Gender and place influences on health risk perspectives in northern Canadian Aboriginal communities

Developing a better understanding of the factors underlying health and environmental risk perspectives has been the focus of significant research in recent years. Although many previous studies have shown that perspectives of risk are often associated with gender, sociocultural variables and place, our understanding of the relationship between these factors and risk remains equivocal. A research study was undertaken to develop better insights into the understanding and perspectives of various types of health risks in two sets of northern Canadian Aboriginal communities – the Yellowknives Dene First Nation communities of N’Dilo and Dettah in the Northwest Territories and the Inuit communities of Nain and Hopedale in Nunatsiavut. Gender was found to have a limited overall effect on risk perspectives, consistent with other studies that found no gender differences in communities stressed by multiple and concurrent risks. Nonetheless, subtle gender differences were seen in the qualitative responses, with women focusing more on community impacts and mitigating actions. Threats to ‘place-identity’ associated with changes in traditional lifestyle and connection to the land were strongly associated with risk perspectives. These results reinforce the need to be cautious in making assumptions about the complex effects of community and personal attributes, such as gender and gender relations, in assessing the factors underlying risk views and concerns. They also suggest the importance of gathering multiple types of data (both quantitative and qualitative) in order to fully assess the effects of both gender and place. Ultimately, understanding risk in a northern context requires recognizing the unique circumstances and identities of northern Aboriginal peoples

The more the better? A comparison of the information sources used by the public during two infectious disease outbreaks

Recent infectious disease outbreaks have resulted in renewed recognition of the importance of risk communication planning and execution to public health control strategies. Key to these efforts is public access to information that is understandable, reliable and meets their needs for informed decision-making on protective health behaviours. Learning from the trends in sources used in previous outbreaks will enable improvements in information access in future outbreaks. Two separate random-digit dialled telephone surveys were conducted in Alberta, Canada, to explore information sources used by the public, together with their perceived usefulness and credibility, during the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic (n = 1209) and 2009–2010 H1N1 pandemic (n = 1206). Traditional mass media were the most used information sources in both surveys. Although use of the Internet increased from 25% during SARS to 56% during H1N1, overall use of social media was not as high as anticipated. Friends and relatives were commonly used as an information source, but were not deemed very useful or credible. Conversely, doctors and health professionals were considered credible, but not consulted as frequently. The use of five or more information sources increased by almost 60% between the SARS and H1N1 surveys. There was a shift to older, more educated and more affluent respondents between the surveys, most likely caused by a decrease in the use of landlines amongst younger Canadians. It was concluded that people are increasingly using multiple sources of health risk information, presumably in a complementary manner. Subsequently, although using online media is important, this should be used to augment rather than replace more traditional information channels. Efforts should be made to improve knowledge transfer to health care professionals and doctors and provide them with opportunities to be more accessible as information sources. Finally, the future use of telephone surveys needs to account for the changing demographics of the respondents accessed through such surveys

Organizing risk: organization and management theory for the risk society

Risk has become a crucial part of organizing, affecting a wide range of organizations in all sectors. We identify, review and integrate diverse literatures relevant to organizing risk, building on an existing framework that describes how risk is organized in three ‘modes’ – prospectively, in real-time, and retrospectively. We then identify three critical issues in the existing literature: its fragmented nature; its neglect of the tensions associated with each of the modes; and its tendency to assume that the meaning of an object in relation to risk is singular and stable. We provide a series of new insights with regard to each of these issues. First, we develop the concept of a risk cycle that shows how organizations engage with all three modes and transition between them over time. Second, we explain why the tensions have been largely ignored and show how studies using a risk work perspective can provide further insights into them. Third, we develop the concept of risk translation to highlight the ways in the meanings of risks can be transformed and to identify the political consequences of such translations. We conclude the paper with a research agenda to elaborate these insights and ideas further

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Youth researching youth: benefits, limitations and ethical considerations within a participatory research process

Objectives. To examine the benefits, limitations and ethical issues associated with conducting participatory research on tobacco use using youth to research other youth. Study design. Community-based participatory research. Methods. Research on tobacco use was conducted with students in the K’àlemì Dene School and Kaw Tay Whee School in the Northwest Territories, Canada, using PhotoVoice. The Grade 9–12 students acted as researchers. Researcher reflections and observations were assessed using “member checking,” whereby students, teachers and community partners could agree or disagree with the researcher's interpretation. The students and teachers were further asked informally to share their own reflections and observations on this process. Results and conclusions. Using youth to research other youth within a participatory research framework had many benefits for the quality of the research, the youth researchers and the community. The research was perceived by the researchers and participants to be more valid and credible. The approach was more appropriate for the students, and the youth researchers gained valuable research experience and a sense of ownership of both the research process and results. Viewing smoking through their children's eyes was seen by the community to be a powerful and effective means of creating awareness of the community environment. Limitations of the approach were residual response bias of participants, the short period of time to conduct the research and failure to fully explore student motivations to smoke or not to smoke. Ethical considerations included conducting research with minors, difficulties in obtaining written parental consent, decisions on cameras (disposable versus digital) and representation of all participants in the final research product

Consultation and remediation in the north: meeting international commitments to safeguard health and well-being

Background . International commitments exist for the safeguarding of health and the prevention of ill health. One of the earliest commitments is the Declaration of Alma-Ata (1978), which provides 5 principles guiding primary health care: equity, community participation, health promotion, intersectoral collaboration and appropriate technology. These broadly applicable international commitments are premised on the World Health Organization's multifaceted definition of health. The environment is one sector in which these commitments to safeguarding health can be applied. Giant Mine, a contaminated former gold mine in the Northwest Territories, Canada, represents potential threats to all aspects of health. Strategies for managing such threats usually involve an obligation to engage the affected communities through consultation. Objective . To examine the remediation and consultation process associated with Giant Mine within the context of commitments to safeguard health and well-being through adapting and applying the principles of primary health care. Methods . Semi-structured interviews with purposively selected key informants representing government proponents and community members were conducted. Results . In reviewing themes which emerged from a series of interviews exploring the community consultation process for the remediation of Giant Mine, the principles guiding primary health were mapped to consultation in the North: (a) “equity” is the capacity to fairly and meaningfully participate in the consultation; (b) “community participation” is the right to engage in the process through reciprocal dialogue; (c) “health promotion” represents the need for continued information sharing towards awareness; (d) “intersectoral collaboration” signifies the importance of including all stakeholders; and (e) “appropriate technology” is the need to employ the best remediation actions relevant to the site and the community. Conclusions . Within the context of mining remediation, these principles form an appropriate framework for viewing consultation as a means of meeting international obligations to safeguard health

Our Way of Life: Importance of Indigenous Culture and Tradition to Physical Activity Practices

To challenge the current negative and disease-oriented view in the Western health science paradigm, researchers from the University of Alberta collaborated with the Yellowknives Dene First Nation’s Community Wellness Program in a participatory action research project that took a wellness- and strengths-based approach to explore physical activity. We worked with youth to develop participatory videos about physical activity, which sparked community conversations on health promotion, community wellness, and ways to encourage more people to engage in physical activity. Findings revealed a multifaceted meaning of physical activity, supported by the theme of cultural identity. Participants highlighted aspects of culture, tradition, participation, and the land in defining physical activity. Being active was not only about soccer and running, but also playing traditional games, checking the fishnet, scraping the hide, being out on the land, and participating in the community. In other words, to be physically active was to be culturally active and to actively contribute in the community. Ultimately, through collaboration and dialogue, we generated different meanings of physical activity grounded in wellness, and we reinforced and provided further understanding of the cultural element of this health science terminology in an Indigenous context

Access and benefits sharing of genetic resources and associated traditional knowledge in northern Canada: understanding the legal environment and creating effective research agreements

Background. Research in northern Canada focused on Aboriginal peoples has historically benefited academia with little consideration for the people being researched or their traditional knowledge (TK). Although this attitude is changing, the complexity of TK makes it difficult to develop mechanisms to preserve and protect it. Protecting TK becomes even more important when outside groups become interested in using TK or materials with associated TK. In the latter category are genetic resources, which may have commercial value and are the focus of this article. Objective. This article addresses access to and use of genetic resources and associated TK in the context of the historical power-imbalances in research relationships in Canadian north. Design. Review. Results. Research involving genetic resources and TK is becoming increasingly relevant in northern Canada. The legal framework related to genetic resources and the cultural shift of universities towards commercial goals in research influence the environment for negotiating research agreements. Current guidelines for research agreements do not offer appropriate guidelines to achieve mutual benefit, reflect unequal bargaining power or take the relationship between parties into account. Conclusions. Relational contract theory may be a useful framework to address the social, cultural and legal hurdles inherent in creating research agreements

Connection to the land as a youth-identified social determinant of Indigenous Peoples’ health

Abstract Background Social determinants of Indigenous health are known to include structural determinants such as history, political climate, and social contexts. Relationships, interconnectivity, and community are fundamental to these determinants. Understanding these determinants from the perspective of Indigenous youth is vital to identifying means of alleviating future inequities. Methods In 2016, fifteen Yellowknives Dene First Nation (YKDFN) youth in the Canadian Northwest Territories participated in the 'On-the-Land Health Leadership Camp'. Using a strength- and community-based participatory approach through an Indigenous research lens, the YKDFN Wellness Division and university researchers crafted the workshop to provide opportunities for youth to practice cultural skills, and to capture the youth’s perspectives of health and health agency. Perspectives of a healthy community, health issues, and health priorities were collected from youth through sharing circles, PhotoVoice, mural art, and surveys. Results The overall emerging theme was that a connection to the land is an imperative determinant of YKDFN health. Youth identified the importance of a relationship to land including practicing cultural skills, Elders passing on traditional knowledge, and surviving off the land. The youth framed future health research to include roles for youth and an on-the-land component that builds YKDFN culture, community relations, and traditional knowledge transfer. Youth felt that a symbiotic relationship between land, environment, and people is fundamental to building a healthy community. Conclusion Our research confirmed there is a direct and critical relationship between structural context and determinants of Indigenous Peoples’ health, and that this should be incorporated into health research and interventions

Canadian H1N1 hospitalized cases and deaths by province and territory, April 12, 2009 to April 24, 2010 (PHAC 2010).

<p>Canadian H1N1 hospitalized cases and deaths by province and territory, April 12, 2009 to April 24, 2010 (PHAC 2010).</p