Canadian Aboriginals Research Articles

Does the Ponseti Method for Clubfoot Treatment Stand Up to the March of Time?: Commentary on an article by Lewis E. Zionts, MD, et al.: "Sixty Years On: Ponseti Method for Clubfoot Treatment Produces High Satisfaction Despite Inherent Tendency to Relapse".

Commentary What can we advise parents about the long-term results expected from the correction of their child’s clubfoot deformity with the Ponseti method? This meticulous 5-year review tells us that there’s a 62% chance of a relapse and a 38% rate of additional surgery (tendon transfer), but that by the age of 5 years, their child should have a cosmetically acceptable, functional foot. These findings are similar to those of the Iowa group1 some 55 years ago and those of Bor et al.2 in 2009. These analyses are important not only from a clinical-treatment point of view but also for prenatal counseling. I well recall being asked to counsel parents of a 4-month fetus in whom a clubfoot had been diagnosed on ultrasound. The parents were requesting an abortion on the basis of the foot deformity! Statistics from this review would have been a great help in reassuring them that their son’s foot deformity could be corrected; ultimately, it was corrected, as they fortunately did not terminate the pregnancy3. What about the 10 years to follow-up at skeletal maturity? We were told by the Iowa group that few relapses occurred after the age of 5 years, but this needs substantiation as well. The prevalence and severity of clubfeet also vary in different geographic areas. In regions where clubfeet are familial, such as Middle Eastern countries or areas with Hawaiian or Canadian aboriginals, the clubfeet are often more rigid, akin to syndromic clubfeet. We need more long-term follow-up data from these areas to assess the global efficacy of the Ponseti method. Also, one of the problems in any review of clubfeet is trying to compare the various severities of the deformities. Even the idiopathic group in this review had variations in severity. The more severe the deformity, the greater the relapse rate and the greater the need for tibialis anterior transfers. The tibialis anterior transfer as recommended by the authors (transfer of the whole tendon under the extensor retinaculum to the lateral cuneiform, held by a cushioned button on the sole of the foot) is an excellent technique and one that I have used with great success for decades. What is still a gray zone, however, is the best timing for the tibialis anterior transfer. My opinion has always been to not risk leaving the transfer until it is too late. If the foot still tends to be in persistent varus after the patient reaches the age of 3 years, proceed with the transfer while the foot is still growing rapidly and can respond to the valgus force of the transfer. Post-cast bracing with a Denis-Browne or similar splint is a critical part of the Ponseti method. Attention to detail here is as important as the casting phase is. Brace failure is often the cause of relapse, in my experience. It is of the utmost importance to ensure parent buy-in via a heart-to-heart discussion with both parents, preferably with the clinician, to emphasize the importance of brace wear in the successful treatment of their child’s clubfoot. If the parents are not on board with the brace treatment, their negative feelings will be subtly transmitted to the child and brace rejection will occur. In older children, to enhance the efficacy of brace management, the child should sleep in only leather boots (never in Oxford-type shoes, as they will ultimately be kicked off) until the boots essentially become part of their pajamas. The feet are then held straight forward on the brace for another week or 2 and then are gradually externally rotated to 45°. A 6 to 8-inch (15 to 20-cm) bar has a comfortable width, and the bar should be bent 30° to 40° convex plantarward to increase the valgus force on the foot with each kick. In older children, a bedclothes elevator can be used to stop the brace from getting tangled in the bedclothes. Although the Ponseti method for the correction of talipes equinovarus has been with us for >50 years, we have been slow learners because it has been a positive triumph of technique over reason. One has had to see it, experience it, and read follow-ups such as this one to appreciate the efficacy of the Ponseti method. Has the Ponseti method for clubfoot treatment stood the test of time? Yes, at least up to the 5-year follow-up. We are now awaiting the 10-year results and the results from patients who have attained skeletal maturity for the final answer to this question. We have more yet to learn from follow-ups such as this one!

Epidemiology of prostate and kidney cancer in the Aboriginal population of Canada: A systematic review

Prostate and kidney cancer rates in the Aboriginal population of Canada is a growing issue. A systematic review of prostate and kidney cancer epidemiology in the Aboriginal population of Canada was performed with international comparison and evaluation of present epidemiological disparities. PubMed, Medline, and Embase (from January 1946 to June 2016), relevant government-published reports, and the websites of organizations contributing to prostate or kidney cancer guidelines were searched. We included studies that informed any of the three epidemiological questions this review is focused on answering. Two systematic reviews, two meta-analyses, five literature reviews, and 21 single-study papers were included. The incidence and mortality rates of kidney cancer were elevated among Canadian Aboriginals when compared to the provincial or national population and to several international regions. No studies reported data on survival. Prostate cancer incidence, mortality, and survival rates were lower in Aboriginals provincially, nationally, and internationally, with incidence and survival reaching statistical significance. Elevated rate of risk factors for kidney cancer was a significant finding among Canadian Aboriginals. Aboriginals were screened for prostate cancer less than the general Canadian population, a trend also observed in the U.S. The elevated incidence and mortality of kidney cancer among Canadian Aboriginals is most likely attributable to the rise in lifestyle-based risk factors. Two correlations concerning prostate cancer are made. However, due to temporal and regional disparities in data, further investigation is required to elucidate these observations.

Tracking the westernization of urban Aboriginal gambling in Canada’s Prairie Provinces

North American Aboriginals have an extensive cultural history of gambling. The purpose of this study was to investigate the influence of modern western gambling on these traditional beliefs. This is the first large-scale study of this issue in Canada. A total of 1114 Aboriginals in 15 cities in Canada’s Prairie Provinces were surveyed, with recruitment occurring at Native Friendship Centres, shopping malls and other locations where Aboriginals congregated. Results showed that ‘gambling’ to most urban Aboriginal people refers to western commercial forms, something distinct from historical traditions. Attitudes toward gambling were negative, except whether Aboriginal provision of western commercial forms was good or bad for Aboriginal people, where opinion was divided. Primary motivations for gambling were the same as for non-Aboriginals: to win money and for entertainment. Although attitudes and motivations were quite similar to non-Aboriginals, overall level of gambling participation was higher, especially for electronic gambling machines, instant lotteries and bingo. It is concluded that Canadian Aboriginals have a largely westernized orientation to western forms of gambling. The policy implication of this finding is that the factors predictive of gambling benefits as well as the factors predictive of gambling harm among Aboriginals do not appear to be culturally unique.

Expanding Social Justice: Exploring Connections Between Immigration and Indigeneity

Most discussions of group--‐differentiated disadvantage seek to explain its covert and overt nature through the experiences of dominant groups and their relations to subordinate groups. This is a vertical approach to social injustice. Instead of taking this approach, I take a horizontal approach that seeks to determine whether there are logics that produce disadvantage that are invisible to the vertical understandings of socially constructed group--‐ differentiated disadvantage. To this end, I critically consider the relationships between disadvantaged groups by reflecting on the experiences of Black Canadians and Canadian Aboriginals. Their experiences reveal the underbelly of Canadian multiculturalism and of discourses of membership and belonging. I explore the ways in which these groups have potentially complex and conflicting modes of injustice that elicit potentially conflicting and complex prescriptions. Recognizing this has the potential to facilitate a finer--‐grained sensitivity to the description and potential amelioration of group--‐differentiated disadvantage and to problematize discourses of membership and belonging in their instantiation in current Canadian practices, norms, and governing arrangements.

Whither the Aborigine

Whither the Aborigine

Breastfeeding as a means to prevent infant morbidity and mortality in Aboriginal Canadians: A population prevented fraction analysis.

Canadian Aboriginal infants experience poor health compared with other Canadian infants. Breastfeeding protects against many infant infections that Canadian Aboriginals disproportionately experience. The objective of our research was to estimate the proportion of select infant infection and mortality outcomes that could be prevented if all Canadian Aboriginal infants were breastfed. We used Levin's formula to estimate the proportion of three infectious outcomes and one mortality outcome that could be prevented in infancy by breastfeeding. Estimates were calculated for First Nations (both on- and off-reserve), Métis and Inuit as well as all Canadian infants for comparison. We extracted prevalence estimates of breastfeeding practices from national population-based surveys. We extracted relative risk estimates from published meta-analyses. Between 5.1% and 10.6% of otitis media, 24.3% and 41.4% of gastrointestinal infection, 13.8% and 26.1% of hospitalizations from lower respiratory tract infections, and 12.9% and 24.6% of sudden infant death could be prevented in Aboriginal infants if they received any breastfeeding. Interventions that promote, protect and support breastfeeding may prevent a substantial proportion of infection and mortality in Canadian Aboriginal infants.

Cultural roles of native patient navigators for american Indian cancer patients.

The purpose of this opinion article is to clarify cultural roles Native Patient Navigators (NPNs) perform in providing cancer support. NPNs, who are American Indian (AI), provide many unique services to indigenous patients who are undergoing treatment (radiation, chemotherapy, surgery, adjuvant therapy) for cancer. AIs experiences of cancer often are complex, requiring a team that not only provides comprehensive, quality cancer care, but also provides care that incorporates cultural norms and beliefs. NPNs are an essential component of AI cancer patients’ recovery and healing. American Indians in the USA have distinct and significant geographic rates of cancer incidence and mortality, whereas White rates remain homogeneous (1–5). Indigenous people living in Alaska and the Northern (e.g., ND, SD, NE, WI, MT, MI) and Southern Plains (e.g., OK, TX, KS) typically have elevated age-adjusted cancer incidence and mortality rates. The substantial progress in reducing cancer death rates experienced by Whites over the past two decades has not been experienced by AIs (6); cancer mortality rates remain the same or more commonly are increased from previous data (1–5). AIs continue to have the poorest 5-year relative survival from cancer in comparison to all other ethnic and minority groups in the US (66.7% for non-Hispanic Whites vs. 59.0% for AIs) (7, 8). Anecdotal data from Canadian First Nations or Aboriginals, New Zealand Maoris, and Australian Aboriginals report similar geographic variability in their respective countries. According to Harold Freeman, MD, the “father” of patient navigation, navigators guide patients through and around barriers in the complex health care system, to help ensure timely diagnosis and treatment (9) of cancer and other illnesses. However, the term “navigator” has varied meanings within healthcare systems, resulting in some confusion. As an example, the federal Affordable Care Act (H.R. 3590) (10) refers to navigators as trained individuals who “establish relationships with employers and employees, consumers (including uninsured and underinsured consumers), or self-employed individuals likely to be qualified to enroll in a qualified health plan” (11). Thus, under the Act, a navigator functions mainly as an insurance broker rather than one who helps patients overcome barriers to accessing and using a specific healthcare system or treatment plan/program. Within many settings, Community Health Workers, who are culturally, well-respected members of underserved populations, help bring these community members to the doors of the clinic or healthcare facility. NPNs function similarly to Community Health Workers; however, they cross the threshold of the clinic and continue providing cultural support within clinical departments (i.e., they cross boundaries). NPNs are familiar with varying tribal beliefs about health and illness and can establish a rapport and trust with patients that allow them to share their fears and spiritual practices necessary to achieve health and healing. NPNs provide services and support that are unlikely to be addressed by other hospital staff and they need to be paid lay professional positions. Ideally, the NPN and the hospital collaborate to provide the optimal healing environment for the AI patients.

Favourable IFNL3 genotypes are associated with spontaneous clearance and are differentially distributed in Aboriginals in Canadian HIV-hepatitis C co-infected individuals.

Canadian Aboriginals are reported to clear Hepatitis C (HCV) more frequently. We tested the association of spontaneous clearance and three single nucleotide polymorphisms (SNPs) near the Interferon-lambda 3 (IFNL3) gene (rs12979860, rs8099917, functional variant rs8103142) and compared the SNP frequencies between HIV-HCV co-infected whites and Aboriginals from the Canadian Co-infection Cohort. HCV treatment-naïve individuals with at least two HCV RNA tests were included (n = 538). A spontaneous clearance case was defined as someone with two consecutive HCV RNA-negative tests, at least six months apart. Data were analyzed using Cox proportional hazards adjusted for sex and ethnicity. Advantageous variants and haplotypes were more common in Aboriginals than Caucasians: 57% vs. 46% had the rs12979860 CC genotype, respectively; 58% vs. 48%, rs8103142 TT; 74% vs. 67%, the rs12979860 C allele; and 67% vs. 64% the TCT haplotype with three favourable alleles. The adjusted Hazard Ratios (95% CI) for spontaneous clearance were: rs12979860: 3.80 (2.20, 6.54); rs8099917: 5.14 (2.46, 10.72); and rs8103142: 4.36 (2.49, 7.62). Even after adjusting for rs12979860, Aboriginals and females cleared HCV more often, HR (95% CI) = 1.53 (0.89, 2.61) and 1.42 (0.79, 2.53), respectively. Our results suggest that favourable IFNL3 genotypes are more common among Aboriginals than Caucasians, and may partly explain the higher HCV clearance rates seen among Aboriginals.

Review and Synthesis of Smoking Cessation Interventions in the Canadian Aboriginal Population

Smoking is a major public health concern among the Aboriginal Canadian Population. The age-adjusted smoking-attributable death rates are two times those of other Canadians; 20% of adult deaths among Aboriginal Canadians is attributable to smoking. There is no research that implemented and examined interventions of smoking cessation in Aboriginal Canadians, particularly in Northern British Columbia. This paper represents a critical review of some of the successful smoking cessation programs conducted in different jurisdictions. It is evident that little consideration is given to Aboriginal knowledge transfer in program development and delivery. This review indicates that in order for an Aboriginal cessation strategy to be successful, culturally relevant criteria must be identified and implemented. Without consideration of culture, there will always be limited success in tobacco cessation initiatives. To be effective, smoking cessation programs need to be comprehensive. Social determinants of health and socio-economic disparities that influence health status outcomes need to be considered as they have major influence in adopting smoking among Canadian Aboriginals. These factors have implications for public health policy. BCCA in other regional centres (1). The NCCS includes program enhancements for the complete continuum of cancer care. There are six core projects that include prevention and promotion, screening, detection and diagnosis, treatment, psychosocial care and palliative/end of life care. Additionally, there are seven enabling platforms that include enhanced information technology, telemedicine, navigation, primary care, human resources, monitoring, research and evaluation and Aboriginal health. The enabling platforms must be developed and support the core projects for the strategy to be a success. A four year capital project is another significant component of the NCCS and will create a new cancer centre in Prince George. This state of the art BCCA facility will be the sixth in the province, and the first in the North. The BCCA Centre for the North will form the hub of the NCCS, providing the radiation therapy and systemic therapy available in other regional centres and supporting the network of cancer control initiatives throughout the North

Health Inequities and Social Determinants: Diabetes Prevalence Among Canadian Aboriginals

Diabetes is a chronic disease that either impairs the production of or response to insulin, a hormone vital to the process of converting food into energy. Diabetic patients usually have one or more chronic conditions, such as diabetic foot, retinopathy, and cardiovascular diseases. Although the Aboriginal population represents 3.3 per cent of the Canadian population, the diabetes rate is three to five times the national average. In the past twenty years there has been a rapid increase in diabetes prevalence among the Aboriginal population. The purpose of this paper is to use social determinant theory to explain the distinct gap in diabetes prevalence between Aboriginals and the general Canadian population. After discussing topics of social determinant theory, policy level strategies are proposed to address diabetes among Aboriginals.

Treatment of Chronic Hepatitis C in a Canadian Aboriginal Population: Results from the Prairie Study

The Aboriginal population of Canada is at increased risk of exposure to the hepatitis C virus (HCV). Previous data indicate that spontaneous clearance of HCV occurs more often in Aboriginals than Caucasians. Whether this enhanced response extends to antiviral therapy for chronic HCV remains to be determined. To document and compare the biochemical and virological responses to antiviral therapy in HCV-infected Canadian Aboriginals and Caucasians. A total of 101 treatment-naive adult patients (46 Aboriginal, 55 Caucasian) with chronic HCV genotype 1 infections were prospectively treated with pegylated-interferon and ribavirin and followed as per national guidelines. Aboriginals had higher HCV-RNA loads at baseline (6.42log(10) versus 5.98log(10); P<0.03). Although normalization of serum aminotransferase levels, decreases in viral loads, and rapid, early and end-of-treatment virological responses were similar in the two cohorts, sustained virological responses were significantly lower in Aboriginals (35% versus 55%; P=0.047). Premature discontinuation of treatment and⁄or loss of patients to follow-up was common (Aboriginals 37%, Caucasians 27%). Treatment-related side effects were similar in the two cohorts. Despite higher rates of spontaneous HCV clearance, the response to antiviral therapy was similar, if not lower, in Aboriginals compared with Caucasians with chronic HCV genotype 1 infections. Compliance with treatment is an issue that needs to be addressed in the management of these patients.

Hepatitis C Virus Infection in Canada’S First Nations People: A Growing Problem

Hepatitis C Virus Infection in Canada’S First Nations People: A Growing Problem

Hepatitis C Virus in American Indian/Alaskan Native and Aboriginal Peoples of North America

Liver diseases, such as hepatitis C virus (HCV), are “broken spirit” diseases. The prevalence of HCV infection for American Indian/Alaskan Native (AI/AN) in the United States and Canadian Aboriginals varies; nonetheless, incidence rates of newly diagnosed HCV infection are typically higher relative to non-indigenous people. For AI/AN and Aboriginal peoples risk factors for the diagnosis of HCV can reflect that of the general population: predominately male, a history of injection drug use, in midlife years, with a connection with urban centers. However, the face of the indigenous HCV infected individual is becoming increasingly female and younger compared to non-indigenous counterparts. Epidemiology studies indicate that more effective clearance of acute HCV infection can occur for select Aboriginal populations, a phenomenon which may be linked to unique immune characteristics. For individuals progressing to chronic HCV infection treatment outcomes are comparable to other racial cohorts. Disease progression, however, is propelled by elevated rates of co-morbidities including type 2 diabetes and alcohol use, along with human immunodeficiency virus (HIV) co-infection relative to non-indigenous patients. Historical and personal trauma has a major role in the participation of high risk behaviors and associated diseases. Although emerging treatments provide hope, combating HCV related morbidity and mortality will require interventions that address the etiology of broken spirit diseases.

Incidence and causes of ESRD among Canadian Aboriginals

Incidence and causes of ESRD among Canadian Aboriginals

Association of Modality with Mortality among Canadian Aboriginals

Previous studies have shown that Aboriginals and Caucasians experience similar outcome on dialysis in Canada. Using the Canadian Organ Replacement Registry, this study examined whether dialysis modality (peritoneal or hemodialysis) impacted mortality in Aboriginal patients. This study identified 31,576 adult patients (hemodialysis: Aboriginal=1839, Caucasian=21,430; peritoneal dialysis: Aboriginal=554, Caucasian=6769) who initiated dialysis between January of 2000 and December of 2009. Aboriginal status was identified by self-report. Dialysis modality was determined 90 days after dialysis initiation. Multivariate Cox proportional hazards and competing risk models were constructed to determine the association between race and mortality by dialysis modality. During the study period, 939 (51.1%) Aboriginals and 12,798 (53.3%) Caucasians initiating hemodialysis died, whereas 166 (30.0%) and 2037 (30.1%), respectively, initiating peritoneal dialysis died. Compared with Caucasians, Aboriginals on hemodialysis had a comparable risk of mortality (adjusted hazards ratio=1.04, 95% confidence interval=0.96-1.11, P=0.37). However, on peritoneal dialysis, Aboriginals experienced a higher risk of mortality (adjusted hazards ratio=1.36, 95% confidence interval=1.13-1.62, P=0.001) and technique failure (adjusted hazards ratio=1.29, 95% confidence interval=1.03-1.60, P=0.03) than Caucasians. The risk of technique failure varied by patient age, with younger Aboriginals (<50 years old) more likely to develop technique failure than Caucasians (adjusted hazards ratio=1.76, 95% confidence interval=1.23-2.52, P=0.002). Aboriginals on peritoneal dialysis experience higher mortality and technique failure relative to Caucasians. Reasons for this race disparity in peritoneal dialysis outcomes are unclear.

High Rates of Diabetes in Canadian Aboriginals Demands a Complex Solution

High Rates of Diabetes in Canadian Aboriginals Demands a Complex Solution

Epidemiology of severe pediatric adenovirus lower respiratory tract infections in Manitoba, Canada, 1991-2005

BackgroundMost pediatric adenovirus respiratory infections are mild and indistinguishable from other viral causes. However, in a few children, the disease can be severe and result in substantial morbidity. We describe the epidemiologic, clinical, radiologic features and outcome of adenovirus lower respiratory tract infections (LRTI) in Aboriginal and Non-Aboriginal children in Manitoba, Canada during the years 1991 and 2005.MethodsThis was a retrospective study of 193 children who presented to the department of pediatrics at Winnipeg Children's Hospital, Manitoba, Canada with LRTI and had a positive respiratory culture for adenovirus. Patients' demographics, clinical and radiologic features and outcomes were collected. Adenovirus serotype distributions and temporal associations were described. Approximate incidence comparisons (detection rates) of adenovirus LRTI among Aboriginal and Non-Aboriginal children were estimated with 95% confidence intervals.ResultsAdenovirus infections occurred throughout the year with clusters in the fall and winter. Serotypes 1 to 3 were the predominant isolates (two thirds of the cases). The infection was more frequent among Canadian Aboriginals, as illustrated in 2004, where its incidence in children 0-4 years old was 5.6 fold higher in Aboriginals (13.51 vs. 2.39 per 10,000, p < 0.000). There were no significant differences in length of hospitalization and use of ventilator assistance between the two groups (p > 0.185 and p > 0.624, respectively) nor across serotypes (p > 0.10 and p > 0.05, respectively). The disease primarily affected infants (median age, 9.5 months). Most children presented with bronchiolitis or pneumonia, with multi-lobar consolidations on the chest x-ray. Chronic (residual) changes were documented in 16 patients, with eight patients showing bronchiectasis on the chest computerized tomography scan.ConclusionsAdenovirus infection is associated with significant respiratory morbidities, especially in young infants. The infection appears to be more frequent in Aboriginal children. These results justify a careful follow-up for children with adenovirus LRTI.

Prevalence of asthma and chronic obstructive pulmonary disease in Aboriginal and non-Aboriginal populations: a systematic review and meta-analysis of epidemiological studies.

Asthma and chronic obstructive pulmonary disease (COPD) have considerable potential for inequities in diagnosis and treatment, thereby affecting vulnerable groups. To evaluate differences in asthma and COPD prevalence between adult Aboriginal and non-Aboriginal populations. MEDLINE, Embase, specialized databases and the grey literature up to October 2011 were searched to identify epidemiological studies comparing asthma and COPD prevalence between Aboriginal and non-Aboriginal adult populations. Prevalence ORs (PORs) and 95% CIs were calculated in a random-effects meta-analysis. Of 132 studies, eight contained relevant data. Aboriginal populations included Native Americans, Canadian Aboriginals, Australian Aboriginals and New Zealand Maori. Overall, Aboriginals were more likely to report having asthma than non-Aboriginals (POR 1.41 [95% CI 1.23 to 1.60]), particularly among Canadian Aboriginals (POR 1.80 [95% CI 1.68 to 1.93]), Native Americans (POR 1.41 [95% CI 1.13 to 1.76]) and Maori (POR 1.64 [95% CI 1.40 to 1.91]). Australian Aboriginals were less likely to report asthma (POR 0.49 [95% CI 0.28 to 0.86]). Sex differences in asthma prevalence between Aboriginals and their non-Aboriginal counterparts were not identified. One study compared COPD prevalence between Native and non-Native Americans, with similar rates in both groups (POR 1.08 [95% CI 0.81 to 1.44]). Differences in asthma prevalence between Aboriginal and non-Aboriginal populations exist in a variety of countries. Studies comparing COPD prevalence between Aboriginal and non-Aboriginal populations are scarce. Further investigation is needed to identify and account for factors associated with respiratory health inequalities among Aboriginal peoples.

Helicobacter pyloriin First Nations and Recent Immigrant Populations in Canada

The diminishing prevalence of Helicobacter pylori infection among most segments of the Canadian population has led to changes in the etiologies and patterns of associated upper gastrointestinal diseases, including fewer peptic ulcers and their complications. Canadian Aboriginals and recent immigrants are among populations in which the prevalence of H pylori infection remains high and, therefore, the health risks imposed by H pylori remain a significant concern. Population-based strategies for H pylori eradication in groups with a low prevalence of infection are unlikely to be cost effective, but such measures are attractive in groups in which the prevalence rates of infection remain substantial. In addition to a lower prevalence of peptic ulcers and dyspepsia, the public health value of eradication may be particularly important if this leads to a reduction in the prevalence of gastric cancer in high prevalence groups. Therefore The Canadian Helicobacter Study Group held a conference that brought together experts in the field to address these issues, the results of which are reviewed in the present article. Canadians with the highest prevalence of H pylori infection are an appropriate focus for considering the health advantages of eradicating persistent infection. In Canadian communities with a high prevalence of both H pylori and gastric cancer, there remains an opportunity to test the hypothesis that H pylori infection is a treatable risk factor for malignancy.

Comprehensive evidence-based assessment and prioritization of potential antidiabetic medicinal plants: a case study from canadian eastern james bay cree traditional medicine.

Canadian Aboriginals, like others globally, suffer from disproportionately high rates of diabetes. A comprehensive evidence-based approach was therefore developed to study potential antidiabetic medicinal plants stemming from Canadian Aboriginal Traditional Medicine to provide culturally adapted complementary and alternative treatment options. Key elements of pathophysiology of diabetes and of related contemporary drug therapy are presented to highlight relevant cellular and molecular targets for medicinal plants. Potential antidiabetic plants were identified using a novel ethnobotanical method based on a set of diabetes symptoms. The most promising species were screened for primary (glucose-lowering) and secondary (toxicity, drug interactions, complications) antidiabetic activity by using a comprehensive platform of in vitro cell-based and cell-free bioassays. The most active species were studied further for their mechanism of action and their active principles identified though bioassay-guided fractionation. Biological activity of key species was confirmed in animal models of diabetes. These in vitro and in vivo findings are the basis for evidence-based prioritization of antidiabetic plants. In parallel, plants were also prioritized by Cree Elders and healers according to their Traditional Medicine paradigm. This case study highlights the convergence of modern science and Traditional Medicine while providing a model that can be adapted to other Aboriginal realities worldwide.