Search Results (1,251)

Remote Indigenous communities experience persistent inequities in access to fresh and nutritious foods due to the fragility of perishable food supply chains (PFSCs). Disruptions across procurement, transportation, storage, retail, and limited local production restrict access to perishable foods, contributing to food insecurity and diet-related health risks. This scoping literature review synthesizes evidence from 84 peer-reviewed, grey, and unpublished sources across fourteen countries to map PFSC management (PFSCM) challenges affecting food access in remote Indigenous communities worldwide and to synthesize reported practices implemented to address these challenges. PFSCM challenges were identified across all supply chain levels, and five categories of reported practices emerged: PFSC redesign strategies, forecasting and decision-support models, technological innovations, collaboration and coordination mechanisms, and targeted investments. These findings informed the development of a multi-scalar conceptual framework comprising seven interconnected PFSCM clusters that organize how reported practices are associated with multiple food access dimensions, including quantity, affordability, quality, safety, variety, and cultural acceptability. This review contributes an integrative, system-oriented synthesis of PFSCM research and provides a conceptual basis to support future scholarly inquiry, comparative inquiry, and policy-relevant discussion of food access and health equity in remote Indigenous communities. Full article

Background/Objectives: Given the high prevalence of obesity and abdominal obesity in Indigenous adults from Sonora (IAS) and its strong association with diet, this study evaluates the association of dietary inflammatory index (DII) with obesity and abdominal obesity and its indicators, such as body mass index (BMI) and waist circumference (WC), respectively. Methods: This cross-sectional study included data from 559 adults across two Indigenous populations (Seris and Yaquis) collected in two separate studies. Obesity and abdominal obesity were classified according to the definitions established by the World Health Organization and the International Diabetes Federation. The DII was calculated with data from population-specific food frequency questionnaires. Multiple linear regression was used to assess the association between the DII variable (expressed as both numeric and categorical) and BMI and WC, separately; multiple logistic regression was used to evaluate the association between obesity and abdominal obesity. Results: The prevalence of obesity and abdominal obesity was 34.1% and 78.2%, respectively. There was a positive association between the DII and BMI (DII as numeric: β = 0.53, p = 0.001; tertile3 of DII vs. tertile1: β = 1.86, p = 0.001) and WC (DII as numeric: β = 1.15, p = 0.002; tertile3 of DII vs. tertile1: β = 3.81, p = 0.005). Similar results were found for both types of obesity. Conclusions: Higher DII scores were associated with increased obesity indicators (BMI and WC) and a higher risk of obesity and abdominal obesity in IAS. Promoting anti-inflammatory diets represents a feasible approach for preventing non-communicable diseases. Full article

Background: Multimorbidity (the co-occurrence of two or more chronic conditions) is increasingly common among older adults and contributes to diminished well-being and greater healthcare use. While national data highlight regional variation, few studies have examined how multimorbidity is patterned within provinces like Saskatchewan or how it relates to access and acute care use. Objective: To describe sociodemographic and geographic patterns of multimorbidity among older adults in Saskatchewan and examine its association with healthcare access, unmet needs, and recent emergency department (ED) visits and hospitalizations. Methods: We conducted a secondary analysis of a population-based telephone survey of 1093 adults aged 65+ across Saskatchewan. Respondents were categorized by chronic disease burden (none, one, or multimorbidity). Descriptive statistics and postal code-level mapping explored health status, access, and utilization. Results: Multimorbidity (10.6%) was more prevalent among older adults aged 75+, Indigenous respondents, and those with lower education. It was associated with poorer self-rated health, greater unmet needs, and higher ED visits (20.7%) and hospitalizations (12.1%) compared to those without chronic conditions. Northern regions had proportionally higher multimorbidity, despite smaller populations. Conclusions: Findings highlight social and spatial disparities in chronic disease burden and underscore the need for equity-focused strategies in Saskatchewan’s rural and northern communities. Full article

Background: Dementia poses a significant health concern among Australia’s First Nations peoples, who experience higher prevalence and earlier onset compared to non-First Nations populations. Despite growing research attention, the overall scope and characteristics of existing literature on dementia in these communities remain unclear. Objective: This scoping review aimed to map and synthesise existing evidence on the burden of dementia among First Nations peoples, focusing on associated risk factors and culturally responsive approaches to prevention, intervention, and care. Methods: Following the PRISMA Extension for Scoping Reviews guidelines, a comprehensive search was conducted across Scopus, EMBASE, PubMed, PsycINFO, CINAHL, the Indigenous Studies Portal, and Google Scholar for English-language studies published between 2004 and 2025. Search terms combined dementia and cognitive impairment with First Nations, Indigenous peoples, and related concepts, alongside terms for risk factors, intervention, prevention, care strategies, and health disparities. Two reviewers independently screened studies and extracted data using a standardised template. Of the 620 records identified, 324 were screened, 130 were assessed in full, and 75 met the inclusion criteria. Data were narratively synthesised to identify key themes and evidence gaps. Results: The review revealed a disproportionate burden of dementia among First Nations peoples, characterised by earlier onset and higher prevalence than in non-First Nations populations. Major modifiable risk factors included social determinants of health, lifestyle behaviours, and inequitable access to healthcare. Studies emphasised the importance of culturally safe, community-led, and multidisciplinary approaches; however, many interventions remain poorly adapted to the diverse cultural contexts of First Nations communities. The review also identified gaps in diagnostic tools, culturally appropriate care pathways, and the integration of traditional knowledge and digital innovations in dementia management. Conclusions: Addressing dementia inequities among First Nations Australians demands transformative, community-driven action that extends beyond descriptive research. Future work should prioritise co-designed, culturally grounded interventions that embed First Nations knowledge systems, strengthen healthcare capacity, and foster long-term community empowerment. Embedding cultural safety within policy and clinical frameworks, and shifting toward preventive, strengths-based approaches, will advance equity in dementia care and provide valuable insights for First Nations health systems globally. Full article

Background: This scoping review aims to systematically examine the extent of the literature on African health histories throughout the pre-colonial, colonial, post-independence, primary health care (PHC), Millennium Development Goals (MDG), and Sustainable Development Goals (SDG) periods. Methods: This scoping review followed the Arksey and O’Malley framework, enhanced by Levac’s updates and adaptations from the Joanna Briggs Institute’s methodology. Data from eligible records were extracted based on inclusion criteria and summarized narratively. Results: We included 83 records, of which the majority (n = 70) were narrative reviews. Eighteen of these provide evidence from Africa as a whole, while country-specific evidence was obtained from 21 countries. South Africa had the most records (n = 17), followed by Ghana (n = 6) and Nigeria (n = 6). The majority of evidence came from the colonial period (n = 13), followed by the PHC and MDG periods (n = 12 each). Health systems in the pre-colonial era were rooted in indigenous practices and community-driven systems; the colonial period introduced Western-style health care systems; the post-independence period focused on health promotion initiatives and infectious disease eradication; the PHC era focused on community-centered health care and equitable service provision; the MDG era expanded on targeted interventions for infectious diseases, and the SDG era aims to build resilient and inclusive health care systems towards universal health coverage. Conclusion: This review revealed diverse influences on health systems from the pre-colonial to SDG eras. However, these records are not exhaustive and require country-specific records, archived documents, and a centralized repository. Addressing these gaps will provide a comprehensive understanding of African health histories and aid in future health interventions. Full article

Background/Objectives: To investigate the relationship between cigarette smoking and long-term stroke outcomes in American Indian participants of the Strong Heart Study (SHS). Methods: SHS is a longitudinal, population-based cohort study of cardiovascular disease in American Indian tribes and communities in Oklahoma, Arizona, and the Dakotas. Data were abstracted from 5802 participants without prevalent stroke, enrolled during two asynchronous sampling periods (1989–1991; 2001–2003), who underwent annual surveillance through 31 December 2021. Age- and sex-specific person–time incidence rates of stroke and their 95% CIs were calculated for each cohort. A combined analysis using shared frailty Cox proportional hazards models assessed the association of incident stroke with baseline smoking status, demographics, and other key risk factors. Results: Among participants, baseline smoking status was positive in 2220 (38.3%). Incident stroke was observed in 456 (7.9%) during a pooled median follow-up time of 19.54 years (range, 0.02–32.62) across the combined cohorts. Stroke incidence was higher among the original cohort, smokers, and older individuals. Across both cohorts, baseline current smokers had a 2.23-fold higher risk of incident stroke compared to nonsmokers (HR = 2.23, 95%CI = 1.73–2.88) and a 1.69-fold higher risk compared to former smokers (HR = 1.69, 95%CI = 1.34–2.13) after controlling for covariates. Conclusions: Smoking remains a key risk factor for stroke in American Indians. The current study extends our prior research with broader age ranges and longer follow-up in two cohorts. While American Indians have higher smoking prevalence and stroke risk, increased risk in current versus former smokers supports smoking cessation benefits and emphasizes the need for culturally tailored interventions. Full article

Chronic diseases disproportionately impact Indigenous peoples in Australia, with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) representing leading causes of morbidity and mortality. Despite evidence supporting community-based exercise interventions for T2DM management, no culturally adapted programs utilizing wearable technology have been co-designed specifically with Indigenous Australian communities. This study protocol aims to determine if wearable-based exercise interventions can effectively prevent CVD development and manage T2DM progression in Indigenous Australians through culturally safe, community-led approaches. The PrIDE study protocol describes a mixed-methods translational research design incorporating Indigenous and Western methodologies across three phases: (1) co-designing culturally adapted exercise programs and assessment tools, (2) implementing interventions with wearable monitoring, and (3) conducting evaluation and scale-up assessment. Sixty-four Indigenous Australian adults with T2DM will be recruited across remote, rural/regional sites to self-select into either individual or group exercise programs using the Withings ScanWatch 2. Primary outcomes include cardiovascular risk factors, physical fitness, and health self-efficacy measured using culturally adapted tools. Indigenous governance structures will ensure cultural safety and community ownership throughout. The PrIDE protocol presents a novel approach to improving health equity while advancing understanding of wearable technology integration in Indigenous healthcare, informing future larger-scale trials and policy development. Full article

Background: Hepatocellular carcinoma (HCC) poses a significant public health challenge in Australia, with poorer survival observed in non-metropolitan populations. This study investigated whether survival disparities persist between non-metropolitan and metropolitan patients if only those with early-stage HCC treated at metropolitan tertiary referral centres are considered. Methods: We performed a retrospective cohort study across ten Australian tertiary centres involving patients with a new diagnosis of Barcelona Clinic Liver Cancer (BCLC) stage 0 or A, recorded from 1 January 2016 to 31 December 2020. Residential postcodes were entered using the Modified Monash (MM) model to define metropolitan versus non-metropolitan residence. The primary endpoint was adjusted for all-cause mortality. Results: Our study included 854 patients (metropolitan n = 612, and non-metropolitan n = 242) with a median follow-up of 42.6 months. We found no significant survival or mortality differences between the two groups with the unadjusted Kaplan–Meier survival analysis (log-rank test p = 0.612) and with the Cox proportional hazards regression analysis (adjusted HR 0.93, 95% CI 0.64–1.34, p = 0.690). As expected, tumour burden, Child–Pugh Score, and Charlson Comorbidity Index (CCI) were significant predictors of mortality. Conclusions: Our findings suggest that previously observed survival disparities may stem from delayed diagnosis and reduced access to tertiary care in non-metropolitan regions and highlight the need for improved HCC surveillance and referral pathways, particularly for rural and Indigenous communities, to mitigate geographic inequities. Full article

First Nations children remain dramatically over-represented in Australia’s Out-of-Home Care (OOHC) system, particularly in New South Wales (NSW), which continues to report the highest numbers nationally. This narrative review, grounded in a relational First Nations Standpoint Theory and decolonising research paradigms, to critically examine the systemic, structural, and historical factors contributing to these disproportionalities. Drawing on interdisciplinary evidence across law, criminology, education, health, governance studies, and public policy, the analysis centres Indigenous-authored scholarship and contemporary empirical literature, including grey literature, inquiries, and community-led reports. Findings reveal that the OOHC system reproduces the colonial logics that historically drove the Stolen Generations. Macro-level structural drivers—including systemic racism, Indigenous data injustice, entrenched poverty and deprivation, intergenerational trauma, and Westernised governance frameworks—continue to shape child protection policies and practices. Micro-level drivers such as parental supports, mental health distress, substance misuse, family violence, and the criminalisation of children in care (“crossover children”) must be understood as direct consequences of structural inequality rather than as isolated individual risk factors. Current placement and permanency orders in NSW further compound cultural disconnection, with ongoing failures to implement the Aboriginal and Torres Strait Islander Child Placement Principle (ATSICPP). Contemporary cultural rights and Indigenous Cultural and Intellectual Property (ICIP) frameworks highlight the urgency of restoring Indigenous authority in decision-making processes. The literature consistently demonstrates that cultural continuity, kinship networks, and ACCO-led models are sort to produce stronger long-term outcomes for children. The review concludes that genuine transformation requires a systemic shift toward Indigenous-led governance, community-controlled service delivery, data sovereignty, and legislative reform that embeds cultural rights and self-determination. Without acknowledging the structural drivers and redistributing genuine power and authority, the state risks perpetuating a cycle of removal that mirrors earlier assimilationist policies. Strengthening First Peoples governance and cultural authority is therefore essential to creating pathways for First Nations children to live safely, remain connected to family and kin, and thrive in culture. Full article

Tick-borne diseases (TBDs) pose a significant threat to livestock productivity and rural livelihoods in South Africa, particularly among resource-poor communal farmers. This narrative review synthesises findings from case studies on communal farmers’ knowledge, attitudes, and practices (KAPs) toward TBDs and their control. The analysis reveals that while many farmers can identify TBDs and their symptoms, significant gaps exist in understanding acaricide resistance and effective tick management. Socioeconomic factors, including age, gender, education, and access to veterinary services, strongly influence knowledge and practices. Indigenous ethnoveterinary practices are commonly used alongside conventional methods, although their efficacy remains understudied. The review emphasises the importance of integrated pest management, participatory approaches, and targeted awareness campaigns. A One Health framework is recommended to enhance surveillance, collaboration, and sustainable TBD control. Empowering farmers through training and inclusive communication strategies is crucial for mitigating the impacts of TBDs on communal farming systems. Full article

Cancer is one of the biggest health burdens for women in the Middle East and North Africa (MENA), with the incidence of breast, cervical and colorectal cancer on the rise. Although preventive measures such as the HPV vaccination and population-based screening are available, access to them remains very unequal. Women in rural, low-income and refugee communities face additional barriers, cultural stigmatisation, low health literacy, gender norms and fragile health systems, leading to delayed diagnoses and poorer outcomes. This review summarises the results of 724 peer-reviewed publications to assess the current situation of cancer screening in MENA and Mediterranean countries. The studies were classified into four dimensions: cancer type (breast, cervical, colorectal), behavioural constructs (awareness, uptake, education), vulnerability factors (e.g., migrants, refugees, low-literacy groups), and geography (indigenous MENA populations versus diaspora and Mediterranean immigrant communities). The results show large inequalities in access and participation due to fragmented policies, socio-cultural resistance and infrastructure gaps. Nevertheless, promising approaches are emerging: community-led outreach, mobile screening programmes, AI-assisted triage and culturally appropriate digital health interventions. Comparisons between the local and diaspora populations make it clear that systemic and cultural barriers persist even in well-equipped facilities. Closing the screening gap requires a culturally sensitive, digitally enabled and policy aligned approach. Key priorities include engaging religious and community leaders, promoting men’s engagement in women’s health and securing sustainable funding. With coordinated action across all sectors, MENA countries can build inclusive screening programmes that reach vulnerable women and reduce preventable cancer mortality. Full article

High-altitude exposure poses significant health challenges to mountaineers, military personnel, travelers, and indigenous residents. Altitude-related illnesses encompass acute conditions such as acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema (HACE), and chronic manifestations like chronic mountain sickness (CMS). Hypobaric hypoxia induces oxidative stress and inflammatory cascades, causing alterations in multiple organ systems through co-related amplification mechanisms. Therefore, this review aims to systematically discuss the injury mechanisms and comprehensive intervention strategies involved in high-altitude diseases. In summary, these pathologies involve key damage pathways: oxidative stress activates inflammatory pathways through NF-κB and NOD-like receptor thermal protein domain-associated protein 3 (NLRP3) inflammasomes; energy depletion impairs calcium homeostasis, leading to cellular calcium overload; mitochondrial dysfunction amplifies injury through mitochondrial permeability transition pore (mPTP) opening and apoptotic factor release. These mechanisms could be converged in organ-specific patterns—blood–brain barrier disruption in HACE, stress failure in HAPE, and right heart dysfunction in chronic exposure. Promising strategies include multi-level therapeutic approaches targeting oxygenation (supplemental oxygen, acetazolamide), specific pathway modulation (antioxidants, calcium channel blockers, HIF-1α regulators), and damage repair (glucocorticoids). Notably, functional foods show significant therapeutic potential: dietary nitrates (beetroot) enhance oxygen delivery, tea polyphenols and anthocyanins (black goji berry) provide antioxidant effects, and traditional herbal bioactives (astragaloside, ginsenosides) offer multi-targeted organ protection. Full article

This study examines the perceptions and experiences of Indigenous Kankuamo women in northern Colombia regarding their sexual and reproductive rights (SRR), exploring how cultural traditions and public policies shape their exercise. The main objective was to understand the tensions between ancestral values, community leadership, and internationally recognized rights. A mixed-methods approach (qualitative–quantitative) was employed, based on semi-structured interviews conducted with 30 women. The instrument included closed Likert-type questions and open-ended items addressing perceptions, cultural practices, access to health services, and government programs. Data were analyzed using descriptive statistics, Spearman correlations, and content analysis through thematic development. The findings revealed a strong correlation between trust in health services, accessibility, cultural compatibility, and the frequency of adolescent pregnancies. Divided perceptions regarding the role of community leaders were identified, along with a recurring demand for education and awareness-raising on sexuality and rights. Participants also noted limitations in state programs, mainly due to their limited cultural relevance. Kankuamo women face ongoing tensions between cultural preservation and sexual autonomy. Strengthening education, inclusive leadership, and policies with an ethnic and gender perspective is recommended to ensure the full exercise of their SRR. Full article

Background/Objectives: This study investigated the relationship between time spent on social media and eating behaviours among young Australian adults. It also examined the types of content discussed and linguistic styles used by health and nutrition content creators on Instagram. Methods: Young adults (aged 18–30 years) who reported viewing social media for nutrition or health content were recruited to complete a self-administered, cross-sectional survey. Data on demographics, time spent on Instagram and TikTok, health content creators viewed, and responses to the Scale of Effects of Social Media on Eating Behaviours (SESMEB) were collected. Associations between time spent on Instagram and TikTok and SESMEB scores were analysed. Inductive content and thematic analysis were conducted on health-related posts from Instagram accounts viewed by study participants. Results: From the 57 participants who completed the demographic survey, 42 participants completed the full study including the SESMEB survey. There was no significant association between SESMEB score and time spent on Instagram (p = 0.38) or TikTok (p = 0.40). A total of 1420 Instagram posts from 71 distinct content creators were analysed. Health and fitness product endorsements or advertisements (56.3%), predominantly posted by laypersons (55.3%), were the most common type of post in the sample. The most common communication style was ‘expert advice’ (47.9%), with ‘informal language’ (85.9%) as the dominant linguistic style. Results from thematic analysis suggest health and nutrition information on social media is often presented to consumers in emotionally charged, stylised, or contradictory ways and requires users to sift through conflicting messages, aesthetics, and ideologies to construct their own understanding of health. Conclusions: This study suggests that young adults are primarily exposed to health and fitness product promotions from unqualified content creators on social media. Dietitians and nutrition professionals may need to consider adopting specific linguistic and communication styles to enhance the dissemination and engagement of credible nutrition information online. These findings have implications for improving digital health literacy and strengthening the impact of evidence-based nutrition messaging in digital environments. Full article

Amidst deepening ecological disruption and widespread disconnection from nature, this study explores the emerging field of Earth Awareness (EA) as a relational and experiential aspect of advancing planetary health. EA practices—rooted in Buddhist, Indigenous, mindfulness, and nature-based traditions—support direct experiences of interconnectedness with Earth, ecological awareness and consciousness, and opportunities to transform underlying patterns and systems. Through 45 reflective dialogues with teachers and practitioners across traditions, this participatory research identifies common inspirations, intentions, and challenges that shape the emerging EA field. Findings reveal that EA is characterized by contemplative practices, rituals, and ceremonies that bridge inner transformation and outer action in the world. Central intentions such as healing, interconnectedness, and justice align closely with planetary health priorities, including mental well-being, equity, and stewardship of the living world. Although the field faces challenges related to access, risk of cultural appropriation, and systemic separation, participants identified opportunities for community building, intercultural exchange, and centering Earth as teacher and co-participant. By mapping coherence in this diverse field, this study highlights EA’s potential to contribute to planetary health by reconnecting people with place, fostering a more ecological consciousness, and supporting culturally grounded pathways for collective action and care for Earth. Full article