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Background: First Nations patients often experience poorer health outcomes than non-First Nations patients. Despite emergency triage primarily focusing on severity, implying comparable outcomes for patients in the same triage group regardless of demographics, the precision of triage for First-Nations Australians may be undermined by multiple factors, although research in this area is scarce., Objective: To compare admission rates, service utilisation and mortality for First Nations and non-First Nations patients, based on their triage categories., Methods: This retrospective cohort study utilised data for all adults presenting between January 2016 and May 2021, to Alice Springs Hospital; totalling 175 199 presentations from 39 882 individual patients. Data were analysed for differences between First Nations and non-First nations patients for outcomes including 30-day mortality, admission to hospital and admission to ICU., Results: First Nations patients had significantly higher admission than non-First Nations patients across all triage categories (P < 0.001). First Nations patients in categories 3 and 4 had a significantly higher 30-day mortality (P = 0.039, P = 0.045, respectively). First Nations patients in categories 2 and 3 were significantly more likely to be admitted to ICU (P < 0.001)., Conclusion: First Nations patients appear to have worse outcomes than non-First Nations patients in the same triage category. Socio-economic factors and high discharge against advice rates from wards may explain the significantly higher admission rate. Under-recognition of serious illness at triage could be attributed to communication issues or a 'well bias'. The results raise many questions and further investigation is required., (© 2025 Australasian College for Emergency Medicine.)

Aboriginal Australians experience a high prevalence of chronic obstructive pulmonary disease (COPD), with high rates of potentially preventable hospitalisations. However, little is known about Aboriginal peoples' experiences of living with COPD and how they navigate health care systems. This study used thematic analysis and Aboriginal methodology to explore Aboriginal peoples' lived experiences of COPD, their health care journey from receiving a diagnosis of COPD to the clinical management, and the impact of COPD on their daily lives. We conducted in-depth semi-structured interviews over a 6-month period with 18 Aboriginal adults diagnosed with COPD from four Aboriginal Community Controlled Health Services (ACCHS) in New South Wales, Australia. Reflexive thematic analysis was employed to ensure rigour. The findings revealed deeply personal and reflective stories shaped by historical, social, and cultural realities of Aboriginal peoples living with COPD. Four themes were identified characterising their experiences. Based on the findings, the following guidance is provided on future COPD care for Aboriginal peoples: Better alignment of existing COPD management with Aboriginal peoples' cultural contexts and perspectives to improve access to culturally safe care; Increased funding for ACCHS to enhance COPD management, such as early detection through case finding and access to ACCHS-led pulmonary rehabilitation; Engaging family members in COPD management and providing culturally centred COPD education that facilitates discussions and builds health literacy and self-management skills; Implementing health promotion initiatives to increase awareness and counteract fear and shame to improve early COPD detection., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Problem/background: Australian First Nations people experience disproportionate burdens of poor outcomes compared to non-First Nations people. Further, women living in remote communities face more barriers to care-seeking in pregnancy. Despite work being done in some remote communities, there is limited data exploring women's experiences of pregnancy care, thus a limited understanding of specific barriers and enablers to care-seeking for these women., Aim: This study aimed to identify barriers and enablers to care-seeking during pregnancy for Australian First Nations women living in several remote communities in the Northern Territory, by listening to their stories., Methods: Yarning, highly regarded and rigorous qualitative approach developed by and for First Nations peoples, was undertaken in several settings with women living in remote First Nations communities. Using purposive sampling, nine women participated., Findings: Two themes emerged: (1) the importance of family and community for women's emotional wellbeing; (2). ways healthcare providers and services build trust with pregnant women., Discussion: Women identified various family and community members as significant sources of support in community and while hospitalised, including having companions while away from home. Further, reduced access to community life impacted emotional wellbeing. Continuity-of-care throughout pregnancy was essential for building trust, as was responsive, clear communication. Intentional connection building by care providers enabled development of trust., Conclusion: Providing culturally safe care will likely facilitate enablers and reduce barriers to care-seeking in pregnancy in remote communities. It requires ongoing and sustained efforts to ensure true partnership and collaboration between First Nations peoples and health services., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Transitional-aged youth have a high burden of mental health difficulties in Canada, with Indigenous youth, in particular, experiencing additional circumstances that challenge their well-being. Mobile health (mHealth) approaches hold promise for supporting individuals in areas with less access to services such as Northern Ontario., Objective: The primary objective of this study is to evaluate the effectiveness of the JoyPop app in increasing emotion regulation skills for Indigenous transitional-aged youth (aged 18-25 years) on a waitlist for mental health services when compared with usual practice (UP). The secondary objectives are to (1) evaluate the impact of the app on general mental health symptoms and treatment readiness and (2) evaluate whether using the app is associated with a reduction in the use (and therefore cost) of other services while one is waiting for mental health services., Methods: The study is a pragmatic, parallel-arm randomized controlled superiority trial design spanning a 4-week period. All participants will receive UP, which involves waitlist monitoring practices at the study site, which includes regular check-in phone calls to obtain any updates regarding functioning. Participants will be allocated to the intervention (JoyPop+UP) or control (UP) condition in a 1:1 ratio using stratified block randomization. Participants will complete self-report measures of emotion regulation (primary outcome), mental health, treatment readiness, and service use during 3 assessments (baseline, second [after 2 weeks], and third [after 4 weeks]). Descriptive statistics pertaining to baseline variables and app usage will be reported. Linear mixed modeling will be used to analyze change in outcomes over time as a function of condition assignment, while a cost-consequence analysis will be used to evaluate the association between app use and service use., Results: Recruitment began September 1, 2023, and is ongoing. In total, 2 participants have completed the study., Conclusions: This study will assess whether the JoyPop app is effective for Indigenous transitional-aged youth on a waitlist for mental health services. Positive findings may support the integration of the app into mental health services as a waitlist management tool., Trial Registration: ClinicalTrials.gov NCT05991154; https://clinicaltrials.gov/study/NCT05991154., International Registered Report Identifier (irrid): DERR1-10.2196/64745., (©Angela MacIsaac, Teagan Neufeld, Ishaq Malik, Elaine Toombs, Janine V Olthuis, Fred Schmidt, Crystal Dunning, Kristine Stasiuk, Tina Bobinski, Arto Ohinmaa, Sherry H Stewart, Amanda S Newton, Aislin R Mushquash. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 30.01.2025.)

Background: To gain culturally appropriate awareness of First Nations, Inuit and/or Métis Health, research suggests that programs focus on sending more trainees to First Nations, Inuit and/or Métis communities Working within this context provides experiences and knowledge that build upon classroom education and support trainees' acquisition of skills to engage in culturally safe healthcare provision. This study examines residents' and faculty members' perceptions of how residency training programs can optimize First Nations, Inuit and/or Métis health training and support residents in gaining the knowledge, skills, and experiences for working in and with First Nations, Inuit and/or Métis communities., Methods: A qualitative approach was used, guided by a relational lens for collecting data and a constructivist grounded theory for data interpretation. Theoretical sampling was used to recruit 35 participants from three main study sites across two western Canadian provinces. Recruitment, data collection, and analysis using constructivist grounded theory occurred concurrently to ensure appropriate depth of exploration., Results: Our data analysis revealed five themes: Five themes were generated: Complexity of voluntourism as a concept; Diversity of knowledge representation required for developing curriculum; Effective models of care for First Nations, Inuit and/or Métis health; Essential traits that residents should have for working in First Nations, Inuit and/or Métis communities; and Building relationships and trust by engaging the community., Conclusions: First Nations, Inuit and/or Métis Health should be prioritized within Canadian postgraduate medical education. Equipping trainees to provide holistic care, immersing in and learning from First Nations, Inuit and/or Métis communities is essential for developing the next generation of clinicians and preceptors. We present educational recommendations for residency programs to optimize First Nations, Inuit and/or Métis health educational experiences and provide residents with skills to provide effective and culturally safe care., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval was received from the University of Alberta (Pro00117423) and Trainee Research Access Committee (TRAC) [TRACMRSF20220510], University of Calgary (Pro00117423 / pSite-22–0011), and University of Manitoba (Ethics #: H2022:110). Informed consent to participate was obtained from all of the participants in the study. Consent for publication: All authors have consented to the publication of this manuscript. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Purpose: Systemic racism across healthcare systems perpetuates health disparities. While pharmacy curricula are changing, most pharmacy team members in Canada have received minimal to no training in First Nations cultural safety and humility. At the time this work was undertaken, no pharmacy-specific First Nations cultural safety and humility courses existed for practicing pharmacy team members., Description: Two online interactive modules were developed for pharmacy team members in British Columbia, Canada. The first focuses on anti-racism and forming relationships built on trust with First Nations clients. The second focuses on how to approach pharmacy-specific interactions with First Nations clients. Both modules leverage the CARE framework (being Considerate, Aware, Respectful, Empowering). Content was guided by a First Nations advisory group. A pharmacy advisory group helped ensure teachings could be actioned by pharmacy team members., Analysis: Many lessons were learned throughout this journey. These included the importance of relationships coming first and recognizing First Nations individuals for sharing their experiences. In relation to module content, lessons centered on determining and communicating project scope, having respect for information that is not ours to share and how much language matters. Lessons in the development process included how doing things in a good way takes time and the need to look beyond module content., Conclusions: These pharmacy-specific First Nations cultural safety and humility modules serve as a good step in affecting change within the profession., Implications: Having an awareness of the learning and unlearning that took place during our work may help other educators as they develop local culturally responsive projects., Competing Interests: Declaration of competing interest The authors are not aware of any potential conflicts of interest., (Crown Copyright © 2025. Published by Elsevier Inc. All rights reserved.)

Background: Injury causes significant burden on Australian Aboriginal and Torres Strait Islander communities. However, a considerable portion of the research conducted in this area has been carried out by Western researchers. It has been acknowledged that historical research methodologies and discourses around Aboriginal and Torres Strait Islander research may not be suitable or beneficial. Co-production methodologies offer opportunities for research to be developed collaboratively ensuring meaningfulness of results and appropriate protection for participants. A scoping review was undertaken to investigate the use of co-production methodologies in research within the unintentional injuries space for Australian Aboriginal and Torres Strait Islander communities over time., Main Body: A systematic search was conducted using PubMed, ProQuest, Embase and Indigenous Health Infonet databases. Study characteristics, remoteness, injury topic, co-production methods and elements were extracted from eligible studies. The search revealed 4175 papers, from which 39 studies were included in this scoping review. It was found that 69% of studies were fully co-produced with community. Studies predominately focused on general injury, falls prevention or brain injury rehabilitation. The most heavily utilised co-production strategy was the inclusion of Aboriginal and Torres Strait Islander researchers into the writing and research team. This helped the collection of culturally safe data and appropriate interpretation of results., Conclusion: There is growing diversity among co-production methodologies, better enabling meaningful engagement between community and research. This co-production helps decolonise the research process to privilege Aboriginal voices, however, more work is needed to appropriately capture Indigenous perspectives., Competing Interests: Declarations. Disclaimer: Please note that due to the inherent nature of the methodology in literature reviews, this paper has/may include deficit-framing language. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: There are no competing interest to declare., (© 2025. The Author(s).)

Problem: Midwives are required to provide care based on Cultural Safety for First Nations women and families. Recent literature has suggested that midwives' understanding of Cultural Safety and how it translates into their practice differs widely. This disparity requires further exploration., Background: The Australian professional midwifery codes and standards state that there is a requirement to provide care based on Cultural Safety. It is critical to understand how First Nations people's history and culture impacts their health and wellbeing, requiring midwives to recognise how this may impact care., Aim: To determine Australian midwives' knowledge and understanding of Cultural Safety and how this translates into their practice when caring for First Nations women and families., Methods: A qualitative study was undertaken. Data were collected via semi-structured interviews with 12 midwives practicing in Australia. Data were transcribed and thematically analysed., Findings: Three themes were identified: 'Society and Systems', 'Knowingness versus Understanding', and 'Personal Qualities, Engagement and Partnerships' which highlight the strengths and deficits of Cultural Safety education and its integration into midwifery practice in Australia., Discussion: Health systems providing maternity care remain rooted in Western biomedical philosophies, which influences the practice of Cultural Safety at all levels. Midwives are beginning to understand the ongoing impact of colonisation on the health and wellbeing of First Nations families, but still face challenges when striving to provide culturally safe care., Conclusion: Cultural Safety must be valued at an organisational level, in which midwives can engage in authentic, maternity-based educational programs led by suitably prepared educators., Competing Interests: Declaration of Competing Interest None., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Issue Addressed: This scoping review aims to explore the size and scope of the body of literature relating to Aboriginal and Torres Strait Islander male health and wellbeing programs and describe key program elements., Methods: This review considered unpublished and published literature from electronic peer-reviewed databases and grey literature sources. Included articles must refer to an Aboriginal and Torres Strait Islander male health and wellbeing program. Descriptive data synthesised, and seven key program elements were analysed: (1) Origin of Design, (2) Governance, (3) Leads/Facilitators, (4) Funding, (5) Length and Frequency, (6) Outcomes and Measures, and (7) Monitoring and Evaluation., Results: The review identified 54 programs described in 49 publications that were published between 1998 and 2022. Only 20 publications were peer-reviewed articles. Most programs (n = 44) were instigated, co-designed or adapted by Aboriginal and Torres Strait Islander people to suit cultural and community needs. Reporting on key program elements varied, with only n = 25 of the included publications reporting governance systems., Conclusions: This work is the first to synthesise the literature and describe the key elements of Aboriginal and Torres Strait Islander male health and wellbeing programs. Relatively few publications were found describing programs designed specifically for this population group. SO WHAT?: While the descriptive findings of the programs and their key elements in this review can assist health promotion and primary care practitioners, further investment and research are required to strengthen the evidence base and achieve the best health and wellbeing outcomes for Aboriginal and Torres Strait Islander males., (© 2024 The Author(s). Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Understanding the dietary patterns of First Nations is crucial for addressing health disparities and promoting well-being. Historical assaults (colonization and loss of control over their lands) have strongly altered dietary practices and impacted health outcomes for generations. Canada conducts regular surveys to assess the extent to which individuals adhere to dietary guidelines. However, Indigenous peoples living on reserves are excluded from these surveys. This study aims to assess the diet quality of First Nations adults using the Healthy Eating Food Index-2019 (HEFI-2019) and the Canadian Healthy Eating Index 2007 (C-HEI 2007) and identify their influencing factors. Data were collected from adults (19 years and older) across ninety-two First Nations communities throughout Canada. Participants provided information on sociodemographic factors and dietary intake using structured questionnaires and 24 h dietary recalls. Statistical analyses included mean scores and regression models to assess associations between dietary indices and influencing factors. The mean HEFI-2019 and C-HEI 2007 scores among First Nations adults were 35/80 and 49/100, respectively, indicating suboptimal adherence to dietary guidelines compared to the Canadian population. Factors such as region, age, sex, education level, number of working people in the household, smoking status, and traditional food intake significantly influenced diet quality. This study underscores the importance of understanding and improving the diet quality of First Nations adults as measured by HEFI-2019 and C-HEI 2007 scores. While acknowledging the low adherence to dietary guidelines, particularly in younger age groups, the study highlights the positive influence of traditional foods on diet quality within Indigenous communities., Competing Interests: The authors declare there are no competing interests.

Background: PTB increases the risk of health problems such as chronic renal disease and diabetes in later life and adverse impacts are inversely correlated with gestational age at birth. Rates of PTB in the Northern Territory (NT) of Australia are amongst the highest nationally and globally, with First Nations babies most affected. This study assessed the magnitude and potential drivers of intergenerational PTB recurrence in the NT., Methods: A retrospective intergenerational cohort study (1986-2017) was conducted amongst 5,366 mothers born singleton who had 9,571 singleton live births (7,673 First Nations, and 1,898 non-First Nations babies). Maternal and offspring PTB was categorised as early (< 34 weeks) and late (34-36 gestational weeks). Modified Poisson regression was used to estimate the relative risk (RR) of PTB associated with maternal PTB, adjusting for moderators such as receipt of antenatal care prior to the offspring PTB. Secondary analyses assessed the impact of additional adjustment for conditions with a familial component, or that PTB predisposes to, on the risk estimate. Mediation analysis assessed the degree of mediation of maternal-offspring PTB relationships by these conditions., Results: Overall, First Nations women born preterm (< 37 weeks) had an increased risk of delivering before 37 gestational weeks (aRR 1.28; 95%CI 1.08, 1.51). Women born preterm had a higher risk of delivering early (< 34 gestational weeks) but not late preterm (34-36 weeks): the risk of early offspring PTB was increased amongst women themselves born early preterm (aRR 1.95, 95%CI 1.17, 3.24) or late preterm (aRR 1.41, 95%CI 1.01, 1.97). Adjustment for pre-eclampsia, intrauterine growth restriction, and hypertensive renal disease attenuated the observed intergenerational PTB associations. Mediation analysis suggested these conditions may mediate up to 26% of the observed intergenerational PTB recurrence. Similar trends were observed when first-time mothers were considered only. Maternal PTB status was not associated with PTB amongst non-First Nations women., Conclusions: First Nations women born preterm have an increased risk of early PTB. This association is in part driven by pre-eclampsia and hypertensive renal disease. Routine inquiry of maternal birth status may be a useful tool to identify NT First Nations women who may benefit from preventative measures., Competing Interests: Declarations. Ethics approval and consent to participate: This project was approved by the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (HREC – 2018-3261) and was supported by a First Nations Advisory Group, which includes independent First Nations community members. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The COVID-19 pandemic exacerbated food insecurity issues in geographically isolated communities, including Fort Albany First Nation (FAFN). This research examines FAFN's adaptive strategies to improve food security, highlighting community resilience and leadership. Data were gathered through semi-structured interviews with 20 community members who were involved in the pandemic response, either as members of the pandemic committee or as managers of community programs. Thematic analysis revealed significant adaptation of existing programs and the establishment of new initiatives to address food security during the pandemic. Initiatives, such as the community garden and the Fort Albany Farmers Market were food security programs that existed prior to the pandemic, and despite labor shortages during the pandemic, logistical hurdles were addressed to maintain operations and enhance food distribution efficiency. New emergency food initiatives, backed by government support and community efforts, successfully delivered food to vulnerable households. Traditional subsistence activities, such as hunting and fishing, were essential for providing sustenance and strengthening community resilience. These adaptive strategies highlight the critical role of local leadership, community participation and ingenuity, and the utilization of Indigenous knowledge in overcoming food security challenges during crises. This paper underscores the need to support Indigenous food sovereignty and build resilient local food systems tailored to the unique needs of First Nations communities. The experiences of FAFN during the COVID-19 pandemic provide invaluable insights into the resilience and innovation required to improve food security in remote and vulnerable populations, emphasizing the need for sustained investment and policy support in these communities., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval for the research was obtained from the research ethics boards of Toronto Metropolitan University (REB-2022-221), the University of Toronto (Protocol no. 00044366), and Auckland University of Technology (23/76). All methods were carried out in accordance with relevant guidelines and regulations. Participants received both oral and written information about the study, and informed consent was obtained through signed written consent forms. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Indigenous Australians in custody experience much greater rates of poor mental health and well-being than those of the general community, and these problems are not adequately addressed. Digital mental health strategies offer innovative opportunities to address the problems, but little is known about their feasibility in or impact on this population., Objective: This study aims to conduct a pilot trial evaluating the impact of adding the Stay Strong app to mental health and well-being services for Indigenous women and men in custody. The trial compared immediate and 3-month delayed use of the app by the health service, assessing its effects on well-being, empowerment, and psychological distress at 3 and 6 months after the baseline., Methods: Indigenous participants were recruited from 3 high-security Australian prisons from January 2017 to September 2019. The outcome measures assessed well-being (Warwick-Edinburgh Mental Wellbeing Scale), empowerment (Growth and Empowerment Measure [GEM]-giving total, 14-item Emotional Empowerment Scale, and 12 Scenarios scores), and psychological distress (Kessler Psychological Distress Scale). Intention-to-treat effects on these outcomes were analyzed using linear mixed models., Results: Substantial challenges in obtaining ethical and institutional approval for the trial were encountered, as were difficulties in timely recruitment and retention due to staff shortages and the release of participants from prison before follow-up assessments and an inability to follow up with participants after release. A total of 132 prisoners (age: mean 33, SD 8 y) were randomized into either an immediate (n=82) or a delayed treatment (n=52) group. However, only 56 (42.4%) could be assessed at 3 months and 37 (28%) at 6 months, raising questions concerning the representativeness of the results. Linear improvements over time were seen in all outcomes (GEM total: Cohen d=0.99; GEM 14-item Emotional Empowerment Scale: Cohen d=0.94; GEM 12 Scenarios: Cohen d=0.87; Warwick-Edinburgh Mental Wellbeing Scale: Cohen d=0.76; Kessler Psychological Distress Scale: Cohen d=0.49), but no differential effects for group or the addition of the Stay Strong app were found., Conclusions: We believe this to be Australia's first evaluation of a digital mental health app in prison and the first among Indigenous people in custody. While the study demonstrated that the use of a well-being app within a prison was feasible, staff shortages led to delayed recruitment and a consequent low retention, and significant beneficial effects of the app's use within a forensic mental health service were not seen. Additional staff resources and a longer intervention may be needed to allow a demonstration of satisfactory retention and impact in future research., Trial Registration: ANZCTR ACTRN12624001261505; https://www.anzctr.org.au/ACTRN12624001261505.aspx., (©Elke Perdacher, David Kavanagh, Jeanie Sheffield, Penny Dale, Edward Heffernan. Originally published in JMIR Mental Health (https://mental.jmir.org), 06.12.2024.)

The urbanization of Indigenous peoples in Canada has increased substantially during recent decades, with over 44% of Indigenous peoples now residing in urban centres. Despite the urban concentration of healthcare services, Indigenous health outcomes remain significantly worse than non-Indigenous health outcomes for people living in urban centres. The historical and subsisting impacts of colonialism have had a profound negative influence on social determinants of health for Indigenous peoples, resulting in higher rates of chronic disease and mortality. Mistrust of the healthcare system, racial discrimination, and medical paternalism remain barriers to accessing care and diminish the quality of care received. This commentary explores how Indigenous-led health services can improve Indigenous health outcomes and how urban reserves could be used to improve the health of urban Indigenous residents., Competing Interests: Declarations. Ethics approval: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s) under exclusive license to The Canadian Public Health Association.)

In Canada, most people prefer to die at home. However, the proportion of deaths that occur in hospital has increased over time. This study examined mortality rates and proportionate mortality in Innu communities in Labrador, and compared patterns to other communities in Labrador and Newfoundland. We conducted a cross-sectional ecological study with mortality data from the vital statistics system. This included information about all deaths in Newfoundland and Labrador from 1993 to 2018. We used descriptive statistics and rates to examine patterns by age, sex, cause and location. During the 2003 to 2018 period the leading cause of death in the Innu communities (excluding external causes) was cancer, followed by circulatory disease and respiratory disease. Between 1993 and 2018, there was a lower percentage of hospital deaths and a higher percentage of at home deaths in Innu communities than in the rest of the province. The majority of deaths among Innu were due to cancer and chronic diseases. We found a higher percentage of at home deaths in Innu communities compared to the rest of the province.

The development and dissemination of health messaging is a critical component of reducing health disparities. Participants ( n  = 87) from a human biomonitoring study in six Dene communities responded to a survey about health communication regarding contaminants. The survey included questions on awareness of health messages and risk perceptions related to country foods and contaminants. The vast majority of participants reported eating country foods (99%) and heard that country foods had beneficial nutrients (90%). Seventy per cent of respondents had heard or seen messages about fish with high levels of mercury, and 60% had concerns about the safety or quality of country foods they consumed. Respondents who reported decreasing the number of fish they ate since hearing the messages about fish and mercury had lower ( p  = 0.04) mercury concentration in hair, compared to those who had not heard the messages. However, no differences in hair mercury were observed for respondents who reported to have changed their fishing location, chosen smaller fish or eaten less predatory fish since hearing the messages. Results indicate the need to examine reasons for self-reported behaviour changes, in addition to awareness. The conclusions of this study can inform the development of messaging and risk management decisions about contaminants within Indigenous populations.

Lung cancer is one of the most commonly diagnosed cancers in Canada and a leading cause of cancer mortality. Lung cancer also affects First Nations, Inuit and Métis peoples significantly in Canada, which deserves further investigation as there is a literature gap on this topic. We sought to develop a deeper understanding of lung cancer diagnosis, incidence, mortality, and survival in First Nations, Inuit, and Métis peoples in Canada. A systematic search was conducted in bibliographic databases to identify relevant studies published between January 2000 and March 2023. Articles were screened and assessed for relevance using the Population/ Concept/ Context (PCC) framework. A total of 22 articles were included in the final analysis, of which 13 were Inuit-specific, 7 were First Nations-specific, and 2 were Métis-specific. The literature suggests that comparative incidence, mortality, and relative risk of lung cancer is higher and survival is poorer in First Nations, Inuit and Métis peoples. Lung cancer also has varying impact on these population depending on sex, age, location and other factors. This review illustrates that more comprehensive quantitative and qualitative lung cancer research is essential to further identify the structural causes for the high incidence of the disease.

Objective: To determine the levels of soluble (pro)renin receptor (s(P)RR) in women carrying Aboriginal and/or Torres Strait Islander (First Nations) babies and investigate whether s(P)RR levels change in women who have complicated pregnancies., Study Design: Cross-sectional analysis of data (2010-2018). Data/samples were from the Gomeroi Gaaynggal Study, a longitudinal cohort study based on Gomeroi/Kamilaroi lands (Tamworth), NSW, Australia. Third trimester samples (blood/urine) were collected from pregnant women carrying a First Nations baby (N = 188)., Methods/main Outcome Measures: Plasma s(P)RR and markers of kidney function (plasma: creatinine, urea and cystatin C; urinary: creatinine, protein, albumin, angiotensinogen, nephrin and Na/K) were measured by enzyme-linked immunosorbent assay or standardised pathology procedures as needed., Results: Soluble (P)RR was detected in plasma of women in the cohort (median: 19.86 ng/mL; IQR: 12.52-26.8). Soluble (P)RR levels correlated positively with maternal plasma creatinine (P = 0.0001) and gestational age in the third trimester (P = 0.002). Levels of s(P)RR tended to positively correlate with urinary protein/creatinine (P = 0.04) and nephrin/creatinine (P = 0.03). Soluble (P)RR levels tended to be higher in women who birthed prematurely (P = 0.06). Soluble (P)RR levels did not change with other pregnancy complications or outcomes (preeclampsia, GDM or small or large for gestational age birth)., Conclusions: Soluble (P)RR is present in the plasma of pregnant women carrying First Nations babies and is correlated with known urinary biomarkers of renal function. Increased maternal s(P)RR levels may be associated with increased risk of preterm birth., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Aim: To examine low birth weight (LBW) in First Nations babies born in a large metropolitan health service in Queensland, Australia., Materials and Methods: A retrospective population-based study using routinely collected data from administrative data sources. All singleton births in metropolitan health services, Queensland, Australia of ≥20 weeks gestation or at least 400 g birthweight and had information on First Nations status and born between 2019 and 2021 were included. The study measured birthweight and birthweight z-score, and also identified the predictors of LBW. Multivariate regression models were adjusted by demographic, socioeconomic and perinatal factors., Results: First Nations babies had higher rates of LBW (11.4% vs 6.9%, P < 0.001), with higher rates of preterm birth (13.9% vs 8.8%, P < 0.001). In all babies, the most important factors contributing to LBW were: maternal smoking after 20 weeks of gestation; maternal pre-pregnancy underweight (body mass index <18.5 kg/m 2 ); nulliparity; socioeconomic disadvantage; geographical remoteness; less frequent antenatal care; history of cannabis use; pre-existing cardiovascular disease; pre-eclampsia; antepartum haemorrhage; and birth outcomes including prematurity and female baby. After adjusting for all contributing factors, no difference in odds of LBW was observed between First Nations and non-First Nation babies., Conclusions: First Nations status was not an independent factor influencing LBW in this cohort, after adjustment for identifiable factors. The disparity in LBW relates to modifiable risk factors, socioeconomic disadvantage, and prematurity. Upscaling culturally safe maternity care, focusing on modifiable risk factors is required to address LBW in Australian women., (© 2024 The Author(s). Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Objectives: Research has shown that insomnia and chronic diseases can simultaneously impact overall health, including physical, mental, emotional, and spiritual health. This study aims to find the association between insomnia and the four domains of health based on an Indigenous Medicine Wheel and to find the role of multimorbidity as a mediator between this relation among First Nations people., Methods: We used data (n = 588) from the First Nations Sleep Health Project, a collaboration between two Cree First Nations communities in Saskatchewan and a research team at the University of Saskatchewan. Insomnia was measured by the Insomnia Severity Index (ISI). A multivariable logistic regression model was fitted, and the strength of significant predictors was presented as odds ratio (OR) and 95% confidence interval (CI). Using generalized structural equation modelling, we assessed the mediating effect of multimorbidity after adjusting confounders., Results: Most participants (~ 70%) reported good or better health in the four domains. After adjusting for potential risk factors, we found that the probability of having poor or fair health in all four domains (physical, mental, emotional, and spiritual) was higher among people with severe to moderate insomnia (OR = 3.06 (1.76-5.30), 2.77 (1.54-4.99), 3.19 (1.85-5.52), and 1.57 (0.88-2.80), respectively). Additionally, the total effect of ISI on physical, mental, emotional, and spiritual health was 51.34%, 61.72%, 44.81%, and 57.27%, respectively, mediated by multimorbidity., Conclusion: The impact of insomnia on four domains of health and the mediation effect of multimorbidity on this path are unique findings. Early diagnosis and treatment of these conditions might improve overall health., Competing Interests: Declarations. Ethics approval: The FNSHP was approved by the University of Saskatchewan’s Biomedical Research Ethics Board (Certificate No. Bio #18–110) and followed Chapter 9 (“Research Involving the First Nations, Inuit and Métis Peoples of Canada”) of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. Consent to participate: Informed written consent was taken from each participant prior to data collection. Consent for publication: Not applicable. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s) under exclusive license to The Canadian Public Health Association.)

Background/objectives: Particularly in racially and ethnically diverse countries, the necessity of providing individualized care to people seeking diet advice is increasingly recognized and embedded in practice guidelines. Some jurisdictions have a history of colonization with subjugation and marginalization of the Indigenous population, which has led to serious health inequities. One overarching strategy to reduce health inequities is to provide education through a decolonizing lens, so that graduate healthcare professionals, such as dietitians, have a better understanding of how to mitigate colonial attitudes, racism, stereotyping and other behaviours, thereby improving health equity. This review aims to summarize and evaluate educational strategies to decolonize dietetics training programs., Methods: A narrative review was conducted., Results: Professional dietetics organizations in Canada, Australia and New Zealand have incorporated Indigenous-specific outcomes into their standards of practice. Six primary research studies were reviewed, two each from Australia, New Zealand and the United States. The strategies developed include reviewing curriculum content, providing experiential learning opportunities and identifying barriers to the participation of Indigenous students in dietetics programs. Lack of engagement of Indigenous persons in curriculum development, planning and evaluation of efforts is a gap that needs to be addressed., Conclusions: Meeting practice standards and closing the health equity gap for Indigenous peoples require additional research and implementation into practice.

Increasing rates of dementia in First Nations populations require culturally grounded approaches to dementia diagnosis and care. To respond to the need for a culturally appropriate cognitive assessment tool, a national team of health services researchers and community partners, guided by a Nakoda Advisory Group, aimed to adapt the Canadian Indigenous Cognitive Assessment tool for a Nakoda First Nation in Carry the Kettle First Nation, Saskatchewan, Canada. The adaptation of the CICA for a Nakoda First Nation community resulted in a slightly modified version of the CICA signalling that the CICA requires minimal adaptation to be used in different First Nations contexts.

Background: To investigate the sociodemographic, anthropometric, biochemical, lifestyle and cardiometabolic risk factors associated with type 2 diabetes (T2D) among First Nations Australians., Methods: A systematic review of prospective cohorts and cross-sectional studies was conducted. Electronic data sources (MEDLINE/PubMed, Embase, CINHAL, and PsycINFO) were searched for peer-reviewed articles until August 2023. We reviewed observational and interventional studies on T2D that reported sociodemographic, anthropometric, lifestyle, and biochemical risk factors for Australian First Nations people. Narrative synthesis was applied without meta-analysis. We highlighted the major risk factors for T2D by reporting the most significant findings from individual studies in the results. The review followed PRISMA guidelines., Results: The review included 20 eligible studies: 12 cross-sectional studies and 8 prospective cohort studies. The findings from these studies showed that First Nations people who resided in very remote areas (Modified Monash Category 7; MM7) (OR = 1.61; 95% CI: 1.03, 2.52), living adjacent to food store stocking "Western" food items (OR = 2.92; 95% CI: 1.51, 5.63), rented their home (OR = 2.07; 95% CI: 1.30, 3.30) and part-time employment (OR = 2.47; 95% CI: 1.54, 3.95) were associated with a statistically higher risk of developing T2D. First Nations people who had obesity class 1 (BMI > 30 kg/m 2 ), central obesity (WC > 88 cm in women; >102 cm in men), and higher waist-to-hip ratio (WHR) (≥ 1.0 in men and 0.85 in women) were more likely to have T2D. First Nations people with elevated triglycerides (≥ 1.7 mmol/L) (OR = 4.9; 95% CI: 2.7, 8.8), one standard deviation (SD) increase in C-reactive protein (CRP) value (AHR = 1.23; 95% CI: 1.05, 1.45) and lower levels of vitamin D (< 53 nmol/L) (AOR = 2.15; 95% CI: 1.10, 2.18) were significantly associated with a higher risk of T2D. However, no significant association was found with either daily smoking or daily alcohol., Conclusion: To address the First Nations Health Gap attributed to T2D in Australia, interventions should prioritise remote areas, socioeconomic disadvantage, central obesity, elevated triglycerides, and vitamin D deficiency. This was the first comprehensive systematic review examining sociodemographic, anthropometric, biochemical, lifestyle, and cardiometabolic risk factors associated with T2D among First Nations Australians., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Social support within Indigenous worldviews is recognized as a component of health and has been associated with physical activity and sedentary behaviour. Physical Activity (PA) is a modifiable behaviour that can help reduce risks of disease and benefit many dimensions of health. The purpose of this study was to compare the physical activity of Indigenous adults in Saskatchewan with and without family/friend support of PA., Methods: The Family Influence on Physical Activity questionnaire was used to record the extent and forms of family/friend support of PA. The Godin Shepard Leisure Exercise Questionnaire (GSLEQ) was used to measure weekly PA, including moderate PA (MPA), vigorous PA (VPA), exercise frequency (WEF) and GSLEQ scores., Results: Indigenous participants overall, First Nations and Cree participants specifically with family/friend involvement in PA reported greater weekly WEF and GSLEQ scores. Indigenous participants overall and First Nations participants specifically with family and friends who watch them engage in PA reported greater weekly VPA and GSLEQ scores. Among First Nations and Cree participants specifically, those with family/friends encouragement of PA reported greater weekly VPA, WEF and GSLEQ scores. Furthermore, First Nations participants with active family/friends reported significantly greater weekly VPA (36.8 ± 51.5 min·week -1 vs. 80.2 ± 108.5 min·week -1 ; p = 0.01). Greater weekly VPA was found in Métis participants with family/friend involvement in PA and with family/friends who watch them engage in PA (67.6 ± 59.6 min·week -1 vs. 29.5 ± 40.8 min·week -1 ; p = 0.01)., Discussion: Social support, specifically family/friends involvement, has a significant impact on Indigenous participation in PA., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Mainra, Ironside, Johnson, Rolfes, Fatima, Melanson and Foulds.)

Objectives: Indigenous peoples in Canada are considered the highest risk populations for type 2 diabetes mellitus (T2DM). Quality improvement (QI) strategies may be considered effective interventions for improving T2DM health outcomes. The purpose of this study was to understand experiences associated with implementation of the SOAR QI program to improve prevention and management of T2DM., Methods: A qualitative study was conducted, and in-depth, semistructured interviews were held with QI team members and key contacts, in person and through videoconference with 2 First Nations communities. Interviews were audio-recorded and transcribed for data analysis., Results: Ten interviews were conducted and emerging themes from the data analysis were organized into 2 categories: facilitators and barriers. Four subthemes were identified. Two subthemes emerged under the category of facilitators (cultural relevance and partnership building) and 2 subthemes emerged under the category of barriers (workload burden, role ambiguity)., Conclusions: This study highlights the necessity of implementing diabetes QI strategies that foster cultural sensitivity and provide opportunities for partnership building to strengthen community relationships. We also highlight the importance of diminishing role ambiguity, and increased workload burdens, which can hinder the successful implementation of QI programs long term. Our findings can be used to improve future adaptations of SOAR and other diabetes First Nations-focussed QI strategies, to benefit Indigenous people in acquiring optimal outcomes relative to T2DM care. Findings can also inform the design, practices, and policies of such QI interventions in support of the spread and sustainability of the intervention long term., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: This longitudinal case study describes the efforts and impacts of community-controlled service organisations on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in Central Australia to tackle food security since the 1980s, with a focus on the last decade, particularly during a year of concerted action from mid-2018., Methods: The co-designed study comprised an interrupted time series with controls. Availability, affordability, accessibility and sales of foods in the community retail stores on the APY Lands were monitored regularly from 2014 to mid-2022, including by local research teams. Store nutrition policy was updated early 2018. For a year from mid-2018, of the eight communities with stores: (i) two were the focus for concerted intervention, including support from a locally based project officer to help implement the policy and action 105 community requests for nutrition activities (ii) three received usual support to implement the policy; and (iii) three were subject to 'business as usual'. From mid-2019, all communities/stores received usual service, from 2020 with some restrictions related to the COVID-19 pandemic. Results were compared over time, across different community/store groups and with controls., Results: In the 12 months from mid-2018, all food security metrics improved most in the two focus communities. Impacts were less marked in the communities without additional support to implement the revised nutrition policy, and even less apparent, although more varied, in the other three communities/stores. Dietary intake improved only in the two focus communities. In all communities from early 2020 most gains eroded due to impacts of the COVID-19 pandemic and other external stressors. Food security metrics, including price of healthy food, appeared more resilient in the focus communities, although diet quality worsened. At all times assessed, healthy diets were unaffordable for welfare-dependant households., Conclusions: This co-designed study demonstrates the effectiveness of community-led approaches, confirming that it is possible to improve food security and diet in remote Aboriginal communities. However, sustained action and monitoring, dedicated resources and employment of local people are critical for success. Results also highlight that low incomes are a major barrier to food security., (© 2024. Crown.)

Sugar-sweetened beverages (SSB) are a health policy target. Indigenous populations are among the highest consumers of SSB in Canada. However, the Truth and Reconciliation Commission calls on governments to recognize health disparities among Indigenous populations as a consequence of colonialism and governmental policies. The purpose of this analysis was to explore emergent perspectives of Indigenous adults on experiences and perspectives of SSB consumption. We conducted a community-based participatory study in partnership with three Indigenous-led organizations. From 2019 to 2022, we completed qualitative interviews with Indigenous adults living in Island Lake Anisininew First Nation, Flin Flon, and Winnipeg's North End, a neighbourhood with high concentration of Indigenous people. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Seventy-four adults participated in interviews, including 46 women, 26 men, and two identifying as two-spirit. Many participants, across all three locations, repeatedly and consistently described SSB or sugar as an addiction, which formed the primary theme for this analysis: addictive-like consumption of SSB. Addictive-like SSB consumption included comparison to other addictive substances, loss of control, and physical symptoms resulting from SSB intake (both positive and adverse) or attempting to reduce SSB intake. We identified two other secondary themes, i) perceived drivers and contexts of SSB consumption, and ii) health outcomes as a motivator for change. Perceived drivers or contexts included consuming SSB as a means to cope with stress, boredom, and poverty; SSB intake as being intertwined with other addictions or addictive substances; and drinking alone. In conclusion, addictive-like SSB consumption was reported by Indigenous adults. To address SSB intake among Indigenous populations, trauma-informed approaches should be explored that consider the colonial context., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Natalie Riediger reports financial support was provided by Canadian Institutes of Health Research. Maria Kisselgoff reports financial support was provided by Canadian Institutes of Health Research. Anne Waugh reports financial support was provided by Canadian Institutes of Health Research. Krista Beck reports financial support was provided by Murphy Foundation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Indigenous children in Canada represent one of the fastest-growing pediatric populations and experience severe health inequities. There is an ongoing need for new research on relevant methods to measure the health and wellbeing of Indigenous children that considers the cultural differences between communities. The Aaniish Naa Gegii: the Children's Health and Well-Being Measure (ACHWM) is a self-reported questionnaire that was developed to meet this need and to include the voices of Indigenous children. The purpose of this study was to assess the cultural relevance of the ACHWM for Wolastoqiyik children and to determine what revisions may be needed to ensure that the questions are well understood and culturally appropriate., Methods: We recruited a community-based sample of nine Wolastoqiyik children (ages 8 to 16 years), two caregivers, and a community Elder within the Madawaska Maliseet First Nation community in New Brunswick. Through a process of cognitive debriefing, we probed children's comprehension of the 62 questions of the First Nation French version of the ACHWM. We analyzed the information reported to determine the participants' understandings relative to the other participants and to the original intent of the ACHWM content., Results: Each of the nine children identified at least one item they recommended for revision during the interview. We observed similarities in the suggestions offered by several respondents. A total of 23 questions were considered, and 14 questions (22.6%) were modified, taking into consideration all participants' suggestions., Conclusion: While measures like the ACHWM offer useful information, relying solely on a 'one size fits all' Indigenous questionnaire is insufficient. Our findings underline the importance of having methods that are easily accessible, adaptable, and culturally appropriate for assessing and addressing Indigenous children's unique health and wellbeing. Such information allows clinicians to develop interventions that are culturally relevant, addressing children's individual needs within the context of their distinct cultural identity.

Objective: Fueled by the commercial tobacco industry, commercial tobacco use continues to be the leading preventable cause of premature death in Canada, with opportunities to improve health outcomes. The objective of this research was to work with Indigenous partners to generate Indigenous population prevalence estimates of commercial tobacco use in Toronto, and examine the association between smoking and sociodemographic, cultural, resiliency, and social variables., Methods: Respondent-driven sampling (RDS) was used to generate prevalence estimates of commercial tobacco use and potentially associated sociodemographic, cultural, resiliency, and social connection variables for Indigenous adults living in Toronto. Statistical analysis examined associations between smoking and variables theorized to be predictors of tobacco use., Results: The findings indicated that 36.3% (95%CI 28.2-44.5) of the Indigenous population in Toronto do not smoke, and 63.6% (95%CI 55.5-71.7) reported smoking. Univariate analysis of demographic, social, and cultural variables found age and employment to be statistically significantly different between adults who smoked and adults who did not smoke. Indigenous adults who were above the before-tax low-income cut-off (LICO) were more likely to smoke compared to those who were below the before-tax LICO. Indigenous adults who completed high school were more likely to smoke compared to those who did not complete high school, similarly to those who were unemployed compared to those who were employed. However, those who were not in the labour force (student or retired) were less likely to smoke compared to those who were employed. These effects remained after adjustment for age, gender, and LICO. Indigenous adults with stable housing were 20% less likely to smoke compared to those experiencing homelessness. Adults who had at least one close friend or family member to confide in were more likely to smoke compared to those who did not have any close friends or family members. Indigenous adults were more likely to smoke if they participated in Indigenous ceremony compared to those who did not participate., Conclusion: The Indigenous population in Toronto continues to experience smoking prevalence nearly four times greater than that in the general population. This highlights the need for accurate population data to inform programs and policies and address the social determinants of health., Competing Interests: Declarations. Ethics approval: The Our Health Counts Toronto engagement processes align with the ethical guidelines used for the research conducted by the Royal Commission on Aboriginal Peoples (RCAP) and the principles of OCAP®, which assist to ensure Indigenous control over Indigenous research data (OCAP® is a registered trademark of the First Nations Information Governance Centre (FNIGC), 1998; Canada, Royal Commission on Aboriginal Peoples, 1993). Ethics approval was provided by the Well Living House Counsel of Grandparents and community partner Seventh Generation Midwives Toronto. The OHCT study also received ethics clearance from the St. Michael’s Hospital Research Ethics Board (REB# 14-083c). Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s).)

Bell's palsy is acute facial palsy due to inflammation involving the facial nerve related to infections. Rates have not been noted to differ by ethnicity. We studied the lifetime prevalence in First Nations and all other Manitobans in people with type 2 diabetes mellitus aged 7 and older in 2013-2014 and 2016-2017. We found a crude lifetime prevalence of 9.9% [95% CI 9.4-10.4%] in the First Nations population versus 3.9% [95% CI 3.8-4.0%] in all other Manitobans. It is unknown if there were differences in glycemic control. The increased prevalence was found in all five provincial health regions. This study indicates that ethnicity may be an important risk factor for Bell's palsy.

Wastewater-based epidemiology (WBE) is regarded as a support tool for detecting and assessing the prevalence of infectious diseases at a population level. For rural, remote, and resource-constrained communities with little access to other public health monitoring tools, WBE can be a low-cost approach to filling gaps in population health knowledge to inform public health risk assessment and decision-making. This rapid review explores and discusses unique considerations of WBE in key settings, with a focus on the detection of the SARS-CoV-2 virus, which has rapidly expanded WBE infrastructure globally. To frame our understanding of possibilities for WBE with First Nations in Alberta, we address the following questions: What are the unique considerations and challenges for WBE under similar contexts in rural, remote, or resource-constrained settings? What are the resources and expertise required to support WBE? This review identifies several unique considerations for WBE in rural, remote, and resource-constrained communities, including costs, accessibility, operator capacity, wastewater infrastructure, and data mobilization-highlighting the need for equity in WBE. In summary, most resource-constrained communities require additional support from external research and/or governmental bodies to undertake WBE.

This study aimed to quantify risk of hospitalisations for kidney diseases related to ambient temperature in Central Australia, Northern Territory (NT). Daily hospitalisation data were extracted for Alice Springs Hospital, Central Australia, 2010-2021. The association between daily mean temperature and daily hospital admissions for total kidney and specific kidney conditions was assessed using a quasi-Poisson Generalized Linear Model combined with a distributed lag non-linear model. A total of 52,057 hospitalisations associated with kidney diseases were recorded. In general, risk of specific kidney related hospitalisations was immediate due to hot temperatures and prolonged due to cold temperatures. Relative to the minimum-risk temperature (5.1 °C), at 31 °C, cumulative relative risk (RR) of hospitalisations for total kidney disease (TKD) was 1.297 [95% CI 1.164,1.446] over lag0-1 days, for chronic kidney disease (CKD) cumulative RR was 1.269 [95% CI 1.115,1.444] and for kidney failure (KF) cumulative RR was 1.252 [95% CI 1.107,1.416] at lag 0, and for urinary tract infection (UTI) cumulative RR was 1.522 [95% CI 1.072,2.162] over lag0-7 days. At 16 °C and over lag0-7 days, cumulative RR of hospitalisations for TKD was 1.320 [95% CI 1.135,1.535], for CKD was 1.232 [95% CI 1.025,1.482], for RF was 1.233 [95% CI 1.035,1.470] and for UTI was 1.597 [95% CI 1.143, 2.231]. Both cold and hot temperatures were also associated with increased risks of kidney related total hospitalisations among First Nations Australians and women. Overall, temperature attributable to 13.7% (i.e. 7138 cases) of kidney related hospitalisations with higher attributable hospitalisations from cold temperature. Given the significant burden of kidney disease and projected increases in extreme temperatures associated with climate change in NT including Central Australia there is a need to implement public health and environmental health risk reduction strategies and awareness programs to mitigate potential adverse health effects of extreme temperatures., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Insomnia is a common sleep complaint in Canada and is associated with increased use of health care services and economic burden. This paper examines the association of insomnia with functional outcomes relevant to daily behaviors and sleep-related quality of life among First Nations participants using the Functional Outcomes of Sleep Questionnaire (FOSQ-10). The First Nations Sleep Health Project follow-up survey was conducted in partnership with two Cree First Nations in the summer of 2022, where 355 individuals participated. Statistical analysis was conducted using logistic regression models. The mean age of the participants was 40.76 ± 14.60 (SD) years, and 59.4% were females. The prevalence of chronic insomnia (Insomnia Severity Index score of ≥15) was 21.0%, with more females (26.1%) than males (13.8%) experiencing it among the 348 participants. Overall, the mean FOSQ-10 score was 17.27 ± 2.98 among the 350 participants, with those who had clinical insomnia reporting significantly lower scores than those without clinical insomnia (mean ± SD: 14.6 ± 3.9 vs. 18.0 ± 2.1; p < 0.001). The FOSQ-10 scores indicated sleep-related functional impairment (FOSQ-10 total score < 17.90) in 46.6% of participants. After adjusting for age, excessive daytime sleepiness, sex, and regular use of prescription medication, we found that clinical insomnia was significantly associated with functional impairments. In fact, a person with clinical insomnia was 3.5 times more likely to have functional impairments than those without clinical insomnia. This study highlights the significant association between insomnia and functional impairments related to daily behaviors and quality of life in two First Nation communities. Identifying this association can help healthcare providers to diagnose and treat patients with insomnia in these communities.

Objective: For First Nations people and Inuit who live on reserves or in rural and remote areas, a guideline requires their travel to urban centres once their pregnancy reaches 36-38 weeks gestation age to await labour and birth. While not encoded in Canadian legislation, this guideline-and invisible policy-is reinforced by the lack of alternatives. Research has repeatedly demonstrated the harm of obstetric evacuation, causing emotional, physical, and financial stress for pregnant and postpartum Indigenous women and people. Our objective was to describe the costs of obstetric evacuation, as reported in the literature., Methods: We conducted a systematic review using online searches of electronic databases (Ovid EMBASE, CINAHL, Ovid Healthstar, PubMed, ScienceDirect, PROSPERO, and Cochrane Database of Systematic Reviews) and identified studies that reported costs related to medical evacuation or transportation in rural and remote Indigenous communities. We performed critical appraisal of relevant studies., Synthesis: We identified 19 studies that met the inclusion criteria. The studies reported various types of cost, including direct, indirect, and intangible costs. Medical evacuation costs ranged from CAD $7714 to CAD $31,794. Indirect and intangible costs were identified, including lost income and lack of respect for cultural practices., Conclusion: Costs associated with obstetric evacuation are high, with medical evacuation as the most expensive direct cost identified. Although we were able to identify a range of costs, information on financing and funding flows was unclear. Across Canada, additional research is required to understand the direct costs of obstetric evacuation to Indigenous Peoples and communities., (© 2024. The Author(s).)

Issue Addressed: While social determinants frameworks are still popular in research about First Nations health in Australia, a growing body of research prefers cultural determinants of health models. Cultural determinants models provide a holistic, strength-based framework to explain connections between health and contextual factors, including the potential role of music and its impact on social and emotional well-being. Given the growing international recognition of links between music, health, and wellbeing through bodies such as the World Health Organisation, this article examines whether and how music practices are acknowledged in First Nations determinants of health literature., Methods: We conducted a scoping narrative review of literature from five databases: Scopus, PsycInfo, CINAHL, PubMed and ProQuest Central. The search returned 60 articles published since 2017, which we analysed in NVivo for common themes., Results: Music was only explicitly identified as a determinant of health in two studies. Yet, participants in five studies identified music and song as directly impacting their social and emotional well-being. When we broadened our frame of analysis to include other forms of expressive cultural practice, one quarter of included studies empirically acknowledged the role of expressive cultural practice for social and emotional well-being., Conclusion: While many recent studies identify the impact of First Nations' expressive practices broadly, they miss important features of First Nations music as a potentially unique cultural, social, political and ecological determinant of health. SO WHAT?: There is an opportunity for future research and health determinant modelling to explicitly examine the role of First Nations music and other creative practices for social and emotional well-being., (© 2024 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Objective: The objective of this study was to determine regional variation in need for mental health care for Aboriginal and Torres Strait Islander adults (18+ years)., Methods: Three Australian Indigenous health surveys were analysed, and prevalence rates of high/very high psychological distress (as per the Kessler-5 tool) by the Index of Relative Socio-economic Disadvantage were computed and combined via meta-analysis. These estimates were applied to census population data to estimate regional needs and summed to geographic planning regions. Final estimates were assessed for face validity by comparing with other existing estimates of mental health need., Results: The Index of Relative Socioeconomic Disadvantage had a dose-response relationship with high/very high psychological distress, whereby the more disadvantaged an area, the greater the levels of reported distress. This methodology resulted in varying levels of need within South East Queensland., Conclusions: The approach was found to have good face validity and provides a data-driven method to determine relative levels of need., Implications for Public Health: To ensure equity of mental health service provision, planners should account for variation in levels of need within a catchment. This method may be used throughout Australia to determine regional variation in need for care where other data are lacking to ensure evidence-based investment planning decisions at the local level., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Disparities in the health of Indigenous people and in the health of rural populations are well described. University Departments of Rural Health (UDRHs) in Australia are federally funded under a program to address ongoing challenges with health workforce distribution for rural and remote areas. They have a significant role in research in regional, rural and remote areas, including research related to Indigenous health. However, a comprehensive analysis of their contributions to original Indigenous health related to Indigenous health is lacking., Objective: This study examines the contributions of UDRHs to Indigenous issues through analysis of publications of UDRHs focused on Indigenous health during the period 2010-2021., Design: This paper examines a database of UDRH Indigenous-related publications from 2010 to 2021., Findings: A total of 493 publications to which UDRHs contributed were analysed, including 354 original research articles. Health services research was the most common category, followed by epidemiology and papers exploring Indigenous culture and health. While health services research substantially increased over the period, the numbers of original research papers specifically focused on Indigenous workforce issues, whether related to Indigenous people, students or existing workforce was relatively small., Discussion: This broad overview shows the nature and trends in Indigenous health research by UDRHs and makes evident a substantial contribution to Indigenous health research, reflecting their commitment to improving the health and well-being of Indigenous communities., Conclusions: The analysis can help direct future efforts, and future analyses should delve deeper into the impact of this research and further engage Indigenous researchers., (© 2024 The Author(s). Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Effective intercultural communication between First Nations peoples and healthcare providers in colonised countries is required to deliver equitable healthcare and improve patient experiences and health outcomes. This paper presents First Nations peoples' perspectives and proposed solutions to problematic communication experiences at Royal Darwin Hospital in northern Australia. The study's methodological foundations comprise decolonising principles rooted in Critical Race Theory, Freirean pedagogy, and cultural safety. Eleven individuals from diverse First Nations backgrounds receiving treatment at the largest hospital in the Northern Territory, participated in in-depth interviews conducted in their preferred languages. Data were inductively analysed, adapted from a constructivist grounded theory approach and guided by First Nations knowledges. First Nations patients at Royal Darwin Hospital described a culturally unsafe hospital due to ineffective intercultural communication. Patient "counterstories" recounted instances of confusion, aggression, healthcare provider resistance to shared decision-making opportunities, pressure to abandon cultural protocols, and institutional neglect. Poor communication incited anger among staff and patients, and contributed to experiences of racism, missed appointments, clinical mistakes, patients prematurely discharging before completing treatment, and patients experiencing financial troubles and homelessness. In a spirit of generosity, patients proposed solutions focused on relationship building and mutual understanding so that new decolonised systems, which draw on First Nations and Western knowledges, can be codesigned. This study serves as a call to action for policymakers, administrators, and healthcare providers to prioritise improving intercultural communication by addressing the behaviour of staff and changing systemically racist policies in the pursuit of health equity and cultural safety for First Nations peoples., (© 2024. The Author(s).)

Health inequity between Indigenous (First Nations, Inuit, and Métis) peoples and other citizens is an important policy concern in Canada, as in other colonial countries. Racism in healthcare has been identified as contributing to poorer care and to worse outcomes. Despite a large literature regarding racism in other healthcare contexts, the dimensions of the existing literature on anti-Indigenous racism in Canadian healthcare are unclear. A scoping review examined the evidence of anti-Indigenous racist experiences in healthcare in the research literature, including the types of racist behaviours identified, settings studied, and Indigenous populations and geographic regions included. We identified English and French language journal articles on anti-Indigenous racism in Canadian healthcare settings in Scopus, PubMed, CINAHL, and the Bibliography of Indigenous Peoples in North America, and grey literature reports. A total of 2250 journal articles and 9 grey literature reports published since 2000 were included in screening, and 66 studies were included in the final review. Most used qualitative interviews with patients, but a large proportion included healthcare providers. Most were conducted in urban settings, a majority in Ontario or British Columbia, with mixed Indigenous populations. The largest proportion focussed on patient experiences with healthcare in general, rather than specific clinical contexts. Most racist experiences identified were 'covert' racism, including patients feeling treated differently from non-Indigenous patients, being ignored, treated more slowly, or not believed. Stereotyping of Indigenous peoples as substance users, poor patients, or poor parents was also commonly reported. 'Overt racism', including the use of racist slurs, was not widely found. Some quantitative studies did use standardized or validated instruments to capture racist experiences, but most did not result in generalizable estimates of their prevalence. The few studies linking racism to health outcomes found that experiencing racism was related to reluctance to seek healthcare, potentially leading to higher unmet healthcare needs. Gender was the intersecting dimension most identified as shaping healthcare experiences, with Indigenous women and girls at risk to specific stereotypes. Some papers suggested that socio-economically disadvantaged Indigenous people were at the highest risk to experiencing racism. Types of anti-Indigenous racism identified in Canadian healthcare appear similar to those reported in other jurisdictions. Indigenous peoples facing multiple dimensions of disadvantage, especially gender and social class, may be the most likely to experience racism. It is likely that the experience of racism in healthcare has implications for Indigenous peoples' health, mainly by reducing healthcare access., (© The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Quality in Health Care.)

Background: The Elders Mentoring Program (EMP) is part of a strengths-based community-based participatory research partnership with the Cree communities of Maskwacîs, Alberta, Canada. The EMP objective is to promote maternal and child health through traditional Cree teachings and support from community Elders to pregnant women and their partners. During the COVID-19 pandemic, the Elders decided to shift the program to an online format in early 2021. The Elders continued to offer mentorship to program participants virtually by Zoom and telephone, and online workshops. The objective of this study was to qualitatively explore the experiences of women that took part in the virtual EMP., Methods: We utilized qualitative description as our method, informed by our overarching community-led research partnership. Semi-structured phone interviews were conducted by Maskwacîs research assistants (RAs) with 11 women who participated in the virtual program. Interviews were conducted between December 2021 and June 2022. The participants were asked about their perceptions of the program and its benefits. The interviews were recorded, transcribed, and coded by four RAs using thematic analysis., Results: Although cultural teachings are traditionally offered in person, the shift to the virtual platform was greatly appreciated by all the women. Technology can be a useful tool for cultural teachings and language to be shared among community members when they cannot be physically together. Four main themes emerged from the data, representing the participants' experiences, and learning through their interactions with the Elders from the EMP. The themes are: Ohpikihâwasowin (grounding and guiding on the path to be a healthy parent); Indigenous ways of healing; On the path of cultural learning; and Identity for self and baby., Conclusion: The virtual adaptation of the EMP allowed a space for Elders to offer support to women living in and out of the community to provide guidance with their pregnancies and into motherhood. The workshops and one-on-one calls allowed for cultural revitalization which is critical for Indigenous well-being. All the participants found that the teachings and interactions positively impacted their pregnancy and parenthood. Overall, the virtual program demonstrated a venue for intergenerational healing and resilience., (© 2024. The Author(s).)

Background: Across Canada, Child Protection Services (CPS) disrupt Indigenous families by apprehending their children at alarmingly high rates. The harms borne by children in out-of-home care (OoHC) have been extensively documented. We examined the impact of OoHC on Manitoba children's health and legal system outcomes to provide rigorous evidence on how discretionary decision-making by CPS agencies can affect these outcomes., Methods: In partnership with First Nations researchers, we used linked administrative data to identify Manitoba children (born 2007-2018) served by First Nations and other Manitoba CPS agencies. We compared those taken into OoHC (n = 19,324) with those never in care but with an open CPS file due to child protection concerns (n = 27,290). We used instrumental variable analysis (CPS agency rates of OoHC as the instrument) to obtain odds ratios (aOR) and 95% confidence intervals adjusted for child, maternal, and family factors., Findings: Mean age (yrs ± standard deviation) at first CPS contact for children taken into OoHC was 2.8 ± 3.7 (First Nations) and 3.0 ± 3.8 (other), and for children never in care was 4.5 ± 4.5 (First Nations) and 5.1 ± 4.7 (other). Among children served by a First Nations agency, males made up 50.6% (n = 5496) in OoHC and 51.0% (n = 6579) never in care. Among children served by other agencies, males made up 51.0% (n = 4324) in OoHC and 51.0% (n = 7428) never in care. Odds of teen pregnancy (First Nations aOR 3.69, 1.40-9.77; other aOR 5.10, 1.83-14.25), teen birth (First Nations aOR 3.23, 1.10-9.49; other aOR 5.06, 1.70-15.03), and sexually transmitted infections (other aOR 7.21, 3.63-14.32) were higher for children in care than children never in care, as were odds of being accused (other aOR 2.71, 1.27-5.75), a victim (other aOR 1.68, 1.10-2.56), charged with a crime (other aOR 2.68, 1.21-5.96), or incarcerated (First Nations aOR 3.64, 1.95-6.80; other aOR 1.19, 1.19-8.04)., Interpretation: Being in OoHC worsened children's health and legal system outcomes. The importance of reducing the number of children taken into care was emphasized in briefings to provincial and First Nations governments. The government response will be monitored., Funding: Social Sciences and Humanities Research Council (no. 890-2018-0029)., Competing Interests: The authors declare no competing interests., (© 2024 The Author(s).)

Introduction: There are limited data on chest computed tomography (CT) findings in the assessment of lung nodules among adult Aboriginal Australians. In this retrospective study, we assessed lung nodules among a group of adult Aboriginal Australians in the Northern Territory of Australia., Methods: Patients who underwent at least two chest CT scans between 2012 and 2020 among those referred to undergo lung function testing (spirometry) were included. Chest CT scans were assessed for the number, location, size and morphological characteristics of lung nodules., Results: Of the 402 chest CTs assessed, 75 patients (18.7%) had lung nodules, and 57 patients were included in the final analysis with at least two CT scans available for assessment over a median follow-up of 87 weeks. Most patients (68%) were women, with a median age of 58 years and smoking history in 83%. The majority recorded only a single nodule 43 (74%). Six patients (10%) were diagnosed with malignancy, five with primary lung cancer and one with metastatic thyroid cancer. Of the 51 (90%) patients assessed to be benign, 64 nodules were identified, of which 25 (39%) resolved, 38 (59%) remained stable and one (1.8%) enlarged on follow-up. Nodules among patients with malignancy were typically initially larger and enlarged over time, had spiculated margins and were solid, showing no specific lobar predilection., Conclusions: Most lung nodules in Aboriginal Australians are likely to be benign. However, a proportion could be malignant. Further prospective studies are required for prognostication and monitoring of lung nodules in this population., (© 2024 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Introduction: First Nations are most at risk of developing end-stage kidney disease. Kidney transplantation is the best treatment option for these patients; however, First Nations donors are underrepresented. The aim of this study was to describe and understand barriers and facilitators of culturally safe organ transplantation and donation from the perspective of First Nations and Health Professionals in the Province of Quebec, Canada. Methods/Approach: This was a qualitative descriptive study using the decolonizing Two-Eyed Seeing approach. The sample consisted of First Nations people and health professionals living in Quebec, Canada, who have had an experience of organ transplantation or donation. Semi-structured interviews were conducted between May and September 2021 with 11 people, including 5 healthcare professionals and 6 First Nations people. Findings: This study enrolled 11 participants. Several individual and contextual factors influencing culturally safe organ transplantation and donation among First Nations people were identified: language barrier, impacts of relocation, lack of knowledge about transplantation, mistrust of the healthcare system, family support and accompaniment, and transplant testimonials. Discussion: This study identified several avenues for reinforcing culturally safe transplantation and donation among First Nations, including the presence of a companion in medical consultations, focusing on access to culturally safe accommodation and sharing transplant testimonials. Further work in partnership with First Nations is needed to improve access to culturally safe organ transplantation.

Introduction: Geese harvesting is a longstanding cultural tradition deeply ingrained among the Omushkego Cree in Fort Albany First Nation, embodying a holistic approach to health that integrates Indigenous knowledge, community wellbeing, and resilience. Despite historical disruptions stemming from colonization and assimilation policies, women have played a pivotal role in preserving and passing down traditional practices. The significance of goose harvesting extends beyond providing a nutrient-rich and cost-effective food source; it serves as a vehicle for cultural preservation and education, particularly fostering language acquisition among children. Nevertheless, concerns persist regarding the potential decline in the transmission of Indigenous knowledge. The interruption of intergenerational knowledge transfer not only poses implications for overall wellbeing but also worsens historical trauma within the community. In response to these challenges, the Niska (goose) harvesting program was developed with an aim to revitalize community harvesting practices, with a specific focus on incorporating the perspectives of women, especially in the preparatory and smoking phases of the geese., Methods: Omushkego Cree women were approached to participate. The study was conducted during the spring of 2018, and employed photovoice and semi-structured interviews that explored the impact of geese preparatory activities on the health and wellbeing of Indigenous women., Results: Major themes from the qualitative data included the importance of knowledge sharing, cultural continuity, healing, and the profound connection to the land. Women emphasized the value of sharing acquired knowledge, passing on traditions, and maintaining a connection to their cultural identity. Cultural continuity, depicted through intergenerational teachings and experiences, emerged as crucial for overall wellbeing. Participants spoke of the healing dynamics derived from engaging in traditional activities, highlighting the positive impact on physical, mental, emotional, and spiritual wellbeing. The land was identified as a central element in this healing process, representing more than just a physical space but an extension of home, contributing to a sense of peace and tranquility. The land became a medium for transmitting cultural teachings, shaping identity, and sustaining a subsistence lifestyle., Conclusion: The study emphasizes the importance of future research including more female youth participants to uncover specific challenges and strengths within this demographic. Overall, the Niska program demonstrates a comprehensive approach that intertwines cultural revitalization, community engagement, and holistic wellbeing, emphasizing the need for interventions that go beyond immediate challenges to create enduring positive impacts on Indigenous communities.

The Northern Territory (NT) and Far North Queensland (FNQ) have a high proportion of Aboriginal and Torres Strait Islander women birthing who experience hyperglycaemia in pregnancy. A multi-component health systems intervention to improve antenatal and postpartum care in these regions for women with hyperglycaemia in pregnancy was implemented between 2016 and 2019. We explored health professional perspectives on the impact of the intervention on healthcare. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) underpinned this mixed-methods evaluation. Clinicians were surveyed before ( n = 183) and following ( n = 137) implementation. The constructs explored included usual practice and satisfaction with care pathways and communication between services. Clinicians, policymakers and the implementation team were interviewed ( n = 36), exploring the impact of the health systems intervention on practice and systems of care. Survey and interview participants reported improvements in clinical practice and systems of care. Self-reported glucose screening practices improved, including the use of recommended tests (72.0% using recommended first-trimester screening test at baseline, 94.8% post-intervention, p < 0.001) and the timing of postpartum diabetes screening (28.3% screening at appropriate interval after gestational diabetes at baseline, 66.7% post-intervention, p < 0.001). Health professionals reported multiple improvements to care for women with hyperglycaemia in pregnancy following the health systems intervention.

For Indigenous populations, one of the most recognized acts of historical trauma has come from boarding schools. These institutions were established by federal and state governments to forcibly assimilate Indigenous children into foreign cultures through spiritual, physical, and sexual abuse and through the destruction of critical connections to land, family, and tribal community. This literature review focuses on the impact of one of the oldest orphanages, asylums, and Indigenous residential boarding schools in the United States. The paper shares perspectives on national and international parallels of residential schools, land, truth and reconciliation, social justice, and the reconnection of resiliency-based Indigenous Knowledge towards ancestral strength, reclamation, survivorship, and cultural continuance.

Music has been linked to improved social and emotional wellbeing for First Nations Peoples, yet little research directly explores the link between music and social emotional wellbeing of Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, Asexual, Sistergirl, and Brotherboy (LGBTIQA+SB) First Nation Peoples in Australia. This article reports on a hybrid scoping narrative review of existing literature that explores LGBTIQA+SB social emotional wellbeing and potential links to music practices, such as music listening, performance, and composing. Findings suggest that music and creative practices can be linked to feelings of elation, positive self-regard, and safety. Music and performance can promote and celebrate the diversity and complexities of Queer First Nations people and identities through art and performance, enhancing a sense of belonging and links to community, generating feelings of pride, and contributing to knowledge sharing. Community connections built through creative arts and digital platforms are seen as enhancing social emotional wellbeing for First Nations Lesbian, Gay, Bisexual, Transgender, Intersex, Queer/Questioning, Brotherboy, Sistergirl people.

Background: Addressing Indigenous food security and food sovereignty calls for community-driven strategies to improve access to and availability of traditional and local food. Participatory approaches that integrate Indigenous leadership have supported successful program implementation. Learning Circles: Local Healthy Food to School is a participatory program that convenes a range of stakeholders including food producers, educators and Knowledge Keepers to plan, implement and monitor local food system action. Pilot work (2014-2015) in Haida Gwaii, British Columbia (BC), showed promising results of the Learning Circles (LC) approach in enhancing local and traditional food access, knowledge and skills among youth and adolescents. The objective of the current evaluation was therefore to examine the process of scaling-up the LC vertically within the Haida Nation; and horizontally across three diverse First Nations contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake Cree Nation, Saskatchewan; and Black River First Nation, Manitoba between 2016 and 2019., Methods: An implementation science framework, Foster-Fishman and Watson's (2012) ABLe Change Framework, was used to understand the LC as a participatory approach to facilitate community capacity building to strengthen local food systems. Interviews (n = 52), meeting summaries (n = 44) and tracking sheets (n = 39) were thematically analyzed., Results: The LC facilitated a collaborative process to: (1) build on strengths and explore ways to increase readiness and capacity to reclaim traditional and local food systems; (2) strengthen connections to land, traditional knowledge and ways of life; (3) foster community-level action and multi-sector partnerships; (4) drive actions towards decolonization through revitalization of traditional foods; (5) improve availability of and appreciation for local healthy and traditional foods in school communities; and (6) promote holistic wellness through steps towards food sovereignty and food security. Scale-up within Haida Gwaii supported a growing, robust local and traditional food system and enhanced Haida leadership. The approach worked well in other First Nations contexts, though baseline capacity and the presence of champions were enabling factors., Conclusions: Findings highlight LC as a participatory approach to build capacity and support iterative planning-to-action in community food systems. Identified strengths and challenges support opportunities to expand, adopt and modify the LC approach in other Indigenous communities with diverse food systems., (© 2024. The Author(s).)

Objective: The 'Deadly RED' project primarily aimed to improve culturally competent care to reduce the number of First Nations patients presenting to a Queensland ED who 'Take own leave' (TOL). The secondary aim was to evaluate the implementation project., Methods: A pre/post-test quasi experimental study design using mixed methods was co-designed with adherence to Indigenous research considerations. Quantitative analysis of First Nations presentations before and after Deadly RED implementation was performed using SPSS. Qualitative analysis of transcribed research yarns in NVIVO was coded and themed for analysis. Staff experiences and perspectives were collated using electronically distributed surveys and process audits were performed., Results: A total of 1096 First Nations presentations June to August 2021 and 1167 in the matched 2022 post-implementation period were analysed. Significantly more patients were recorded as TOL post-implementation (13.0% pre vs 21.3% post) and representations rates were unchanged. Forty-six staff surveyed identified improvements in all parameters including cultural appropriateness and quality of care. Qualitative analysis of 85 research yarns revealed themes migrated to increasingly acceptable, accessible, and usable care. Notably, 45% of the First Nation's patients recorded as TOL self-reported that their treatment was complete. The study was feasible as 80% of packs distributed and 73% follow-up screening after TOL., Conclusions: The Deadly RED evaluation revealed significant discrepancies in the reported data points of TOL and the 'story' of the First Nations persons experience of appropriate and completed care. Staff awareness and cultural capability improved significantly, and yarning allowed knowledge translation and improvements in communication which contributed to a better healthcare experience for First Nations patients attending our ED., (© 2024 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)