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Background Differential access to healthcare has contributed to a higher burden of illness and mortality among First Nations compared to other people in Canada. Throughout the Coronavirus Disease 2019 (COVID-19) pandemic, First Nations organizations in Manitoba partnered with public health and Manitoba government officials to ensure First Nations had early, equitable and culturally safe access to COVID-19 diagnostic testing and vaccination. In this study, we examined whether prioritizing First Nations for vaccination was associated with faster uptake of COVID-19 vaccines among First Nations versus All Other Manitobans (AOM). Methods and findings In this retrospective cohort study, we used linked, whole-population administrative data from the Manitoba healthcare system (February 2020 to December 2021) to determine rates of COVID-19 diagnostic testing, infection, and vaccination, and used adjusted restricted mean survival time (RMST) models to test whether First Nations received their first and second vaccine doses more quickly than other Manitobans. The cohort comprised 114,816 First Nations (50.6% female) and 1,262,760 AOM (50.1% female). First Nations were younger (72.3% were age 0 to 39 years) compared to AOM (51% were age 0 to 39 years) and were overrepresented in the lowest 2 income quintiles (81.6% versus 35.6% for AOM). The 2 groups had a similar burden of comorbidities (65.8% of First Nations had none and 6.3% had 3 or more; 65.9% of AOM had none and 6.0% had 3 or more) and existing mental disorders (36.9% of First Nations were diagnosed with a mood/anxiety disorder, psychosis, personality disorder, or substance use disorder versus 35.2% of AOM). First Nations had crude infection rates of up to 17.20 (95% CI 17.15 to 17.24) COVID-19 infections/1,000 person-months compared with up to 6.24 (95% CI 6.16 to 6.32) infections/1,000 person-months among AOM. First Nations had crude diagnostic testing rates of up to 103.19 (95% CI 103.06 to 103.32) diagnostic COVID-19 tests/1,000 person-months compared with up to 61.52 (95% CI 61.47 to 61.57) tests/1,000 person-months among AOM. Prioritizing First Nations to receive vaccines was associated with faster vaccine uptake among First Nations versus other Manitobans. After adjusting for age, sex, income, region of residence, mental health conditions, and comorbidities, we found that First Nations residents received their first vaccine dose an average of 15.5 (95% CI 14.9 to 16.0) days sooner and their second dose 13.9 (95% CI 13.3 to 14.5) days sooner than other Manitobans in the same age group. The study was limited by the discontinuation of population-based COVID-19 testing and data collection in December 2021. As well, it would have been valuable to have contextual data on potential barriers to COVID-19 testing or vaccination, including, for example, information on social and structural barriers faced by Indigenous and other racialized people, or the distrust Indigenous people may have in governments due to historical harms. Conclusion In this study, we observed that the partnered COVID-19 response between First Nations and the Manitoba government, which oversaw creation and enactment of policies prioritizing First Nations for vaccines, was associated with vaccine acceptance and quick uptake among First Nations. This approach may serve as a useful framework for future public health efforts in Manitoba and other jurisdictions across Canada., Author(s): Nathan C. Nickel 1,*, Wanda Phillips-Beck 2,*, Jennifer E. Enns 1, Okechukwu Ekuma 1, Carole Taylor 1, Sarah Fileatreault 1, Nkiru Eze 1, Leona Star 2, Josée Lavoie 3, [...]

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Introduction: Use of substances during pregnancy is a global health concern. Interprofessional care teams can provide an optimal care approach to engage individuals who use substances during the perinatal period. The purpose of this scoping review is to provide a comprehensive summation of published literature reporting on interprofessional care models for perinatal individuals who use substances. Methods: We conducted a systematic search for articles from health-related databases. The Preferred Reporting Items for Systematic Reviews for Scoping Reviews (PRISMA-ScR) was followed. Data were extracted and synthesized to identify the interprofessional care team roles, program and/or provider characteristics, and care outcomes of these models. Results: We screened 645 publications for full text eligibility. Eleven articles met full inclusion criteria and were summarized. Programs were built on co-location of services, partnership with other agencies, available group/peer support and approaches inclusive of cultural care, trauma informed care, and harm reduction principles. Discussion: There is growing evidence supporting integrated care models that are inclusive of relational care providers from multiple health care professions to achieve wraparound care. Conclusions: Many of the interprofessional care models studied have successfully blended social, primary, pregnancy, and addictions care. The success and sustainability of programs varies, and more work is needed to evaluate program and patient outcomes. [ABSTRACT FROM AUTHOR]

There is a profoundly troubling history of research being done on Indigenous peoples without regard for their priorities and accompanying calls to decolonize health research. Storytelling methods can privilege Indigenous voices in research. Indigenous people's knowledge systems have existed for millennium, where knowledge is produced and shared through stories. Our collaborative team of Indigenous and non-Indigenous researchers, and Indigenous Elders, patients, healthcare providers, and administrators, conducted a participatory, scoping review to examine how storytelling has been used as a method in Indigenous health research on Turtle Island (North America), Australia, and Aotearoa (New Zealand). We searched key databases and online sources for qualitative and mixed-methods studies that involved Indigenous participants and used storytelling as a method in health research. Reviewers screened abstracts/full texts to confirm eligibility. Narrative data were extracted and synthesized. An intensive collaboration was woven throughout and included gatherings incorporating Indigenous protocol, Elders' teachings on storytelling, and sharing circles. We included 178 articles and found a diverse array of storytelling approaches and adaptations, along with exemplary practices and problematic omissions. Researchers honoured Indigenous ways of knowing, being, and doing through careful preparation and community engagement to do storywork, inclusion of Indigenous languages and protocols, and Indigenous initiation and governance. Storytelling centered Indigenous voices, was a culturally relevant and respectful method, involved a healing process, and reclaimed Indigenous stories. But it could result in several challenges when researchers did not meaningfully engage with Indigenous peoples. These findings can guide respectful storytelling research that bridges divergent Indigenous and Western knowledge systems, to decolonize health research. [ABSTRACT FROM AUTHOR]

Globally, Indigenous Peoples experience disparate COVID-19 outcomes. This paper presents case studies from Aotearoa New Zealand, Australia, Canada, and the United States of America and explores aspects of government policies, public health actions, and Indigenous nursing leadership for Indigenous communities during a pandemic. Government under-performance in establishing Indigenous-specific plans and resources, burdened those countries with higher COVID-19 cases and mortality rates. First, availability of quality data is an essential element of any public health strategy, and involves disaggregated, ethnic-specific data on Indigenous COVID-19 cases, mortality rates, and vaccination rates. When data is unavailable, Indigenous Peoples are rendered invisible. Data sovereignty principles must be utilised to ensure that there is Indigenous ownership and protections of these data. Second, out of necessity, Indigenous communities expressed their self-determination by uniting to protect their Peoples and providing holistic and culturally meaningful care, gathering quality data and advocating. Indigenous leaders used an equity lens that informed national, state, regional, and community-level decisions relating to their Peoples. Third, at the forefront of the pandemic, Indigenous nursing leadership served as a trusted presence within Indigenous communities. Indigenous nurses often led advocacy, COVID-19 testing, nursing care, and vaccination efforts in various settings and communities. Indigenous nurses performed vital roles in a global strategy to reduce Indigenous health inequities during the COVID-19 pandemic and beyond. Fourth, historically, pandemics have heightened Indigenous Peoples' vulnerability. COVID-19 amplified Indigenous health inequities, underscoring the importance of high-trust relationships with Indigenous communities to enable rapid government support and resources. Holistic approaches to COVID-19 responses by Indigenous peoples must consider the wider determinants of wellbeing including food and housing security. Findings from these case studies, demonstrate that Indigenous self-determination, data sovereignty, holistic approaches to pandemic responses alongside with Governmental policies, resources should inform vaccination strategies and future pandemic readiness plans. Finally, in any pandemic of COVID-19-scale, Indigenous nurses' leadership and experience must be leveraged for a calm, trusted and efficient response. [ABSTRACT FROM AUTHOR]

In this study, we focused on readmissions for Ambulatory Care Sensitive Conditions (ACSC) ending in death, to capture those admissions and readmissions that might have been prevented if responsive primary healthcare was accessible. We propose this as a sentinel indicator of equity. We conducted analyses of Manitoba-based 30-day hospital readmission rates for ACSC which resulted in death, using data from 1986-2016 adjusted for age, sex, and socio-economic status. Our findings show that, across Manitoba, overall rates of readmissions ending in death are slowly increasing, and increasing more dramatically among northern First Nations, larger First Nations not affiliated with Tribal Councils, and in the western region of the province. These regions have continuously been highlighted as disadvantaged in terms of access to care, suggesting that the time for action is overdue. Rising rates of readmissions for ACSC ending in death suggest that greater attention should be placed on access to responsive primary healthcare. These findings have broader implications for territorial healthcare systems which purchase acute care services from provinces south of them. As an indicator of quality, monitoring readmissions ending in death could provide territorial governments insights into the quality of care provided to their constituents by provincial authorities. [ABSTRACT FROM AUTHOR]