OBJECTIVE: The purpose of this study was to explore the perspectives of Indigenous adults on consuming beverages with non-nutritive sweeteners.
METHODS: In this work, we used a community-based, participatory design in partnership with National Indigenous Diabetes Association, Four Arrows Regional Health Authority, and Fearless R2W. We conducted 74 qualitative interviews with Indigenous adults living in Manitoba, including Island Lake First Nations (n=39), Flin Flon (n=15), and the North End neighbourhood of Winnipeg (n=20). Data were indexed in NVivo, and transcripts were analyzed thematically.
RESULTS: Participants exclusively discussed beverages with non-nutritive sweeteners (BNNSs) as an alternative to regular pop or sugary drinks, which were widely available, accessible, and consumed. Why or how BNNSs were viewed as an alternative comprised 3 subthemes: an alternative for health reasons; divergent taste preferences; and an alternative with mysterious but negative health effects. Participants who reported regular consumption of BNNSs largely described consuming them to manage type 2 diabetes. Fewer participants discussed BNNS as a means of weight management or as a preventive health behaviour. Participants who did not report regular BNNS consumption described not liking the taste of BNNSs. Finally, many participants described negative health impacts of consuming BNNSs, and specifically aspartame, although few articulated what those negative impacts were.
CONCLUSIONS: Divergent perspectives among Indigenous adults regarding the health implications of consuming BNNSs may reflect ongoing scholarly debates. These findings have implications for the prevention and dietary management of type 2 diabetes in Indigenous communities.

The prevalence of gestational diabetes mellitus (GDM) is dramatically higher in Indigenous compared with non-Indigenous populations in Canada. In this scoping review, we synthesize the existing literature regarding GDM among Indigenous peoples in Canada, including social and structural determinants that contribute to its higher prevalence in this population. Seven themes related to GDM in Indigenous populations emerged from a synthesis of the 44 included articles. The themes were GDM prevalence and trends; risk factors; screening; diagnosis and treatment; maternal outcomes; child outcomes; systemic barriers; and Indigenous perceptions, concerns and health behaviours. The findings from this review suggest culturally appropriate health care and improved screening practices may help to mitigate the high prevalence and poor health outcomes associated with GDM in Indigenous communities across Canada. More community-driven, participatory research that includes the social determinants of health and a culturally safe lens is required to assess the effects and reduce the impact of GDM in this population.

Background. Calls to Action outlined by the Truth and Reconciliation Commission (TRC) necessitate critical reflection and urgent action to improve occupational therapy with Indigenous Peoples in Canada. Purpose. This scoping review aims to synthesize the literature related to Indigenous Peoples and occupational therapy practice, research, and education in Canada, and appraise empirical research using adapted Indigenous Health Research criteria. Method. A scoping review was conducted across published academic and grey literature with additional appraisal of empirical studies. Findings. A total of 6 themes emerged from 47 articles spanning from 1970 to 2020: recognizing colonial history, responding to the TRC, participating in personal and professional reflection, identifying Western ideologies, engaging in partnership in practice, and recognizing social and systemic barriers. Empirical studies met appraisal criteria inconsistently. Implications. To meaningfully engage in reconciliation, the profession of occupational therapy must generate Indigenous-led and relevant research, critically transform curricula, and address tensions between themes in practice.

Comprehensive school-based nutrition interventions offer a promising strategy to support healthy eating for First Nations children. A targeted strategic review was performed to identify nutrition interventions in 514 First Nation-operated schools across Canada through their websites. Directed content analysis was used to describe if interventions used 1 or more of the 4 components of the Comprehensive School Health (CSH) framework. Sixty schools had interventions. Nearly all (n = 56, 93%) schools offered breakfast, snack, and (or) lunch programs (social and physical environment). About one-third provided opportunities for students to learn about traditional healthy Indigenous foods and food procurement methods (n = 18, 30%) (teaching and learning) or facilitated connections between the school and students\' families or the community (n = 16, 27%) (partnerships and services). Few schools (n = 10, 17%) had a nutrition policy outlining permitted foods (school policy). Less than 1% (n = 3) of interventions included all 4 CSH components. Results suggest that most First Nation-operated schools provide children with food, but few have nutrition interventions that include multiple CSH components. First Nation-operated schools may require additional financial and (or) logistical support to implement comprehensive school-based nutrition interventions, which have greater potential to support long-term health outcomes for children than single approaches.

The food security crisis and disproportionately high burden of dietary related disease amongst northern Indigenous populations in Canada continues to be a troubling reality with little sign of improvement. The Government of Canada is responding by developing programs to support local food initiatives for northern isolated communities. While such investments appear commendable, the impact of local food harvesting to improve food security has yet to be determined. While there are clear nutritional and cultural benefits to traditional food sources, communities face considerable barriers acquiring it in sufficient amounts because of historically imposed lifestyle changes that have increased food insecurity rates. This study responds by providing a novel multidisciplinary approach that draws from firsthand experiences working with First Nations community members in a remote subarctic region in northwestern, Ontario, to estimate their community\'s total food requirement and the amount of wild animal food sources needed to sustain yearly food intake. This transferrable energy demand approach will be critical for policy makers to put into perspective the amount of wild food needed to have an impact on food security rates and ultimately improve dietary related diseases. Novelty: Provide government policy makers information about current harvest yields in a remote northern First Nation to understand the potential contribution of traditional food to improve local food security. Provide Indigenous communities a means to assess local food resources to measure the caloric contributions of traditional foods toward household food security.

The Inuit in Greenland have gone through dramatic lifestyle changes during the last half century. More time is spent being sedentary and imported foods replaces traditional foods like seal and whale. The population has also experienced a rapid growth in obesity and metabolic disturbances and diabetes is today common despite being almost unknown few decades ago. In this paper, we describe and discuss the role of lifestyle changes and genetics for Inuit metabolic health. Novelty: Cardiometabolic disease risk has increased in Greenland. Lifestyle changes and possibly gene-lifestyle interactions play a role.

OBJECTIVE: Our aim in this study was to assess the impact of the Mobile Diabetes Telemedicine Clinic, which serves First Nations communities in British Columbia, on clients\' with diabetes condition and management.
METHODS: A travelling team visits approximately 120 sites annually. Assessment of persons with diabetes includes interview, physical exam, point-of-care laboratory (glycated hemoglobin, blood glucose, lipid profile, kidney profile) and retinal fundus photographs. Nurses provide education and lifestyle, medication and wellness recommendations. The endocrinologist reviews records and provides further recommendations to primary care providers. To assess the impact at second and later visits, compared with the immediately preceding visit, we measured mean changes in body weight, glycated hemoglobin, urinary albumin:creatinine ratio and estimated glomerular filtration rate, as well as changes in proportions of clients meeting targets for blood pressure, low-density lipoprotein cholesterol, medications, smoking and physical activity.
RESULTS: From 2012 to 2018, a total of 3,045 visits were completed by 1,056 clients with diabetes who attended on at least 2 occasions. Mean time since the preceding visit was 1.6 years. Mean change (after vs before) in glycated hemoglobin was 0.06 (95% confidence limit, -0.03 to 0.14), body weight 0.0 kg (-0.2 to 0.2), albumin:creatinine ratio 1.31 mg/mmol (0.27 to 2.35) and estimated glomerular filtration rate -4.8 mL/min (-6.2 to -3.4). The proportion of clients meeting both blood pressure targets (systolic <130 mmHg and diastolic <80 mmHg) increased from 25% at first visit to 33% at the second and 32% at the third or later visits (p<0.001, chi-square test). The proportion of those with low-density lipoprotein cholesterol of <2.0 mmol/L increased from 56% to 62% at the second visit and 69% at the third or later visits (p<0.001). The proportion of those taking renin-angiotensin-aldosterone system inhibitors or other antihypertensive agents and statins increased (p<0.001), and proportions decreased for smoking (p<0.001) and exercising ≥60 min/week (p=0.002).
CONCLUSIONS: Weight and diabetic control were stabilized. Most management practices showed improvement.

OBJECTIVE: Our aim in this study was to identify interventions that improve cultural safety for Indigenous people living with diabetes in the health-care setting, and their potential impact on patients and health-care professionals.
METHODS: Using a systematic approach, we conducted a rapid review of quantitative, qualitative and mixed studies between January 2000 and February 2018 in MEDLINE, Embase, Web of Science, ERIC, CINAHL and PsycINFO. Two reviewers independently identified, selected and reviewed studies relating to cultural safety in diabetes care for Indigenous populations in Canada, New Zealand, Australia and the United States.
RESULTS: Of the 406 studies identified, we retained 7 articles (2 strong quality, 5 moderate quality) for analysis. The included studies evaluated 3 main types of strategies to improve cultural safety: educating health professionals, fostering culturally safe practices by modifying clinical environments and integrating Indigenous health professionals in the workforce. Studies showed that culturally safe interventions had positive effects on clinical outcomes for patients, increased patient satisfaction and health professional confidence in providing care as well as patient access to health care.
CONCLUSIONS: Although based on a small number of studies, this review establishes moderate evidence that interventions to improve cultural safety can have positive effects on treatment of diabetes in Indigenous populations. Further research with stronger study designs should be conducted to further validate our conclusions.

La recherche en santé autochtone au Canada a été négligée dans le passé et qualifiée de problématique, notamment en raison du manque de collaboration avec les peuples autochtones. L\'Énoncé de politique des trois Conseils sur l\'éthique de la recherche avec des êtres humains décrit au chapitre 9 la conduite éthique de la recherche axée sur les Premières nations, les Inuits et les Métis. Les principes PCAP® des Premières nations (propriété, contrôle, accès et possession) soulignent l\'importance majeure de l\'engagement et de la gouvernance autochtones. En vue d\'assurer que les buts et les activités de la recherche développée soient réalisés en partenariat complet et significatif avec les peuples et les communautés autochtones, il est possible de faire appel à des méthodes de recherche participative communautaire (RPC) intégrant leur plein engagement. Les recherches utilisant des ensembles de données secondaires, telles que les données administratives sur la santé recueillies en routine, ne devraient plus être exclues de cette approche. Notre objectif était de décrire comment notre équipe de chercheurs universitaires, alliée à un organisme national de santé autochtone, a adapté les méthodes de RPC dans le cadre d\'un projet de recherche utilisant des données recueillies antérieurement pour examiner les lacunes dans la prestation de soins de fin de vie aux peuples autochtones en Ontario. Nous décrivons le processus d\'élaboration de ce partenariat de recherche et expliquons comment l\'intégration des principes de base et des processus de formation du savoir autochtones ont guidé cette collaboration. Notre partenariat de recherche, qui implique l\'adaptation de méthodes de RPC, illustre un processus d\'engagement qui pourrait guider d\'autres chercheurs désirant mener des recherches en santé autochtone à l\'aide de données déjà recueillies. Nous faisons aussi état d\'une entente de recherche transparente, négociée équitablement entre un organisme national de santé autochtone et des chercheurs, qui pourrait servir de cadre pour des collaborations de recherche similaires. Il est essentiel de s\'assurer que les perspectives autochtones soient au cœur des processus de recherche et qu\'elles soient reflétées dans ceux-ci lorsque des données administratives sur la santé sont utilisées.
Indigenous health research in Canada has a chequered past and has been identified as problematic and lacking in appropriate collaboration with Indigenous people. The Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans, Chapter 9 describes ethical conduct of research regarding First Nations, Inuit, and Métis Peoples. First Nations Ownership, Control, Access, and Possession (OCAP®) Principles highlight the necessity of Indigenous engagement and governance. To ensure that the aims and activities of the research being developed are in full and meaningful partnership with Indigenous peoples and communities, community-based participatory research (CBPR) methods provide a process in which full engagement is possible. Research utilizing secondary data sets, such as routinely collected health administrative data, should no longer be excluded from this approach. Our aim was to describe how our research team of academic researchers and a national Indigenous health organization adapted CBPR methods in a research project using previously collected data to examine end-of-life health care service delivery gaps for Indigenous people in Ontario. We describe the process of how we developed our research partnership and how grounding principles and Indigenous ways of knowing guided our work together. Through the adaptation of CBPR methods, our research partnership illustrates a process of engagement that can guide others hoping to conduct Indigenous health research using previously collected data. We also present a transparent research agreement negotiated equally by a national Indigenous health organization and research scientists, which can also be used as a framework for others wishing to establish similar research partnerships. Ensuring that Indigenous perspectives are central to and reflected in the research process is essential when using health administrative data.

Ce projet en application de connaissances a exploré la pertinence d\'une documentation en promotion de la santé élaborée pour une population autochtone nationale en vue de son utilisation dans une communauté autochtone urbaine du nord de l\'Ontario. Une approche décolonisée et communautaire de recherche-action participative faisant appel à l\'épistémologie tribale a été suivie pour former un groupe consultatif autochtone local et établir un partenariat avec le N\'Swakamok Native Friendship Centre. Deux groupes de discussion (n=8) composés d\'adultes autochtones et cinq entrevues individuelles avec des aidants autochtones soignant une personne atteinte de démence ont alimenté l\'analyse thématique qualitative. Quatre thèmes sont ressortis des données: (1) la nécessité d\'une compréhension commune des cultures autochtones et occidentales dans le cadre des soins de santé; (2) l\'amélioration de la communication interculturelle dans les discussions sur la santé; (3) l\'ancrage du matériel de promotion de la santé dans la culture, et (4) les stratégies autochtones de littératie en matière de santé et la sensibilisation aux maladies neurodégénératives. Considérant que les prestataires de soins de santé cherchent des moyens efficaces pour communiquer avec les peuples autochtones, il est important de fournir de l\'information pertinente localement et sur le plan culturel afin d\'améliorer l\'adoption et l\'efficacité chez ces populations.
This knowledge translation project explored the appropriateness of utilizing health promotion materials developed for a national Indigenous population with Indigenous people living in a northern Ontario urban community. A de-colonized, community-based participatory action research approach using tribal epistemology assisted in establishing a local Indigenous advisory group and a partnership with the N’Swakamok Native Friendship Centre. Two focus groups (n = 8) with Indigenous adults and five one-on-one interviews with Indigenous caregivers of a person with dementia informed a qualitative thematic analysis. Four themes emerged from the data: (1) the need for shared understandings of Indigenous and Western cultures in health care; (2) improving cross-cultural communication within health-related encounters; (3) grounding health promotion materials in culture; and (4) Indigenous health literacy strategies for dementia awareness. As health care providers search for effective ways to communicate with Indigenous people, it is important to deliver locally and culturally relevant information to improve uptake and effectiveness by Indigenous people.
Maanda enkiichigaadeg binda kenjigemgad gezhi nakaasang dibaajimowinan gaazhitoong giiwedinong anishinaabek endaajig nji. Enanchgwenzigwaa miinwaa N’swakamok Friendship Center maamwi giinaadmaadok nokiitmowaad wii maandonaa’aad waa nkwenmaagenjig. Niish we’aangizijig, kchi aak miinwaa enkiitaagejig gii nibwaachidook nenendamaawziwin nji wii rnkamwaad ge minodaapinigaadeg. Niiwin giibi zikaamgadoon ge naadmaagemgak. (1) Zhindawendaagwod nsastaadwin wiiteg Anishinaabe miinwaa Ewaabshkiiwed ezhi naagdawendiwaad; (2) Weweni wii ginoonding nokiitaageng; (3) Wii kinoomaading weweni dibaajimowinan waazhi giniwendizad bemaadzid; miinwaa (4) Anishinaabe ji nsastang enaabiisjigeng nenendamaawziwin nji. Epiichtaawaad bemiikgagejig wii mkamowaad gezhi ginoonaawaad Anishinaaben, kchi piitendaagwad weweni ji nsastamookiiwaad mii dash dani naawsek.