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1.
Int J Circumpolar Health ; 83(1): 2336680, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38590216

RESUMO

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.


Assuntos
COVID-19 , Inuíte , Humanos , Nunavut , Estudos Transversais , Pandemias
2.
Glob Chang Biol ; 30(2): e17193, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38380447

RESUMO

The Arctic is the fastest warming biome on the planet, and environmental changes are having striking effects on freshwater ecosystems that may impact the regional carbon cycle. The metabolic state of Arctic lakes is often considered net heterotrophic, due to an assumed supply of allochthonous organic matter that supports ecosystem respiration and carbon mineralization in excess of rates of primary production. However, lake metabolic patterns vary according to regional climatic characteristics, hydrological connectivity, organic matter sources and intrinsic lake properties, and the metabolism of most Arctic lakes is unknown. We sampled 35 waterbodies along a connectivity gradient from headwater to downstream lakes, on southern Victoria Island, Nunavut, in an area characterized by low precipitation, organic-poor soils, and high evaporation rates. We evaluated whether lakes were net autotrophic or heterotrophic during the open water period using an oxygen isotopic mass balance approach. Most of the waterbodies were autotrophic and sites of net organic matter production or close to metabolic equilibrium. Autotrophy was associated with higher benthic primary production, as compared to its pelagic counterpart, due to the high irradiance reaching the bottom and efficient internal carbon and nutrient cycling. Highly connected midstream and downstream lakes showed efficient organic matter cycling, as evidenced by the strong coupling between gross primary production (GPP) and ecosystem respiration, while decoupling was observed in some headwater lakes with significantly higher GPP. The shallow nature of lakes in the flat, arid region of southern Victoria Island supports net autotrophy in most lakes during the open water season. Ongoing climate changes that lengthen the ice-free irradiance period and increase rates of nutrient evapoconcentration may further promote net autotrophy, with uncertain long-term effects for lake functioning.


Assuntos
Ecossistema , Lagos , Nunavut , Canadá , Processos Autotróficos , Ciclo do Carbono , Carbono/metabolismo , Água
3.
Int J Circumpolar Health ; 82(1): 2276983, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37992403

RESUMO

Eekeeluak Avalak, an 18-year-old Inuk wrestler who won the first-ever gold medal for Nunavut at the Canada Summer Games in 2022, dedicated his win to his late brother who died by suicide in 2015. Avalak openly attributed sport - specifically wrestling - to saving his own life. This story raises important questions about the role of sport and traditional games in Inuit suicide prevention strategies. Few studies have examined the role of sport or traditional games in Inuit suicide prevention strategies. In an attempt to reduce Inuit suicide rates, in addition to the National Inuit Prevention Strategy, three of the four land claim regions that constitute Inuit Nunangat have suicide prevention strategies. In this study, we used settler colonial theory, critical Inuit studies, and content analysis to examine if and how sport and Inuit traditional games are identified as prevention tools in these Inuit suicide prevention strategies. The results demonstrate that sport and traditional games have largely been overlooked as protective factors in current Inuit-wide and land-claim specific suicide prevention strategies. Moving forward, evidence-based and community-driven approaches could be funded, created, implemented, and evaluated as culturally-safe Inuit mental health intervention models to address the disproportionately high suicide rates among Inuit in Inuit Nunangat.


Assuntos
Esportes , Prevenção ao Suicídio , Suicídio , Adolescente , Humanos , Masculino , Canadá/epidemiologia , Inuíte , Nunavut , Suicídio/psicologia
4.
Int J Law Psychiatry ; 91: 101921, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37690360

RESUMO

Circumpolar regions face unique challenges in establishing and maintaining mental health care systems, including forensic psychiatry services. The scarcity of data and lack of evidence concerning the forensic psychiatry patient (FPP) populations of Nunavut and Greenland exacerbates the challenges of informing best practices and healthcare planning. By comparing the prevalence of forensic psychiatry patients, the mental health care services, and the legislation in these two relatively similar but unique regions, insight may be gained that can help inform healthcare planning. This cross-sectional study includes all forensic psychiatry in- and outpatients in one year from Nunavut (2018) and on February 29, 2020, in Greenland. The Greenland sample (n = 93) was nearly four times larger than the Nunavut sample (n = 15) at the population level. Despite considerable differences in forensic legislation and service supply, the forensic psychiatry patients in the two areas share several similarities. A total of 87% (n = 13) in the Nunavut sample were diagnosed with a DSM-5 schizophrenia spectrum disorder or other psychotic disorder. In Greenland, 82% (n = 76) were diagnosed with an ICD-10 F2 diagnosis (schizophrenia, schizotypal and delusional disorders). Approximately 2/3 of the patients in both populations were diagnosed with substance use disorder, and 60% of the Nunavut FPP received long-acting antipsychotic injections versus 62% in Greenland. Nearly half of the FPPs in both populations had never been convicted prior to entering the forensic psychiatry system; Nunavut 45% versus Greenland 47%. A substantial proportion of Greenlandic FPPs were outpatients compared to Nunavut (83% versus 47%). This study is an essential first step toward describing a Model of Care for forensic psychiatry patients in circumpolar regions; furthermore, the clinical similarities between the two populations provide support for future joint Arctic research and the inclusion of artic forensic patients in international studies.


Assuntos
Psiquiatria Legal , Pacientes Ambulatoriais , Humanos , Nunavut/epidemiologia , Groenlândia , Estudos Transversais
5.
Int J Circumpolar Health ; 82(1): 2259122, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37731361

RESUMO

Across Canada, the COVID-19 pandemic placed considerable stress on territorial and provincial healthcare systems. For Nunavut, the need to continue to provide access to critical care to its citizens meant that medical travel to provincial points of care (Edmonton, Winnipeg and Ottawa) had to continue through the pandemic. This complexity created challenges related to the need to keep Nunavut residents safe while accessing care, and to manage the risk of outbreaks in Nunavut resultant from patients returning home. A number of strategies were adopted to mitigate risk, including the expansion of virtual care, self-isolation requirements before returning from Winnipeg, and a level of cross-jurisdictional coordination previously unprecedented. Structural limitations in Nunavut however limited opportunities to expand virtual care, and to allow providers from Manitoba to access the Nunavut's electronic medical records of patients requiring follow up. Thus, known and long-standing issues exacerbated vulnerabilities within the Nunavut healthcare system. We conclude that addressing cross-jurisdictional issues would be well served by the development of a more formal Nunavut-Manitoba agreement (with similar agreements with Ontario and Alberta), outlining mutual obligations and accountabilities.


Assuntos
COVID-19 , Acesso aos Serviços de Saúde , Humanos , Inuíte , Manitoba/epidemiologia , Nunavut , Ontário , Pandemias , Atenção à Saúde
6.
Mar Pollut Bull ; 196: 115557, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37776739

RESUMO

Oil spilled in marine environments can settle to the seafloor through aggregation and sedimentation processes. This has been predicted to be especially relevant in the Arctic due to plankton blooms initiated by melting sea ice. These conditions exist in the Kivalliq region in Nunavut, Canada, where elevated shipping traffic has increased the risk of accidental spills. Experimental microcosms combining surface sediment and crude oil were incubated at 4 °C over 21 weeks to evaluate the biodegradation potential of seabed microbiomes. Sediments sampled near the communities of Arviat and Chesterfield Inlet were assessed for biodegradation capabilities by combining hydrocarbon geochemistry with 16S rRNA gene and metagenomic sequencing, revealing decreased microbial diversity but enrichment of oil-degrading taxa. Alkane and aromatic hydrocarbon losses corresponded to detection of genes and genomes that encode enzymes for aerobic biodegradation of these compounds, pointing to the utility of marine microbiome surveys for predicting the fate of oil released into Arctic marine environments.


Assuntos
Microbiota , Poluição por Petróleo , Petróleo , Petróleo/metabolismo , Nunavut , RNA Ribossômico 16S/genética , Hidrocarbonetos/metabolismo , Canadá , Biodegradação Ambiental
7.
Med Vet Entomol ; 37(4): 656-664, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37220211

RESUMO

The North has experienced unprecedented rates of warming over the past few decades, impacting the survival and development of insects and the pathogens that they carry. Since 2019, Arctic foxes from Canada (Nunavut) have been observed with fur loss inconsistent with natural shedding of fur. Adult lice were collected from Arctic foxes from Nunavut (n = 1) and Svalbard (n = 2; Norway) and were identified as sucking lice (suborder Anoplura). Using conventional PCR targeting the mitochondrial cytochrome c oxidase subunit 1 gene (cox1), lice from Canada and Svalbard were 100% similar (8 pooled samples from Nunavut and 3 pooled samples from Svalbard), indicating that there is potential gene flow between ectoparasites on Scandinavian and North American Arctic fox populations. The cox1 sequences of Arctic fox lice and dog sucking lice (Linognathus setosus) had significant differences (87% identity), suggesting that foxes may harbour a cryptic species that has not previously been recognised. Conventional PCR targeting the gltA gene for Bartonella bacteria amplified DNA from an unknown gammaproteobacteria from two pooled louse samples collected from Svalbard foxes. The amplified sequences were 100% identical to each other but were only 78% like Proteus mirabilis reported in GenBank (CP053614), suggesting that lice on Arctic foxes may carry unique microorganisms that have yet to be described.


Assuntos
Anoplura , Parasitos , Animais , Cães , Svalbard , Raposas/parasitologia , Nunavut , Noruega , Canadá , Regiões Árticas
8.
Scand J Public Health ; 51(7): 1027-1032, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37042670

RESUMO

BACKGROUND: In Nunavut, where 70% of children are food insecure, many households rely on school breakfast or community food programmes for nourishment. The COVID-19 pandemic and resulting policies to reduce the spread of the disease have the potential to exacerbate existing issues, including increasing food insecurity in households. Funding programmes were implemented to limit the impact of public-health measures on household and community food security. The overall effects of the actions are not yet understood. METHODS: This project used a qualitative approach to examine the determinants of food security and sovereignty and the impact of the COVID-19 pandemic policy responses on these determinants in Arviat and Iqaluit. Narrative analysis applied within a relational epistemology was used to describe the experiences of community members in Iqaluit and Arviat during the COVID-19 pandemic. RESULTS: Seven participants were interviewed in Iqaluit (n=3) and Arviat (n=4). Key themes included the importance of decolonisation for food sovereignty, the importance of food sharing to communities and the resilience of communities during COVID-19. Community members wished to see greater support and strengthening of the country (locally harvested) food economy to increase knowledge of food and harvesting skill, and for communities to find ways to reach residents who may fall through the cracks during times of need or crisis. CONCLUSIONS: This study is one of the first to document Nunavummiut experiences and perspectives of food security and sovereignty in Arviat and Iqaluit during the COVID-19 pandemic.


Assuntos
COVID-19 , Pandemias , Criança , Humanos , Nunavut , Abastecimento de Alimentos , Inuíte , COVID-19/epidemiologia , Segurança Alimentar
9.
Scand J Public Health ; 51(7): 1023-1026, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36803095

RESUMO

In Canada, there are vast differences between the state of accommodation/housing, health, social inequalities, education and economic conditions for people in the northern and southern regions of the country. Overcrowding in Inuit Nunangat is a direct result of the promises made by past government policy that led to Inuit people settling in sedentary communities in the North on the understanding that they would be provided with social welfare. However, these welfare programmes proved to be either insufficient or non-existent for Inuit people. Therefore, Inuit are living in overcrowded homes in Canada, resulting in a severe housing shortage, poor-quality housing and homelessness. This has led to the spread of contagious diseases, mould, mental-health issues, gaps in education for children, sexual and physical violence, food insecurity and adverse challenges for the youth of Inuit Nunangat. This paper proposes several actions to ease the crisis. First, funding should be stable and predictable. Next, there should be ample construction of transitional homes which could be used to accommodate people before moving them into proper public housing. Policies regarding staff housing should be amended, and if possible, these vacant staff houses could provide shelter to eligible Inuit people, which could help lessen the housing crisis. The advent of COVID-19 has made the issue of affordable and safe housing more serious because without safe housing, the health, education and well-being of the Inuit people in Inuit Nunangat are in peril. This study focuses on how the governments of Canada and Nunavut are dealing with this issue.


Assuntos
Habitação , Criança , Adolescente , Humanos , Nunavut/epidemiologia , Canadá/epidemiologia , Fatores Socioeconômicos , Escolaridade
10.
Can J Public Health ; 114(2): 241-253, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36214994

RESUMO

INTERVENTION: In 2014-2015, more than 400 public housing units were constructed in Nunavut and Nunavik, two of the four Inuit regions in Canada. This provided the opportunity to assess the impact of improved housing conditions from a population health perspective in 12 Inuit communities where housing needs were the most severe. The aim of the research is to examine the associations between changes in housing conditions and changes in psychological distress pre-post rehousing. METHODS: A pre-post uncontrolled study was conducted in collaboration with Nunavut- and Nunavik-based organizations. Applicants at the top of public housing waitlists were recruited by local housing officers; participants completed questionnaires 1-6 months before rehousing, and 15-18 months after. Change in psychological distress was measured with the Kessler 6-item scale. Changes in three housing measures were examined: number of adults per household, number of children per household, and sense of home score. For each housing measure, a categorical variable stratified participants into three categories. The reference category included participants reporting significant change in the concerned housing measure; the two other categories included participants reporting little or no change. Associations were tested with linear multilevel regression models for change. RESULTS: A total of 102 Inuit adults completed the study. A reduction in the number of adults per household (living with 2 adults or less after rehousing) and an increase in sense of home were associated with significant decline in psychological distress pre-post rehousing (p < 0.001). CONCLUSION: Increased investments leading to such improvements in housing circumstances are promising ways to promote mental health in Inuit regions.


RéSUMé: INTERVENTION: En 2014-2015, plus de 400 logements sociaux ont été construits au Nunavut et au Nunavik, deux des quatre régions inuites du Canada, permettant ainsi d'évaluer l'impact de l'amélioration des conditions de logement sur la santé. Cette étude vise à examiner les associations entre les changements dans les conditions de logement et les changements dans la détresse psychologique avant et après le déménagement, dans 12 communautés inuites où les besoins en logement étaient les plus criants. MéTHODES: Une étude pré-post non contrôlée a été menée en collaboration avec des organisations du Nunavut et du Nunavik. Les participants figurant en tête des listes d'attente pour le logement social ont rempli les questionnaires de recherche 1-6 mois avant le déménagement et 15-18 mois après. Les changements de la détresse psychologique ont été mesurés à l'aide de l'échelle Kessler 6-item. Les changements des trois conditions de logement suivantes ont été examinés : le nombre d'adultes par ménage, le nombre d'enfants par ménage et le sentiment d'avoir un chez-soi. Pour chaque condition de logement, une variable catégorielle a été créée pour stratifier les participants ayant rapporté des changements (référence) et les participants n'ayant rapporté que peu ou pas de changement. Les associations ont été testées avec des modèles de régression linéaire multiniveaux. RéSULTATS: Un total de 102 adultes Inuit ont complété l'étude. Une réduction du nombre d'adultes par ménage (vivre avec 2 adultes ou moins après le déménagement) et une augmentation du sentiment d'avoir un chez-soi étaient associées à une baisse significative de la détresse psychologique (p < 0,001). CONCLUSION: Des investissements accrus menant à de telles améliorations des conditions de logement représentent une avenue prometteuse pour promouvoir la santé mentale dans les régions inuites.


Assuntos
Inuíte , Saúde Mental , Angústia Psicológica , Habitação Popular , Adulto , Criança , Humanos , Canadá/epidemiologia , Nunavut
11.
Int J Circumpolar Health ; 81(1): 2151551, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36451521

RESUMO

To assess the effect of eConsultation in providing Orthopaedic Surgery specialist service to patients in Nunavut. A cross-sectional study of 161 Orthopaedic Surgery consultations received from primary care providers (PCPs) in Nunavut via the Champlain Building Access to Specialist service through eConsult (BASETM) service over the 2-year period from January 2017 to December 2018. Data captured were: reason for consultation, impact of advice on referral, perceived value to the PCPs and time spent. eConsult avoided unnecessary in-person consultation 62% of the time while catching 5% of the referrals that would have otherwise been missed. PCP referral behaviour was modified 48% of the time. 94% of eConsults were rated as valuable to PCPs in their practice and 100% of eConsults resulted in actionable advice. Further, eConsults took an average of 15.4 minutes of specialist time to complete, and the mean time from referral to response was 1.4 days. eConsultation spares unnecessary consultation to Orthopaedic Surgery, catches important referrals that would have otherwise been missed, decreases wait time, and may reduce cost in remote healthcare systems such as Nunavut.


Assuntos
Ortopedia , Humanos , Nunavut , Estudos Transversais , Encaminhamento e Consulta
12.
BMC Pregnancy Childbirth ; 22(1): 870, 2022 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-36434515

RESUMO

BACKGROUND: The Qanuinngitsiarutiksait study aimed to develop detailed profiles of Inuit health service utilization in Manitoba, by Inuit living in Manitoba (approximately 1,500) and by Inuit from the Kivalliq region of Nunavut who travel to Manitoba to access care not available in Nunavut (approximately 16,000 per year). METHODS: We used health administrative data routinely collected in Manitoba for all services provided and developed an algorithm to identify Inuit in the dataset. This paper focused on health services used by Inuit from the Kivalliq for prenatal care and birthing. RESULTS: Our study found that approximately 80 percent of births to women from the Kivalliq region occur in Manitoba, primarily in Winnipeg. When perinatal care and birthing are combined, they constitute one third of all consults happening by Kivalliq residents in Manitoba. For scale, hospitalizations for childbirths to Kivalliq women about to only 5 percent of all childbirth-related hospitalizations in Manitoba. CONCLUSIONS: The practice of evacuating women from the Kivalliq for perinatal care and birthing is rooted in colonialism, rationalized as ensuring that women whose pregnancy is at high risk have access to specialized care not available in Nunavut. While defendable, this practice is costly, and does not provide Inuit women a choice as to where to birth. Attempts at relocating birthing to the north have proven complex to operationalize. Given this, there is an urgent need to develop Inuit-centric and culturally appropriate perinatal and birthing care in Manitoba.


Assuntos
Inuíte , Parto , Gravidez , Feminino , Humanos , Manitoba/epidemiologia , Nunavut/epidemiologia , Parto Obstétrico
13.
PeerJ ; 10: e13231, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35722266

RESUMO

The truncate soft-shell clam Mya truncata is an important source of country food for Inuit communities across the territory of Nunavut, Canada. M. truncata also plays an important role in marine ecosystems, yet there is little understanding of their life history and condition in Canadian Arctic waters. To provide a foundation on which aspects of the life history and condition of M. truncata of Baffin Island can be monitored in the future with a changing climate and fishery development, this study estimated size at maturity and provides insights into the spawning cycle and weight-length condition indices of clams from inner Frobisher Bay and the north shore of the Hudson Strait. Male and female M. truncata exhibited similar lengths at 50% attainment of sexual maturity, 31 mm and 32 mm shell length (SL), respectively. Most (77%) of the sexually mature M. truncata collected from inner Frobisher Bay in late August and 35% of clams collected from the Hudson Strait in early September were in the ripe stage of gonadal development. These results lead us to suggest a spring spawning season and that M. truncata invest in gonadal development for the next year's spawning during the late summer-early autumn ice-free season while phytoplankton concentrations are high. Dry bodyweight-SL relationships were used to show that M. truncata condition can differ significantly over small and large spatial scales based on plotted 95% confidence intervals.


Assuntos
Mya , Animais , Feminino , Masculino , Canadá , Nunavut , Ecossistema , Gônadas
14.
Artigo em Inglês | MEDLINE | ID: mdl-35682015

RESUMO

This study explores the ways in which a rehousing intervention shapes the mental well-being of Inuit adults living in Nunavut, Canada, where the prevalence of core housing need is four times the national average. More specifically, it compares the housing experiences of participants who were rehoused in a newly built public housing unit, to the experiences of participants on the public housing waitlist. The study was developed in collaboration with organizations based in Nunavut and Nunavik. Semi-structured interviews were transcribed, and a deductive-inductive thematic analysis was performed based on Gidden's concept of ontological security, and Inuit-specific mental health conceptualization. Twenty-five Inuit adults participated (11 rehoused, 14 waitlist). Three themes were identified to describe how the subjective housing experiences of participants improved their mental well-being after rehousing: (1) refuge creation; (2) self-determination and increased control; (3) improved family dynamics and identity repair. Implicit to these themes are the contrasting housing experiences of participants on the waitlist. Construction initiatives that increase public housing stock and address gaps in the housing continuum across Inuit regions could promote well-being at a population level. However, larger socio-economic problems facing Inuit may hamper beneficial processes stemming from such interventions.


Assuntos
Inuíte , Saúde Mental , Adulto , Canadá , Humanos , Inuíte/psicologia , Nunavut/epidemiologia , Habitação Popular
15.
Int J Circumpolar Health ; 81(1): 2071410, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35491889

RESUMO

While Inuit living in Nunavut have been advocating for decades for the return of birthing to their own communities, over two-third of births continue to occur outside of the territory. We conducted a literature review to answer the question, why has birthplace choice not been given back to Inuit yet. Based on our review we identified a number of factors impacting birthplace choice, including the organisation of the Nunavut medical system that is focused on primary health care and that cannot easily accommodate the potential clinical risks Western health care associates with birthing, often in isolation from socio-cultural risks; staffing vacancies and turn over in Nunavut, which creates challenges in continuity of care and in maintaining trust; and trends in Canada towards the medicalisation of birthing, which resulted in the displacement of traditional midwifery, and lately in the professionalisation of midwifery with training centres mostly located outside of Nunavut. We recognise that providing more options to birth in the north is complex. While birthing in the north as an option is a given objective, operationalising this objective in a consistent manner is likely going to be a challenge for years to come.


Assuntos
Inuíte , Tocologia , Regiões Árticas , Canadá , Feminino , Humanos , Nunavut , Gravidez
16.
CMAJ Open ; 10(2): E304-E312, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35504694

RESUMO

BACKGROUND: Structural aspects of health care systems, such as limited access to specialized surgical and perioperative care, can negatively affect the outcomes and resource use of patients undergoing elective and emergency surgical procedures. The aim of this study was to compare postoperative outcomes of Nunavut Inuit and non-Inuit patients at a Canadian quaternary care centre. METHODS: We conducted a retrospective cohort study involving adult (age ≥ 18 yr) patients undergoing inpatient surgery from 2011 to 2018 at The Ottawa Hospital, the quaternary referral hospital for the Qikiqtaaluk Region of Nunavut. The study was designed and conducted in collaboration with Nunavut Tunngavik Incorporated. The primary outcome was a composite of in-hospital death or complications.Secondary outcomes included postoperative length of stay in hospital, adverse discharge disposition, readmissions within 30 days and total hospitalization costs. RESULTS: A total of 98 701 episodes of inpatient surgical care occurred among patients aged 18 to 104 years; 928 (0.9%) of these involved Nunavut Inuit, and 97 773 involved non-Inuit patients. Death or postoperative complication occurred more often among Nunavut Inuit than non-Inuit patients (159 [17.2%] v. 15 691 [16.1%]), which was significantly different after adjustment for age, sex, surgical specialty, risk and urgency (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.03-1.51). This association was most pronounced in cases of cancer (OR 1.63, 95% CI 1.03-2.58) and elective surgery (OR 1.58, 95% CI 1.20-2.10). Adjusted rates of readmission, adverse discharge disposition, length of stay and total costs were significantly higher for Nunavut Inuit. INTERPRETATION: Nunavut Inuit had a 25% relative increase in their odds of morbidity and death after surgery at a major quaternary care hospital in Canada compared with non-Inuit patients, while also having higher rates of other adverse outcomes and resource use. An examination of perioperative systems involving patients, Inuit leadership, health care providers and governments is required to address these differences in health outcomes.


Assuntos
Inuíte , Adulto , Canadá , Mortalidade Hospitalar , Humanos , Nunavut/epidemiologia , Estudos Retrospectivos
17.
BMC Public Health ; 22(1): 1042, 2022 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-35614429

RESUMO

BACKGROUND: Nunavut, the northernmost Arctic territory of Canada, experienced three community outbreaks of the coronavirus disease 2019 (COVID-19) from early November 2020 to mid-June 2021. We sought to investigate how non-pharmaceutical interventions (NPIs) and vaccination affected the course of these outbreaks. METHODS: We used an agent-based model of disease transmission to simulate COVID-19 outbreaks in Nunavut. The model encapsulated demographics and household structure of the population, the effect of NPIs, and daily number of vaccine doses administered. We fitted the model to inferred, back-calculated infections from incidence data reported from October 2020 to June 2021. We then compared the fit of the scenario based on case count data with several counterfactual scenarios without the effect of NPIs, without vaccination, and with a hypothetical accelerated vaccination program whereby 98% of the vaccine supply was administered to eligible individuals. RESULTS: We found that, without a territory-wide lockdown during the first COVID-19 outbreak in November 2020, the peak of infections would have been 4.7 times higher with a total of 5,404 (95% CrI: 5,015-5,798) infections before the start of vaccination on January 6, 2021. Without effective NPIs, we estimated a total of 4,290 (95% CrI: 3,880-4,708) infections during the second outbreak under the pace of vaccination administered in Nunavut. In a hypothetical accelerated vaccine rollout, the total infections during the second Nunavut outbreak would have been 58% lower, to 1,812 (95% CrI: 1,593-2,039) infections. Vaccination was estimated to have the largest impact during the outbreak in April 2021, averting 15,196 (95% CrI: 14,798-15,591) infections if the disease had spread through Nunavut communities. Accelerated vaccination would have further reduced the total infections to 243 (95% CrI: 222-265) even in the absence of NPIs. CONCLUSIONS: NPIs have been essential in mitigating pandemic outbreaks in this large, geographically distanced and remote territory. While vaccination has the greatest impact to prevent infection and severe outcomes, public health implementation of NPIs play an essential role in the short term before attaining high levels of immunity in the population.


Assuntos
COVID-19 , Vacinas , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Canadá , Controle de Doenças Transmissíveis , Surtos de Doenças/prevenção & controle , Humanos , Nunavut/epidemiologia , SARS-CoV-2 , Vacinação
18.
Nutrients ; 14(8)2022 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-35458135

RESUMO

The history of health research in Inuit communities in Canada recounts unethical and colonizing research practices. Recent decades have witnessed profound changes that have advanced ethical and community-driven research, yet much work remains. Inuit have called for research reform in Inuit Nunangat, most recently creating the National Inuit Strategy on Research (NISR) as a framework to support this work. The present study details the process undertaken to create a research program guided by the NISR to address food security, nutrition, and climate change in Inuit Nunangat. Four main elements were identified as critical to supporting the development of a meaningful and authentic community-led program of research: developing Inuit-identified research questions that are relevant and important to Inuit communities; identifying Inuit expertise to answer these questions; re-envisioning and innovating research methodologies that are meaningful to Inuit and reflect Inuit knowledge and societal values; and identifying approaches to mobilizing knowledge that can be applied to support food security and climate change adaptation. We also identify considerations for funding agencies to support the meaningful development of Inuit-led research proposals, including aligning funding with community priorities, reconsidering who the researchers are, and investing in community infrastructure. Our critical reflection on the research program development process provides insight into community-led research that can support Inuit self-determination in research, enhance local ethical conduct of research, privilege Inuit knowledge systems, and align Inuit-identified research priorities with research funding opportunities in health research. While we focus on Inuit-led research in Nunavut, Canada, these insights may be of interest more broadly to Indigenous health research.


Assuntos
Mudança Climática , Inuíte , Canadá , Segurança Alimentar , Humanos , Nunavut
19.
Int J Circumpolar Health ; 81(1): 2043577, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35331088

RESUMO

This study investigated how COVID-19 has affected the wellness of a group of Inuit youth leaders in Nunavut in the context of their involvement with an ongoing mental health research initiative, the Making I-SPARX Fly in Nunavut [I-SPARX] project. The study had three goals: (1) to understand how the pandemic has affected I-SPARX leaders' perceived involvement in the I-SPARX Project; (2) to build knowledge around how the pandemic has impacted the daily life and wellbeing of youth in Nunavummiut communities; and (3) to acquire a culturally specific understanding of their coping mechanisms and resilience strategies through the lens of Inuit Qaujimajatuqangit (IQ). Nine Inuit youth were interviewed virtually about their participation in I-SPARX, their life during the pandemic, and their coping strategies. Their comments were analysed using inductive thematic analysis. Pandemic challenges, the utility of I-SPARX teachings and participation, and culturally and community-embedded pathways to resilience were discussed.The implications of COVID-19 on Inuit youth in remote communities are not fully understood. The current study illuminates their experiences of the pandemic to inform future research on ways in which Inuit youth might be supported in situations, such as a global pandemic, that restrict their traditional resilience-enhancing activities and create social isolation.


Assuntos
COVID-19 , Pandemias , Adaptação Psicológica , Adolescente , Humanos , Inuíte/psicologia , Nunavut
20.
Oecologia ; 198(2): 393-406, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35066670

RESUMO

Seabirds breeding in the high Arctic contend with variable annual sea ice conditions, with important consequences depending on a species' unique reproductive and foraging ecology. We assessed the influence of sea ice extent and phenology on seabird breeding biology using monitoring data collected for northern fulmar (Fulmarus glacialis), glaucous gull (Larus hyperboreus), black-legged kittiwake (Rissa tridactyla), and thick-billed murre (Uria lomvia) breeding at Prince Leopold Island, Nunavut, Canada over 4 decades. We expected that years of later sea ice break-up and greater ice cover around the colony would create greater challenges to foraging and could result in delayed nest initiation, decreased colony attendance, and lower nesting success, but with distinct responses from each species. We also tested for time-lagged effects of ice conditions, where sea ice in a given year could impact food availability or juvenile recruitment in later years. Ice conditions around the colony exhibited no significant overall temporal trends or changepoints over the past 50 years (1970-2021), while counts of kittiwakes and murres increased over the study period 1975-2013. No trends were evident in counts of fulmars or gulls or in egg-laying dates or nest success for any species. However, three species (all but glaucous gulls) exhibited unique responses between breeding metrics and sea ice, highlighting how breeding decisions and outcomes may differ among species under the same environmental conditions in a given year. Time-lagged effects were only detected for kittiwake nest counts, where the date of spring ice break-up around the colony was negatively associated with counts at a 5-year lag. Greater distances to open water were associated with lower colony attendance by fulmars and later nest initiation by kittiwakes and murres. Our analyses provide additional insights to effects of sea ice on high-Arctic seabird breeding ecology, which will be useful in predicting and planning for the complex effects of a changing climate and changing human pressures on this high-latitude ecosystem and for the management of high-Arctic marine-protected areas.


Assuntos
Charadriiformes , Poluentes Ambientais , Animais , Regiões Árticas , Aves/fisiologia , Canadá , Ecossistema , Monitoramento Ambiental , Poluentes Ambientais/análise , Humanos , Camada de Gelo , Nunavut
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