The Oskâyak (Youth) Power Program (YPP) at Pakitahaw Sākahikan Iýiniwak (Sturgeon Lake First Nation) was co-created by and with youth to strengthen (wellness) among (young men) and (boys). Using a participatory empowerment evaluation grounded in a braided framework of community-based participatory research (CBPR), transformative learning, and ethical space, guided conversations were held with 14 youth supported by Kēhtēyak (Elders) and Kayāsi Kistēyihtamow Kanawēyihcikēw (Traditional Knowledge Keepers). Oskâyak (Youth) described how cultural teachings, land-based activities, and mentorship nurtured confidence, identity, and connection, cultivating hope, belonging, purpose, and meaning. The findings show how Nation-led, strength-based programs grounded in Indigenous knowledge can foster holistic , agency, and community connectedness. The YPP illustrates the power of Indigenous youth-led, culturally grounded approaches to address health inequities while honoring self-determination and Ownership, Control, Access, and Possession (OCAP®) principles.

Maritime medical fitness is vital for safety in high-risk and medically isolated environments, yet current international policies remain inconsistent, opaque, and weakly evidence-based. This paper presents the Integrated EBM-Policy Framework (IEPF), a three-tier model integrating systematic clinical evidence appraisal, a maritime-specific risk stratification matrix, and adaptive regulatory feedback. Developed via a mixed-methods study of 112 maritime health professionals across nine jurisdictions, the IEPF increases clarity, defensibility, and international harmonization of fitness-to-embark decisions, especially for cardiovascular and mental health risks. It reduces unnecessary exclusions and strengthens applicability in circumpolar and remote operations, positioning IEPF as a scalable benchmark for global maritime health governance and high-risk occupational policy.

Chronic back pain (CBP) is a widespread public health issue. There is a lack of community-based care options for Indigenous Peoples with CBP. A virtual care clinic co-designed with community was implemented in the Cree Community of Pelican Narrows using remote presence (RPR) technology. Methods We used a community-based participatory action framework and pre-post design to evaluate this intervention. Pain, quality of life and experience outcomes were measured. An assessment was provided by a local nurse practitioner and a physical therapist joining over RPR. The physical therapist provided jp to four follow-up treatments per participant using RPR. Results Thirty-eight participants were assessed, and 78 follow-up treatments delivered. No significant differences between pre- and post- pain or quality of life were found. Thirteen patient participants and five health providers completed interviews. Patient themes included: (1) community and healthcare context, (2) community preferences for back pain care, and (3) experience with virtual back pain clinic. Health care provider themes included: (1) getting people to clinic, (2) experience with virtual back pain clinic, and (3) ways to enhance care. Conclusion Virtual CBP clinic enhanced access to therapy and was experienced positively. Participants suggested ways to address challenges, including a hybrid model of care.

Nunavik (Québec, Canada) has been inhabited by Inuit for over 4,000 years. Inuit midwives assisted in childbirth for centuries before colonization removed birth from our communities. In the 1980s, after years of evacuation for birth to southern hospitals, local women and Inuit leaders brought birth back to our remote Hudson Coast and Hudson Strait villages. As Inuit midwives, we have continuously offered local midwifery care to the population since that time, supported by southern midwives and an interprofessional team. Our midwifery service is nationally and internationally recognized as a model for returning childbirth to remote communities and reclaiming Indigenous midwifery. Inuulitsivik midwifery demonstrates that birth services and midwifery education can be integrated into health care systems in remote communities with safe outcomes. To understand the factors that contribute to our success and sustainability, we brought together experienced midwives and student midwives and met in person, by teleconference and online. Themes that emerged include Inuit values and language; Inuit leadership; local midwifery education; an adapted role for midwives in remote communities; flexibility in the organization and implementation of practice; midwifery-led interdisciplinary care and strategic collaboration with southern Canadian and international allies. We explore these themes and use common frameworks for policy analysis to consider effectiveness; impacts on the experience of pregnant women and families; health equity and access to services; costs; feasibility and acceptability. Our local midwifery service makes an important contribution to meeting the calls to Action of the Truth and Reconciliation Commission of Canada.

To investigate how the number of face-to-face office-hours nurse consultations changed in response to the continuously decreasing number of consultations with general practitioners (GPs) in the fourth largest city in Finland, Vantaa we performed a retrospective register-based follow-up cohort study in public primary health care. The number of monthly consultations per practitioner in public primary health care were examined and counted from all recorded face-to-face office-hour consultations with GPs, practical nurses (PNs), registered nurses (RNs), and public health (PHNs) nurses of Vantaa's public primary health care system between 1 January 2009 and 31 December 2014. Over the follow-up period, the monthly mean number of GP consultations adjusted per practitioner decreased from 159 (mean; SD 29) in 2009 to 135 (16) in 2014 (p<0.001), and the number of RN consultations decreased from 34 (14) to 27 (7; p<0.001). There was no significant decrease in the practitioner-adjusted median monthly number of office-hour consultations with PN or PHN. The total number of monthly office-hour consultations per practitioner decreased from 40 (11) to 34 (6; p<0.001). In public office-hours PHC, face-to-face medical consultations have not automatically shifted from GPs to nurses. Surprisingly, recorded RN consultations may even decrease, and the overall productivity of PHC may worsen.

Greenland has a high prevalence of chronic suppurative otitis media (CSOM), causing hearing loss (HL) in children. Understanding regional differences in prevalence is essential for public health service provision. This school-based cross-sectional study is the first to examine the prevalence of HL among children attending the only school in Tasiilaq, East Greenland. Video-otoscopy, tympanometry and pure-tone air and bone conduction audiometry were performed. In total 92 of 114 children aged 5-11 were included. 51 children (55%) had HL defined as pure-tone-average (PTA) >15 dB in the worst hearing ear according to the American-Speech-Language-Hearing-Association-criteria. Whereas 21 children (23%) had HL with PTA >20 in worst hearing ear according to the WHO-criteria. None of the children had previously been diagnosed. Among the 184 otoscopies, 45 were normal (24%), 43 showed wax-block (23%), 10 showed tympanic membrane perforation (5%) and 86 had other otitis media-related sequelae (47%). A high prevalence of HL and CSOM were found among children in East Greenland. 25% of the children should be assessed for hearing rehabilitation, indicating that HL on the east coast remains undiagnosed and untreated. The results highlight regional variation in CSOM and HL and support the need for regional data and new initiatives to prevent HL across Greenland.

Northern regions of Canada have the highest reported incidence of childhood rickets in the country, yet this public health problem remains poorly described. The goal of this research was to explore the food and vitamin D supplementation experiences in pregnancy and infancy and examine associations with rickets diagnosis. Data were collected systematically through a retrospective chart review of Inuit children from 18 communities in Nunavut born from 2010-2013. Although most pregnant people reported consuming country food daily or weekly, one in three pregnant people reported being food insecure. Fewer than half of infants were reported to have received daily vitamin D supplement at two months of age, and frequency of supplement use declined with age. Rickets diagnosis was present in 1.63% of children (95% CI = 1.20%-2.20%). The odds of rickets diagnosis were higher for children whose mothers experienced food insecurity during pregnancy than for those whose mothers had never experienced food insecurity (OR = 5.279; 95% CI = 1.248-16.191). Enhanced support for food security, breastfeeding and vitamin D supplementation in early life is needed. In the context of social determinants of health, this study highlights the far-reaching and negative impacts of food insecurity on the health of Inuit children in Nunavut.

Despite overall improvements in general health, the prevalence of mental illness continues to rise, underscoring the need for innovative approaches to health promotion. This study examines how purpose-driven small and medium-sized enterprises (SMEs) design and develop nature-based interventions (NBIs) as social innovations to promote mental health. Using a case study approach, the research draws on data from workshops, semi-structured interviews, and expert stakeholder discussions involving 28 SME practitioners, eight public actors from social and healthcare sectors, nine entrepreneurs, and four experienced stakeholders. The analysis reveals that the successful development of NBIs depends on five core dimensions: accessibility, acceptance, affordability, meaningfulness, and knowledge. In addition, the study identifies a range of strengths, weaknesses, opportunities, and threats that SMEs encounter when navigating the complex landscape of NBI implementation. The findings highlight the potential of NBIs to complement traditional healthcare by fostering empowerment and supporting tailored recovery, while also offering strategic insights into the collaboration required for sustainable social innovation.

This paper presents the background, planning, implementation, and outcomes of the inaugural Circumpolar Maternal and Child Health (CMCH) workshop, which aimed to co-develop a values-based and culture-informed research agenda for maternal and child health in the Circumpolar region. Recognizing the historical and ongoing impacts of colonization on Indigenous health systems, the workshop employed community-based participatory research (CBPR) methods to ensure inclusive and equitable engagement of care providers, program designers, Indigenous knowledge holders, and researchers. Through facilitated panels, sharing circles, and breakout sessions, participants explored culturally grounded approaches to maternal health, including the First 1000 Days, trauma-informed care, and birthing practices. Discussions emphasized Indigenous epistemologies, relational approaches, and the need to reframe Western concepts such as risk and trauma through community-defined perspectives. The workshop fostered relationship building and collective reflection, identifying key priorities for future research and collaboration. Reflections underscore the importance of holistic, community-responsive maternal health systems that honour Indigenous values, support local governance, and promote culturally safe, strengths-based care and research.

Alberta Health Services enacted the policy on National Indigenous Peoples' Day in 2023. The policy aims to directly support Indigenous patients to practice their traditional ceremonies on healthcare premises. This paper details the process of developing and implementing the policy, explores the challenges, and underscores the broader implications for healthcare institutions seeking to integrate cultural practices. Relational conversations and storytelling with key players in the development of the policy were carried out, explored alongside review of the literature and analysis of ethical considerations. Policy development involved consultations with Indigenous communities, Elders, and healthcare professionals to ensure cultural authenticity and safety of the policy implemented across various healthcare levels. The development process encountered several challenges that required careful navigation, including managing open flames within medical facilities, addressing concerns around ceremonial smoke, and the effort to institutionalize such a policy highlighted underlying issues of racial bias that needed to be addressed proactively. The policy exemplifies a commitment to respecting spiritual practices while maintaining a safe and inclusive environment for patients and represents a significant stride towards addressing historical injustices and promoting cultural inclusivity in healthcare.

Indigenous Sámi women in Norway are entitled to equitable and culturally safe maternity care. However, research on the Sámi perspectives in maternity care is limited. To explore midwives' experiences with Sámi women in birthing units in Northern Norway, we conducted 11 interviews, which were analysed using reflexive thematic analysis. The main theme, "We are all Norwegians: We are all the same," reflects a recurring perception that equality in care means treating all women equally, regardless of their cultural background. This approach, while well-intentioned, risked obscuring the specific cultural needs of Sámi women. The analysis showed tensions between sameness and difference: some midwives emphasised individualised, woman-centred care without reference to cultural identity, while others recognised that Sámi women's backgrounds could shape communication, expectations, and needs in childbirth. Midwives with Sámi heritage described their background as influencing their understanding, even when they did not self-identify as Sámi. While midwives strive to provide individualised and equal care, this may unintentionally reproduce assimilative norms and contribute to culturally unsafe care by under-communicating difference. The findings underscore the importance of enhancing cultural safety in Norwegian midwifery through education, reflection on historical injustices, and acknowledgement of Sámi women's cultural identities.

Working with an Indigenous Advisory Committee, including an Inuit Health Advisor and Researcher, we analyzed the 2017 Aboriginal Peoples Survey to examine prevalence and factors associated with pain-related disabilities (PRDs) among Inuit in Canada. Self-reported data were collected from Inuit ≥15 years. PRDs were defined as 'sometimes', 'often', or 'always' experiencing activity limitations due to pain from a long-term condition lasting ≥ six months. We computed PRD prevalence [95% CI] overall, and by geographic location, age, sex, type and number of co-existing disabilities. Modified Poisson regression with robust variance estimation modelled associations between Inuit social determinants of health and PRDs. Person-level and bootstrap weights were applied for all analyses. Among Inuit, 11.1% [10.0, 12.4] reported PRDs. Females [13.4% (11.8, 15.1)], individuals 55 + [23.7% (21.6, 25.9)], and those who lived outside Inuit Nunangat [17.1% (14.1, 20.5)] experienced higher prevalence of PRDs. Prevalence increased with the number of disabilities-highest among those with co-existing physical disabilities. Additionally, higher education, residential school attendance, and those who experienced difficulties related to food, housing, employment, and health were more likely to report PRDs. Characteristics which may increase the risk of PRDs need to be shared with Inuit stakeholders to guide next steps for awareness, advocacy, services and interventions.

Sauna bathing has gained increasing attention in medical and nursing research for its potential health-enhancing properties. It may be a valuable self-care practice for women, complementing conventional healthcare in prevention of diseases and promoting health and well-being. Since most studies focus on male participants, it is important to explore women's experiences with sauna bathing and its significance for their health and well-being. The aim of this study was to examine women's perceptions of sauna bathing and its impact on their health and well-being. A cross-sectional study was conducted using an online questionnaire comprising 17 items and four open-ended questions, which formed a subset of a larger questionnaire. A total of 384 women sauna users participated. Data was analyzed using descriptive statistics and qualitative content analysis. Women described a range of health and well-being experiences, with sauna bathing perceived as restorative and emotionally grounding, promoting improved sleep and reduced bodily pain, yet occasionally associated with social insecurity and counterproductive effects.

In Nunavut, Inuit territory in Canada, young people have suicide rates nine times higher than the overall Canadian rates. However, mental health services struggle to reach young people. Regional suicide prevention organizations call for improved services and a better continuum of care. Yet little research has explored young people's experiences with the services currently available. As part of a larger study on resilience in Inuit youth, we asked them to explain their lack of use of mental health and suicide prevention services. The study was conducted in Arviat and Pangnirtung and followed the Inuit methodology Aajiiqatigiingniq Research Methodology (ARM), a cultural process for consensus building and solution-seeking compatible with a qualitative research approach. Advisory boards were created in each community. Interviews were conducted with thirty-one Inuit youths age 15 to 24. Data were analyzed by a thematic analysis. Young Inuit expressed a general discomfort with available services, including uneasiness with the health center and the way services are provided, they lacked information about services, lamented inadequate outreach methods and expressed a feeling of mistrust. Our findings support the value of several ongoing initiatives based upon cultural traditions, and may inform the continuum of care for suicide prevention .

Challenges persist in delivering good-quality and safe health care to the Norwegian Sámi population. This cross-sectional study explored system-level factors affecting healthcare services for Sámi people. Specifically, it assessed (1) the extent to which Norwegian municipalities provided good and safe health and care services to Sámi users, as reported by managers, and (2) whether good and safe service provision was associated with selected municipal characteristics. An online survey was conducted in 2019 across 135 municipalities in the four northernmost counties, and 77 responded (57% response rate). Service quality was measured using a single five-point ordinal-scale question, and proportional odds regression models were used to analyse associations with municipal characteristics. Overall, 40% of municipalities reported offering good and safe services to a 'large' or 'very large' extent to Sámi users. More favourable assessments were observed among municipalities located within the Sámi language area and among those with higher net operating surplus. The results suggest that while certain contextual factors may support service provision, there remains considerable potential for improvement across municipalities. Continued policy attention and resource allocation, combined with initiatives to strengthen cultural and linguistic competence, are needed to enhance equitable access to health care for Sámi communities.

Chronic obstructive pulmonary disease (COPD) presents a significant health burden in Greenland. Pulmonary telerehabilitation (PTR) provides an evidence-based, feasible approach to deliver care to the geographically dispersed population. This mixed-method study evaluates the feasibility and acceptability of PTR for individuals with COPD in Greenland, combining quantitative evaluation of adherence, satisfaction, and clinical outcomes with qualitative interviews and a field log. Seven participants were enrolled in the 10-week program; four completed it. Satisfaction was high and clinical outcomes improved. Participants reported increased self-efficacy and perceived the intervention as effective for disease management. However, dropout rate was high, technical issues were frequent, and some found online sessions less engaging, expressing a desire for more peer support and structural incentives to sustain motivation beyond the program. In this small sample, PTR appeared to be an acceptable and valuable addition to COPD care in Greenland. However, questions remain about the suitability of this approach for the broader population, given Greenland's telehealth infrastructure and digital readiness. Future efforts should focus on strengthening peer support and sustained engagement beyond programs. Considering digital health literacy and user readiness is essential for telerehabilitation efforts in Greenland.

Lack of in-home water service remains a persistent challenge in rural Alaska due to underfunding, high construction and operating costs, extreme cold, and environmental change. Alaska has the highest proportion of households in the U.S. lacking complete plumbing, resulting in self-hauling of water and waste, reuse of limited supplies, and higher rates of water-washed disease than in plumbed homes. During the COVID-19 response, the Alaska Native Tribal Health Consortium (ANTHC) and Silverline LLC developed and installed the Miniature Portable Alternative Sanitation System (Mini-PASS) in 14 unplumbed Alaska Native communities. To evaluate its impact on hand hygiene, water-hauling behaviors, and system use, we conducted seasonal interviews with 147 households. Among 139 households reporting handwashing methods, 63% (n=93) used the in-home handwashing station (HWS) as their primary method. Longer ownership was associated with greater HWS use and increased water hauling. Analysis of 163 interviews from 52 households showed a monthly rise of 0.08 gal/c/d (0.30 L/c/d) in water use following installation. These findings indicate that in-home HWS interventions such as the Mini-PASS improve hand hygiene, reduce wash-basin water reuse, and modestly increase household water use over time. Longitudinal monitoring is critical to assess sustained behavioral and WASH outcomes in unpiped communities.

Indigenous older adults across the globe face higher rates of chronic illness and lower life expectancy than non-Indigenous populations, yet little research has examined how physical literacy might support their health and well-being. Traditionally applied to children and youth, physical literacy-understood as one's relationship with movement and physical activity across the life course-shares with Indigenous worldviews an emphasis on holistic well-being rooted in culture, community, and the environment. This exploratory review examines global literature to identify how physical literacy concepts-such as motivation, confidence, physical competence, and knowledge-connect with ways of knowing, being, and doing among Indigenous older adults, as well as in physical activity programs for this population. Findings reveal strong connections between physical literacy and culturally grounded forms of movement, with successful programs often integrating physical activity with cultural practices such as sharing circles. These initiatives reflect holistic views of health and highlight opportunities for culturally rooted approaches to physical literacy. The findings suggest that meaningful engagement with Indigenous older adults calls for physical literacy frameworks co-developed through community partnerships that honor Indigenous ways of knowing, being, and doing. Implications for policy and practice include the need for participatory program design that prioritizes social connection, intergenerational learning, spiritual health, and community well-being.

We compared a school-based portable and a clinic-based standard model for examining the oral health of school-age children in Finland. Two socioeconomically comparable regions were examined to discover the differences between these models for providing oral health examinations for primary school-age children in Finland. A retrospective registry study using patient records from the electronic health system (2020-2023) was conducted in two socioeconomically comparable regions: Nokia (portable model, n=481) and Tampere (standard model, n=538). The analysed variables included the number of visits, the longest gap between visits, diagnoses, oral health care procedures and recall intervals. The standard model exhibited significantly longer gaps between visits (median 25 vs. 11 months, p<0.001) and fewer individualised recall intervals (11.7% vs. 24.9%, p<0.001). Recall intervals were longer in the standard model (17 vs. 6 months, p<0.001). The standard model also showed higher prevalence of caries (21.1% vs. 11.7%, p<0.005), restorative treatments (41.3% vs. 33.1%, p<0.001) and tooth extractions (35.5% vs. 22.4%, p=0.005). The portable model had a higher proportion of children who received only a dentist's examination (35% vs. 9.6%, p<0.001) compared to hygienist-led examinations. Organisational factors play a more significant role than mere geographical accessibility in ensuring effective oral health care in Finland.

Few studies on epilepsy in Greenlandic children exist, and the results are inconsistent. The objective of this study was to estimate the burden of epilepsy in children in Greenland and Denmark and secondly to identify demographic risk factors. Third, the risk of epilepsy after febrile seizures should be estimated. A register-based cohort study of all children in Greenland and Denmark aged 0-15 years from 1987 to 2014 was conducted. Using the Greenlandic and Danish National Patient Register, cases were identified and coupled to demographics through the Civil Registration System. The outcomes were incidence rates (IR) per 100,000 person-years (PY) and hazard ratios (HR).The study showed an epilepsy IR of 150/100,000 PY (139-162) in Greenland and 110/100,000PY (108-111) in Denmark and an HR of 1.34. The IRs were very high in the first years of life. A significantly higher HR was found for male sex, Inuit ethnicity in Greenland and habitation in Greenland outside of the capital. The risk of epilepsy after the diagnosis of febrile seizures was almost doubled in Greenland compared with Denmark.