Is ethnicity an appropriate measure of health care marginalization? A systematic review and meta-analysis of the outcomes of diabetic foot ulceration in Aboriginal populations.

BACKGROUND: Aboriginal people have higher prevalence rates of diabetes than non-Aboriginal people in the same geographic locations, and diabetic foot ulcer (DFU) complication rates are also presumed to be higher. The aim of this systematic review and meta-analysis was to compare DFU outcomes in Aboriginal and non-Aboriginal populations. METHODS: We searched PubMed, Embase, CINAHL and the Cochrane Library from inception to October 2018. Inclusion criteria were all types of studies comparing the outcomes of Aboriginal and non-Aboriginal patients with DFU, and studies from Canada, the United States, Australia and New Zealand. Exclusion criteria were patient age younger than 18 years, and studies in any language other than English. The primary outcome was the major amputation rate. We assessed the risk of bias using the ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) tool. Effect measures were reported as odds ratio (OR) with 95% confidence interval (CI). RESULTS: Six cohort studies with a total of 244 792 patients (2609 Aboriginal, 242 183 non-Aboriginal) with DFUs were included. The Aboriginal population was found to have a higher rate of major amputation than the non-Aboriginal population (OR 1.85, 95% CI 1.04-3.31). Four studies were deemed to have moderate risk of bias, and 2 were deemed to have serious risk of bias. CONCLUSION: Our analysis of the available studies supports the conclusion that DFU outcomes, particularly the major amputation rate, are worse in Aboriginal populations than in non-Aboriginal populations in the same geographic locations. Rurality was not uniformly accounted for in all included studies, which may affect how these outcome differences are interpreted. The effect of rurality may be closely intertwined with ethnicity, resulting in worse outcomes.

Diabetes-by-Proxy: Virtual Embodiment of Disease by Oklahoma Choctaw Parents of Children with Type 1 Diabetes.

Childhood type 1 diabetes is increasing globally and requires meticulous at-home care due to risks for fatal outcomes if glucose levels are not continuously and correctly monitored. Type 1 diabetes research has focused on metabolism and stress measurements confirming high parental worry levels. However, research on caregivers' management strategies has lagged. We show parents' intense, all-encompassing work to preempt a disastrous drop in their child's glucose as a stress-path to the virtual embodiment of their child's condition. That is, parents acquire diabetes-by-proxy. Our findings derive from four and half years of ethnographic research with the same 19 families in the Choctaw Nation of Oklahoma. These parents were exceptionally engaged as caregivers and distressed by the potentially fatal outcome of type 1 diabetes mismanagement. Diabetes-by-proxy names the parents' experience and validates clinical attention to them as they cope with their crucial caregiving commitment.

Past-Year Racial Discrimination and Allostatic Load Among Indigenous Adults in Canada: The Role of Cultural Continuity.

OBJECTIVE: This study aimed to examine the association between racial discrimination and allostatic load (AL) and whether this association was moderated by cultural continuity among Indigenous adults. METHODS: Data were collected from Indigenous adults attending university in a small city in western Canada between 2015 and 2017 (mean age = 27.8 years). The Experience of Discrimination Situation Score and the Vancouver Index Enculturation Subscale were used to assess racial discrimination and cultural continuity, respectively. AL was measured as a composite of seven biomarkers assessing neuroendocrine, cardiovascular, metabolic, and immune system function. Bias-corrected and accelerated bootstrapped linear regression models were used to examine associations adjusting for confounders (n = 104; 72.5% women). RESULTS: Across the full sample, racial discrimination was associated with a linear, dose-response increase in AL score after adjustment for confounders. Among adults with low cultural continuity, past-year discrimination was associated with increased AL and explained 22% (adjusted R) of the variance in AL score. Taken together, the full model including age, sex, and income explained 38% of the variance in AL score in this subgroup. Among adults with high cultural continuity, racial discrimination was not associated with AL, whereas age remained significant and explained 13% of the variance in AL score. CONCLUSIONS: Past-year racial discrimination was associated with early and more pronounced wear and tear on stress response systems among Indigenous adults relative to peers. Indigenous cultural continuity served as an important buffer that promoted biological resilience against the adverse effects of racial discrimination on physiologic regulation among Indigenous adults.

Acceptability of an eHealth Intervention to Prevent Alcohol-Exposed Pregnancy Among American Indian/Alaska Native Teens.

BACKGROUND: A tribally led Changing High-Risk Alcohol Use and Increasing Contraception Effectiveness Study (CHOICES) Program has successfully decreased the risk of alcohol-exposed pregnancies (AEPs) among adult American Indian/Alaska Native (AI/AN) women by either reducing risky drinking or increasing contraception use. However, a community needs assessment revealed a need to implement a similar intervention with AI/AN teens. The goal of the project was to develop and establish the acceptability of CHOICES for AI/AN teens. METHODS: Key informant interviews were conducted to review the existing OST CHOICES intervention. After modifications to the existing program, focus groups with AI/AN teens were conducted to ensure validity and to finalize the OST CHAT (CHOICES for American Indian Teens) intervention. RESULTS: Key informant (N = 15) participants suggested that a Web-based intervention may increase teen engagement by making the intervention more interactive and visually stimulating. Based on this formative research, CHAT was developed via Research Electronic Data Capture (REDCap). Feedback on the online CHAT curriculum was given by focus groups comprised of AI/AN adolescents, and participants felt that this type of intervention would be both acceptable and able to implement with a community of reservation-based teens. CONCLUSIONS: This study outlines the development of a Web-based intervention for an AEP intervention for AI/AN teens and will inform future prevention efforts. Implications include an expansion of the evidence-based CHOICES intervention for AI/AN teens and also development of a Web-based intervention for rural, reservation-based AI/AN communities.

Adverse Childhood Experiences and Immune System Inflammation in Adults Residing on the Blackfeet Reservation: The Moderating Role of Sense of Belonging to the Community.

BACKGROUND: Previous research documents an association between adverse childhood experiences (ACEs) and immune system inflammation. High chronic inflammation is believed to be one biological pathway through which childhood adversity may affect health into adulthood. The Blackfeet tribal community has high rates of childhood trauma and community members are disproportionately affected by inflammatory diseases. PURPOSE: To investigate whether belonging to the tribal community may moderate the relationship between childhood trauma and immune system inflammation in the Blackfeet tribal community. METHODS: In a sample of 90 adults residing on the Blackfeet reservation, we measured ACEs belonging to the tribal community and two markers of immune system inflammation, interleukin-6 (IL-6) and C-reactive protein (CRP). RESULTS: We found that independent of age, gender, annual income, body mass index, and depressive symptoms, belonging to the tribal community and ACEs interacted to predict levels of both IL-6 and CRP (B= -.37, t[81] = -3.82, p < .001, R2 change = .07 and B = -.29, t[81] = -2.75, p = .01, R2 change = .08, respectively). The association between ACEs and markers of immune system inflammation was statistically significant for community members who reported low levels of belonging to the community. CONCLUSIONS: The findings of this study have important implications for intervention research seeking to reduce risk for inflammatory diseases for at-risk populations. Fostering stronger connections to the larger tribal community may positively affect risk for inflammatory diseases. Future work should examine the behavioral and psychosocial pathways through which stronger connections to community may confer health benefits.

Upper Palaeolithic Siberian genome reveals dual ancestry of Native Americans.

The origins of the First Americans remain contentious. Although Native Americans seem to be genetically most closely related to east Asians, there is no consensus with regard to which specific Old World populations they are closest to. Here we sequence the draft genome of an approximately 24,000-year-old individual (MA-1), from Mal'ta in south-central Siberia, to an average depth of 1×. To our knowledge this is the oldest anatomically modern human genome reported to date. The MA-1 mitochondrial genome belongs to haplogroup U, which has also been found at high frequency among Upper Palaeolithic and Mesolithic European hunter-gatherers, and the Y chromosome of MA-1 is basal to modern-day western Eurasians and near the root of most Native American lineages. Similarly, we find autosomal evidence that MA-1 is basal to modern-day western Eurasians and genetically closely related to modern-day Native Americans, with no close affinity to east Asians. This suggests that populations related to contemporary western Eurasians had a more north-easterly distribution 24,000 years ago than commonly thought. Furthermore, we estimate that 14 to 38% of Native American ancestry may originate through gene flow from this ancient population. This is likely to have occurred after the divergence of Native American ancestors from east Asian ancestors, but before the diversification of Native American populations in the New World. Gene flow from the MA-1 lineage into Native American ancestors could explain why several crania from the First Americans have been reported as bearing morphological characteristics that do not resemble those of east Asians. Sequencing of another south-central Siberian, Afontova Gora-2 dating to approximately 17,000 years ago, revealed similar autosomal genetic signatures as MA-1, suggesting that the region was continuously occupied by humans throughout the Last Glacial Maximum. Our findings reveal that western Eurasian genetic signatures in modern-day Native Americans derive not only from post-Columbian admixture, as commonly thought, but also from a mixed ancestry of the First Americans.

The relationship between fraternal birth order and childhood sex-atypical behavior among the Istmo Zapotec muxes.

Research on male androphilia (i.e., sexual attraction towards adult males) consistently finds that androphilic males tend to have more older biological brothers than males who are gynephilic (i.e., sexually attracted to adult females). This fraternal birth order effect (FBOE) has been well replicated among androphilic males who present publically in a male-typical (cisgender) and a female-typical (transgender) manner. There is some evidence that the FBOE is more pronounced among transgender androphilic males. However, no studies have directly compared both forms of male androphilia within the same culture. This study tested the FBOE, and its association with childhood sex-atypical behavior (CSAB), among the Istmo Zapotec of Oaxaca, Mexico, where both forms of male androphilia are referred to as a third gender, muxes. Our results indicated that both cisgender muxe nguiiu (n = 124) and transgender muxe gunaa (n = 120) were more likely to be later born among brothers than gynephilic men (n = 194). However, the number of older brothers did not differentiate between transgender and cisgender muxes, nor did it predict CSAB among muxes. These findings replicate the FBOE among both cisgender and transgender muxes but show no evidence that it is more pronounced among transgender androphilic males.

Performing Pimâtisiwin: The Expression of Indigenous Wellness Identities through Community-based Theater.

The performing arts can be a powerful means of wellness, identity exploration, and positive social representation for Indigenous young people. In this article, we outline the results of a year-long collaborative study that explored Indigenous young peoples' relationships between the performing arts, wellness, and resilience. Twenty in-depth interviews were conducted with 10 Cree and Métis youth about their participation in the Circle of Voices theater program at the Gordon Tootoosis Nik̄an̄iw̄in Theatre in Saskatoon, Saskatchewan, Canada. A strength-based analysis focused on performing pimâtisiwin, that is, how young people learn to enact, protest, and play with a wide range of social identities, while also challenging racially stereotyped identities often imposed on them within inner-city environments. This research critically engages performative theory to more readily understand aspects of Indigenous youth identity and wellness and offers new empirical and methodological directions for advancing Indigenous youth wellness in urban settings.

Exploring health and wellness among Native American adults with intellectual and/or developmental disabilities and their family caregivers.

BACKGROUND: Adults with intellectual and/or developmental disabilities (IDD) experience health inequities, and those who also identify as a member of an ethnic minority group face additional health inequities. In the United States, a majority of adults with IDD continue to be supported by family caregivers making their health equity also important. The purpose of this study was to explore how Native American adults with IDD and their family caregivers experience health and wellness. METHOD: This community-engaged research was guided by a Community Advisory Board (CAB) with study participants completing a Photovoice project. RESULTS: Participants identified individual, family and community level influences on health and wellness including the importance of participation in meaningful activities and connection to culture. CONCLUSIONS: In order to address health inequities, more research is needed to understand health and wellness from the unique perspectives of individuals with IDD and those from racial and ethnic minority groups.

An Approach to Improve Dementia Health Literacy in Indigenous Communities.

This project aims to improve health literacy in Indigenous communities through the development of evidence-based culturally relevant health promotion materials on dementia that bridge the gap between Indigenous and Western perspectives of the illness. The research team worked in partnership with Health Canada's First Nations and Inuit Home and Community Care Program (FNIHCC) and consulted with Indigenous elders to utilize a two-eyed seeing framework that draws upon Indigenous knowledge and Western biomedicine. A consolidated review of materials and research involving Indigenous perspectives of Alzheimer's and age-related dementias led to the development of two culturally appropriate fact sheets. Two Indigenous-specific fact sheets were developed "What is Dementia? Indigenous Perspectives and Cultural Understandings" and "Signs and Symptoms of Dementia: An Indigenous Guide." The fact sheets prioritize Indigenous knowledge and pay particular attention to Indigenous languages, diverse Indigenous cultures, and literacy levels. The content uses phrasing and words from Indigenous people involved in the research to share information. Biomedical concepts and words were included when necessary but language or presentation of these aspects were often modified to reflect Indigenous conceptualizations. This project provides a foundation for evidence-based knowledge translation in relation to cultural safety in dementia care. Specifically, the researchers outline how health care providers can develop culturally appropriate health promotion material, thus increasing Indigenous cultural understandings of dementia and health literacy.

Lifestyle Risk Factors and Findings on Brain Magnetic Resonance Imaging of Older Adult American Indians: The Strong Heart Study.

BACKGROUND: Clinical stroke is prevalent in American Indians, but the lifestyle risk factors for vascular brain injury have not been well-studied in this population. The purpose of this study was to correlate brain magnetic resonance imaging (MRI) findings with obesity, alcohol use, and smoking behaviors in elderly American Indians from the Strong Heart Study. METHODS: Cranial MRI scans (n = 789) were analyzed for dichotomous measures of infarcts, hemorrhages, white matter hyperintensities (WMH), and cerebral atrophy and continuous measures of total brain, WMH, and hippocampal volume. Poisson regression was used to estimate prevalence ratios, and linear regression was used to estimate measures of association for continuous outcomes. Models were adjusted for the risk factors of interest as well as age, sex, study site, income, education, hypertension, diabetes, and low-density lipoprotein cholesterol. RESULTS: Smoking was associated with increased hippocampal atrophy (p = 0.002) and increased prevalence of sulcal widening (p < 0.001). Relative to nonsmokers, smokers with more than 25 pack-years of smoking had a 27% (95% CI 7-47%) increased prevalence of high-grade sulci, p = 0.005. Body mass index was inversely associated with prevalence of nonlacunar infarcts and sulcal widening (all p = 0.004). Alcohol use was not significantly associated with any of the measured MRI findings. CONCLUSIONS: This study found similar associations between smoking and vascular brain injury among American Indians, as seen in other populations. In particular, these findings support the role of smoking as a key correlate for cerebral atrophy.

Vascular Risk Factors and Findings on Brain MRI of Elderly Adult American Indians: The Strong Heart Study.

BACKGROUND: Clinical stroke is prevalent in American Indians, but the risk factors for cerebrovascular pathology have not been well-studied in this population. The purpose of this study was to correlate abnormalities on brain magnetic resonance imaging (MRI) with clinical risk factors in a cohort of elderly American Indians. METHODS: Brain MRI scans from 789 participants of the Strong Heart Study were analyzed for infarcts, hemorrhage, white matter disease, and measures of cerebral atrophy including ventricular and sulcal grade and total brain volume. Clinical risk factors included measures of hypertension, diabetes, and high levels of low-density lipoprotein (LDL) cholesterol. Regression models adjusted for potential confounders were used to estimate associations between risk factors and brain MRI outcomes. RESULTS: -Hypertension was associated with the presence of infarcts (p = 0.001), ventricle enlargement (p = 0.01), and increased white matter hyperintensity volume (p = 0.01). Diabetes was associated with increased prevalence of cerebral atrophy (p < 0.001), ventricular enlargement (p = 0.001), and sulcal widening (p = 0.001). High LDL was not significantly associated with any of the measured cranial imaging outcomes. CONCLUSIONS: This study found risk factors for cerebrovascular disease in American Indians similar to those seen in other populations and provides additional evidence for the important roles of hypertension and diabetes in promoting cerebral infarcts and brain atrophy, respectively.

Experiences of the HIV Cascade of Care Among Indigenous Peoples: A Systematic Review.

Indigenous leaders remain concerned that systemic oppression and culturally unsafe care impede Indigenous peoples living with HIV from accessing health services that make up the HIV cascade of care. We conducted a systematic review to assess the evidence related to experiences of the HIV care cascade among Indigenous peoples in Australia, Canada, New Zealand, and United States. We identified 93 qualitative and quantitative articles published between 1996 and 2017 reporting primary data on cascade outcomes disaggregated by Indigenous identity. Twelve involved data from Australia, 52 from Canada, 3 from New Zealand and 26 from United States. The majority dealt with HIV testing/diagnosis (50). Relatively few addressed post-diagnosis experiences: linkage (14); retention (20); treatment initiation (21); adherence (23); and viral suppression (24). With the HIV cascade of care increasingly the focus of global, national, and local HIV agendas, it is critical that culturally-safe care for Indigenous peoples is available at all stages.

Tobacco Industry Promotional Strategies Targeting American Indians/Alaska Natives and Exploiting Tribal Sovereignty.

BACKGROUND: American Indians/Alaska Natives have the highest commercial tobacco use in the United States, resulting in higher tobacco-caused deaths and diseases than the general population. Some American Indians/Alaska Natives use commercial tobacco for ceremonial as well as recreational uses. Because federally recognized Tribal lands are sovereign, they are not subject to state cigarette taxes and smoke-free laws. This study analyzes tobacco industry promotional efforts specifically targeting American Indians/Alaska Natives and exploiting Tribal lands to understand appropriate policy responses in light of American Indians'/Alaska Natives' unique sovereign status and culture. METHODS: We analyzed previously secret tobacco industry documents available at the Truth Tobacco Documents Library (https://industrydocuments.library.ucsf.edu/tobacco/). RESULTS: Tobacco companies used promotional strategies targeting American Indians/Alaska Natives and exploiting Tribal lands that leveraged the federally recognized Tribes' unique sovereign status exempting them from state cigarette taxes and smoke-free laws, and exploited some Tribes' existing traditional uses of ceremonial tobacco and poverty. Tactics included price reductions, coupons, giveaways, gaming promotions, charitable contributions, and sponsorships. In addition, tobacco companies built alliances with Tribal leaders to help improve their corporate image, advance ineffective Youth Smoking Prevention programs, and defeat tobacco control policies. CONCLUSIONS: The industry's promotional tactics likely contribute to disparities in smoking prevalence and smoking-related diseases among American Indians//Alaska Natives. Proven policy interventions to address these disparities including tobacco price increases, cigarette taxes, comprehensive smoke-free laws, and industry denormalization campaigns to reduce smoking prevalence and smoking-related disease could be considered by Tribal communities. The sovereign status of federally recognized Tribes does not prevent them from adopting these measures. IMPLICATIONS: American Indians/Alaska Natives suffer disparities in smoking prevalence and smoking-related diseases as compared with other groups. The tobacco industry has used promotional tactics including price reductions, coupons and giveaways, casino and bingo promotions, charitable contributions and sponsorships, and so-called Youth Smoking Prevention (YSP) programs to specifically target American Indians/Alaska Natives and exploit Tribal sovereignty, which likely contribute to disparities in tobacco use and related diseases and deaths among this population. Tribal and public health policy makers should consider rejecting ineffective YSP programs and instead consider adopting proven policy interventions including tobacco price increases, cigarette and casino taxes, comprehensive smokefree laws, and anti-industry denormalization campaigns to reduce smoking and smoking-related disease.

Place of origin of the sacrificial victims in the sacred Cenote, Chichén Itzá, Mexico.

OBJECTIVES: The ancient city of Chichén Itzá in the northern Yucatán of Mexico was one of the most important in the Maya area, but its origins and history are poorly understood. A major question concerns the origins of the peoples who founded and later expanded the ancient city. Hundreds of people were ritually executed and their bodies thrown into the waters of the Sacred Cenote at Chichén. MATERIALS AND METHODS: In this study, we use strontium and oxygen isotopes to study the place of origin of a large sample of these individuals. Isotopes are deposited in human tooth enamel. Enamel forms during the first years of life, remains largely unchanged long past death, and can provide a signature of the place of birth. If the isotope ratios in enamel are different from the place of death, the individual must have moved during his/her lifetime. RESULTS: Comparison of our results from the cenote with information on isotope ratios across the Maya region and elsewhere suggests that the individuals in the cenote came from a number of different parts of Mexico and possibly beyond. DISCUSSION: It is not known if all of the sacrificial victims resided in Chichén Itzá, but their suggested origins likely reflect patterns of population movement and social networks that existed between Chichén Itzá and both neighboring and distant regions. Various lines of evidence point to places in the Yucatán, along the Gulf Coast, Central America, or even in the Central Highlands of Mexico.

Indicators of stress and their association with frailty in the precontact Southwestern United States.

OBJECTIVES: Physiological disturbances in early life have been shown to increase individual mortality risk and impact health in adulthood. This study examines frailty through analysis of lesion status of two commonly collected skeletal indicators of stress (cribra orbitalia [CO] and porotic hyperostosis [PH]) and their association with mortality risk in the precontact U.S. Southwest. Several predictions are addressed: (a) individuals with active skeletal lesions are the frailest; (b) individuals with healed lesions are the least frail; (c) CO lesions, regardless of status, are associated with increased mortality risk. MATERIALS AND METHODS: Odds ratios and Kaplan-Meier survival analysis are used to examine the association between stress indicators and mortality in the U.S. Southwest. This study includes 335 individuals (75 females, 81 males, 20 adults of unknown sex, and 159 juveniles) from precontact New Mexico archaeological sites dating to A.D. 1,000-1,400. RESULTS: Active CO and PH lesions are associated with lower survivorship and greater mortality risk than healed or absent lesions. Only juvenile individuals have active CO and PH lesions, as is expected given their physiology. CO lesions in any state are associated with greater mortality risk and earlier ages of death. DISCUSSION: Individuals with active lesions are the frailest; while individuals with healed lesions are the least frail. CO and PH likely have different etiologies: CO lesions are associated with increased mortality risk and decreased individual longevity. These results indicate that CO's presence suggests a more severe underlying condition than PH lesions alone.

Assessing subsistence and its relationship to cultural complexity in the late prehistoric upper Midwest: A new perspective provided by dental health.

OBJECTIVE: Previous researchers have assumed that the Late Prehistoric Oneota were less reliant on maize agriculture than their Middle Mississippian neighbors to the south. This assumption is based on the idea that intensive maize agriculture is related to sociopolitical complexity, and that the climate of the Great Lakes region was less conducive to full-scale agriculture than that of the American Bottom. Here, we assess the diet of the Oneota using dental pathology to test the hypothesis that the Oneota in Eastern Wisconsin were highly reliant on maize agriculture. MATERIALS AND METHODS: To test our hypothesis, skeletal remains representing 187 individuals and 1,102 teeth were examined from nine Oneota sites from the Middle Fox and Koshkonong Localities, as well as the Late Woodland/Middle Mississippian site of Aztalan. Dental caries, antemortem tooth loss (AMTL), and dental abscesses were assessed for each individual in the sample. Dental pathologies in the Oneota groups were compared to each other based on Locality and to the Aztalan population using chi-squared tests. RESULTS: Dental caries rates for the Oneota, based on the tooth count approach, were observed at 16.8% for the Middle Fox Locality, and 49% for the Koshkonong Locality. Comparatively, the Late Woodland/Middle Mississippian population from Aztalan had a tooth count rate of 19.5%. AMTL rates were similar across samples. Dental abscessing was universally low. DISCUSSION: The relatively high rate of dental caries among the Oneota is comparable to Middle Mississippian populations from throughout the Midwest, suggesting similar reliance on maize between the groups.

Mental Health in the Cree Peoples of Northern Quebec: Relationships Among Trauma, Familial Psychological Distress, and Mood or Anxiety Disorders.

OBJECTIVE: This study examined the physical and mental health of Cree adults, as well as the personal, clinical, and environmental factors associated with the presence of lifetime anxiety and mood disorders. METHODS: Mental health was assessed using the computerised version of the Diagnostic Interview Schedule (CDIS-IV), and standardised instruments were used to assess physical health, addiction severity, and psychological distress in 506 randomly selected participants from 4 Northern Cree communities in Quebec. RESULTS: Overall, 46.1% of participants reported chronic medical problems, 42.1% were current smokers and 34.5% met the DSM-IV criteria for an anxiety or mood disorder. Individuals with an anxiety or mood disorder were younger, predominantly female, and with higher educational levels, and a large proportion (47.7%) met the lifetime criteria for substance dependence. Hierarchical regression determined that anxiety or mood disorders were associated with serious problems getting along with parents, a history of physical and sexual abuse, and a lifetime diagnosis of substance dependence. Overall, 29.7% of Cree adults reported sexual abuse, 47.1% physical abuse, and 52.9% emotional abuse. CONCLUSIONS: This study highlights the high rates of physical and mental health problems in Cree communities and the association among parental history of psychological problems, history of abuse, and psychological distress. Participants expressed a desire for additional medical and psychological treatments to address the patterns of abuse, trauma, and mental disorders that are burdening the Cree communities in Northern Quebec.

Health, Social, Education, and Justice Outcomes of Manitoba First Nations Children Diagnosed with Fetal Alcohol Spectrum Disorder: A Population-Based Cohort Study of Linked Administrative Data.

OBJECTIVE: To examine health services, social services, education, and justice system outcomes among First Nations children and youth with fetal alcohol spectrum disorder (FASD). METHODS: In this retrospective cohort study, health and social services, education, and justice data were linked with clinical records on First Nations (FN) individuals aged 1 to 25 and diagnosed with FASD between 1999 and 2010 (n = 743). We compared the FN FASD group to non-FN individuals with FASD (non-FN FASD; n = 315) and to First Nations individuals (matched on age, sex, and income) not diagnosed with FASD (FN non-FASD; n = 2229). Rates and relative risks (RRs) were calculated using generalized linear models. RESULTS: FN FASD individuals had similar health services use to non-FN FASD individuals but had greater involvement with child welfare (RR, 1.20; 95% confidence interval [CI], 1.02 to 1.41) and the justice system (RR, 1.37; 95% CI, 1.07 to 1.74) and were more likely to be charged with a crime (RR, 1.40; 95% CI, 1.05 to 1.86). There were no suicides/suicide attempts among the non-FN FASD individuals during the study, but the crude rate/100 person-years of suicides among FN FASD individuals (0.22 for females; 1.06 for males) was substantially higher than for FN non-FASD individuals (0.08 for females; 0.32 for males). There were no significant differences between groups in the education outcomes we measured. CONCLUSIONS: Young people with FASD are at risk for poor health, education, and social outcomes, but First Nations young people with FASD face comparably higher risks, particularly with child welfare and justice system involvement. The study emphasizes a critical need for appropriate resources for First Nations children with FASD.

Effect of multi-component school-based program on body mass index, cardiovascular and diabetes risks in a multi-ethnic study.

BACKGROUND: Mexico occupies one of the first places worldwide in childhood obesity. Its Mestizo and Indigenous communities present different levels of westernization which have triggered different epidemiological diseases. We assessed the effects of a multi-component school-based intervention program on obesity, cardiovascular and diabetes risk factors. METHODS: A physical activity, health education and parent involvement (PAHEPI) program was developed and applied in six urban (Mestizo ethnic group) and indigenous (Seri and Yaqui ethnic groups) primary schools for 12 weeks. A total of 320 children aged 4-12 years participated in intervention program; 203 under Treatment 1 (PAHEPI program) and 117, only from Mestizo groups, under Treatment 2 (PAHEPI+ school meals). For Body Mass Index (BMI), cardiovascular and diabetes factors, pairwise comparisons of values at baseline and after treatments were done using Wilcoxon signed rank test. Generalized linear models were applied to assess the intervention effect by age, sex and nutritional status in relation to ethnicity and treatment. RESULTS: We observed improvements on BMI in children with overweight-obesity and in triglycerides in the three ethnic groups. The Mestizo ethnic group showed the largest improvements under Treatment 2. While Seris showed improvements only in cardiovascular risk factors, Yaquis also showed improvements in diabetes risk factors, though not in BMI. CONCLUSIONS: This study showed that the same intervention may have positive but different effects in different ethnic groups depending on their lifestyle and their emerging epidemiological disease. Including this type of intervention as part of the school curriculum would allow to adapt to ethnic group in order to contribute more efficiently to child welfare. TRIAL REGISTRATION: This study was retrospectively registered under the identifier NCT03768245 .