Reshaping Policies to Achieve a Strategic Plan for Indigenous Engagement in Nursing Education.

Canadian universities are developing strategies to address the Truth and Reconciliation Commission (TRC) Calls to Action. There has been much attention paid to the positivist, individualistic and Eurocentric foundations of nursing and its educational curricula, but limited focus on assessing organizational structures or engaging with stakeholders. Without both approaches, the success of new initiatives may be limited. The College of Nursing at the University of Saskatchewan implemented a "Learn Where You Live" model that demonstrated a sense of place by providing access and opportunity in rural, remote and northern regions of the province. Key to this initiative was the creation of the position of Strategist for Outreach and Indigenous Engagement, whose role it is to develop strategic initiatives designed to interpret and influence socio-political and policy-level system changes. This paper shares how adding a political scientist to nursing education created an interprofessional team by introducing new ways of thinking and being that have cultural relevance and understanding for a sustainable future.

Development and Use of Health-Related Technologies in Indigenous Communities: Critical Review.

BACKGROUND: Older Indigenous adults encounter multiple challenges as their age intersects with health inequities. Research suggests that a majority of older Indigenous adults prefer to age in place, and they will need culturally safe assistive technologies to do so. OBJECTIVE: The aim of this critical review was to examine literature concerning use, adaptation, and development of assistive technologies for health purposes by Indigenous peoples. METHODS: Working within Indigenous research methodologies and from a decolonizing approach, searches of peer-reviewed academic and gray literature dated to February 2016 were conducted using keywords related to assistive technology and Indigenous peoples. Sources were reviewed and coded thematically. RESULTS: Of the 34 sources captured, only 2 concerned technology specifically for older Indigenous adults. Studies detailing technology with Indigenous populations of all ages originated primarily from Canada (n=12), Australia (n=10), and the United States (n=9) and were coded to four themes: meaningful user involvement and community-based processes in development, the digital divide, Indigenous innovation in technology, and health technology needs as holistic and interdependent. CONCLUSIONS: A key finding is the necessity of meaningful user involvement in technology development, especially in communities struggling with the digital divide. In spite of, or perhaps because of this divide, Indigenous communities are enthusiastically adapting mobile technologies to suit their needs in creative, culturally specific ways. This enthusiasm and creativity, coupled with the extensive experience many Indigenous communities have with telehealth technologies, presents opportunity for meaningful, culturally safe development processes.

THE COGNITIVE COMPETENCES OF IMMIGRANT AND NATIVE STUDENTS ACROSS THE WORLD: AN ANALYSIS OF GAPS, POSSIBLE CAUSES AND IMPACT.

Immigration, immigration policies and education of immigrants alter competence levels. This study analysed their effects using PISA, TIMSS and PIRLS data (1995 to 2012, N=93 nations) for natives' and immigrants' competences, competence gaps and their population proportions. The mean gap is equivalent to 4.71 IQ points. There are large differences across countries in these gaps ranging from around +12 to -10 IQ points. Migrants' proportions grow roughly 4% per decade. The largest immigrant-based 'brain gains' are observed for Arabian oil-based economies, and the largest 'brain losses' for Central Europe. Regarding causes of native-immigrant gaps, language problems do not seem to explain them. However, English-speaking countries show an advantage. Acculturation within one generation and intermarriage usually reduce native-immigrant gaps (≅1 IQ point). National educational quality reduces gaps, especially school enrolment at a young age, the use of tests and school autonomy. A one standard deviation increase in school quality represents a closing of around 1 IQ point in the native-immigrant gap. A new Greenwich IQ estimation based on UK natives' cognitive ability mean is recommended. An analysis of the first adult OECD study PIAAC revealed that larger proportions of immigrants among adults reduce average competence levels and positive Flynn effects. The effects on economic development and suggestions for immigration and educational policy are discussed.

The impact of culturally responsive self-management interventions on health outcomes for minority populations: A systematic review.

OBJECTIVES: The health of people from Indigenous and ethnic minorities is poorer than the remainder of the population. Frequently, Westernized health systems respond by introducing self-management interventions to improve chronic illness health outcomes. The aim of this study was to answer the research question: "Can self-management programs that have been adapted or modified still be effective for ethnic minority and Indigenous populations?" METHODS: A systematic review across four databases was conducted. RESULTS: Twenty-three publications met the inclusion criteria. As the studies were heterogeneous, meta-analysis was not possible. Overall, interventions resulted in more positive health outcomes than usual care, but findings were inconsistent. DISCUSSION: We argue that rather than focusing on individual skills, knowledge, self-efficacy, and attitudes toward self-management, it may be more important to explore the structures and processes that underpin the sharing of information and skills within clinical or education encounters. Given that self-management is a Western cultural construct, creating empathic and responsive systems might be more effective for improving health of Indigenous and ethnic minority groups rather than relying predominantly on individual skill development.

A tertiary approach to improving equity in health: quantitative analysis of the Maori and Pacific Admission Scheme (MAPAS) process, 2008-2012.

INTRODUCTION: Achieving health equity for indigenous and ethnic minority populations requires the development of an ethnically diverse health workforce. This study explores a tertiary admission programme targeting Maori and Pacific applicants to nursing, pharmacy and health sciences (a precursor to medicine) at the University of Auckland (UoA), Aotearoa New Zealand (NZ). Application of cognitive and non-cognitive selection tools, including a Multiple Mini Interview (MMI), are examined. METHODS: Indigenous Kaupapa Maori methodology guided analysis of the Maori and Pacific Admission Scheme (MAPAS) for the years 2008-2012. Multiple logistic regression models were used to identify the predicted effect of admission variables on the final MAPAS recommendation of best starting point for success in health professional study i.e. 'CertHSc' (Certificate in Health Sciences, bridging/foundation), 'Bachelor' (degree-level) or 'Not FMHS' (Faculty of Medical and Health Sciences). Regression analyses controlled for interview year, gender and ancestry. RESULTS: Of the 918 MAPAS interviewees: 35% (319) were Maori, 58% (530) Pacific, 7% (68) Maori/Pacific; 71% (653) school leavers; 72% (662) females. The average rank score was 167/320, 40-80 credits below guaranteed FMHS degree offers. Just under half of all interviewees were recommended 'CertHSc' 47% (428), 13% (117) 'Bachelor' and 38% (332) 'Not FMHS' as the best starting point. Strong associations were identified between Bachelor recommendation and exposure to Any 2 Sciences (OR:7.897, CI:3.855-16.175; p < 0.0001), higher rank score (OR:1.043, CI:1.034-1.052; p < 0.0001) and higher scores on MAPAS mathematics test (OR:1.043, CI:1.028-1.059; p < 0.0001). MMI stations had mixed associations, with academic preparation and career aspirations more consistently associated with recommendations. CONCLUSIONS: Our findings raise concerns about the ability of the secondary education sector to prepare Maori and Pacific students adequately for health professional study. A comprehensive tertiary admissions process using multiple tools for selection (cognitive and non-cognitive) and the provision of alternative entry pathways are recommended for indigenous and ethnic minority health workforce development. The application of the MMI within an equity and indigenous cultural context can support a holistic assessment of an applicant's potential to succeed within tertiary study. The new MAPAS admissions process may provide an exemplar for other tertiary institutions looking to widen participation via equity-targeted admission processes.

Ngati and healthy: translating diabetes prevention evidence into community action.

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a major health issue in New Zealand Maori. Clinical trials have demonstrated potential for the prevention of T2DM, but whether community public health programmes aiming to prevent diabetes are effective is untested. OBJECTIVE: To describe the planning and design of an intervention aiming to translate T2DM prevention clinical trial evidence into a community-wide population health intervention in a high risk predominantly Maori community. APPROACH: Community concerns about the diabetes burden were heard by the local diabetes nurse, herself a tribal member, and discussed with a locally raised academic. Project planning ensued. The intervention and its evaluation were designed using a participatory community development model. The planned intervention had three components: community-wide health promotion initiatives conveying healthy lifestyle messages, community education and monitoring for identified high-risk individuals and their extended families, and a structural strategy aimed at adapting local environments to support lifestyle changes. The evaluation plan involved interrupted time series surveys coupled with formative and process evaluations rather than a randomised control trial design. DISCUSSION: Consulting communities, validating community concerns and prioritising cultural and ethical issues were key steps. Time spent developing good relationships amongst the health provider and academic research team members at the outset proved invaluable, as the team were united in addressing the project planning and implementation challenges, such as funding obstacles that arose because of our ethically and culturally appropriate non-randomised control trial evaluation design. The pre-intervention survey demonstrated high rates of diabetes (13%), insulin resistance (33%) and risk factors, and provided evidence for positive, as opposed to negative, lifestyle intervention messages. CONCLUSION: Community-wide lifestyle interventions have the potential to reduce rates of type 2 diabetes and other chronic diseases in high-risk communities, but require a high level of commitment from the health sector and buy-in from the community. Adequate commitment, leadership, planning and resources are essential.

A demographic explanation for the recent rise in European fertility.

Between 1998 and 2008 European countries experienced the first continent-wide increase in the period total fertility rate (TFR) since the 1960s. After discussing period and cohort influences on fertility trends, we examine the role of tempo distortions of period fertility and different methods for removing them. We highlight the usefulness of a new indicator: the tempo- and parity-adjusted total fertility rate (TFRp*). This variant of the adjusted total fertility rate proposed by Bongaarts and Feeney also controls for the parity composition of the female population and provides more stable values than the indicators proposed in the past. Finally, we estimate levels and trends in tempo and parity distribution distortions in selected countries in Europe. Our analysis of period and cohort fertility indicators in the Czech Republic, Netherlands, Spain, and Sweden shows that the new adjusted measure gives a remarkable fit with the completed fertility of women in prime childbearing years in a given period, which suggests that it provides an accurate adjustment for tempo and parity composition distortions. Using an expanded dataset for ten countries, we demonstrate that adjusted fertility as measured by TFRp* remained nearly stable since the late 1990s. This finding implies that the recent upturns in the period TFR in Europe are largely explained by a decline in the pace of fertility postponement. Other tempo-adjusted fertility indicators have not indicated such a large role for the diminishing tempo effect in these TFR upturns. As countries proceed through their postponement transitions, tempo effects will decline further and eventually disappear, thus putting continued upward pressure on period fertility. However, such an upward trend may be obscured for a few years by the effects of economic recession.

Sexual minorities, human rights and public health strategies in Africa.

Remarkable progress has been made towards the recognition of sexual minority rights in Africa. At the same time, a marked increase in attacks, rhetorical abuse, and restrictive legislation against sexual minorities or 'homosexuality' makes activism for sexual rights a risky endeavour in many African countries. Campaigns for sexual rights and 'coming out' are frequently perceived as a form of Western cultural imperialism, leading to an exportation of Western gay identities and provoking a patriotic defensiveness. Cultures of quiet acceptance of same-sex relationships or secretive bisexuality are meanwhile also problematic given the high rate of HIV prevalence on much of the continent. This article examines specific initiatives that are using subtle, somewhat covert means to negotiate a path between rights activism and secretive bisexuality. It argues that strategies primarily focused on health concerns that simultaneously yet discreetly promote sexual rights are having some success in challenging prevalent homophobic or 'silencing' cultures and discourses.

Fat, desire and disgust in the colonial imagination.

This article tracks the relatively unexamined ways in which ethnographic, travel and medical knowledge interrelated in the construction of fat stereotypes in the nineteenth century, often plotted along a temporal curve from 'primitive' corpulence to 'civilized' moderation. By showing how the complementary insights of medicine and ethnography circulated in beauty manuals, weight-loss guides and popular ethnographic books ­ all of which were aimed at middle-class readers and thus crystallize certain bourgeois attitudes of the time ­ it argues that the pronounced denigration of fat that emerged in Britain and France by the early twentieth century acquired some of its edge through this ongoing tendency to depict desire for and acceptance of fat as fundamentally 'savage' or 'uncivilized' traits. This tension between fat and 'civilization' was by no means univocal or stable. Rather, this analysis shows, a complex and wide-ranging series of similarities and differences, identifications and refusals can be traced between British and French perceptions of their own bodies and desires and the shortcomings they saw in foreign cultures. It sheds light as well on those aspects of their own societies that seemed 'primitive' in ways that bore an uncomfortable similarity to the colonial peoples they governed, demonstrating how a gendered, yet ultimately unstable, double standard was sustained for much of the nineteenth century. Finally it reveals a subtle and persistent racial subtext to the anti-fat discourses that would become more aggressive in the twentieth century and which are ubiquitous today.

Skin lighteners, Black consumers and Jewish entrepreneurs in South Africa.

This article considers the rise and decline of South Africa's lucrative and controversial skin-lighteners market through examination of the business history of the largest manufacturers, Abraham and Solomon Krok, and their evolving personas as millionaires and philanthropists. Such examination reveals how the country's skin-lighteners trade emerged as part of the broader growth of a black consumer market after the Second World War and how elements of that market became the target of anti-apartheid protests in subsequent decades. It also demonstrates how the Kroks' experiences as second-generation Jewish immigrants shaped their involvement in the trade and how, later, their self-identification as Jewish philanthropists informed their efforts to rehabilitate their reputations following South Africa's 1990 ban on all skin lighteners. Such efforts include the building of Johannesburg's highly acclaimed Apartheid Museum, modelled after the United States Holocaust Memorial Museum. This article explores the profound ironies that some South Africans see in the fact that a museum dedicated to commemorating those who suffered under and, ultimately, triumphed against state racism was financed by a family fortune generated through the sale of skin lighteners to black consumers.

Pathways to El Norte: origins, destinations, and characteristics of Mexican migrants to the United States.

The geography Mexican migration to the U.S. has experienced deep transformations in both its origin composition and the destinations chosen by migrants. To date, however, we know little about how shifting migrant origins and destinations may be linked to each another geographically and, ultimately, structurally as relatively similar brands of economic restructuring have been posited to drive the shifts in origins and destinations. In this paper, we describe how old and new migrant networks have combined to fuel the well-documented geographic expansion of Mexican migration. We use data from the 2006 Mexican National Survey of Population Dynamics, a nationally representative survey that for the first time collected information on U.S. state of destination for all household members who had been to the U.S. during the 5 years prior to the survey. We find that the growth in immigration to southern and eastern states is disproportionately fueled by undocumented migration from non-traditional origin regions located in Central and Southeastern Mexico and from rural areas in particular. We argue that economic restructuring in the U.S. and Mexico had profound consequences not only for the magnitude but also for the geography of Mexican migration, opening up new region-to-region flows.

Instant noodles as an antifriction device: making the BOP with PPP in PNG.

Focusing primarily, but not exclusively, on urban and periurban Papua New Guinea (PNG), we discuss the significance of instant ramen noodles to those now known as the "bottom of the pyramid" (BOP). Although instant noodles are remarkable in that they are eaten by virtually everyone in the world, albeit in different amounts and for different reasons, they are marketed in PNG specifically as a "popularly positioned product" (PPP) for the BOP. Cheap, convenient, tasty, filling, and shelf stable, they are a modern addition to Sidney Mintz's classic "proletarian hunger killers" of sugar, tea, and coffee. But, we argue, instant noodles have a distinctive contemporary role: they do more than sustain the poor; they transform them into the aspiring consumers of the BOP. As such, instant noodles can be viewed as an antifriction device, greasing the skids of capitalism as it extends its reach.

The plague under Commodus as an unintended consequence of Roman grain market regulation.

This paper begins with a review of Roman grain market policies. It is argued that policies such as forced sales and maximum prices made urban consumers hesitant to rely on the market for secure access to grain. Consequently, consumers hoarded grain in their homes. The hoarded grain formed a volatile fuel ready to be ignited by the arrival of the bubonic plague bacillus. This scenario fits events in the city of Rome under Commodus. Attested grain market interventions were followed by a severe epidemic, arguably bubonic plague, which decimated the city's population.

Tourism and the Hispanicization of race in Jim Crow Miami, 1945-1965.

This article examines how Miami's significant presence of Anglo Caribbean blacks and Spanish-speaking tourists critically influenced the evolution of race relations before and after the watershed 1959 Cuban Revolution. The convergence of people from the American South and North, the Caribbean, and Latin America created a border culture in a city where the influx of Bahamian blacks and Spanish-speakers, especially tourists, had begun to alter the racial landscape. To be sure, Miami had many parallels with other parts of the South in regard to how blackness was understood and enforced by whites during the first half of the twentieth century. However, I argue that the city's post-WWII meteoric tourist growth, along with its emergence as a burgeoning Pan-American metropolis, complicated the traditional southern black-white dichotomy. The purchasing power of Spanish-speaking visitors during the postwar era transformed a tourist economy that had traditionally catered to primarily wealthy white transplanted Northerners. This significant change to the city's tourist industry significantly influenced white civic leaders' decision to occasionally modify Jim Crow practices for Latin American vacationers. In effect, Miami's early Latinization had a profound impact on the established racial order as speaking Spanish became a form of currency that benefited Spanish-speaking tourists­even those of African descent. Paradoxically, this ostensibly peculiar racial climate aided the local struggle by highlighting the idiosyncrasies of Jim Crow while perpetuating the second-class status of native-born blacks.

Race and imprisonments: vigilante violence, minority threat, and racial politics.

The effects of lynchings on criminal justice outcomes have seldom been examined. Recent findings also are inconsistent about the effects of race on imprisonments. This study uses a pooled time-series design to assess lynching and racial threat effects on state imprisonments from 1972 to 2000. After controlling for Republican strength, conservatism, and other factors, lynch rates explain the growth in admission rates. The findings also show that increases in black residents produce subsequent expansions in imprisonments that likely are attributable to white reactions to this purported menace. But after the percentage of blacks reaches a substantial threshold­and the potential black vote becomes large enough to begin to reduce these harsh punishments­reductions in prison admissions occur. These results also confirm a political version of racial threat theory by indicating that increased Republican political strength produces additional imprisonments.

The new "new racism" thesis: limited government values and race-conscious policy attitudes.

Some contend that Whites' application of values to form opinions about race-conscious policy may constitute a subtle form of racism. Others challenge the new racism thesis, suggesting that racism and values are exclusive in their influence. Proponents of the thesis assert that many Whites' attitudes about such policy are structured by a mix of racism and American individualism. The author suggests that an even more subtle form of racism may exist. Racism may actually be expressed in opposition to big government. The test results presented here indicate that the effects of limited-government values on attitudes about race-conscious policy are conditional on levels of racial prejudice for many Whites, whereas the effects on racially ambiguous social welfare policy attitudes are not. The author contends that these results provide support to the argument that racism still exists and has found a new subtle expression.

Welfare policymaking and intersections of race, ethnicity, and gender in U.S. state legislatures.

Welfare policy in the American states has been shaped profoundly by race, ethnicity, and representation. Does gender matter as well? Focusing on state welfare reform in the mid-1990s, we test hypotheses derived from two alternative approaches to incorporating gender into the study of representation and welfare policymaking. An additive approach, which assumes gender and race/ethnicity are distinct and independent, suggests that female state legislators­regardless of race/ethnicity­will mitigate the more restrictive and punitive aspects of welfare reform, much like their African American and Latino counterparts do. In contrast, an intersectional approach, which highlights the overlapping and interdependent nature of gender and race/ethnicity, suggests that legislative women of color will have the strongest countervailing effect on state welfare reform­stronger than that of other women or men of color. Our empirical analyses suggest an intersectional approach yields a more accurate understanding of gender, race/ethnicity, and welfare politics in the states.