Kica-wasimisinanahk Miyo-ayawin ~ Our Children's Health. Promoting Physical Activity and Nutrition Through a Health Promoting School-Based Intervention in a Métis Community

First Nations and Métis children living in Canada continue to experience disproportionately high levels of obesity and type 2 diabetes (T2D) compared to the general Canadian child population (Young 2003; Oster and Toth 2009). Evidence supports the need to develop and implement culture-based physical activity and nutrition health programming in order to support the adoption of healthy lifestyles among First Nations and Métis school-aged children (Macaulay, Paradis et al. 1997; Potvin, Cargo et al. 2003; Ng, Young et al. 2010). Culturally relevant health promoting interventions have been created in collaboration with First Nations communities; however, given that Métis populations have unique cultural characteristics that differ from First Nations groups, there is strong rationale for developing, implementing and evaluating culture-based health programs in collaboration with Métis communities that take a preventative approach with school-aged children. Therefore, the purpose of this research was to evaluate the impact of a Métis culture-based comprehensive school health program on the physical activity and nutrition knowledge, attitudes, beliefs and behaviours of Métis children, using participatory action research (PAR). Initially, relationships were built and nurtured with the participating community and collaborations commenced to develop and implement a Métis culture-based school health program. Métis community members’ input was sought to develop a series of 17 culturally relevant physical activity and nutrition health promoting lessons. The participating teacher delivered these lessons to one split class of Grade 3 and 4 Métis students (age 8 and 9 years; n=16) attending the local elementary school once per week over a 4-month timeframe. Overall, children were taught about healthy eating and physical activity and how a healthy lifestyle can prevent obesity and diabetes. Physical activity and nutrition knowledge, attitudes, beliefs and behaviours among the Métis children were measured prior to and following the implementation of the health program. A group of 21 age-matched students attending separate Grade 3 and 4 classes acted as a comparison standard care group and did not receive health promotion programming. A variety of qualitative and quantitative methods were used including interviews (focus groups; individual with children and teachers), questionnaires (food frequency; knowledge, attitude and beliefs; physical activity questionnaire (PAQ-C)), accelerometry (using Actical accelerometers), and photovoice (using digital cameras). Physical activity data showed that participating students were more physically active than students who did not receive the intervention. Participating students spent significantly fewer minutes in sedentary activities compared to a comparison group post-intervention, 495 min/day compared to 527 min/day respectively. Moderate-to-vigorous physical activity (MVPA) levels did not significantly decrease in students participating in the intervention, while a comparison group experienced significant decreases in MVPA levels. This suggests that the intervention was successful in preventing a decline in MVPA levels that may normally be observed. Nutrition data revealed no statistically significant differences between the two groups. However, greater improvements were measured in the reported consumption of low nutrient dense foods such as cakes, cookies, pie, doughnuts and pop beverages. Fifty percent and 46% of intervention participants improved their consumption of “pop drinking” and “cakes, cookies, pie and doughnuts”, respectively. Student perceptions and awareness of healthy foods were positively impacted following the health programming. Although the primary purpose of the project was to evaluate the effectiveness of a school health program on physical activity and nutrition knowledge, attitudes, beliefs and behaviours, an important component of the research was also to evaluate the process of using PAR methods in collaboration with a Métis community. My reflections on using PAR methods integrated my personal observations, experiences, interactions and feedback received from the participating teacher and community research team members throughout the project. The successes and challenges of using PAR methods included the importance of (1) building rapport with the community; (2) maintaining flexibility regarding research timelines; (3) respecting reciprocity of exchanging knowledge and action between the community and myself; and (4) finding balance to ensure that the community was actively participating. The overall results of this study indicate that a comprehensive school health program can improve physical activity levels and can influence awareness of healthy foods among Métis children. The active engagement of the community ensured the integration of Métis culture, enhanced the sustainability of the program in the community, and largely influenced my learning of engaging in collaborative, Métis community-based research that will be lasting for me as a researcher in the future

Treatment of obesity and diabetes by a regulatable leptin cell therapy system

Obesity, a chronic disorder that is increasing in prevalence worldwide, is a major risk factor for the development of type 2 diabetes, a metabolic disorder characterized by hyperglycemia. In this thesis, the efficacy of a leptin cell therapy was evaluated for the treatment of obesity and diabetes in leptin-deficient ob/ob mice and in high fat fed, leptin-resistant C57BL/6J mice. A gut endocrine K-cell line was engineered to produce leptin under the regulation of an RU486 controlled GeneSwitch™ system. In culture, these cells express and release leptin in an RU486 dose- and time-dependent manner. These cells were transplanted into ob/ob mice via (a) kidney capsule and (b) intraperitoneal (IP) injection of alginate encapsulated cells along with 14-day RU486 pellets. In mice that received leptin-producing cells under the kidney capsule, reductions in body weight (10%), food intake (50%) and blood glucose levels (67%) were observed 10 days post-transpjant, relative to controls. Body weight and food intake rapidly increased thereafter to that of controls. Interestingly, however, blood glucose concentrations remained reduced by 40% up to 2 weeks post-transplantation. Animals given IP encapsulated cells lost up to 17% of body weight and then rapidly returned to their starting weight 14 days later at exhaustion of the RU486. Remarkably, despite the fact that body weight was completely regained within 20 days posttransplantation, blood glucose concentrations remained reduced by almost 70% up to 50 days post-transplantation. Both the number of transplanted cells and the dose of RU486 given could regulate the effects of leptin cell therapy. Obese C57BL/6J mice on a high fat diet did not respond with reductions in body weight, food intake or blood glucose levels after being transplanted with encapsulated leptin-producing gut cells. These data demonstrate that leptin administered via a cell therapy strategy can result in a reduction in body weight, food intake and long term corrections of blood glucose concentrations in leptin sensitive ob/ob mice but not in high fat fed leptin resistant C57BL/6J mice under the conditions tested.Medicine, Faculty ofCellular and Physiological Sciences, Department ofGraduat

Preventing type 2 diabetes among Indigenous youth: A systematic review of community-based interventions

ABSTRACTA systematic review was conducted to assess evidence on effectiveness of community-based interventions promoting wellbeing and prevention of type 2 diabetes (T2D) among Indigenous youth. A convergent, segregated, mixed methods approach was used, with six databases and four grey literature sites searched from inception to May 2022. Articles selected for inclusion were about community-based interventions related to T2D prevention with Indigenous youth that evaluated effectiveness or youth experience published in English. Reference lists were also searched for relevant sources. Seven quantitative research articles met the inclusion and quality assessment criteria. No qualitative articles were identified. The results were synthesised through narrative analysis, while meta-analysis was not possible due to heterogenous study designs. Common foci across interventions included promoting physical wellness, improving physical activity and healthy eating patterns, enhancing knowledge, and psychosocial wellness. Interventions deemed effective addressed multiple areas, were school-based, and operated for at least a year. Findings support multi-strategy, community-based interventions implemented over longer periods of time. However, gaps in research and reporting included the extent to which interventions are culturally informed and based on community-driven priorities. Future research should include Indigenous, mixed and qualitative methods and Indigenous-driven measures of success to better understand effectiveness in alignment with Indigenous worldviews

Experiences of Health Care Access Challenges for Back Pain Care Across the Rural-Urban Continuum in Canada: Protocol for Cross-sectional Research

BackgroundBack pain is common and costly, with negative impacts on both individuals and the health care system. Rural, remote, and Indigenous populations are at greater risk of experiencing back pain compared to urban and non-Indigenous populations. Potential barriers to health care access among Canadians with chronic back pain (CBP) have been identified; however, no study has used lived experiences of people with CBP to drive the selection, analysis, and interpretation of variables most meaningful to patients. ObjectiveThe aims of this study are to (1) engage with rural, remote, and urban Indigenous and non-Indigenous patients, health care providers, and health system decision makers to explore lived experiences among people with CBP in Saskatchewan, Canada; (2) cocreate meaningful indicators of CBP care access and effectiveness; and (3) identify program and policy recommendations to overcome access barriers to CBP care. MethodsIn phase 1, one-on-one interviews with 30 people with current or past CBP and 10 health care providers residing or practicing in rural, remote, or urban Saskatchewan communities will be conducted. We will recruit Indigenous (n=10) and non-Indigenous (n=20) rural, remote, and urban people. In phase 2, findings from the interviews will inform development of a population-based telephone survey focused on access to health care barriers and facilitators among rural, remote, and urban people; this survey will be administered to 383 residents with CBP across Saskatchewan. In phase 3, phase 1 and 2 findings will be presented to provincial and national policy makers; health system decision makers; health care providers; rural, remote, and urban people with CBP and their communities; and other knowledge users at an interactive end-of-project knowledge translation event. A World Café method will facilitate interactive dialogue designed to catalyze future patient-oriented research and pathways to improve access to CBP care. Patient engagement will be conducted, wherein people with lived experience of CBP, including Indigenous and non-Indigenous people from rural, remote, and urban communities (ie, patient partners), are equal members of the research team. Patient partners are engaged throughout the research process, providing unique knowledge to ensure more comprehensive collection of data while shaping culturally appropriate messages and methods of sharing findings to knowledge users. ResultsParticipant recruitment began in January 2021. Phase 1 interviews occurred between January 2021 and September 2022. Phase 2 phone survey was administered in May 2022. Final results are anticipated in late 2022. ConclusionsThis study will privilege patient experiences to better understand current health care use and potential access challenges and facilitators among rural, remote, and urban people with CBP in Saskatchewan. We aim to inform the development of comprehensive measures that will be sensitive to geographical location and relevant to culturally diverse people with CBP, ultimately leading to enhanced access to more patient-centered care for CBP. International Registered Report Identifier (IRRID)DERR1-10.2196/4248