Indigenous food sovereignty (IFS) has the potential to reconnect Indigenous peoples in Canada to their food systems, reduce health problems and improve food security. Using PRISMA-ScR guidelines to search Medline, Web of Science, Embase and Cabi databases, this review sought to explore the characteristics of IFS promotion and the food environments involved through food and nutrition interventions in Indigenous communities in Canada. Data from 30 relevant studies published between 2004 and 2022 were included, analysed and synthesised using a thematic approach based on key IFS principles and a food environment typology. Most studies were conducted in urban contexts, mainly in provinces with the largest Indigenous populations. Local descriptions of IFS showed conceptual and operational similarities. Among the four key principles of IFS, the principle of participation was the most reported. Gardening, farming, hunting, fishing and gathering were the main food activities used to operationalise IFS in traditional and cultivated food environments. Several IFS facilitators and barriers were identified. The IFS movement that emerged from the literature in Canada advocates for a healthy and sustainable food system based on traditional beliefs and controlled by communities to ensure wellbeing and food security. This review provides evidence of converging visions for food autonomy despite the heterogeneity of Indigenous nations in Canada.

During the COVID-19 pandemic, Sweden adopted a recommendation-based approach rather than strict lockdowns. This approach relies on public willingness to adhere to guidelines and motivations for prosocial behaviour. This study aimed to explore the motivations behind adherence or non-adherence to COVID-19 recommendations in Sweden. Semi-structured interviews were conducted in 2022 with 20 participants aged 26 to 63, all residing and working in Stockholm. The interviews were conducted via online platforms, Teams and Zoom, transcribed and analysed using content analysis. The analysis yielded two overarching themes that motivated adherence or non-adherence, and derived from six categories: (i) Social pressure and the desire to appear prosocial, (ii) Embracing a new reality as a means to return to normalcy, (iii) The absence of punitive measures for non-adherence, (iv) Creating safe environments and circumventing the system, (v) Negotiating which recommendations to follow and (vi) Diminished adherence over time. Adherence to public health recommendations was driven by social pressure and a desire to protect loved ones, often requiring personal sacrifices and behavioural adjustments. Conversely, non-adherence stemmed from a sense of autonomy, mental well-being preservation and tiredness, highlighting the challenges of sustaining compliance over time.

Safe drinking water is key to individual and community health. Water safety is often evaluated based on whether or not a community's drinking water meets the quality standards specified by a governing authority. These water quality standards address many microbial and chemical water safety risks but may not capture risks that are difficult to quantify or community-specific needs and preferences. Water safety planning, first introduced by the World Health Organization, is a more holistic approach that aims to integrate water system stakeholders, system mapping, hazard identification and matrices to better characterise risk. In this study, we documented previous efforts to apply water WSPs in Arctic jurisdictions and evaluated existing risk scoring systems for potential application to Nunavut, an Arctic territory in Canada. The observations from the evaluation informed the development of a preliminary WSP framework for Nunavut which considers both past frequency and the existing hazard barriers in place when determining the likelihood score.

Sensory impairments, including hearing and vision loss, are common in older adults and can affect quality of life. This study examines the integration of hearing and vision assessments in preventive home visits (PHVs) for older adults in the Faroe Islands, comparing outcomes between urban and rural settings. To evaluate the feasibility of including sensory assessments in PHVs and compare sensory measurements between Tórshavn (urban) and rural districts. A cross-sectional study with 175 participants aged 76 was conducted in Tórshavn and five rural areas. Data included demographics, self-assessments, and clinical evaluations using standardized tools. Visual impairments were slightly more prevalent in rural areas, while hearing impairments showed no significant differences. Discrepancies between self-reported and measured impairments emphasized the importance of objective assessments. Sensory acreenings during PHVs improved early detection and highlighted inequities in access to specialized services. Integrating sensory assessments in PHVs is feasible and beneficial, adressing disparities between urban and rural areas. These screenings support equitable healthcare and early intervention, promoting better quality of life for older adults across diverse settings.

The Arctic region, characterised by its remote and geographically challenging environment, is home to predominantly Indigenous populations who experience significant healthcare disparities compared to urban counterparts. This paper synthesises evidence on the persistent challenges in delivering healthcare in the Arctic, including geographical remoteness, healthcare personnel shortages, and cultural and language barriers. Telehealth emerges as a crucial solution, offering a nuanced approach to overcoming physical and systemic barriers. We review current implementations of telehealth in the Arctic, highlighting successful adaptations to local cultural contexts and technological limitations. By integrating a patient-centred approach, infrastructure readiness, and relevant telehealth services, a holistic healthcare delivery model tailored for the Arctic environment is proposed. New type of technologies is also proposed to enhance remote care possibilities. This paper underscores the need for collaborative efforts in research, policy making, and healthcare provision to ensure the sustainability and effectiveness of health services in the Arctic, aiming to close the gap in health equity. Key references from seminal works and recent studies provide a foundation for the discussions and recommendations presented.

This study aimed to 1) describe the prevalence of Adverse Childhood Experiences (ACE) in relation to the type of substance used (alcohol or cannabis) among adults seeking treatment for Substance Use Disorder (SUD) in Greenland, and 2) examine whether an association exists between ACE and the type of substance used (alcohol and/or cannabis). The analysis was conducted using register data from individuals receiving SUD treatment in Greenland between 1 June 2020 to 31 December 2022 ( = 1037). The results showed a higher prevalence and a greater variety of ACE among women compared to men. Among men, no significant associations were found between ACE and the substance categories. However, among women, unstable conditions in the childhood home were associated with high use of either alcohol or cannabis. Additionally, high cannabis use was significantly associated with parent(s) with cannabis abuse and physical abuse for women. No cumulative effect of the number of ACE, and any type of substance abuse was found. Growing up with parents with alcohol problems emerged as the most frequently reported ACE for both sexes (reported by 74.6% of women and 62.7% of men).

Country foods (i.e. wild traditional food) are associated with improved nutrition for northern populations. In response to community concerns, a project was implemented from 2019 to 2021 in the Sahtú region, Northwest Territories, Canada, to: 1) analyse nutrition biomarkers (vitamins A, B1, B2, B6, B12, D, E, folate, P, Na) in blood samples, in order to assess nutritional status and identify nutrient deficiencies, and 2) use a survey to document how access to country foods may improve food security in the community of Tulı́t'a. Findings from the nutritional biomarker assessments (n = 128) indicated that 94% of participants experienced clinical vitamin D deficiency (<20 ng/L of plasma 25-hydroxy-vitamin D3) and 9% had folate deficiency (<8.7 nmol/L total folate). In the previous 12 months, 71% of participants did not always have money to get more food when needed, but 92% of participants said they were not left hungry. Country foods were used to increase the quality or quantity of the diet. Increasing country food consumption, such as fatty fish and large game meat and organs could mitigate the vitamin D and folate deficiencies. Policies should be implemented to improve food security in the North by facilitating access to country food.

The perspectives of Yukon's nurses and physicians can determine what might mitigate burnout and strengthen the response to the COVID-19 pandemic and/or future health emergencies. The study was conducted in the Yukon Territory, Canada in two phases: completion of the Copenhagen Burnout Inventory (CBI), and in-depth oral interviews. This paper will discuss the results of the interviews. A hybrid thematic analysis of 38 interviews revealed five primary themes: personal impacts; work-related effects; client effects/patient care; perceptions of the territorial response to COVID-19; and recommendations for future pandemics. The loss of social connection and burden of childcare contributed to personal burnout. Stressful work environments, increased workload, limited resources and feeling undervalued contributed to job stress and work-related burnout. Healthcare workers ascribed meaning to their roles in improving community health , which may have mitigated client-related burnout. Systemic change is needed to ensure the healthcare workforce can maintain service delivery and respond to future pandemics. The response to COVID-19 was mounted on the backs of frontline healthcare workers who made personal sacrifices and worked to exhaustion to serve their patients. As the healthcare system and its workforce recover from the pandemic, the calls to support healthcare workers must be answered.

We aimed to characterise the medical and social complexities experienced by Inuit children and their families from Nunavut who were cared for at a general paediatrics clinic at an urban tertiary-level hospital located in Eastern Ontario. A retrospective chart review of this cohort was completed between 2016 and 2019. Two independent reviewers extracted data from charts. The cohort included 36 children, median (interquartile range [IQR]) age 13.5 (6.8, 28.2) months and full age range (1,140) months. They had a median (IQR) of 12.5 (7.8, 18.0) comorbidities, 11 (8.0, 14.2) healthcare services accessed and 3 (2, 5) medications. Almost all children (97.2%) had been hospitalised and the median number of days spent as an inpatient was 31.5. With respect to social complexity variables, 51.9% of clinical interactions (14 of 27 charts reviewed) at any point would have benefitted from an interpreter and 96.7% of 30 patient escorts/companions showed evidence of having difficulty in coping with homesickness. Improving social history taking and integrating screening for social determinants of health within the clinic should be considered. A dedicated interdisciplinary team approach focused on integrative care could be an effective method to improve communication and collaboration between service providers and with Inuit children and their families to reduce systemic health and social inequities.

Children from circumpolar regions must travel long distances to southern tertiary care centres for specialised care. While there are initiatives underway to support care closer to home, medical travel remains a necessity for many families. The Aakuluk clinic has been operating since 2019 at a tertiary hospital in Ottawa, Canada, to provide care to children from Nunavut. The clinic team includes nurse case managers, physicians, social workers, interpreters, and several community partners. This project aimed to identify the strengths and the challenges of the clinic from the perspectives of parents and healthcare providers. The study was conducted in collaboration with healthcare professionals and community members and was guided by Inuit research approaches. Fifty-one participants (parents and healthcare providers) in Nunavut and Ottawa were interviewed. The main strengths and challenges of the clinic that were reported are related to the following themes: access to holistic care, supporting the role of Inuit professionals as part of the care team, and resources needed to continue offering programmes such as Aakuluk to Inuit families. From the perspectives of parents and healthcare providers, there are several components of the Aakuluk model that can be considered when developing services for Inuit families in other tertiary care centres.

Task shifting can improve access, availability, efficiency, and quality of health services in under resourced settings. Task shifting can occur formally or informally within health professions, between health professions, between support staff and health professions, or between lay community members and health professionals. There are currently thousands of Indigenous peoples in Canada's high Arctic, living in remote communities, north of the 60 parallel with limited access to basic medical services. In Nunavut, 25 remote fly-in communities exist in some of the most sparsely populated and harshest conditions on earth. Diminished access to or absence of basic health services such as diagnostic imaging and staff resources in remote communities can have a detrimental effect on patient care, and health outcomes. The existence of a community based diagnostic x-ray training program using a task shifting model addresses a gap in quality and access to services and subsequent treatment for community residents in this region.

In northern Canada, medical travel - the movement of patients to a larger centre to access healthcare services outside their home community - is a dominant feature of the healthcare system. This qualitative study explored the medical travel experiences of Gwich'in living above the Arctic Circle in the Gwich'in Settlement Area in Northwest Territories (NT). Data collection in 2020 comprised storytelling sessions with 10 Gwich'in medical travellers (6 female, 4 male). Using inductive and deductive methods with continual critical reflexivity, and guided by Gwich'in values, concerns about access to healthcare were found to be at the heart of each story. A broad conceptualisation of access was applied to understand and interpret the results according to six dimensions: accessibility, availability, affordability, adequacy, acceptability, and awareness. Situated within a context of colonialism, structural inequities and other factors relevant across the Circumpolar North, the results suggest that the NT medical travel policy framework provides only partial access to care. This article illustrates a need for healthcare and other government systems to think about policy and programmes in a more wholistic, equitable and relationship-centred way, which would help not only to bridge distances across geography, but also between peoples.

Rates of respiratory tract infections for children living in remote First Nations communities in the Sioux Lookout Zone in Northwestern Ontario are elevated and associated with poor indoor environmental quality including high exposures to endotoxin and serious dampness and mould damage. The studies also revealed a high prevalence of cigarette smoking and most houses have wood stoves, of variable quality. Depending on structure, polycyclic aromatic hydrocarbons (PAH) are carcinogens, immunotoxins and/or inflammatory mediators that are byproducts of the incomplete combustion of organic materials. Indoor sources of PAHs include tobacco smoke, cooking, and burning wood and/or fossil fuels for house heating. Twelve PAHs were measured in the <300 µm fraction of settled house dust by GC-MS in 59 houses. Nine PAHs were detected in all 59 houses, and median concentrations of individual PAHs measured ranged from 66 to 804 ng/g. PAHs associated with environmental tobacco smoke and with wood smoke dominated the PAH profile. Limiting tobacco smoking indoors and upgrading to low emission airtight wood stoves would improve indoor air quality and the respiratory health of children in this remote region of Ontario.

Patients with psychotic disorders exhibit elevated mortality and morbidity rates compared to the general population primarily due to comorbid somatic diseases. This study aims to describe the prevalence of selected risk factors and somatic disorders among psychiatric patients with a diagnosis of psychotic disorder. Material and methods: Data were retrieved from Greenland's nationwide electronic medical record. The study population consists of 104 patients diagnosed with a psychotic disorder, encompassing schizophrenia or schizotypal and delusional disorders, residing in Nuuk. The study population comprised 104 patients (68 males and 36 females) with a mean age of 40 years. More than 80% were daily smokers, and 68% had harmful use of cannabis. More than half had dyslipidemia (any imbalance in lipids), while over a quarter were classified as obese with body mass index of 30 kg/m2 or higher. Eighteen percent had hypertension, and six percent suffered from diabetes. This study revealed a notable prevalence of risk factors for somatic diseases, particularly smoking and cannabis use among patients with schizophrenia in Nuuk, indicating that a high prevalence of somatic diseases might be expected as the population gets older and the risk of developing somatic diseases becomes greater. Increased focus on monitoring and preventing those as part of the health care is recommended.

This study aims to estimate the prevalence of cardiovascular disease, kidney disease, and other selected diseases including hypertension, atrial fibrillation, asthma, chronic obstructive lung disease, osteoarthritis, osteoporosis, psoriasis and depression among Greenlanders living in Nuuk with and without type 2 diabetes (T2D). The study was designed as a cross-sectional case-control study based on data from the electronic medical record (EMR) in Greenland. Persons with a registered T2D diagnosis in EMR and residence in Nuuk ( = 435) were included. The prevalence of cardiovascular disease was 17.9% among persons with T2D and significantly higher compared to the control group (10.1%). In addition, our results showed a significantly higher prevalence of ischaemic heart disease, hypertension, heart failure, atrial fibrillation, osteoarthritis and psoriasis among persons with T2D compared to the control group.Our study found a higher prevalence in five out of 10 selected diseases in regularly followed persons with T2D in Nuuk compared to unselected controls. This enlightens the importance of a broad multifaceted approach in combination of changing primary health care to focus on early detection of controllable risk factors and chronic conditions care in Artic Greenland.

This study examines trends in health, well-being, and risk behaviours among high school students in Finnmark, Norway, and compares them with the national average. Data were drawn from the Ungdata survey, covering three waves between 2014 and 2023. The sample included 6,084 high school students in Finnmark and 254,048 students nationwide. MANOVA with polynomial contrasts assessed linear trends among students in Finnmark, and MANOVA with difference contrast tested pairwise differences between Finnmark and national samples. Trend analysis revealed that 26 out of 63 variables, including digital use, school-related variables, antisocial behaviours, and depressive thoughts, increased over time, while 25 variables, such as physical activities, local environment, and bullying remained unchanged. Relationships with parents and substance use improved. Pairwise comparisons showed worse outcomes for Finnmark students in 43 and 41 out of 63 variables across waves, except for substance use and antisocial behaviours. This study indicates limited improvement in health and risk behaviours among high school students in Finnmark. Public health policies tailored to adolescents in Finnmark should focus on mental health services, promoting physical activity, and reducing antisocial behaviours and bullying. Further research should explore Finnmark's multiethnic context, including the Sámi and Kven populations.

The Arctic Monitoring Assessment Program Human Health Assessment report 2021 presents a summary of the presence of environmental contaminants in human populations across the circumpolar Arctic and related health effects. Based on this report the objective of this paper is giving a short summary of the health effects related to the current level of persistent organic pollutants (POP) and metals. The overall key findings are as follows: i. metals and POP (polychlorinated biphenyls, per- and polyfluoroalkyl substances (PFAS)) in the Arctic have known adverse health impacts on humans especially on developing foetuses and children. Lifestyle, diet and nutrition and genetics influence the risk; ii. POP and metals negatively impact the brain and immune system, increasing the risk of childhood obesity, type 2 diabetes later in life and negatively affect foetal growth and development: iii. marine food omega-3 fatty acids can diminish adverse effects of high mercury exposure on cardiovascular and neurological outcomes; iv. the interaction of genetic, lifestyle, nutrition status and contaminants can influence the risk of cancer, metabolic disease, nervous system disorders, disruption of reproduction and foetal and child growth. Future investigations must focus on genetically and effect modifiers and mixtures of POP exposures to explore the effect of chemical interaction on health outcomes.

Self-sampling for oncogenic human papillomavirus (HPV) offers an alternative to the Papanicolaou (Pap) test for cervical cancer screening. We aimed to assess Inuit women's cervical cancer screening preferences. Eligible Inuit women aged between 25 and 65 in 2022-2023 were given the choice between self-sampling, sampling performed solely by the nurse or the Pap test and were administered a questionnaire on screening preference. Thematic analysis was performed on qualitative data collected through a questionnaire asking if and why women prefer HPV self-sampling or the Pap test for cervical cancer screening. A total of 103 women agreed to participate. Of these, 12 (11.6%) chose to have the nurse perform the HPV test rather than self-collect. Among the 91 left for analysis, 80.2% (73) of women who self-sampled preferred self-sampling to the Pap test and 82.4% (75) would prefer self-sampling in the future. The most common reason given was comfortability (54.9%) and privacy (25.2%). Participants that did not prefer self-sampling ( = 7) expressed desire for a physical exam by the nurse or a lack of confidence in their ability to collect the sample. Eleven either did not indicate a preference, were unsure, or indifferent to cervical cancer screening method. This represents an improvement from a previously conducted study in 2012 among the same population who reported a preference for HPV self-sampling of 56%.

In Arctic populations, a primary route of exposure to contaminants is through the diet. The health risks associated with these exposures can be characterised by conducting human health risk assessments. However, while there is guidance from many international and national organisations, there are limited examples of human health risk assessment in the Arctic. The 2022 AMAP Human Health Assessment Report was the first AMAP report to describe, in one place, the utility of food-based, dietary intake-based and human tissue-based contaminant data in estimating risk. Here, we present available tools, case studies and challenges associated with conducting human health risk assessments in the Arctic. Future efforts in the Arctic should be able to use this information to best interpret human exposure to contaminants in a risk-based context.

Comprehensive evaluation of cancer screening activities based on individual experiences is urgently needed to address the burden of cancer among Métis people. In this co-designed and co-led study, a cancer screening questionnaire developed for Métis people to evaluate their cancer screening histories and to explore barriers and facilitators to cancer screening was used. Adult Métis Albertans were invited to participate in the anonymous survey through a multi-modal strategy used for community consultations. Descriptive analyses compared responses between regions, age groups and geographic locations. In total, 370 participants who identified as Métis consented and contributed responses between 12 September and 2 December 2022. Female respondents reported higher rates of cervical and breast cancer screening (>94%) and lower rates of colorectal cancer screening (67-78%). Most of the barriers and facilitators were rated as very important, especially access to reliable and accurate information on screening, risks and benefits of cancer screening, explanation of the test results or procedures, trust in their health care provider(s) and health care system and access to a primary health care provider. This study fills a crucial gap that can inform targeted interventions to increase cancer screening awareness and rates among Métis Albertans and reduce their cancer burden.