Conceptualising the relationships between food sovereignty, food security and oral health among global Indigenous Communities: a scoping review.

OBJECTIVE: Invasive colonial influences and continuing neoliberal policies have a detrimental impact on Land, health, food and culture for Indigenous Communities. Food security and sovereignty have significant impacts on Indigenous well-being and, specifically, oral health. Aspects relating to food security, such as availability of nutritious foods, are a common risk factor of oral diseases. This scoping review aimed to collate existing evidence regarding the relationship between food sovereignty and/or food security and oral health for Indigenous Communities, globally. DESIGN: Four databases were searched using keywords related to 'Food security' or 'Food sovereignty,' 'Indigenous Peoples' and 'Oral health.' Duplicates were removed, and two independent reviewers screened the titles and abstracts to identify articles for full-text review. Extracted data were summarised narratively, presenting a conceptual model which illustrates the findings and relationships between food security and/or food sovereignty and oral health. RESULTS: The search identified 369 articles, with forty-one suitable for full-text review and a final nine that met inclusion criteria. The impact of food security and food sovereignty on oral health was discussed across different populations and sample sizes, ranging from eighteen Kichwa families in Brazil to 533 First Nations and Metis households in Canada. Pathways of influence between food sovereignty and/or food security are explored clinically, quantitatively and qualitatively across oral health outcomes, including early childhood caries, dental caries and oral health-related quality of life for Indigenous Communities. CONCLUSIONS: Innovative strategies underpinned by concepts of Indigenous food sovereignty are needed to promote oral health equity for Indigenous Communities. The nexus between oral health and Indigenous food sovereignty remains largely unexplored, but has immense potential for empowering Indigenous rights to self-determination of health that honour Indigenous ways of knowing, being and doing.

Beliefs around the causes of inequities and intergroup attitudes among health professional students before and after a course related to Indigenous Peoples and colonialism.

BACKGROUND: Addressing the Truth and Reconciliation Calls to Action on including anti-racism and cultural competency education is acknowledged within many health professional programs. However, little is known about the effects of a course related to Indigenous Peoples and colonialism on learners' beliefs about the causes of inequities and intergroup attitudes. METHODS: A total of 335 learners across three course cohorts (in 2019, 2020, 2022) of health professional programs (e.g., Dentistry/Dental Hygiene, Medicine, Nursing, and Pharmacy) at a Canadian university completed a survey prior to and 3 months following an educational intervention. The survey assessed gender, age, cultural identity, political ideology, and health professional program along with learners' causal beliefs, blaming attitudes, support for social action and perceived professional responsibility to address inequities. Pre-post changes were assessed using mixed measures (Cohort x Time of measurement) analyses of variance, and demographic predictors of change were determined using multiple regression analyses. Pearson correlations were conducted to assess the relationship between the main outcome variables. RESULTS: Only one cohort of learners reported change following the intervention, indicating greater awareness of the effects of historical aspects of colonialism on Indigenous Peoples inequities, but unexpectedly, expressed stronger blaming attitudes and less support for government social action and policy at the end of the course. When controlling for demographic variables, the strongest predictors of blaming attitudes towards Indigenous Peoples and lower support for government action were gender and health professional program. There was a negative correlation between historical factors and blaming attitudes suggesting that learners who were less willing to recognize the role of historical factors on health inequities were more likely to express blaming attitudes. Further, stronger support for government action or policies to address such inequities was associated with greater recognition of the causal effects of historical factors, and learners were less likely to express blaming attitudes. CONCLUSION: The findings with respect to blaming attitudes and lower support for government social action and policies suggested that educational interventions can have unexpected negative effects. As such, implementation of content to address the Truth and Reconciliation Commissions Calls to Action should be accompanied by rigorous research and evaluation that explore how attitudes are transformed across the health professional education journey to monitor intended and unintended effects.

Costs and benefits of community water fluoridation in remote Aboriginal communities of the Northern Territory.

OBJECTIVE: To undertake an economic evaluation of community water fluoridation (CWF) in remote communities of the Northern Territory (NT). DESIGN: Dental caries experiences were compared between CWF and non-CWF communities before and after intervention. Costs and benefits of CWF are ascertained from the health sector perspective using water quality, accounting, oral health, dental care and hospitalisation datasets. SETTING AND PARTICIPANTS: Remote Aboriginal population in the NT between 1 January 2008 and 31 December 2020. INTERVENTION: CWF. MAIN OUTCOME MEASURES: Potential economic benefits were estimated by changes in caries scores valued at the NT average dental service costs. RESULTS: Given the total 20-year life span of a fluoridation plant ($1.77 million), the net present benefit of introducing CWF in a typical community of 300-499 population was $3.79 million. For each $1 invested in CWF by government, the estimated long-term economic value of savings to health services ranged from $1.1 (population ≤300) to $16 (population ≥2000) due to reductions in treating dental caries and associated hospitalisations. The payback period ranged from 15 years (population ≤300) to 2.2 years (population ≥2000). CONCLUSIONS: The economic benefits of expanding CWF in remote Aboriginal communities of NT outweigh the costs of installation, operation and maintenance of fluoridation plants over the lifespan of CWF infrastructure for population of 300 or more.

Olva Odlum BDS MSc LDS, the First Female Faculty Member in Manitoba and Dentist to the Indigenous Population.

Olva Odlum qualified as a dentist in England but went on to make a professional life in Canada. She became the first female member of the Manitoba dental faculty and provided care for many dentally-deprived groups, including disabled patients, those with cancer and members of the First Nation tribes.

Consulting a Victorian Aboriginal community about their oral health.

BACKGROUND: The legacy of colonisation, assimilation, racism and victim blaming has created inequality in health for Aboriginal people, reflected in their oral health status. Despite the existence of community dental services, oral disease levels continue to be of concern. This study, initiated by a rural Victorian ACCHO (Aboriginal Community Controlled Health Organisation), aimed to consult their community about the barriers to and enablers of oral health and understand their lived experiences with dental services. METHODS: Using an Aboriginal knowledge framework and collaborative approach involving an Aboriginal researcher and Community Mentor, this study consulted an ACCHO community about their oral health. Following community engagement, 21 community members participated in digitally recorded yarning circles and semi-structured interviews. RESULTS: Themes emerging from the data included dental care history and past experiences involving pain and shame, the value of having community-centred services and engagement with patients and the community. DISCUSSION: Experiences of dental care are often related to pain driving attendance resulting in experiences that multiply fear and anxiety. While community-based care was considered a strength, approaches to individual dental care often resulted in increasing shame and diminishing trust. Increasing cultural safety and participatory approaches to designing and delivering dental care may increase engagement and trust. CONCLUSIONS: Important gaps in cultural and clinical understanding between the community and dental service providers have been identified. These findings will be used to inform the delivery of dental services and to develop oral health promotion programs at the ACCHO, and cultural safety preparation for student dental practitioners.

Ancient DNA Reconstructs the Genetic Legacies of Precontact Puerto Rico Communities.

Indigenous peoples have occupied the island of Puerto Rico since at least 3000 BC. Due to the demographic shifts that occurred after European contact, the origin(s) of these ancient populations, and their genetic relationship to present-day islanders, are unclear. We use ancient DNA to characterize the population history and genetic legacies of precontact Indigenous communities from Puerto Rico. Bone, tooth, and dental calculus samples were collected from 124 individuals from three precontact archaeological sites: Tibes, Punta Candelero, and Paso del Indio. Despite poor DNA preservation, we used target enrichment and high-throughput sequencing to obtain complete mitochondrial genomes (mtDNA) from 45 individuals and autosomal genotypes from two individuals. We found a high proportion of Native American mtDNA haplogroups A2 and C1 in the precontact Puerto Rico sample (40% and 44%, respectively). This distribution, as well as the haplotypes represented, supports a primarily Amazonian South American origin for these populations and mirrors the Native American mtDNA diversity patterns found in present-day islanders. Three mtDNA haplotypes from precontact Puerto Rico persist among Puerto Ricans and other Caribbean islanders, indicating that present-day populations are reservoirs of precontact mtDNA diversity. Lastly, we find similarity in autosomal ancestry patterns between precontact individuals from Puerto Rico and the Bahamas, suggesting a shared component of Indigenous Caribbean ancestry with close affinity to South American populations. Our findings contribute to a more complete reconstruction of precontact Caribbean population history and explore the role of Indigenous peoples in shaping the biocultural diversity of present-day Puerto Ricans and other Caribbean islanders.

Challenges in identifying indigenous peoples in population oral health surveys: a commentary.

There are currently 370 million persons identifying as indigenous across 90 countries globally. Indigenous peoples generally face substantial exclusion/marginalization and poorer health status compared with non-indigenous majority populations; this includes poorer oral health status and reduced access to dental services. Population-level oral health surveys provide data to set priorities, inform policies, and monitor progress in dental disease experience/dental service utilisation over time. Rigorously and comprehensively measuring the oral health burden of indigenous populations is an ethical issue, though, given that survey instruments and sampling procedures are usually not sufficiently inclusive. This results in substantial underestimation or even biased estimation of dental disease rates and severity among indigenous peoples, making it difficult for policy makers to prioritise resources in this area. The methodological challenges identified include: (1) suboptimal identification of indigenous populations; (2) numerator-denominator bias and; (3) statistical analytic considerations. We suggest solutions that can be implemented to strengthen the visibility of indigenous peoples around the world in an oral health context. These include acknowledgment of the need to engage indigenous peoples with all data-related processes, encouraging the use of indigenous identifiers in national and regional data sets, and mitigating and/or carefully assessing biases inherent in population oral health methodologies for indigenous peoples.

Point of care and oral fluid hepatitis B testing in remote Indigenous communities of northern Australia.

Many Indigenous Australians in northern Australia living with chronic hepatitis B are unaware of their diagnosis due to low screening rates. A venous blood point of care test (POCT) or oral fluid laboratory test could improve testing uptake in this region. The purpose of this study was to assess the field performance of venous blood POCT and laboratory performance of an oral fluid hepatitis B surface antigen (HBsAg) test in Indigenous individuals living in remote northern Australian communities. The study was conducted with four very remote communities in the tropical north of Australia's Northern Territory. Community research workers collected venous blood and oral fluid samples. We performed the venous blood POCT for HBsAg in the field. We assessed the venous blood and oral fluid specimens for the presence of HBsAg using standard laboratory assays. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the POCT and oral fluid test, using serum laboratory detection of HBsAg as the gold standard. From 215 enrolled participants, 155 POCT and 197 oral fluid tests had corresponding serum HBsAg results. The POCT had a sensitivity of 91.7% and specificity of 100%. Based on a population prevalence of 6%, the PPV was 100% and NPV was 99.5%. The oral fluid test had a sensitivity of 56.8%, specificity of 98.1%, PPV of 97.3% and NPV of 65.9%. The venous blood POCT has excellent test characteristics and could be used to identify individuals with chronic HBV infection in high prevalence communities with limited access to health care. Oral fluid performance was suboptimal.

Dental Caries Remains a Significant Public Health Problem for South American Indigenous People.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Dental caries in South American Indigenous people: A systematic review. Soares GH, Pereira NF, Gabriela M, Biazevic H, Braga MM, Michel-Crosato E. Community Dent Oral Epidemiol 2019;47(2):142-52. SOURCE OF FUNDING: Brazilian National Council for Scientific and Technological Development (CNPq). TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Relational continuity of oral health care in Indigenous communities: a qualitative study.

BACKGROUND: The relational continuity of care is an essential function of primary health care. This study reports on the perspectives of Cree communities and their primary health care providers regarding the barriers and enablers of relational continuity of oral health care integrated at a primary health care organization. METHODS: A multiple case study design within a qualitative approach and developmental evaluation methodology were used to conduct this research study in Cree communities of Northern Québec. Maximum variation sampling and snowball techniques were used to recruit the participants. Data collection consisted of individual interviews and focus group discussions. Thematic analysis was conducted which included transcription, debriefing, codification, data display, and interpretation. The consolidated criteria for reporting qualitative studies (COREQ) were used to guide the reporting of study findings. RESULTS: A total of six focus group discussions and 36 individual interviews were conducted. Five major themes emerged from the thematic analyses for barriers (two) and enablers (three). Themes for barriers included impermanence and lack of effective communication, whereas themes for enablers included culturally competent professionals, working across professional boundaries, and proactive organizational engagement. CONCLUSIONS: Based on these findings, relational continuity can be empowered by effective strategies for overcoming barriers and encouraging enablers, such as recruitment of permanent professionals, organizing cultural competency training, development of a Cree language dental glossary, encouraging inter-professional collaboration, and promoting the organization's efforts.

Prevalence and incidence of oral cancer and pre-cancerous lesions in indigenous populations: a systematic review protocol.

OBJECTIVE: This review will determine the prevalence and incidence of oral cancer and pre-cancerous lesions in indigenous populations. INTRODUCTION: There are approximately 476 million indigenous individuals worldwide. Oral cancer affected over 350,000 people globally in 2018, with approximately 80% of cases occurring in the indigenous population. Moreover, the incidence of pre-cancerous lesions is high in this population, accounting for 48.3%. Limited evidence exists regarding the burden of oral cancer among indigenous populations despite research on oral health disparities in this group. INCLUSION CRITERIA: Studies on the burden of oral cancer and pre-cancerous lesions in indigenous groups, considering rates, ratios (prevalence or mortality), or survival proportions, will be considered for inclusion. There will be no limitations on study design, language, age, gender, or geography. We will exclude studies that only identify, diagnose, or screen oral cancer and pre-cancerous lesions without mentioning prevalence and incidence. METHODS: This review will follow the JBI methodology for systematic reviews of prevalence and incidence. Databases to be searched will include MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Central Register of Controlled Trials, Scopus, and Dentistry and Oral Sciences Source (EBSCOhost). ProQuest Dissertations and Theses, OAIster, International Association for Dental Research conference abstracts, Google Scholar, government reports, and cancer registry reports will also be screened for unpublished studies. Two reviewers will independently screen articles, and data will be extracted using a customized form. Narrative data synthesis will be conducted and, where appropriate, meta-analysis will be performed. Methodological quality will be assessed using JBI's critical appraisal tool for prevalence studies. REVIEW REGISTRATION: PROSPERO CRD42023402858.

Oral health of an indigenous population in northeastern Brazil: a cross-sectional Study of the Fulni-ô ethnic group.

BACKGROUND: There is a lack of studies evaluating the oral health of traditional indigenous communities in Brazil. OBJECTIVES: Thus, the objective of this study was to describe the oral health characteristics of the indigenous Fulni-ô ethnic group in Northeast Brazil. DESIGN AND SETTING: A cross-sectional observational investigation was conducted within the Project on Atherosclerosis among Indigenous Populations. METHODS: This study included participants of both sexes from the Fulni-ô ethnic group. The participants included in this investigation underwent a comprehensive oral health evaluation by a registered and experienced dentist to assess oral health and identify potentially malignant oral lesions. Participants with suspicious lesions were referred for biopsy. Shapiro-Wilk, Mann-Whitney, and Student's t-tests were used, and measures of central tendency and dispersion were described. Statistical significance was 5%. RESULTS: A total of 104 individuals were included in this study. The prevalence of the use of tobacco derivatives was 94.0%, with similarities between sexes. The prevalence of oral changes in this study population was 84.4%. Fifty-one individuals who underwent oral reassessment were referred for oral lesion biopsy. CONCLUSIONS: This study demonstrated a high prevalence of oral alterations in the Fulni-ô population. Histopathological analyses indicated the presence of mild oral epithelial dysplasia in five cases.

History of dental caries in Inuit populations: genetic implications and 'distance effect'.

Dental caries is considered the third most important scourge in the world. In North America, Inuit populations are the population the most severely affected by dental caries. It is often assumed that this situation can be explained by a combination of factors classical for Indigenous populations: remoteness (geographical distance), low economic status and low health literacy (cultural distance). Using a bibliographic approach, we tested this hypothesis of the "distance effect" by exploring the caries prevalence in other Indigenous populations living in high-income countries. Next, we tested whether the high prevalence of caries is due to population-specific characteristics by tracking caries prevalence over the past few centuries. In result, we showed that while other Indigenous populations are more impacted by caries than the general populations, the Inuit populations present the highest prevalence. Paradoxically, we showed also that past Inuit populations were almost immune to caries before 1950. These two elements suggest that the prevalence of caries observed presently is a recent maladaptation and that beyond the effect of cultural and geographical distance, specific biocultural factors have to be investigated.

Kinship analysis of 5th- to 6th-century skeletons of Romanized indigenous people from the Bled-Pristava archaeological site.

The familial relationship between skeletons buried together in a shared grave is important for understanding the burial practices of past human populations. Four skeletons were excavated from the Late Antiquity part of the Bled-Pristava burial site in Slovenia, dated to the 5th to 6th century. They were anthropologically characterized as two adults (a middle-aged man and a young woman) and two non-adults (of unknown sex). Based on stratigraphy, the skeletons were considered to be buried simultaneously in one grave. Our aim was to determine whether the skeletons were related. Petrous bones and teeth were used for genetic analysis. Specific precautions were followed to prevent contamination of ancient DNA with contemporary DNA, and an elimination database was established. Bone powder was obtained using a MillMix tissue homogenizer. Prior to extracting the DNA using Biorobot EZ1, 0.5 g of powder was decalcified. The PowerQuant System was used for quantification, various autosomal kits for autosomal short tandem repeat (STR) typing, and the PowerPlex Y23 kit for Y-STR typing. All analyses were performed in duplicate. Up to 28 ng DNA/g of powder was extracted from the samples analyzed. Almost full autosomal STR profiles obtained from all four skeletons and almost full Y-STR haplotypes obtained from two male skeletons were compared, and the possibility of a familial relationship was evaluated. No amplification was obtained in the negative controls, and no match was found in the elimination database. Autosomal STR statistical calculations confirmed that the adult male was the father of two non-adult individuals and one young adult individual from the grave. The relationship between the males (father and son) was additionally confirmed by an identical Y-STR haplotype that belonged to the E1b1b haplogroup, and a combined likelihood ratio for autosomal and Y-STRs was calculated. Kinship analysis confirmed with high confidence (kinship probability greater than 99.9% was calculated for all three children) that all four skeletons belonged to the same family (a father, two daughters, and a son). Through genetic analysis, the burial of members of the same family in a shared grave was confirmed as a burial practice of the population living in the Bled area in Late Antiquity.

Prevalence of dental caries, periodontal disease, malocclusion, and tooth wear in indigenous populations in Brazil: a systematic review and meta-analysis.

The aim of this review was to evaluate the prevalence of dental caries, periodontal disease, malocclusion, and tooth wear in indigenous in Brazil. A systematic review of observational studies was performed according to the PRISMA guidelines (CRD42020218704). The search strategy involved the electronic databases of Embase, LILACS, PubMed, Web of Science, Scopus, and the CAPES Theses and Dissertations for gray literature. The eligibility criteria consisted of publications that assessed the prevalence of oral conditions in indigenous populations in Brazil. Studies with indigenous people living in urban area were excluded. The risk of bias was evaluated by using JBI Critical Appraisal for prevalence studies. Thirty studies were included in the review, and the majority showed a low risk of bias. A meta-analysis of 20 studies was conducted using the random-effects model and a 95% confidence interval. Several ethnicities were studied in isolation or in groups (n = 7,627 for dental caries; n = 2,774 for periodontal disease; n = 1,067 for malocclusion; n = 150 for tooth wear). The prevalence of caries ranged from 50% among indigenous people aged 18-36 months to 100% among those aged 65-74 years. The prevalence of periodontal disease ranged from 58% to 83%. The prevalence of malocclusion was 43%. Tooth wear was assessed in only one ethnic group and showed a prevalence of 100% in indigenous people aged >18 years. The certainty of evidence assessed by the GRADE system ranged from very low to moderate. This systematic review showed significant differences in the prevalence of dental caries, periodontal disease and malocclusion between indigenous population groups and territories in which indigenous people live.

Developing a land-based oral health promotion project with an Indigenous community in northern British Columbia, Canada.

In British Columbia, Canada, First Nations children and youth consistently present with a higher incidence of dental disease. Efforts to improve the oral health status of Indigenous populations have had mixed success, and programs have typically been offered through a Western lens. Recent years have brought calls for oral health professionals to embrace a more holistic approach to health promotion, representative of Indigenous cultures. Colonization has been considered a negative health determinant as it led to the destruction of culture, language, and the removal of Indigenous peoples from their traditional lands. Self-determination and cultural connection are critical to mitigating cultural genocide. Health promotion projects have the potential to support these goals. Fundamental to decolonizing oral health promotion is the development of a sustainable program founded in the traditional ways of Indigenous health and healing. The purpose of this short communication is to report on a collaborative oral health project that used cultural connection as the framework for oral health promotion in a remote Indigenous community.

En Colombie-Britannique, au Canada, les enfants et les jeunes des Premières Nations présentent systématiquement une incidence plus élevée de maladies dentaires. Les efforts visant à améliorer l'état de santé buccodentaire des populations autochtones ont connu un succès mitigé, bien que les programmes aient généralement été offerts dans une optique occidentale. Ces dernières années, les professionnels de la santé buccodentaire ont été appelés à adopter une approche plus globale de la promotion de la santé, représentative des cultures autochtones. La colonisation a été considérée comme un déterminant négatif de la santé, car elle a mené à la destruction de la culture et de la langue, ainsi que l'expulsion des Autochtones de leurs terres traditionnelles. L'autodétermination et le lien culturel sont essentiels pour atténuer le génocide culturel. Les projets de promotion de la santé ont le potentiel de soutenir ces objectifs. L'élaboration d'un programme durable fondé sur les méthodes traditionnelles de santé et de guérison autochtones est essentielle à la décolonisation de la promotion de la santé buccodentaire. L'objectif de cette brève communication est de faire le point sur un projet de santé buccodentaire collaboratif qui a utilisé le lien culturel à titre de cadre pour la promotion de la santé buccodentaire dans une communauté autochtone éloignée.

Prevalence of periodontal disease among Indigenous and non-Indigenous populations: protocol for systematic review and meta-analysis.

BACKGROUND: Indigenous populations globally experience worse oral health than their non-Indigenous counterpart. Globally, the occurrence of periodontal diseases such as gingivitis and chronic periodontitis is high among Indigenous people. This systematic review aims to quantify, at a global level, the prevalence of periodontal disease among Indigenous populations compared to non-Indigenous populations. METHODS: This review will only consider studies that have reported the prevalence (%) of periodontal disease among Indigenous and compared against non-Indigenous populations. Studies that have no comparative population or data only on one particular population or lack of data on periodontal clinical assessment will be excluded. An electronic search will be conducted using keywords and appropriate MeSH terms across several databases capturing both published and unpublished articles. The search will be conducted from the time of database inception to February 2021. After the initial search, duplicates will be removed, and the remaining titles and abstracts will be assessed for eligibility. The full text of eligible studies will be assessed by two independent reviewers who will also complete the critical appraisals and data extraction. Outcomes measures would be the mean prevalence (%) and standard deviation of periodontal disease among Indigenous and non-Indigenous populations. From the selected studies, we will conduct a random-effects meta-analysis using standardized mean difference as the effect measure. Forest plots will be used for the visualization of differences in the prevalence of periodontitis. A subgroup analysis will be conducted based on the definition of periodontitis, age, publication type, and geographical location. Heterogeneity among studies will be assessed by I2 and chi-square test. Egger's test and funnel plots will be used to assess publication bias. DISCUSSION: Our systematic review and meta-analysis will facilitate an increased understanding of the magnitude of periodontal disease inequalities that exist globally for Indigenous populations through pooled prevalence estimates. The findings will be helpful to design selective targeted preventive and interventional strategies for periodontal disease for reducing oral health inequalities at a global level. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020188531.

Strategies to Support Sustained Participant Engagement in an Oral Health Promotion Study for Indigenous Children and Their Families in Australia.

The health inequities of Indigenous peoples compared with non-Indigenous peoples are significant and long-standing across many countries. Colonisation and dispossession of land and culture has led to profound and devastating consequences on the health of Indigenous peoples. A lack of trust and cultural security of health services remains a barrier to participation in health care services. Similarly, engagement in research activities is also hindered by a history of unethical research practices. Creating partnerships between researchers and Indigenous communities is key in developing research studies that are culturally appropriate, acceptable and relevant to the needs of Indigenous peoples. Baby Teeth Talk was a randomised controlled trial conducted with Indigenous children and their mothers in South Australia that tested an intervention involving dental care, anticipatory guidance on oral health and dietary intake, and motivational interviewing. The study was developed in consultation and partnership with local Indigenous communities in South Australia and overseen by the study's Aboriginal reference group. The recruitment and retention of participants in the study has been strong over numerous waves of follow-up. The purpose of this paper is to describe the strategies employed in the study that contributed to the successful and sustained engagement of the participants. These strategies included the establishment of an Aboriginal reference group, building relationships with organisations and community, flexibility of appointment scheduling and allocating adequate time, reimbursement for participant time, developing rapport with participants, encouraging participant self-determination, and adaptation of dietary data collection to better suit participants.

Coming of age: 21 years of providing opioid substitution treatment within an Aboriginal community-controlled primary health service.

In Australia, Aboriginal and Torres Strait Islander community controlled health services have been established since 1971 to provide accessible, quality and culturally-appropriate primary healthcare. The first of these services, the Aboriginal Medical Service Cooperative Redfern ('the AMS'), created its own Drug and Alcohol Unit ('the Unit') in 1999. The Unit initially prescribed opioid substitution treatment (OST) and its coordinator, Bradley Freeburn, a Bundjalung man, provided counselling. Soon afterwards, the Unit started dispensing OST. It now cares for around 150 individuals, each of whom is understood in the context of family, community and culture. The Unit is on the same site as the AMS's primary care service, specialised medical and mental health clinics, and dental clinic. This allows for integrated physical and mental health care. The Unit contributes to drug and alcohol workforce development for other AMS staff, state-wide and nationally. Several Aboriginal and Torres Strait Islander community controlled health services around Australia now offer OST prescription, and a small number administer slow-release buprenorphine. We are not aware of others that dispense Suboxone. In the USA and Canada, over the last 10 years, First Nations communities have also responded to lack of treatment access, by creating standalone OST clinics. We were not able to find examples of Maori-controlled OST clinics in Aotearoa, New Zealand. The feasibility of this model of readily accessible OST, situated within a holistic, culturally-grounded primary health-care service recommends it for consideration and evaluation, for Indigenous or non-Indigenous communities.

Associations between Maternal Education and Child Nutrition and Oral Health in an Indigenous Population in Ecuador.

The global nutrition transition has increased the prevalence of childhood dental caries. Greater understanding is needed of the impact of social determinants­including maternal education­on child oral health. This is a cross-sectional analysis of a convenience sample of families of 458 indigenous Ecuadorian children aged 6 months through 6 years from 2011−2013. Data was collected by mother interviews and child dental and anthropometric examinations. Multivariate logistic and Zero-Inflated-Poisson regression analyses assessed associations between years of maternal education and maternal-child oral health practices and child oral health outcomes. Each additional year of maternal education was significantly (p < 0.05) associated with some healthier practices including greater likelihood of mothers and children drinking milk daily (OR 1.20; 95% CI 1.08, 1.34); and less healthy practices including greater likelihood of bottle-feeding children with sugary liquids (OR 1.14; 95% CI 1.06, 1.22) and to older age, giving children sweets daily, calming children with a bottle or sweets, and less likelihood of helping brush their children's teeth (OR 0.93; 95% CI 0.88, 0.98). Each year of maternal education had a small but statistically non-significant influence on increasing the odds of children being among those who are cavity-free (OR 1.03; 95% CI 0.92, 1.16). Interventions to improve health outcomes should focus not just on maternal education but also address social and commercial determinants of health through nutrition and oral health education, as well as policies to reduce sugar and ensure universal access to oral health care.