The Medicine Wheel: informing the management of tuberculosis outbreaks in Indigenous communities

ABSTRACTMany Indigenous communities in Canada experience endemic tuberculosis with superimposed periodic epidemic outbreaks. Failures in outbreak management have resulted in the “seeding” of future infection and disease. In this paper we present a model that may be used in planning, implementation and review of tuberculosis outbreak management in Cree Indigenous communities in Canada, based on the Medicine Wheel, a paradigm for holistic living. In the context of tuberculosis management, the Medicine Wheel provides a path for the establishment of respectful cross-cultural relationships, the expression of values through action, true community engagement and partnership, and the establishment of culture-based processes of transparency, accountability and change

Old Keyam – A Framework for Examining Disproportionate Experience of Tuberculosis Among Aboriginal Peoples of the Canadian Prairies

On the Canadian Prairies, First Nations and Métis peoples are disproportionately affected by tuberculosis (TB) compared to other Canadians. Statistics show enduring transmission and high rates of active TB disease. Despite awareness of the social determinants of TB transmission—such as substance abuse, comorbidities, and basic needs being unmet—transmission and outbreaks continue to occur among Aboriginal people. The Determinants of Tuberculosis Transmission project is a mixed methods, interdisciplinary study that used quantitative questionnaires and qualitative interviews to look more closely at patients’ experiences of TB. Provincial Network Committees (PNCs) comprised of Elders, traditionalists, community-based TB workers, and health researchers in three participating provinces guided the project from inception through to data analysis, interpretation, and dissemination. The collaborative efforts of the patients, the research team, and the PNCs uncovered a continuing influence of colonization in TB transmission. Overwhelming feelings of apathy and despair for the hold that TB continues to have in the lives of patients, families, and communities is captured by the Cree word “keyam,” which may be translated as “to give up” or to ask, “What is the use?” This paper explores the concept of keyam in relation to TB transmission

“Finally when I started falling down”: Indigenous tuberculosis patient experiences of health and illness on the Canadian prairies

This paper adds evidence to a growing body of literature seeking to understand the disproportionate occurrence of tuberculosis (TB) in Indigenous populations of Canada and reveals insights that may inform effective interventions. As a disease, TB is recognized as a disorder of the body, for which there are successful treatments. Its persistence in some populations, however, requires an understanding of TB as an illness, whereby disease is shaped into behaviours and experiences. Fifty-five self-identified Indigenous participants with infectious pulmonary TB completed a questionnaire and an interview as part of the Determinants of Tuberculosis Transmission (DTT) project. Questionnaire data report on sociodemographic information and exposure to TB risk factors, while interview data describe participants’ experiences of TB within the context of their personal histories and everyday lives. Analysis showed that TB symptoms did not stand out as unusual in the everyday life and health experiences of participants. State of health and decisions about accessing healthcare were associated with socioeconomic deprivation, as well as negative experiences connected with historical and contemporary impacts of colonization. The “tipping point” concept effectively captures the shift in health that pushes participants to seek healthcare. Family, friends, and other caregivers are important influences and need to be part of the effort to avoid advanced TB illness and stop the cycle of transmission. More significantly, there is a need to address the structures and systems that produce and perpetuate life conditions that result in a usual state of compromised health

Associations between Housing Factors and Respiratory Symptoms in Two Saskatchewan First Nations Communities

Inadequate housing is commonplace in First Nations in Canada, often leading to environmental impacts on housing such as dampness and mold. First Nations communities suffer from a higher prevalence of respiratory-related health conditions than the general Canadian population. There is limited Canadian literature evaluating the relationship between housing factors and the respiratory health of adults within First Nations communities. This study was undertaken with two Saskatchewan First Nations communities. The study population consisted of 293 individuals within 131 households. The individuals completed questionnaires on their general and respiratory health, and one member of each household completed a household questionnaire. The collection of environmental samples from within the house was undertaken. The respiratory outcomes of interest focused on the individuals with ever wheeze, reported by 77.8% of the individuals, and shortness of breath, reported by 52.6% of the individuals. Body mass index, the nontraditional use of tobacco (i.e., current and ex-smoking), the nontraditional use of tobacco in the house (i.e., smoking in the house), dampness in the house in the last 12 months, and always having a smell of mold in the house were significantly associated with respiratory symptoms. The results reveal that respiratory symptom rates were high in the population and housing factors were significantly associated with respiratory symptoms. Addressing and redressing housing inadequacies in First Nations communities are important in preventing additional burdens to health

HOXA/PBX3 knockdown impairs growth and sensitizes cytogenetically normal acute myeloid leukemia cells to chemotherapy

The cytogenetically normal subtype of acute myeloid leukemia is associated with an intermediate risk which complicates therapeutic options. Lower overall HOX/TALE expression appears to correlate with more favorable prognosis/ better response to treatment in some leukemias and solid cancer. The functional significance of the associated gene expression and response to chemotherapy is not known. Three independent microarray datasets obtained from large cohorts of patients along with quantitative polymerase chain reaction validation were used to identify a four-gene HOXA/TALE signature capable of prognostic stratification. Biochemical analysis was used to identify interactions between the four encoded proteins and targeted knockdown used to examine the functional importance of sustained expression of the signature in leukemia maintenance and response to chemotherapy. An 11 HOXA/TALE code identified in an intermediate-risk group of patients (n=315) compared to a group with a favorable risk (n=105) was reduced to a four-gene signature of HOXA6, HOXA9, PBX3 and MEIS1 by iterative analysis of independent platforms. This signature maintained the favorable/intermediate risk partition and where applicable, correlated with overall survival in cytogenetically normal acute myeloid leukemia. We further showed that cell growth and function are dependent on maintained levels of these core genes and that direct targeting of HOXA/PBX3 sensitizes cytogenetically normal acute myeloid leukemia cells to standard chemotherapy. Together the data support a key role for HOXA/TALE in cytogenetically normal acute myeloid leukemia and demonstrate that targeting of clinically significant HOXA/PBX3 elements may provide therapeutic benefit to patients with this subtype of leukemia

Obesity, Sex, Snoring and Severity of OSA in a First Nation Community in Saskatchewan, Canada

Sleep disorders have been related to body weight, social conditions, and a number of comorbidities. These include high blood pressure and type 2 diabetes, both of which are prevalent in the First Nations communities. We explored relationships between obstructive sleep apnea (OSA) and risk factors including social, environmental, and individual circumstances. An interviewer-administered survey was conducted with adult participants in 2018–2019 in a First Nations community in Saskatchewan, Canada. The survey collected information on demographic variables, individual and contextual determinants of sleep health, and objective clinical measurements. The presence of OSA was defined as an apnea–hypopnea index (AHI) ≥5. Multiple ordinal logistic regression analysis was conducted to examine relationships between the severity of OSA and potential risk factors. In addition to the survey, 233 men and women participated in a Level 3 one-night home sleep test. Of those, 105 (45.1%) participants were reported to have obstructive sleep apnea (AHI ≥ 5). Mild and moderately severe OSA (AHI ≥ 5 to <30) was present in 39.9% and severe OSA (AHI ≥ 30) was identified in 5.2% of participants. Being male, being obese, and snoring loudly were significantly associated with severity of OSA. The severity of OSA in one First Nation appears relatively common and may be related to mainly individual factors such as loud snoring, obesity, and sex

Prevalence and associated risk factors of chronic bronchitis in First Nations people

Abstract Background Inadequate housing, low family income, household smoking, personal smoking status, and poor schooling are some of the conditions that have been significantly associated with the prevalence and incidence of chronic bronchitis. The aim of the current study was to determine the prevalence of chronic bronchitis (CB) and associated risk factors among First Nations people. Methods An interviewer-administered survey was conducted as part of the First Nations Lung Health Project in 2012 and 2013 with 874 individuals from 406 households in two First Nations communities located in the province of Saskatchewan, Canada. The questionnaire collected information on individual and contextual determinants of health and a history of ever diagnosed with CB (outcome variable) from the two communities participating in the First Nations Lung Health Project. Clustering effect within households was adjusted using Generalized Estimating Equations. Results The prevalence of CB was 8.9% and 6.8% among residents (18 years and older) of community A and community B respectively and was not significantly different. CB prevalence was positively associated with odour or musty smell of mildew/mould in the house [OR adj (95% CI) = 2.33 (1.21, 4.50)], allergy to house dust [3.49 (1.75, 6.97)], an air conditioner in home [2.33 (1.18, 4.24)], and increasing age [0.99 (0.33, 2.95), 4.26 (1.74, 10.41), 6.08 (2.58, 14.33)]. An interaction exposure to environmental tobacco smoke in the house*body mass index showed that exposure to household smoke increased the risk of CB for overweight and obese participants (borderline). Some of the variables of interest were not significantly associated with the prevalence of CB in multivariable analysis, possibly due to small numbers. Conclusions Our results suggest that significant determinants of CB were: increasing age; odour or musty smell of mildew/mould in the house; allergy to house dust; and, body mass index. Modifiable risk factors identified were: (i) community level-housing conditions (such as mould or mildew in home, exposure to environmental tobacco smoke in house); and, (ii) policy level-remediation of mould, and obesity. Trial registration Not applicable

Prevalence of Insomnia in Two Saskatchewan First Nation Communities

Insomnia is a common problem in Canada and has been associated with increased use of health care services and economic burden. This paper examines the prevalence and risk factors for insomnia in two Cree First Nation communities in Saskatchewan, Canada. Five hundred and eighty-eight adults participated in a baseline survey conducted as part of the First Nations Sleep Health Collaborative Project. The prevalence of insomnia was 19.2% among participants with an Insomnia Severity Index score of ≥15. Following the definition of nighttime insomnia symptoms, however, the prevalence of insomnia was much higher, at 32.6%. Multivariate logistic regression modeling revealed that age, physical health, depression diagnosis, chronic pain, prescription medication use for any health condition, and waking up during the night due to terrifying dreams, nightmares, or flashbacks related to traumatic events were risk factors for insomnia among participants from two Saskatchewan Cree First Nation communities