Inuit

因纽特人
  • 文章类型: Journal Article
    人们对野生动植物研究中的“一个健康和土著”方法和方法的兴趣越来越大,但它们在北极的研究应用并不广泛。这两种方法的范围很广,源于不同的知识系统,但经常被同义地比较。我们回顾了因纽特人Nunaat关于野生动物研究的术语“一个健康”和因纽特人Qaujimajatuqangit(因纽特人土著知识)之间重叠的文献。三个数据库(SCOPUS,WebofScience,和BIOSIS)用于在因纽特人Nunaat的范围内查找英语文章和书籍。虽然OneHealth和因纽特人Qaujimajatuqangit的研究方法具有协同作用,由于认识论的不同,他们从根本上是不同的,包括对自然环境和野生动物管理的看法。我们描述了因纽特人Nunaat正在实施的一种健康的当前例子,并确定了解决有关野生动物健康的更大,更复杂的问题的潜力,以陆地和海洋北极野生动物为例。土著方法和“一个健康”自然都以人的成分为核心,无缝地适合野生动物管理的讨论,因为人类的行为和法规直接影响环境和野生动物的健康。
    There is increasing interest in One Health and Indigenous methodologies and approaches in wildlife research, but they are not widely used research applications in the Arctic. Both approaches are wide in scope and originate from different knowledge systems but are often compared synonymously. We review the literature of overlap between the term One Health and Inuit Qaujimajatuqangit (Inuit Indigenous Knowledge) throughout Inuit Nunaat on wildlife research. Three databases (SCOPUS, Web of Science, and BIOSIS) were used to find English language articles and books within the bounds of Inuit Nunaat. While One Health and Inuit Qaujimajatuqangit research approaches share synergies, they are fundamentally disparate owing to their differences in epistemology, including views on the natural environment and wildlife management. We describe current examples of One Health being operationalized in Inuit Nunaat and identify potential to address larger and more complex questions about wildlife health, with examples from terrestrial and marine Arctic wildlife. Both Indigenous methodologies and One Health naturally have a human component at their core, which seamlessly lends itself to discussions on wildlife management, as human actions and regulations directly impact environment and wildlife health.
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  • 文章类型: Journal Article
    肺癌是加拿大最常见的癌症之一,也是癌症死亡的主要原因。肺癌也会影响原住民,因纽特人和梅蒂斯人在加拿大显着,这值得进一步调查,因为在这个话题上存在文献空白。我们寻求对肺癌诊断有更深入的了解,发病率,死亡率,在第一民族中生存,因纽特人,和加拿大的梅蒂斯人。在书目数据库中进行了系统的搜索,以确定2000年1月至2023年3月之间发表的相关研究。使用人口/概念/背景(PCC)框架对文章进行了筛选和相关性评估。共有22篇文章被纳入最终分析,其中13个是因纽特人特有的,7是针对第一民族的,2个是梅蒂斯特有的。文献表明,比较发病率,死亡率,原住民患肺癌的相对风险更高,生存率更差,因纽特人和梅蒂斯人。肺癌对这些人群也有不同的影响,取决于性别,年龄,位置和其他因素。这篇综述表明,更全面的定量和定性研究对于进一步确定肺癌高发的结构性原因至关重要。
    Lung cancer is one of the most commonly diagnosed cancers in Canada and a leading cause of cancer mortality. Lung cancer also affects First Nations, Inuit and Métis peoples significantly in Canada, which deserves further investigation as there is a literature gap on this topic. We sought to develop a deeper understanding of lung cancer diagnosis, incidence, mortality, and survival in First Nations, Inuit, and Métis peoples in Canada. A systematic search was conducted in bibliographic databases to identify relevant studies published between January 2000 and March 2023. Articles were screened and assessed for relevance using the Population/ Concept/ Context (PCC) framework. A total of 22 articles were included in the final analysis, of which 13 were Inuit-specific, 7 were First Nations-specific, and 2 were Métis-specific. The literature suggests that comparative incidence, mortality, and relative risk of lung cancer is higher and survival is poorer in First Nations, Inuit and Métis peoples. Lung cancer also has varying impact on these population depending on sex, age, location and other factors. This review illustrates that more comprehensive quantitative and qualitative lung cancer research is essential to further identify the structural causes for the high incidence of the disease.
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  • 文章类型: Systematic Review
    背景:共享决策促进了患者和医疗保健提供者之间的合作,以做出明智的健康决策。我们的审查确定了支持土著人民做出健康决定的干预措施。目标是综合证据并确定影响共享决策干预措施使用的因素。
    方法:由服务提供商和学术研究人员组成的因纽特人和非因纽特人团队使用集成的知识翻译方法和框架综合来共同进行系统综述。我们开发了一个概念框架来组织和描述共同的决策过程,并指导确定描述干预措施以支持土著人民做出健康决策的研究。我们从2012年9月至2022年3月对电子数据库进行了全面搜索,并进行了灰色文献检索。对两名独立的团队成员进行了筛选,并对质量进行了评估,其中包括有关研究对共同决策和土著自决的贡献的优势和相关性的研究。对调查结果进行了与概念框架相关的描述性分析,并使用准则进行报告,以确保报告的透明度和完整性,并进行面向公平的系统审查。
    结果:在筛选的5068篇引文中,10份出版物中报道的9项研究符合纳入条件.我们将这些研究分为以下几类:包括土著知识和治理(\“面向土著”)(n=6);以及基于西方学术知识和治理(\“面向西方”)(n=3)。这些研究被发现对共同决策和自决的贡献具有不同的质量,以本土为导向的研究总体上比西方为导向的研究质量更高。四个主题反映在更新的概念框架中:1)共享决策发生影响决策机会的地方,2)对参与共享决策过程的医疗保健提供者的特征知之甚少,3)社区是共同决策的伙伴,4)共享决策过程涉及建立信任。
    结论:很少有研究报告和评估与土著人民共同的决策干预措施。总的来说,面向土著的研究力求使卫生保健系统更适合土著人民的共同决策,而面向西方的研究将共同决策与医疗保健环境分开。需要进一步研究以解决方案为重点并支持土著自决。
    BACKGROUND: Shared decision-making facilitates collaboration between patients and health care providers for informed health decisions. Our review identified interventions to support Indigenous Peoples making health decisions. The objectives were to synthesize evidence and identify factors that impact the use of shared decision making interventions.
    METHODS: An Inuit and non-Inuit team of service providers and academic researchers used an integrated knowledge translation approach with framework synthesis to coproduce a systematic review. We developed a conceptual framework to organize and describe the shared decision making processes and guide identification of studies that describe interventions to support Indigenous Peoples making health decisions. We conducted a comprehensive search of electronic databases from September 2012 to March 2022, with a grey literature search. Two independent team members screened and quality appraised included studies for strengths and relevance of studies\' contributions to shared decision making and Indigenous self-determination. Findings were analyzed descriptively in relation to the conceptual framework and reported using guidelines to ensure transparency and completeness in reporting and for equity-oriented systematic reviews.
    RESULTS: Of 5068 citations screened, nine studies reported in ten publications were eligible for inclusion. We categorized the studies into clusters identified as: those inclusive of Indigenous knowledges and governance (\"Indigenous-oriented\")(n = 6); and those based on Western academic knowledge and governance (\"Western-oriented\")(n = 3). The studies were found to be of variable quality for contributions to shared decision making and self-determination, with Indigenous-oriented studies of higher quality overall than Western-oriented studies. Four themes are reflected in an updated conceptual framework: 1) where shared decision making takes place impacts decision making opportunities, 2) little is known about the characteristics of health care providers who engage in shared decision making processes, 3) community is a partner in shared decision making, 4) the shared decision making process involves trust-building.
    CONCLUSIONS: There are few studies that report on and evaluate shared decision making interventions with Indigenous Peoples. Overall, Indigenous-oriented studies sought to make health care systems more amenable to shared decision making for Indigenous Peoples, while Western-oriented studies distanced shared decision making from the health care settings. Further studies that are solutions-focused and support Indigenous self-determination are needed.
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  • 文章类型: Journal Article
    因纽特人比加拿大普通人群面临更差的癌症生存率和预后。如果不审查造成不平等并继续影响因纽特人健康和福祉的结构性因素,就无法理解持续的健康差距。本范围审查旨在综合有关加拿大因纽特人经历的影响癌症护理的结构因素的可用已发表和灰色文献。在加拿大Pauktuutit因纽特人妇女以及JoannaBriggs研究所范围审查方法的因纽特人意见的指导下,进行了全面的电子搜索以及对灰色文献和相关期刊的手工搜索。共纳入30篇论文进行相关性分析和评估。研究结果被分为五类,如与殖民有关的先验框架中定义的那样,以及卫生系统,社会,经济,和政治结构。研究结果强调了种族主义和殖民主义之间的相互联系,缺乏城市因纽特人的卫生服务信息,以及需要全系统努力解决癌症治疗中的结构性障碍。
    Inuit face worse cancer survival rates and outcomes than the general Canadian population. Persistent health disparities cannot be understood without examining the structural factors that create inequities and continue to impact the health and well-being of Inuit. This scoping review aims to synthesise the available published and grey literature on the structural factors that influence cancer care experienced by Inuit in Canada. Guided by Inuit input from Pauktuutit Inuit Women of Canada as well as the Joanna Briggs Institute scoping review methodology, a comprehensive electronic search along with hand-searching of grey literature and relevant journals was conducted. A total of 30 papers were included for analysis and assessment of relevance. Findings were organised into five categories as defined in the a priori framework related to colonisation, as well as health systems, social, economic, and political structures. The study results highlight interconnections between racism and colonialism, the lack of health service information on urban Inuit, as well as the need for system-wide efforts to address the structural barriers in cancer care.
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  • 文章类型: Systematic Review
    自1970年代以来,自杀一直是格陵兰的主要公共卫生问题。世界卫生组织强调了确定与自杀有关的风险和保护因素的重要性。本文的目的是确定有关格陵兰因纽特人自杀和自杀行为的风险和保护因素的科学文献。在PubMed和PsycInfo中进行的搜索导致了420项研究,这些研究由三位作者进行了筛选。筛选后,作者纳入了15项接受质量评估和数据提取的研究.所有15项研究都报告了危险因素,只提到了三个保护因素。大多数报告的风险因素是在个人层面上的,与社会经济地位有关,心理健康,酒精和物质的使用,和生活压力。与家庭相关的危险因素主要与不良童年经历有关,虽然社区一级关注受教育的机会,工作,和冲突。结果表明,有关自杀和自杀行为的保护因素的知识差距很大。报道的少数保护因素与男人有家庭有关,社会经济地位高,出生于1901年至1950年之间.
    Since the 1970s, suicide has been a major public health issue in Greenland. The World Health Organization has emphasised the importance of the identification of both risk and protective factors in relation to suicide. The aim of this paper was to identify scientific literature on risk and protective factors for suicide and suicidal behaviour among Greenland Inuit. Searches in PubMed and PsycInfo resulted in 420 studies that were screened by three of the authors. After screening, the authors included 15 studies that were subject to quality assessment and data extraction. All 15 studies reported on risk factors, and only three mentioned protective factors. Most reported risk factors were on an individual level and were related to socioeconomic status, mental health, alcohol and substance use, and life stress. Risk factors related to the family mainly related to adverse childhood experiences, while the community level concerned access to education, work, and conflicts. The results indicate a large knowledge gap about protective factors for suicide and suicidal behaviour. The few protective factors reported were related to men having a family, high socioeconomic status, and being born between 1901 and 1950.
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  • 文章类型: Systematic Review
    在加拿大,大约52%的第一民族,因纽特人和梅蒂斯(土著)人民生活在城市地区。尽管城市地区拥有世界上最好的医疗服务,对土著人民在获得这些服务时面临的障碍或促进者知之甚少。这篇综述旨在填补这些知识空白。Embase,Medline和WebofScience的检索时间为1981年1月1日至2020年4月30日。共有41项研究确定了城市地区土著人民获得保健服务的障碍或促进因素。障碍包括与卫生专业人员沟通困难,药物问题,被医护人员解雇,等待时间,对医疗保健的不信任和回避,种族歧视,贫困和交通问题。促进者包括获得文化,传统治疗,土著主导的卫生服务和文化安全。消除障碍和实施促进者的政策和方案可以改善居住在加拿大城市和相关家园的土著人民获得保健服务的机会。
    In Canada, approximately 52% of First Nations, Inuit and Métis (Indigenous) peoples live in urban areas. Although urban areas have some of the best health services in the world, little is known about the barriers or facilitators Indigenous peoples face when accessing these services. This review aims to fill these gaps in knowledge. Embase, Medline and Web of Science were searched from 1 January 1981 to 30 April 2020. A total of 41 studies identified barriers or facilitators of health service access for Indigenous peoples in urban areas. Barriers included difficult communication with health professionals, medication issues, dismissal by healthcare staff, wait times, mistrust and avoidance of healthcare, racial discrimination, poverty and transportation issues. Facilitators included access to culture, traditional healing, Indigenous-led health services and cultural safety. Policies and programs that remove barriers and implement the facilitators could improve health service access for Indigenous peoples living in urban and related homelands in Canada.
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  • 文章类型: Journal Article
    背景:耳部和听力护理计划对于中耳炎(或中耳疾病)的早期发现和管理至关重要。中耳炎和相关听力损失不成比例地影响第一民族儿童。这会影响言语和语言的发展,社会和认知发展,反过来,教育和生活结果。这项范围审查旨在更好地了解高收入殖民地定居者国家的原住民儿童的耳朵和听力护理计划如何旨在减轻中耳炎的负担并增加公平获得护理的机会。具体来说,审查旨在制定计划战略,将每个项目的重点映射到护理路径的4个部分(预防,检测,诊断/管理,康复),并确定表明计划长期可持续性和成功的因素。
    方法:2021年3月使用Medline进行了数据库搜索,Embase,全球卫生,APAPsycInfo,CINAHL,WebofScience核心合集,Scopus,和学术搜索总理。如果计划在2010年1月至2021年3月之间的任何时间开发或运行,则符合资格或纳入。搜索术语包括第一民族儿童等术语,耳朵和听力护理,和健康计划,倡议,竞选活动,和服务。
    结果:27篇文章符合纳入审查的标准,共描述了21项耳朵和听力护理计划。方案采用的策略是:(I)将患者与专科服务联系起来,(二)加强服务的文化安全,和(iii)增加获得耳部和听力保健服务的机会。然而,计划评估措施仅限于输出或服务水平结果的评估,而不是以患者为基础的结果。促进计划可持续性的因素包括资金和社区参与,尽管在许多情况下这些因素有限。
    结论:这项研究的结果突出表明,项目主要在护理路径的两个方面运作-检测和诊断/管理,大概是最需要的地方。有针对性的策略被用来解决这些问题,一些在他们的方法中受到限制。许多程序的成功被评估为输出,许多项目依赖资金来源,这可能会限制长期可持续性。最后,第一民族人民和社区的参与通常只发生在实施期间,而不是整个方案的发展。未来的计划应该嵌入到一个互联的护理系统中,并与现有的政策和资金流挂钩,以确保长期的生存能力。方案应由第一民族社区管理和评估,以进一步确保方案是可持续的,旨在满足社区需求。
    BACKGROUND: Ear and hearing care programs are critical to early detection and management of otitis media (or middle ear disease). Otitis media and associated hearing loss disproportionately impacts First Nations children. This affects speech and language development, social and cognitive development and, in turn, education and life outcomes. This scoping review aimed to better understand how ear and hearing care programs for First Nations children in high-income colonial-settler countries aimed to reduce the burden of otitis media and increase equitable access to care. Specifically, the review aimed to chart program strategies, map the focus of each program against 4 parts of a care pathway (prevention, detection, diagnosis/management, rehabilitation), and to identify the factors that indicated the longer-term sustainability and success of programs.
    METHODS: A database search was conducted in March 2021 using Medline, Embase, Global Health, APA PsycInfo, CINAHL, Web of Science Core Collection, Scopus, and Academic Search Premier. Programs were eligible or inclusion if they had either been developed or run at any time between January 2010 to March 2021. Search terms encompassed terms such as First Nations children, ear and hearing care, and health programs, initiatives, campaigns, and services.
    RESULTS: Twenty-seven articles met the criteria to be included in the review and described a total of twenty-one ear and hearing care programs. Programs employed strategies to: (i) connect patients to specialist services, (ii) improve cultural safety of services, and (iii) increase access to ear and hearing care services. However, program evaluation measures were limited to outputs or the evaluation of service-level outcome, rather than patient-based outcomes. Factors which contributed to program sustainability included funding and community involvement although these were limited in many cases.
    CONCLUSIONS: The result of this study highlighted that programs primarily operate at two points along the care pathway-detection and diagnosis/management, presumably where the greatest need lies. Targeted strategies were used to address these, some which were limited in their approach. The success of many programs are evaluated as outputs, and many programs rely on funding sources which can potentially limit longer-term sustainability. Finally, the involvement of First Nations people and communities typically only occurred during implementation rather than across the development of the program. Future programs should be embedded within a connected system of care and tied to existing policies and funding streams to ensure long term viability. Programs should be governed and evaluated by First Nations communities to further ensure programs are sustainable and are designed to meet community needs.
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  • 文章类型: Journal Article
    背景:鱼类和海鲜在提高因纽特人努南加特的粮食安全方面发挥着重要作用。因此,本范围审查旨在探讨(1)在与鱼类和海鲜与粮食安全相关的障碍和途径相关的文献中广泛探索了哪些主题和/或主题;(2)研究,政策,和行动差距存在;(3)渔业目前如何促进粮食安全。
    方法:使用六个数据库对同行评审的文章进行了系统搜索。文章由两名独立审稿人筛选。符合条件的研究包括在因纽特人努南加特进行的初步研究,探索鱼类和海鲜在粮食安全中的作用。
    结果:共纳入31篇文章进行综述。总的来说,我们发现渔业可以通过直接途径影响粮食安全(例如,食用鱼类以获取营养),并通过间接途径,如增加家庭购买力(例如,通过就业)。研究表明,与野生动植物和渔业管理有关的政策需要与粮食和卫生政策相结合,以更好地解决因纽特人努南加特的粮食不安全问题。
    结论:未来的研究需要对鱼类和海鲜收获和/或参与商业渔业缓解家庭粮食不安全的明确机制建立更有力的理解。
    Fish and seafood play an important role in improving food security in Inuit Nunangat. Therefore, this scoping review aims to explore (1) what topics and/or themes have been widely explored in the literature related to barriers and pathways linking fish and seafood to food security; (2) where research, policy, and action gaps exist; and (3) how fisheries currently contribute to food security.
    A systematic search of peer-reviewed articles was conducted using six databases. Articles were screened by two independent reviewers. Eligible studies included primary research conducted in Inuit Nunangat that explored the roles of fish and seafood in food security.
    Thirty-one articles were included for review. Overall, we found that fisheries can influence food security through direct pathways (e.g., consuming fish for nutrition), and through indirect pathways such as increasing household purchasing power (e.g., through employment). Research indicated that policies relating to wildlife and fisheries management need to be integrated with food and health policies to better address food insecurity in Inuit Nunangat.
    Future research is needed to establish a more robust understanding of the explicit mechanisms that fish and seafood harvest and/or the participation in commercial fisheries alleviates household food insecurity.
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  • 文章类型: Journal Article
    背景:因纽特人努南加特和阿拉斯加的粮食安全学术研究经常采用联合国粮食及农业组织对粮食安全的工作定义和西方对“粮食安全”的概念。然而,2014年,因纽特人北极圈理事会(ICC)的阿拉斯加分支机构表示,学术和政府间的定义和理解很重要,但不是我们所说的粮食安全。该组织随后制定了自己的概念和定义:阿拉斯加因纽特人粮食安全概念框架(AIFSCF),它在2020年得到了ICC-加拿大的非正式同意。
    目的:该协议建立了一种审查策略,以检查学术研究如何很好地反映因纽特人对粮食安全的概念化和理解,如AIFSCF所述。
    方法:审查结构和报告将根据系统证据综合(ROSES)指南的修改后的重新申报标准完成。全面的搜索策略将用于查找Medline的同行评审研究,Scopus,WebofScience以及北极和南极地区(EBSCO)数据库。双审稿人筛选将在摘要中进行,title,全文阶段。不同的研究方法(定性,定量,和混合方法)将被纳入审查,关于条款确定粮食安全驱动因素的条件。一个先验编码框架将由单个审阅者应用,以提取有关出版物特征的数据,方法和文章目的。然后,演绎主题内容分析将确定文献中提供给AIFSCF确定的粮食安全驱动因素和维度的频率和优先级。
    BACKGROUND: Academic research on food security in Inuit Nunangat and Alaska frequently adopts the Food and Agriculture Organization of the United Nations\' working definition of food security and Western conceptualisations of what it means to be \'food secure\'. However, in 2014, the Alaskan branch of the Inuit Circumpolar Council (ICC) stated that academic and intergovernmental definitions and understandings \'are important, but not what we are talking about when we say food security\'. The organisation subsequently developed its own conceptualisation and definition: the Alaskan Inuit Food Security Conceptual Framework (AIFSCF), which in 2020 received informal assent by ICC-Canada.
    OBJECTIVE: This protocol establishes a review strategy to examine how well academic research reflects Inuit conceptualisations and understandings of food security, as outlined in the AIFSCF.
    METHODS: Review structure and reporting will be completed according to adapted RepOrting standards for Systematic Evidence Syntheses (ROSES) guidelines. A comprehensive search strategy will be used to locate peer-reviewed research from Medline, Scopus, Web of Science and the Arctic and Antarctic Regions (EBSCO) databases. Dual reviewer screening will take place at the abstract, title, and full-text stages. Different study methodologies (qualitative, quantitative, and mixed methods) will be included for review, on the proviso that articles identify drivers of food security. An a priori coding framework will be applied by a single reviewer to extract data on publication characteristics, methods and article aims. Deductive thematic content analysis will then identify the frequency and precedence afforded within literature to the drivers and dimensions of food security identified by the AIFSCF.
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  • 文章类型: Review
    国家因纽特人战略研究重点是推进因纽特人治理研究,增加对数据的所有权和能力建设。响应因纽特人在研究中自决的呼吁,学术研究人员应在研究中考虑文化安全,并推广因纽特人主导的方法。
    本范围审查整理了2010年至2022年加拿大因纽特人社区公共卫生研究的学术文献。对因纽特人社区公共卫生研究中使用的方法进行了严格评估,检查了文化安全性和因纽特人协调方法的使用。描述性和分析性数据汇总在表格和数字中。通过主题分析对知识用户在研究过程中的参与度进行了分析。
    356篇文章符合纳入标准。发表的大部分研究都是关于营养和心理健康的,很少有倡议报告转化为推广方案。几乎所有发表的研究都是以疾病或缺陷为重点的,并且基于生物医学范式,特别是在毒理学方面,孕产妇健康和慢性病。近年来,使用非殖民化镜头并专注于复原力的参与性研究越来越多。虽然一些定性研究提到因纽特人的方法,并让社区参与研究过程,大多数定量研究在文化上并不安全。总的来说,社区参与仍处于共同设计研究方案和干预措施的早期阶段.关于治理和数据所有权的讨论是有限的。近年来,关于这些问题的讨论正在兴起。知识用户能力建设仅限于对常规数据收集方法进行简要培训。
    发表的公共卫生研究的最后十年没有回应国家因纽特人研究战略。参与式研究正在取得进展,但尚未充分发挥其潜力。从生物医学到非殖民化方法的转变正在缓慢发生,尚未接受这种范式转变的公共卫生研究人员应该这样做。
    The National Inuit Strategy on Research focuses on advancing Inuit governance in research, increasing ownership over data and building capacity. Responding to this call for Inuit self-determination in research, academic researchers should consider cultural safety in research and ways to promote Inuit-led methods.
    This scoping review collated academic literature on public health research in Inuit communities in Canada between 2010 and 2022. A critical assessment of methods used in public health research in Inuit communities examined cultural safety and the use of Inuit-attuned methods. Descriptive and analytical data were summarised in tables and figures. Knowledge user engagement in the research process was analysed with thematic analysis.
    356 articles met the inclusion criteria. Much of the published research was in nutrition and mental health, and few initiatives reported translation into promotion programmes. Almost all published research was disease or deficit focused and based on a biomedical paradigm, especially in toxicology, maternal health and chronic diseases. Recent years saw an increased number of participatory studies using a decolonial lens and focusing on resilience. While some qualitative research referred to Inuit methodologies and engaged communities in the research process, most quantitative research was not culturally safe. Overall, community engagement remained in early stages of co-designing research protocols and interventions. Discussion on governance and data ownership was limited. Recent years saw emerging discussions on these issues. Knowledge user capacity-building was limited to brief training on conventional data collection methods.
    The last decade of published public health research has not responded to the National Inuit Strategy on Research. Participatory research is gaining ground, but has not reached its full potential. A shift from biomedical to decolonised methods is slowly taking place, and public health researchers who have not yet embraced this paradigm shift should do so.
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