Statistics on indigenous peoples: International effort needed

In 2007, the UN General Assembly endorsed the United Nations Declaration on the Rights of Indigenous Peoples. In the following years, there has been a strong call from a range United Nations agencies and spokespersons for countries to act to improve their statistics relating to Indigenous peoples as part of their response to the Declaration. These calls have emphasised the need for a holistic approach, describing strengths and resilience of Indigenous peoples and not just a focus on gaps and disadvantage. National responses have been mixed and overall statistics remain inadequate. Significantly, there has been no international statistical effort through the United Nations statistical structures to respond to the Declaration and the increasing array of calls for improved statistics. The United Nations Statistical Commission in particular has an array of mechanisms to study statistical needs and develop solutions across a broad international statistical agenda. It is time for countries to make a concerted effort to improve their own statistics on Indigenous peoples, and to insist that the Statistical Commission work in partnership with the Permanent Forum on Indigenous Issues and other stakeholders to lead a major international drive to improve statistics on and for Indigenous peoples

Temporomandibular disorders among Sami women : perspectives based on an epidemiological survey with mixed methods

Introduction The aim of the research project was to examine prevalence, co-morbidity, and impact on daily life of pain and dysfunction in the jaw-face, head, and neck-shoulder regions among adult Sami women in northern Sweden. The aim of the qualitative part of the study was to explore, thoughts, experiences, and beliefs regarding temporomandibular disorders (TMD) among Sami women with and without TMD, to gain insights into their health care experiences. Methods The research project used a mixed methods approach including questionnaire analysis, a case-control study, and thematic interviews. The study population (Papers I and III) included 487 women living in the Arctic region of northern Sweden and enrolled in the register of the Swedish Sami Parliament or registered as reindeer owners or reindeer herders in the Swedish Board of Agriculture. Two years after the questionnaire study, 22 women (cases) with longstanding, intense, and frequent symptoms indicative of TMD, together with 46 age-matched women (controls) without any symptoms in the jaw–face region, underwent a clinical examination of the function of the temporomandibular joint, jaw- and neck muscles, mandibular mobility, and dental occlusion. The examiner was blind to the women’s affiliation (Paper II). Thematic interviews with a strategic subsample of 17 Sami women (Paper IV) were thereafter conducted and analyzed with a grounded theory approach. Results The prevalence of frequent symptoms indicative of TMD was 17%, of headaches 19%, and of neck-shoulder pain (NSP) 30%. Seventeen percent reported that their TMD affected daily life. Duration of jaw pain, troublesome impaired jaw opening, and neck pain, together with a low education level, affected the statement of whether TMD influenced daily life or not. Factors related to pain had the greatest influence when these Sami women rated the related impairment. There was a statistically significant relationship between TMD, frequent headaches, and frequent NSP (P <0.0001). Longstanding, intense, and frequent symptoms indicative of TMD remained essentially unchanged over the two-year follow-up period. Cases reported impaired general health and awareness of clenching teeth significantly more frequently than did controls. Variations in dental occlusion did not distinguish cases from controls. In the qualitative part of the project the core category, “Grin(d) and bear it,” summarizes the participants’ various ways and stages of processing and handling the interacting categories: (1) triggers, (2) strains, (3) distrust, and (4) reconciliation with pain and/or difficulties in life. Perpetuating factors were described as mental-physical strain and stress, and also a tooth clenching behavior. Women without TMD expressed factors that helped them to handle strains, reconcile, and stay healthy. They relied on helpful social support. Conclusion Disabling TMD, headaches, and NSP are common in Sami women. Women with TMD commonly expressed that tooth clenching was a familiar habit related to strains in life; they described an impaired general state of health and distrust in the care providers’ competence and ability to manage their problems. Women without TMD expressed confidence in their self-efficacy and were generally less concerned with strains in their lives. Rehabilitation strategies aiming at empowerment and improved self-efficacy may be a successful approach in women with disabling TMD

Somatic health in the Indigenous Sami population - a systematic review

The objective of this systematic review was to survey the current scientific knowledge regarding the state of somatic health among situation of the Indigenous Sami people in Norway, Finland, Sweden and the Kola Peninsula in Russia; and assess the quality of the identified studies. A systematic search in the databases Pubmed, EBSCOhost (AMED, Medline, Cinahl) and Svemed was conducted from January 2000, through December 2017. This systematic search identified 399 articles. After screening abstracts, 93 articles were reviewed in full text, 32 of which met the inclusion criteria. The scientific quality of the evidence was rated according to the Newcastle–Ottawa scale. Based on the studies with moderate to high scientific quality, there is evidence for stating that the majority of the Sami included in this review experience good health. Mortality and life expectancy are similar, with only minor differences, to those of a non-Sami population. The cancer risk rate among Sami was lower than that of the general population of Norway, Sweden and Finland. Self-reported myocardial infarction prevalence was similar between Sami and non-Sami, but Angina pectoris was more prevalent among Sami. In Sweden, cardiovascular disease rates were similar between Sami and non-Sami. Musculoskeletal pain symptoms are common among the Sami population, as are obesity and overweight. To conclude, there are knowledge gaps in regard to the somatic health situation of the Indigenous Sami in the circumpolar area, especially in Russia, Finland and Sweden; as current knowledge is mainly based on publications from the SAMINOR study in Norway. No study obtained the highest quality score, suggesting a need to implement longitudinal prospective studies

Samisk hälsoforskning - framsteg och utmaningar

Forskningen rörande samisk hälsa har de senaste två decennierna ökat avsevärt och bit för bit börjat förbättra ett fragmentariskt kunskapsläge. Det kan också sägas om det internationella forskningsområdet urfolkshälsa (Indigenous Health), där samisk hälsoforskning ofta hämtar jämförelser och inspiration. Vi önskar med detta temanummer väcka intresse för den samiska befolkningens hälsa och sätta ljus på den pågående samiska hälsoforskningen. Temanumret innehåller sammanlagt fem peer-review granskade originalartiklar, två översiktsartiklar och tre recensioner. Välkomna till det första temanumret om samisk hälsoforskning!Tema: Hälsa i Sápmi</p

Fokus på hälsa och hälsoforskning i Sápmi : resultat från elva samiska fokusgrupper

En sammanfattning av rapporten finns på svenska, nord- och lulesamiska. En sydsamisk översättning utgår på grund av återbud med kort varsel där ingen ersättare kunnat hittas inom tidsfristen.  Syfte: Fokusgruppstudiens syfte var att möjliggöra för samer att delta i öppna samtal om hälsotillstånd och hur levnadsvillkor och livsstil kan påverka hälsan och att låta denna kunskap berika utformningen av en enkät och en klinisk studie om hälsotillstånd som nästa steg av HALDI-studien. Metod: Elva fokusgrupper med samiska deltagare geografiskt fördelade från södra delarna till norra delarna av Sápmi genomfördes under hösten 2018-våren 2019. Deltagarnas ålder sträcker sig från 23-77 år, med en medelålder på 53 år. Två över-gripande frågeområden avhandlades vid fokusgruppdiskussionerna; samisk hälsa och hälsoforskning med fokus på samernas hälsa. Samtalen ljudinspelades och transkriberades till text. Texterna analyserades av tre oberoende forskare med hjälp av kvalitativ innehållsanalys. Resultat: Deltagarna beskriver en holistisk syn på hälsa, det vill säga att allt hänger samman. De lägger stor vikt vid upplevelser/tillstånd av andlighet, vistelsei naturen, fysisk aktivitet och harmoni för att uppnå en god hälsa. Andligheten kopplas inte samman med religion utan förknippas starkt med naturen. Det framkom att en kulturell norm ”ieš birget” kan påverka benägenheten att söka vård. Denna norm innebär en strävan efter att klara sig själv, att vara stark, inte visa sig svag och att inte belasta andra med problem. I fokusgruppdiskussionerna framkom även att det både är svårt och ovanligt att öppet prata om psykisk ohälsa och missbruksproblematik. Detta kan på sikt påverka hälsan och benägenhet att söka vård negativt. Deltagarna har negativa erfarenheter av bristfällig kulturförståelse och okunskap om samiska livsvillkor i mötet med hälso- och sjukvården. Utsatthet i form av diskriminering, rasism och okunskap om samisk historia och samiska livsvillkor framkommer som vanligt förekommande och beskrevs vara en risk för ohälsa och ansågs ha en negativ inverkan på hälsotillståndet. Det uttrycktes skepsis och misstroende mot forskning generellt. Detta grundades på upplevelse av brist på delaktighet, bristfällig information och utebliven återkoppling av resultat men även på historiska erfarenheter kopplade till bland annat rasbiologi. Samtidigt påtalades att ökad kunskap avseende samernas hälsa behövs och därför ansåg deltagarna att det ändå var viktigt att delta i forskningsstudier. Vikten av att tydliggöra forskningens syfte och dess nytta betonades särskilt. Slutsatser: Fokusgruppstudien har gett värdefulla bidrag om viktiga forskningsområden och hur kommande hälsostudier som involverar samisk befolkning bör utformas och genomföras. Det går att konstatera att inom samisk hälsoforskning i Sverige finns många områden som går att förbättra och tydlig-göra exempelvis kring etik, information, återkoppling, datahantering och utformning av studier Haldi - hälsa och levnadsvillkor i Sápmi, Sverig

Work ability and productivity among dentists : associations with musculoskeletal pain, stress, and sleep

Purpose: Work ability can be measured by the work ability index (WAI), and work-related questions measuring productivity loss in terms of quality and quantity of work. Dentists have high occupational risk of musculoskeletal pain and the exposure of ergonomic strain is already high during dental education. The aim was to evaluate work ability and productivity among dentists, and to identify gender differences and associations with sleep, stress, and reported frequent pain. Methods: The study population comprised 187 dentists (123 women and 64 men) who had been working as dentists between 5 and 12 years. Participants completed a questionnaire regarding sleep, stress, presence of pain at different sites, work ability assessed by WAI, and productivity in terms of quality and quantity of work. Results: Poor sleep quality and high level of stress were reported by 31% and 48.1% of participants, respectively, with no gender differences and no association with age. The prevalence of frequent pain ranged 6.4–46.5% with shoulders being the most prevalent site. Thirty-three percent reported reduced work ability. Poor sleep, high amount of stress, and multi-site pain were associated with decreased work ability. Conclusions: A high prevalence of pain was shown among dentists. Decreased work ability in terms of productivity loss was associated with poor sleep quality, high amount of stress, and multi-site pain. Preventive actions at the workplace should promote good musculoskeletal health, and measures taken, both individual and organizational, to minimize the risk of high, persistent stress and work-related pain

Social determinants of self-reported oral health among Sámi in Sweden

Objectives: To investigate the prevalence of poor self-reported oral health and to identify socio-demographic, socio-economic and cultural-related risk factors associated with poor oral health among Sámi in Sweden. Methods: A Sámi sample frame was constructed drawing from three pre-existing registers. All identified persons aged 18–84 were invited to participate in the study during February–May 2021. Among the 9249 invitations, 3779 answered the survey. The frequencies of the independent variables in terms of socio-economic, socio-demographic and cultural-related factors as well as the outcome, self-reported oral health, were calculated first. Prevalence ratios (PRs) and their 95% confidence interval (95% CI) were estimated to assess the relationship between the independent variables and the outcome. Results: Overall, 32.5% of the participants reported a poor oral health with a higher prevalence among men compared to women. Among the socio-demographic factors, being old (PR: 1.99; 95% CI: 1.59–2.51), unmarried (PR: 1.17; 95% CI: 1.03–1.33) and divorced or widow-er (PR: 1.27; 95% CI: 1.09–1.46) were statistically associated to poor self-reported oral health. Among the socio-economic factors, a low education level (PR: 1.56; 95% CI: 1.29–1.89), belonging to the poorest quintile (PR: 1.63; 95% CI: 1.35–1.96), and experiencing difficulties to make ends meet several times during the last 12 months (PR: 1.74; 95% CI: 1.51–1.99) were statistically significant related to poor oral health. Conclusions: The self-reported oral health among Sámi in Sweden appears to be worse than that of the general Swedish population. Several socio-economic and socio-demographic factors were found to be strongly associated with poor self-reported oral health. Targeted interventions addressing these social determinants are needed to reduce inequalities in oral health among the Sámi population

Patients' experiences of supervised jaw-neck exercise among patients with localized TMD pain or TMD pain associated with generalized pain

Objective: To evaluate temporomandibular disorder (TMD) patients’ experiences of a supervised jaw-neck exercise programme. Materials and methods: The study used a mixed method design. All patients were diagnosed with myalgia according to the Research Diagnostic Criteria for TMD and divided into local myalgia (n = 50; 38 women, mean age 43 yrs, SD 14), and myalgia with generalized pain (n = 28; 27 women, mean age 43 yrs, SD 13). Patients participated in a ten-session supervised exercise programme that included relaxation, coordination and resistance training of the jaw, neck and shoulders. After the 10 sessions an evaluation form was filled out including both open- and closed-ended questions. The quantitative analysis was based on closed-ended questions concerned experience, adaptation and side-effects from the exercise programme. The qualitative analysis was employing inductive content analysis of open-ended questions. Results: Patients reported similar positive overall experiences of exercise regardless of diagnosis, although more individuals in the general pain group experienced pain during training (57%) compared to the local pain group (26%; p = .015). Patients in both groups shared similar experiences and acknowledged the possibility to participate in an individualized and demanding exercise programme. They expressed feelings of being noticed, taken seriously and respectful care management to be key factors for successful treatment outcome. The exercise programme was acknowledged as a valuable part of treatment. Conclusion: The hypothesis generated was that individualized and gradually demanding exercise in the rehabilitation process of TMD stimulates self-efficacy and confidence in chronic TMD patients regardless of whether the pain was localized or combined with wide-spread pain

The Incidence of Stroke in Indigenous Populations of Countries With a Very High Human Development Index: A Systematic Review Protocol

Background and Aims: Despite known Indigenous health and socioeconomic disadvantage in countries with a Very High Human Development Index, data on the incidence of stroke in these populations are sparse. With oversight from an Indigenous Advisory Board, we will undertake a systematic review of the incidence of stroke in Indigenous populations of developed countries or regions, with comparisons between Indigenous and non-Indigenous populations of the same region, though not between different Indigenous populations. Methods: Using PubMed, OVID-EMBASE, and Global Health databases, we will examine population-based incidence studies of stroke in Indigenous adult populations of developed countries published 1990-current, without language restriction. Non-peer-reviewed sources, studies including &lt;10 Indigenous People, or with insufficient data to determine incidence, will be excluded. Two reviewers will independently validate the search strategies, screen titles and abstracts, and record reasons for rejection. Relevant articles will undergo full-text screening, with standard data extracted for all studies included. Quality assessment will include Sudlow and Warlow's criteria for population-based stroke incidence studies, the Newcastle-Ottawa Scale for risk of bias, and the CONSIDER checklist for Indigenous research. Results: Primary outcomes include crude, age-specific and/or age-standardized incidence of stroke. Secondary outcomes include overall stroke rates, incidence rate ratio and case-fatality. Results will be synthesized in figures and tables, describing data sources, populations, methodology, and findings. Within-population meta-analysis will be performed if, and where, methodologically sound and comparable studies allow this. Conclusion: We will undertake the first systematic review assessing disparities in stroke incidence in Indigenous populations of developed countries. Data outputs will be disseminated to relevant Indigenous stakeholders to inform public health and policy research