A cross-sectional study exploring community perspectives on the impacts of COVID-19 in Nunavut and recommendations for a Holistic Inuit Qaujimajatuqangit approach to emergency response.

The goal of this study was to examine and address critical knowledge gaps and develop an understanding of both the positive and negative societal outcomes resulting from the public health measures associated with the COVID-19 pandemic in Nunavut and the interventions being undertaken to promote positive well-being. Data collection for this study included narrative, in-person interviews in Iqaluit, Rankin Inlet, Baker Lake, and Cambridge Bay between September 2022 and January 2023. A total of 70 participants were interviewed for this study. Community highlighted challenges, such as crowding and food insecurity, and concern for the collective wellbeing of the community. Strengths included financials supports, food sharing, and maintaining community connections over a distance. Recommendations included a focus on holistic health such as 1) public education and awareness about communicable disease, 2) financial supports, 3) housing, 4) access to healthcare, 5) focus on Inuit Qaujimajatuqangit, 6) mental-health and addiction supports, and 7) community spaces. Community members described both strengths and challenges they believe impacted their experiences and service delivery as well as recommendations for the future.

Using latent class analysis to operationalize a wholistic assessment of Inuit health and well-being.

Many indigenous cultures conceptualize health wholistically, whereby physical, mental, spiritual and relational dimensions of health are interconnected. Yet, quantitative approaches to studying Indigenous health remain anchored in western perspectives, that separate the dimensions of health. This paper aims to operationalize a wholistic indicator of health based on the IQI model of Inuit health. Variables from the 2017 Nunavik Health Survey (N = 1196) were selected based on their representativeness of IQI model. Exploratory Latent Class Analysis (LCA) was used to identify wholistic health profiles. Once participants assigned to their health profile, sociodemographic characteristics were compared across profiles, and multinomial regression models were used to examine the relationship between community-level social determinants of health and the profiles. The LCA revealed three health profiles, labelled as "excellent", "good" and "fair" based on the distribution of answers to the indicators. Nunavimmiut in "excellent" and "good" health were more likely to: rate their health positively; be over 30 years old; be in a relationship; and have participated or volunteered in community events. Nunavimmiut in "fair" health tended to report lower levels of community cohesion, family relationships, and emotional support. Intergrating culturally relevant models of health can support improved health status assessments and identify opportunities for health promotion.

Prevalence and determinants of insufficient vitamin D status in young Canadian Inuit children from Nunavik.

Background: Vitamin D deficiency has reached pandemic levels affecting over one billion people worldwide. However, limited data is available on the prevalence and determinants of vitamin D status of Canadian Indigenous children and no study has been reported in Inuit children from Nunavik. Aim: Therefore, using data collected between 2006 and 2010, we aimed to investigate the prevalence and main determinants of insufficient serum 25-hydroxyvitamin D (s25(OH)D) concentrations in Inuit children attending childcare centres in Nunavik. Methods: This study included 245 Inuit children aged 11 to 54 months. s25(OH)D concentrations were measured by radioimmunoassay. Dietary intakes were assessed using 24-hour recalls. Usual dietary intakes were estimated using the National Cancer Institute method. We used a multiple imputation technique to replace missing values when performing regression analysis. Results: Our findings revealed that 64.5% of children had a s25(OH)D concentration < 75 nmol/L, while 78.1% did not meet the estimated average requirement (EAR) for vitamin D. Vitamin D intake and fluid milk consumption were positively associated with s25(OH)D concentrations, while negative associations were observed with children' energy intake, non-alcoholic beverage consumption, body weight, breastfeeding duration and, biological/adoptive/foster parents' educational level. Conclusion: Vitamin D inadequacy was highly prevalent and closely aligned with levels observed over the years in non-Indigenous children. Breastfed children who do not receive vitamin D supplementation, overweight and obese children, and children with inadequate milk consumption were at high risk of vitamin D insufficiency. Eating vitamin D rich foods such as fluid milk and seafood along with vitamin D supplementation when needed are recommended.

What Is Wellbeing, and What Is Important for Wellbeing? Indigenous Voices from across Canada.

Indigenous peoples' perceptions of wellbeing differ from non-Indigenous constructs. Thus, it is imperative to recognize that Indigenous peoples will conceptualize wellbeing from their perspectives and set their own wellbeing priorities. In keeping with this viewpoint, the aims of the present study were to conceptualize wellbeing and determine what was (and is) important for wellbeing from Canadian Indigenous peoples' perspectives. In this paper, we take a partnership approach based on the elements of respect, equity, and empowerment. One primary data source and two existing data sources were examined and analyzed thematically utilizing a combination approach of deductive and inductive coding. Indigenous leadership and organizations viewed wellbeing holistically and conceptualized wellbeing multidimensionally. From across Canada, wellbeing was communicated as physical, economic, political, social, and cultural. The scaling of wellbeing represented a collectivist perspective, and land was the connecting thread between all types of wellbeing, being a place to practice cultural traditions, reassert one's Indigenous identity, find solace, and pass on Indigenous knowledge and languages. Although wellbeing was discussed in the context of the individual, family, community, and nation, wellbeing was most often discussed at the cultural level by regional and national Indigenous leadership and organizations. Even in acknowledging the great cultural diversity among Canadian Indigenous nations, four concordant themes were identified regionally and nationally, with respect to what was important for cultural wellbeing: land and water, sustainability, and inherent obligations; being on the land, and indigenous languages and knowledge systems; sustainable development; and meaningful involvement in decision-making, and free, prior, and informed consent. Taking into account these themes is foundational for any interaction with Indigenous peoples, especially in the context of land, culture, and development. There needs to be a new beginning on the journey to reconciliation with land and cultural wellbeing at the forefront.

The Problem of Vitamin D Scarcity: Cultural and Genetic Solutions by Indigenous Arctic and Tropical Peoples.

Vitamin D metabolism differs among human populations because our species has adapted to different natural and cultural environments. Two environments are particularly difficult for the production of vitamin D by the skin: the Arctic, where the skin receives little solar UVB over the year; and the Tropics, where the skin is highly melanized and blocks UVB. In both cases, natural selection has favored the survival of those individuals who use vitamin D more efficiently or have some kind of workaround that ensures sufficient uptake of calcium and other essential minerals from food passing through the intestines. Vitamin D scarcity has either cultural or genetic solutions. Cultural solutions include consumption of meat in a raw or boiled state and extended breastfeeding of children. Genetic solutions include higher uptake of calcium from the intestines, higher rate of conversion of vitamin D to its most active form, stronger binding of vitamin D to carrier proteins in the bloodstream, and greater use of alternative metabolic pathways for calcium uptake. Because their bodies use vitamin D more sparingly, indigenous Arctic and Tropical peoples can be misdiagnosed with vitamin D deficiency and wrongly prescribed dietary supplements that may push their vitamin D level over the threshold of toxicity.

Giving birth in rural Arctic Greenland results from an Eastern Greenlandic birth cohort.

Eastern Greenland is one of the most remote areas in the world. Approximately 3,500 people lives in two small towns and five villages. There is limited information on birth outcomes in Eastern Greenland. A cohort of all birthing women from Eastern Greenland from 2000 to 2017 was established and pregnancy, birth, and neonatal outcomes were described. A total of 1,344 women and 1,355 children were included in the cohort where 14.5% of the women were 18 years or younger, and 36.2% were single parents. Most women, 84.8% gave birth in East Greenland and 92.9%, experienced a vaginal, non-instrumental birth. The overall caesarean section rate was 6.5%. The rate of premature births was 10.1% and 2.2% of the children were born with malformations. The rate of premature births was high, preventive initiatives such as midwifery-led continuity of care including a stronger focus on the pregnant woman's social and mental life situation may be recommended. Organisation of maternity services in East Greenland may benefit from a strong focus on public health, culture, and setting specific challenges, including the birth traditions of the society.

Preventing symptomatic vitamin D deficiency and rickets among Indigenous infants and children in Canada.

Vitamin D deficiency (VitDD) rickets and other manifestations of severe VitDD, such as cardiomyopathy and hypocalcemic seizures, continue to be diagnosed in Canada. Breastfed Indigenous infants, particularly those living in northern communities, are disproportionately impacted, although formula-fed infants are not exempt in cases where the mother's vitamin D status is critically low. This statement deals with the prevention of rickets and hypocalcemia due to VitDD for Indigenous children, and revises an earlier document from the Canadian Paediatric Society. An assessment of the risk for VitDD is recommended for each maternal-infant dyad because of the link between maternal and infant VitDD. Along with supports for enhanced adherence, additional VitD supplementation is recommended for prenatal women and infants deemed at high risk and, in certain situations, intermittent higher dose supplementation may be required. Food insecurity can also contribute to rickets, so advocacy is required to prevent VitDD rickets in Indigenous children.

The Role of the Indigenous Patient Navigator: A Scoping Review.

BACKGROUND: Healthcare systems are complex and as a result patients may experience fragmentation of services. Indigenous populations experience increasingly disproportionate health disparities compared to non-Indigenous populations. Patient navigation is known as a patient-centered approach to empower individuals to connect with appropriate services. Literature surrounding the Indigenous Patient Navigator (IPN) remains sparse necessitating this scoping review. Purpose: To map the current state of the role of the IPN internationally within Canada, United States, Australia and New Zealand. METHODS: Estalished methodological framework by Arksey and O'Malley and the PRISMA extension for scoping reviews was used. RESULTS: A total of 820 articles were reviewed from four databases, yielding sixteen articles. CONCLUSIONS: The absence of published literature surrounding the IPN role in Australia and New Zealand was surprising considering similar histories of colonization. The term navigator was used most often and was typically used when describing lay/peer roles. Professional roles were described using specific role descriptions. Six IPN roles were identified including: (1) social service navigation, (2) wholistic support of Indigenous people, (3) advocacy/building capacity, (4) health assessment, (5) administrative navigation, and (6) outreach. Additionally, barriers and enablers IPNs address are identified. This scoping review will assist to promote and reinforce the IPN role.

Serum selenium levels and asthma among seafood processing workers in Greenland.

Selenium levels in the Inuit population of Greenland have been declining during the last decades. The association between Selenium and asthma has been investigated previously, but with conflicting results. The objective was to measure human serum Se (s-Se) in Greenlandic seafood processing workers, to compare with levels recorded in previous decades and to establish if s-Se is associated with asthma or lung function. Data, including questionnaire answers, spirometry, skin-prick test and s-Se from 324 seafood processing workers in Greenland were collected during 2016-2017. Mean s-Se values were compared by t-test and one-way ANOVA. Associations between s-Se and asthma, symptoms from the lower airways at work and lung function were assessed using linear regression. The mean s-Se was 96.2 µg/L. S-Se was higher among non-smokers and workers living in settlements. Workers with asthma did not have s-Se levels significantly different from those of non-asthmatics. We found a positive association between s-Se levels and FEV1 values. Selenium levels appear to continue declining in Greenland, presumably because of a more Westernised lifestyle. The health effects of declining Selenium levels remain unclear. We did not establish an association between s-Se and asthma, but we did record a positive association between s-Se and FEV1.

People and Plants in Nunatsiavut (Labrador, Canada): Examining Plants as a Foundational Aspect of Culture in the Subarctic.

This paper emphasizes the cultural value of plants in Nunatsiavut (Labrador, Canada), a self-governing Inuit region in the Subarctic. Via interviews with community members, we describe the links between plant usage and culture to understand the direct ways that plants are utilized for food, construction, gardening, and medicine, and to then link these uses to deeper cultural significance among three communities in Nunatsiavut (Hopedale, Postville, and Rigolet). Many plants were common amongst communities with a total of 66 taxa identified. About 75% of taxa were reported in at least two communities, corresponding to 95% of all responses. Edible plants were the most common reported usage, with emphasis on berry-producing taxa such as blueberry shrubs. Our study shows that a diversity of plants (i) support cultural activities; (ii) act as markers for historical events; (iii) highlight intergenerational exchange and valuing of plant knowledge; (iv) express the deep awareness that people have for their local environment; and (v) a medium for the expression of traditional values. The similarities in the plant responses among the communities suggest a shared body of plant knowledge. Our study supports the great cultural importance of plants in northern communities. Supplementary Information: The online version contains supplementary material available at 10.1007/s12231-021-09530-7.

Implementation of AUDIT in the treatment planning process for alcohol use disorder in Greenland.

INTRODUCTION: The aim was to describe the treatment-seeking population with alcohol use disorder by means of data from the AUDIT questionnaire at referral and to evaluate and discuss if this information can be of use in treatment and service planning. METHODS: Data from 2016 to 2018 were extracted from the National Database on Substance Abuse Treatment. The sample included 1281 individual treatment seekers from all over Greenland. RESULTS: Mean age was 38.2 years (SD 12.1 years). Only 60.1% had a total AUDIT score suggesting dependency, and 15.5% had a harmful use. While most only drank 2-4 times a month, about 95% binge drank. Half reported loss of control at least weekly, and one of three had been unable to do what was expected of them, or needed a drink first thing in the morning weekly or more often. In two-third others had been concerned about the drinking. Users of cannabis had a higher AUDIT score, while gambling was unassociated to alcohol use. Substantial gender and regional differences were seen. DISCUSSION: The AUDIT screening was found useful in individual and national treatment planning. Data suggested that particular focus should be given to women in treatment, and the service offered to the East Greenlandic population.

Mercury in Ringed Seals (Pusa hispida) from the Canadian Arctic in Relation to Time and Climate Parameters.

Mercury is found in Arctic marine mammals that are important in the diet of northern Indigenous peoples. The objectives of the present long-term study, spanning a 45-yr period, were to 1) investigate the temporal trends of total mercury (THg; muscle and liver) and selenium (Se; liver) in ringed seals (Pusa hispida) from different regions of the Canadian Arctic; and 2) examine possible relationships with age, diet, and climate parameters such as air temperature, precipitation, climatic indices, and ice-coverage. Ringed seals were collected by hunters in northern communities in the Beaufort Sea, Central Arctic, Eastern Baffin Island, Hudson Bay, and Ungava/Nunatsiavut regions (Canada) between 1972 and 2017. Mercury levels did not change through time in seal liver, but THg levels in muscle decreased in seals from Hudson Bay (-0.91%/yr) and Ungava/Nunatsiavut (-1.30%/yr). Carbon stable isotope values in seal muscle decreased significantly through time in 4 regions. Selenium-to-THg ratios were found to be >1 for all years and regions. Variation partitioning analyses across regions indicated that THg trends in seals were mostly explained by age (7.3-21.7%), climate parameters (3.5-12.5%), and diet (up to 9%); climate indices (i.e., Arctic and North Atlantic Oscillations, Pacific/North American pattern) explained the majority of the climate portion. The THg levels had a positive relationship with Arctic Oscillation for multiple regions. Associations of THg with air temperature, total precipitation, and sea-ice coverage, as well as with North Atlantic Oscillation and Pacific/North American pattern were found to vary with tissue type and geographical area. Environ Toxicol Chem 2020;39:2462-2474. © 2020 Her Majesty the Queen in Right of Canada. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. Reproduced with the permission of the Minister of Fisheries and Oceans Canada.

Omega-3 fatty acids and risk of cardiovascular disease in Inuit: First prospective cohort study.

BACKGROUND AND AIMS: No prospective study have ever assessed if marine n-3 polyunsaturated fatty acids protect Inuit against cardiovascular disease as claimed. It is highly relevant as cardiovascular disease (CVD) incidence rates are rising concurrent with a westernization of diet. We aimed to assess the association between blood cell membrane phospholipid content of eicosapentaenoic acid and docosahexaenoic acid (EPA + DHA) on CVD risk in Inuit. METHODS: We used data from a cohort of adult Greenlanders with follow-up in national registers. The main outcome was fatal and non-fatal CVD incidence among participants without previous CVD. The continuous effect of EPA + DHA was calculated as incidence rate ratios (IRRs) using Poisson regression with age as time scale, adjusting for age, sex, genetic admixture, lifestyle and dietary risk factors. RESULTS: Out of 3095 eligible participants, 2924 were included. During a median follow-up of 9.7 years, 216 had their first CVD event (8.3 events/1000 person years). No association between EPA + DHA and CVD risk was seen, with IRR = 0.99 per percentage point EPA + DHA increase (95% CI: 0.95-1.03, p = 0.59). No association was seen with risk of ischemic heart disease (IHD) (IRR = 1.03, 95% CI: 0.97-1.09) and stroke (IRR = 0.98, 95% CI: 0.93-1.03) as separate outcomes or for intake of EPA and DHA. CONCLUSIONS: We can exclude that the CVD risk reduction is larger than 21% for individuals at the 75% EPA + DHA percentile compared to the 25% percentile. We need a larger sample size and/or longer follow-up to detect smaller effects and associations with IHD and/or stroke.

The social determinants of healthy ageing in the Canadian Arctic.

A better knowledge of the social determinants of health (SDH) promoting healthy ageing in Inuit communities is needed to adapt health and social policies and programs. This study aims to identify SDH associated with healthy ageing. Using the 2006 Aboriginal Peoples Survey (n = 850 Inuit aged ≥50 years), we created a holistic indicator including multiple dimensions of health and identified three groups of participants: those in 1) good 2) intermediate and 3) poor health. Sex and age-adjusted multinomial regression models were applied to assess the associations between this indicator and SDH measured at the individual, household and community scales. In comparison to APS respondents in the "Poor health" profile, those in the "Good health" profile were more likely to have a higher individual income, to participate in social activities, and to have stronger family ties in the community ; those in the "Intermediate health" profile were less likely be in a relationship, more likely to live in better housing conditions, and in better-off communities. Results indicate that SDH associated with the "Good health" profile related more to social relationships and participation, those associated with the "Intermediate health" profile related more to economic and material conditions.

Selenoneine is a major selenium species in beluga skin and red blood cells of Inuit from Nunavik.

Nunavimmiut (Inuit of Nunavik, Northern Quebec, Canada) exhibit a high selenium (Se) status because of their frequent consumption of marine mammal foods. Indirect evidence from our previous studies had suggested that selenoneine - a novel selenocompound - may be accumulating in the blood of Nunavimmiut. We used a liquid-chromatography/inductively coupled tandem mass spectrometry (LC-ICP-MS/MS) method to measure concentrations of selenoneine and its methylated metabolite Se-methylselenoneine in archived red blood cells (RBC) obtained from 210 Nunavimmiut living in communities along the Hudson Strait, where marine mammal hunting and consumption are most frequent in Nunavik. This method was adapted to quantify selenoneine and its methylated metabolite in beluga mattaaq, an Inuit delicacy consisting of the skin with the underlying layer of fat and the major dietary source of Se for Nunavimmiut. Total selenium concentration was also measured in RBC and beluga mattaaq samples by isotope dilution ICP-MS/MS. The median selenoneine concentration in RBC was 413 µg Se/L (range = 3.20-3230 µg Se/L), representing 54% (median) of total Se content (range = 1.6-91%). Quantification of selenoneine in five beluga mattaaq samples (skin layer) from Nunavik revealed a median concentration of 1.8 µg Se/g wet wt (range = 1.2-7.4 µg Se/g), constituting 54% (median) of the total Se content (range = 44-74%). Se-methylselenoneine was also detected in Inuit RBC but not in beluga mattaaq, suggesting that selenoneine undergoes methylation in humans. Selenoneine may protect Nunavimmiut from methylmecury toxicity by increasing its demethylation in RBC and in turn decreasing its distribution to target organs.

Determinants of selenoneine concentration in red blood cells of Inuit from Nunavik (Northern Québec, Canada).

Selenium (Se) is a trace mineral essential to human health, and is especially abundant in marine foods consumed by Inuit populations in Nunavik (northern Quebec, Canada), leading to exceptionally high whole blood Se levels. While most epidemiological studies to date examine plasma or whole blood Se, little is known about the health implications of specific Se biomarkers (e.g. selenoproteins and small Se compounds). Selenoneine, a novel Se compound, is found in high concentrations in marine foods (and particularly beluga mattaaq) and the red blood cells (RBCs) of populations that consume them. We report here RBC selenoneine concentrations in a population of Inuit adults (n = 885) who participated in the Qanuippitaa? 2004 survey. Simple associations between RBC selenoneine and other Se and mercury (Hg) biomarkers were assessed using Spearman correlations and linear regressions. Wilcoxon ranksum tests were used to examine differences in biomarkers and characteristics between tertiles of RBC selenoneine concentration. A multiple linear regression analysis was used to determine factors (sociodemographic, lifestyle, and dietary) associated with RBC selenoneine concentrations. Selenoneine comprised a large proportion of whole blood Se and RBC Se in this population. Age and sex-adjusted geometric mean RBC selenoneine concentration was 118 µg/L (range: 1-3226 µg/L) and was much higher (p = 0.001) among women (150.3 µg/L) than men (87.6 µg/L) across all regions of Nunavik after controlling for age, region, and diet. RBC selenoneine was highly correlated with RBC Se (rs = 0.96, p < 0.001) and whole blood Se (rs = 0.89, p < 0.001), but only weakly correlated with plasma Se (rs = 0.13, p < 0.001). Overall, increasing age (standardized ß = 0.24), higher body-mass index (BMI; ß = 0.08), female sex (ß = 0.10), living in a Hudson Strait community (compared to Hudson Bay and Ungava Bay; ß = 0.38), and consuming beluga mattaaq (g/day; ß = 0.19) were positively associated with RBC selenoneine. Meanwhile, consumption of market meats (g/day; ß = -0.07) was negatively associated with RBC selenoneine. RBC selenoneine is an important biomarker of Se dietary intake from local marine foods in Inuit populations. Further studies are needed to examine the health effects of selenoneine intake and the underlying mechanisms for sex differences among Inuit populations.

Environmental impact assessment of uranium exploration and development on indigenous land in Labrador (Canada): a community-driven initiative.

There is hardly any study on environmental impacts of uranium exploration and mining development prior to actual mining activities. Rather, the majority of the literature addresses the environmental impacts of either ongoing or decommissioned mines. The objective of the study was to measure the possible radioactive contamination (total uranium and lead) in the local ecosystem surrounding an abandoned uranium development site on indigenous land in Labrador (Canada). Water (brook and ponds), soil/sediments (brook and ponds), plants (growing along the brook and pond shores), and local fish (trout) and clams from bays were collected from mine development site, downstream, and control sites. Uranium and lead mobilization in the local environment appears to be slightly enhanced near the proposed mining site, but rapidly drops downstream. Developing a low-cost, community-based environmental health monitoring tool is an ideal strategy for generating baseline information and further follow-up.

Prevalence of heart attack and stroke and associated risk factors among Inuit in Canada: A comparison with the general Canadian population.

BACKGROUND: It is generally believed that cardiovascular disease (CVD) is rare in the Inuit population because of their traditional marine-based diet, but the evidence is inconsistent. OBJECTIVE: To describe the cardiovascular health profile of Canadian Inuit, including disease prevalence, risk factors, country food consumption, and contaminant exposure, and compare to that of the general Canadian population. METHODS: Cardiovascular outcomes and risk factors were obtained for 2070 Inuit adults aged 20-79 years from the Inuit Health Survey (IHS, 2007-2008) and for 3464 general Canadian adults aged 20-79 years from the Canadian Health Measures Survey, Cycle 1 (CHMS, 2007-2009) and Cycle 3 (2012-2013). Sex- and age-specific (20-39, 40-59, 60-79) estimates are reported. To compare results between the IHS and CHMS, age-standardized estimates were calculated for males and females, using the CHMS as the reference population. RESULTS: Inuit had higher prevalence of heart attack (3.1% vs. 1.8% females), stroke (2.1% vs. 0.8% males and 2.2% vs. 1.0% females), diabetes (14.6% vs. 9.0% elderly females), obesity (35.8% vs. 24.2% females), and hypertension (12.2% vs. 2.5% young males and 7.5% vs. 2.5% young females). However, Inuit had better blood lipid profile (hyperlipidemia: 29.0% vs. 46.5% males and 28.4% vs. 35.2% females). Metals and persistent organic pollutant exposures were higher among the Inuit compared with general Canadians. CONCLUSION: Inuit and the general Canadian population differ in cardiovascular health profiles. Further research is needed to characterize the health transition among Inuit, especially among the youth and female.

Determinants of an integrated public health approach: the implementation process of Greenland's second public health program.

BACKGROUND: Greenland struggles with a high prevalence of smoking, alcohol and drug abuse. In response to the increasing need for preventive initiatives, the first public health program Inuuneritta was introduced in 2007. Internationally, frameworks focus primarily on the implementation of a single, well-described intervention or program. However, with the increasing need and emergence of more holistic, integrated approaches, a need for research investigating the process of policy implementation from launch to action arises. This paper aims to augment the empirical evidence on the implementation of integrated health promotion programs within a governmental setting using the case of Inuuneritta II. In this study, the constraining and enabling determinants of the implementation processes within and across levels and sectors were examined. METHODS: Qualitative methods with a transdisciplinary approach were applied. Data collection consisted of six phases with different qualitative methods applied to gain a comprehensive overview and understanding of Inuuneritta II's implementation process. These methods included: observations and focus group discussions at the community health worker (CHW) conference, telephone interviews, document analysis, and a workshop on results dissemination. RESULTS: Enabling determinants influencing the implementation process of Inuuneritta II positively were high motivation among adopters, local prevention committees supporting community health workers, and the initiation of the central prevention committee. In contrast, constraining determinants were ambiguous program aims, high turnovers, siloed budgets and work environments, and an inconsistent and neglected central prevention committee. CONCLUSION: Inuuneritta II provided a substantial framework for an integrated health policy approach. However, having a holistic and comprehensive program enabling an integrated approach is not sufficient. Inuuneritta II's integrated approach does not harmonise with the government's inflexible organisational structure resulting in insufficient implementation.

Caribou (Rangifer tarandus) and Inuit Nutrition Security in Canada.

Caribou (Rangifer tarandus) has been fundamental to the diet and culture of Arctic Indigenous Peoples for thousands of years. Although caribou populations observe natural cycles of abundance and scarcity, several caribou herds across the Circumpolar North have experienced dramatic declines in recent decades due to a range of interrelated factors. Broadly, the objectives of this study are to examine food and nutrition security in relation to wildlife population and management status across Inuit Nunangat (the Inuit homeland, consisting of four regions across the Canadian Arctic). Specifically, we: (1) characterize the contribution of caribou to Inuit nutrition across northern Canada and (2) evaluate the population and management status of caribou herds/populations harvested by Inuit. Dietary data were derived from the 2007-2008 Inuit Health Survey, which included dietary information for Inuit adults (n = 2097) residing in thirty-six communities, spanning three regions (the Inuvialuit Settlement Region, Nunavut, and Nunatsiavut) of the Canadian North. Published information regarding the range, abundance, status, and management status of caribou herds/populations was collected through document analysis and was validated through consultation with northern wildlife experts (territorial governments, co-management, and/or Inuit organizations). While caribou contributed modestly to total diet energy (3-11% of intake) across the regions, it was the primary source of iron (14-37%), zinc (18-41%), copper (12-39%), riboflavin (15-39%), and vitamin B12 (27-52%), as well as a top source of protein (13-35%). Restrictions on Inuit subsistence harvest (harvest quotas or bans) are currently enacted on at least six northern caribou herds/populations with potential consequences for country food access for over twenty-five Inuit communities across Canada. A holistic multi-sectorial approach is needed to ensure the sustainability of wildlife populations, while supporting Inuit food and nutrition security in the interim.