormalities were assessed among 2102 unique subjects with diabetes. Mean values of diabetes health indicators at baseline and subsequent visits for returning subjects were compared. Secular trends were sought by examining trends in mean baseline health indicators per year. RESULTS High baseline rates of obesity, poor HbAlc concentrations, hypercholesterolemia, hypertension, foot abnormalities and kidney damage were observed. Significant improvements in BMI, blood pressure, total cholesterol and HbA1c concentrations were identified (p < 0.01) in returning subjects. Similarly, significant decreasing secular trends in total cholesterol and HbA1c concentrations were observed (p < 0.01). At baseline, females had a higher prevalence of obesity and abnormal waist circumference (p < 0.05); however, males had more inadequate HbA1c concentrations (>8.4%), hypercholesterolemia, hypertension, foot abnormalities and kidney damage (p < 0.05). DISCUSSION Despite worrisome baseline clinical characteristics, diabetes-related health appears to be improving modestly in Alberta First Nations individuals.
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Affiliation(s)
- Richard T. Oster
- Division of Endocrinology & Metabolism, Department of Medicine, 362 Heritage Medical Research Centre, Edmonton, AB T6G 2S2 Canada
| | | | | | - Ellen L. Toth
- Division of Endocrinology & Metabolism, Department of Medicine, 362 Heritage Medical Research Centre, Edmonton, AB T6G 2S2 Canada
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Oster RT, Toth EL. Restoring Aboriginal culture through community-based type 2 diabetes screening. Int J Circumpolar Health 2010; 69:218-9. [PMID: 20579455 DOI: 10.3402/ijch.v69i3.17619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oster RT, Ralph-Campbell K, Connor T, Pick M, Toth EL. What happens after community-based screening for diabetes in rural and Indigenous individuals? Diabetes Res Clin Pract 2010; 88:e28-31. [PMID: 20197205 DOI: 10.1016/j.diabres.2010.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 09/16/2009] [Accepted: 02/02/2010] [Indexed: 11/17/2022]
Abstract
Rural individuals (mostly Indigenous) were screened for undiagnosed diabetes and cardiovascular risk. A subsequent survey showed roughly half engaged in timely follow-up with the health care system. The Mobile Diabetes Screening Initiative identifies a substantial number of people needing medical attention, who may otherwise be "missed" through conventional healthcare delivery.
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Affiliation(s)
- Richard T Oster
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Ralph-Campbell K, Oster RT, Connor T, Pick M, Pohar S, Thompson P, Daniels M, Deschambeau L, Werner-Leonard A, Cardinal-Lamouche S, Toth EL. Increasing rates of diabetes and cardiovascular risk in Métis Settlements in northern Alberta. Int J Circumpolar Health 2010; 68:433-42. [PMID: 20044962 DOI: 10.3402/ijch.v68i5.17382] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine the prevalence of diabetes (using secondary data analysis), as well as undiagnosed diabetes and pre-diabetes (using primary research methods) among adult Métis Settlement dwellers in northern Alberta. We also sought to identify cardiovascular risk factors. STUDY DESIGN Quantitative research study utilizing both population census and community-based diabetes screening data. METHODS Self-reported diabetes was analyzed from the results of the Métis Settlement specific censuses in 1998 and 2006. Mobile clinics travelled into each of the 8 Métis Settlement communities in Alberta recruiting 693 subjects for screening for undiagnosed diabetes, pre-diabetes and metabolic syndrome. Logistic regression analyses (adjusted for age and sex) were used to identify associated factors. RESULTS According to the censuses, 4,312 Métis individuals were living on Settlements in 1998 and 5,059 in 2006. Self-reported age-adjusted prevalence of diabetes increased significantly from 5.1% in 1998 to 6.9% in 2006 (p < 0.01), with a crude prevalence increase of 66% (p < 0.01). In 2006, diabetes prevalence was higher among females than males, 7.8% vs. 6.1% respectively (p < 0.05). Of the 266 adults screened in the fasting state, 5.3% had undiagnosed diabetes, whereas 20.3% (Canadian Diabetes Association criteria) and 51.9% (American Diabetes Association criteria) had pre-diabetes. Rates of obesity and metabolic syndrome were 49.4% (n = 693) and 46.4% (n = 266), respectively. Hemoglobin A1c > 6.1% was strongly associated with diabetes, pre-diabetes and metabolic syndrome. CONCLUSIONS Our results indicate high rates of diabetes, undiagnosed diabetes, pre-diabetes and metabolic syndrome among adult Alberta Métis Settlement dwellers.
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Oster RT, Virani S, Strong D, Shade S, Toth EL. Diabetes care and health status of First Nations individuals with type 2 diabetes in Alberta. Can Fam Physician 2009; 55:386-93. [PMID: 19366950 PMCID: PMC2669013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To describe the state of diabetes care among Alberta First Nations individuals with diabetes living on reserves. DESIGN Survey and screening for diabetes-related complications. SETTING Forty-three Alberta First Nations communities. PARTICIPANTS A total of 743 self-referred First Nations individuals with known diabetes. MAIN OUTCOME MEASURES Clinical measurements (glycated hemoglobin A(1c) levels, body mass index, waist circumference, total cholesterol, blood pressure, and the presence of kidney complications or proteinuria, retinopathy, and foot abnormalities), self-reported health services utilization, clinical history, and knowledge of and satisfaction with diabetes services. RESULTS Female participants tended to be more obese (P < .05) and to have abnormal waist circumferences more often than men (P < .05). Male participants, however, had a higher proportion of proteinuria (P < .05), hypertension (P < .05), limb complications (P < .05), and retinopathy (P < .05). Family physicians were the main diabetes care providers for most participants. Nearly half the participants felt they did not have care from a diabetes team. A total of 38% had never seen dietitians. Diabetes-related concerns were responsible for 24% of all hospitalizations and emergency department visits. Approximately 46% and 21% of participants had recommended hemoglobin A(1c) testing and foot examinations, respectively. Only 24% of participants with kidney complications were receiving treatment. A considerable proportion of participants had undiagnosed complications of diabetes: kidney damage or proteinuria (23%), high cholesterol (22%), foot complications (11%), hypertension (9%), and retinopathy (7%). CONCLUSION Diabetes care is suboptimal in Alberta First Nations communities. Rural physicians caring for First Nations individuals on reserves should be involved, along with other members of diabetes health care teams, in strategies to improve diabetes care. Our results justify the need for community-based screening for diabetes control and complications in First Nation communities.
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Affiliation(s)
- Richard T Oster
- Department of Medicine, University of Alberta, 362C Heritage Medical Research Centre, Edmonton, Alberta.
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Oster RT, Toth EL. Differences in the prevalence of diabetes risk-factors among First Nation, Métis and non-Aboriginal adults attending screening clinics in rural Alberta, Canada. Rural Remote Health 2009; 9:1170. [PMID: 19496641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Populations that are developing (westernizing) are suffering the highest rates of increases in diabetes incidence and prevalence worldwide, with the most notable and documented increases in Canada seen among the First Nations. Less is known about the Métis (mixed blood) or the rural populations in general. To date, no studies have assessed the contributions of ethnicity to diabetes risk-factors. Our objective was to examine diabetes risk factors in First Nations, Métis and non-Aboriginal individuals residing in rural or remote locations, investigating whether ethnicity contributed to any differences. METHODS From the databases of three separate community-based diabetes screening projects in Alberta we created a unique subject pool of 3148 adults without diabetes (1790 First Nation, 867 Métis, and 491 non-Aboriginals). Age, body mass index (BMI), waist circumference, reported history of gestational diabetes (GDM) or babies over nine pounds (females only), hemoglobin A1c (A1c) fasting plasma glucose (FPG) or random plasma glucose (RPG) were assessed. Chi-square tests and logistic regression analysis were used to identify between-group differences. RESULTS The highest mean values for waist circumference (104.7 cm) and BMI (31.2) were found in First Nations subjects (p<0.01). First Nations individuals had the highest prevalence of overweight/obesity (84.4%), abnormal waist circumference (76.8%) and history of GDM (9.0%) (p<0.01). The RPG was also higher in First Nations, but there were no differences between groups with respect to mean FPG and A1c levels, and there were no differences with respect to the prevalence of pre-diabetes or undiagnosed diabetes. Métis (OR 0.80; p = 0.01) and non-Aboriginal individuals (OR 0.62; p< 0.01) were less likely to be obese after age/gender adjustment, compared with First Nations. Métis (OR 0.70; p<0.01) and non-Aboriginals (OR 0.35; p<0.01) were also less likely than the First Nations group to have abnormal waist circumferences. Individuals in the non-Aboriginal group had a lower prevalence of pre-diabetes (OR 0.50; p = 0.01) compared with both the Métis and First Nations groups. CONCLUSIONS First Nations individuals had more risk factors for diabetes than Métis and non-Aboriginal individuals, although Métis rates appeared intermediate. While these risk-factor differences did not translate to more undiagnosed diabetes or pre-diabetes, they are consistent with known rates of diagnosed diabetes in Alberta.
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Affiliation(s)
- Richard T Oster
- Department of Medicine, University of Alberta, 362C Heritage Medical Research Centre, Edmonton, Alberta, Canada.
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