Aboriginal People Research Articles

Prevalence and clinical characteristics of vasculitis in the Alaska Native and American Indian peoples of Alaska.

Our objective was to determine the prevalence and clinical characteristics of vasculitis in Alaska Native and American Indian (AN/AI) peoples of Alaska. We queried the electronic health records of participating tribal health organizations within the Alaska Tribal Health System (ATHS) to identify adults with diagnostic codes related to vasculitis. Medical record abstraction was performed for all adults with potential vasculitis to confirm fulfillment of inclusion criteria, subtype, and clinical characteristics. The denominator for prevalence was the 2019 ATHS user population ≥ 18 (except giant cell arteritis (GCA), defined for persons ≥ 50). The age-adjusted prevalence per 1,000,000 AN/AI adults was 752 (95% Confidence Interval (CI) 581-959) for all vasculitis, with systemic vasculitis being the most common at 518 (95% CI 379-695). The most prevalent types of systemic vasculitis were ANCA-associated vasculitis (AAV) at 340 per million adults (95% CI 230-488) and GCA at 28 per 100,000 ≥ 50 (95% CI 12-56). The most prevalent subtype of AAV was granulomatosis with polyangiitis (GPA) at 244 per million adults (95% CI 148-380). AAV was diagnosed at a mean age of 54.2 years (Standard Deviation (SD) 17), often with high inflammatory markers and renal involvement. GCA was diagnosed at a mean age of 69.6 years (SD 9.2). The prevalence of AAV (especially GPA) in AN/AI peoples is high. GCA prevalence is lower than White populations, but higher than many other populations. AN/AI peoples with AAV and GCA may present at younger ages with more severe disease than other populations.

Sovereign budyaan flying together: sovereign relationships across the Wiradyuri PhD journey

First Nations sovereignty is core in supporting research experiences of First Nations PhD students. This article is based upon the relationality of three sovereign budyaan (birds), and the sovereign Wiradyuri (sovereign First Nations in so-called New South Wales, Australia; also spelt or referred to as Wiradjuri) cosmology, by exploring a Wiradyuri Wambuul (Macquarie River Clan of the Wiradyuri Nation in so-called New South Wales, Australia) scholar’s experiences with her two sovereign yalmambildhaany (teachers), connect with Wiradyuri concepts of teaching, speaking and Country. Yalmambildhaany guide and support the First Nations researcher to learn from Country, ancestors, buyaa (Wiradyuri cultural law) and songlines to ensure their research embodies sovereignty. This article highlights the importance of sovereign research for First Nations peoples and the need to centre First Nations cosmologies.

Diminished Returns of Educational Attainment on Welfare Receipt of American Indian/Alaska Native People: National Health Interview Survey (NHIS) 2023

Diminished Returns of Educational Attainment on Welfare Receipt of American Indian/Alaska Native People: National Health Interview Survey (NHIS) 2023

Potentially preventable medication-related hospitalisations with cardiovascular disease of Aboriginal and Torres Strait Islander people, Queensland, 2013-2017: a retrospective cohort study.

To identify the proportion of hospitalisations (inpatient admissions and emergency department presentations) of Aboriginal and Torres Strait Islander people in Queensland that were medication-related and potentially preventable for nine clinical indicators of cardiovascular disease (CVD). Retrospective cohort study; analysis of linked hospitalisations and emergency department presentations data and administrative records of medical services, pharmaceuticals, and deaths. Aboriginal or Torres Strait Islander adults (18 years or older) admitted to Queensland public and private hospitals, 1 January 2013 - 31 December 2017. Potentially preventable medication-related hospitalisations (PPMRHs), defined by a set of clinical indicators describing CVD; deaths within 30 days of PPMRHs; hospital costs. We identified 31 472 CVD-related hospitalisations, of which 11 469 were of people with medical histories suggesting harm that was foreseeable and preventable with appropriate treatment. Of the 7886 hospitalisations with congestive heart failure, 4350 (55%) were of people with prior CVD diagnoses; 681 (16%) were associated with use of medicines known to exacerbate congestive heart failure, and 1488 (34%) were associated with underuse of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors. Of the 1089 hospitalisations with myocardial infarction of people who had previously experienced myocardial infarction or acute coronary syndrome events, 809 (74%) were not receiving recommended treatment at the time of hospitalisation. Of the 5417 hospitalisations with ischaemic events of people with histories including diabetes and earlier ischaemic events, 3343 (62%) were not receiving antiplatelet or lipid-lowering therapy. The median cost associated with PPMRHs for the time period (2013-2017) was $4352 (interquartile range, $8742), and 136 (3%) of CVD-related deaths within 30 days of hospital discharge followed PPMRH events. Interventions supporting targeted and timely medication safety services for Aboriginal and Torres Strait Islander people need to be reviewed and improved to reduce the numbers of avoidable hospitalisations and deaths.

Process approach in the configuration of a construction project for the conservation of the Weenhayek native people

Since the systematic approach of the processes and their interactions, the aim is to establish the configuration of a construction project for the housing of the Weenhayek indigenous people. Applied from the theoretical research of various authors on a group of methodologies, phases and tools for project management, through rational scientific methods, such as descriptive, analytical, comparative, analytical-synthetic, inductive-deductive, historical-logical, analogies, modeling, systemic-structural-functional, systematization; and empirical methods, such as interpretivism that involves inductive, qualitative, phenomenological and transversal research, and the interview technique; the way in which the implementation processes are organized, interacted and structured is established. This reveals an alternative for the detailed configuration of a construction project for Weenhayek houses, based on phases, activities, actions and work tasks with characteristics in accordance with the needs of the project.

Internal colonisation, national liberation and cultural resistance: A postcolonial reading of pre-Bangladesh Bangla poetry of resistance

Bengali poets of the pre-Bangladesh period engaged in the struggle for the national liberation of Bengalis 1 through their poetry by offering cultural resistance to East Pakistan’s internal colonisation by West Pakistan. In this article, I examine the Bangla poetry written at the height of the Bangladesh independence movement, especially from the Mass Uprising of 1969 to the Liberation War of 1971, from a postcolonial perspective, and I argue that the theme of resistance prevalent in this poetry is essentially anti-colonial in nature because its main objective was to free the native people from the foreign domination of Pakistan, resisting its colonial-style oppression, exploitation and injustice. My reading of this poetry foregrounds the anti-colonial elements of resistance poetry written in the Bangla vernacular, and thus makes a novel contribution to postcolonial studies, which dominantly deals with Anglophone literature.

The Role of Aboriginal Kidney Health Mentors in the Transplant Journey: A Qualitative Evaluation.

Whilst Aboriginal and Torres Strait Islander people in Australia experience disproportionately high rates of chronic kidney disease, they have lower rates of kidney transplantation and face many barriers to accessing culturally safe health care. Aboriginal kidney health mentors with lived experience of transplantation have been proposed to improve the patient journey and increase health promotion, but there has been limited evaluation of the role of mentors. A qualitative evaluation of the 'Hunting Kidney Transplant' patient mentoring project implemented by Purple House in the Northern Territory involved in-depth interviews, focus groups and participant observation with Aboriginal kidney health mentors and renal staff. Data analysis methods included inductive thematic coding and collaborative synthesis of emerging themes with Aboriginal co-researchers. Aboriginal kidney health mentors play a holistic and multi-directional role helping people to navigate the transplant process. The role of mentors encompasses both visible and invisible work and is centred on a 'Right Way Working' approach, including building trust, respect and taking time during the work-up period. Key enablers include kinship and community connections and ongoing support from Purple House. Key barriers include COVID-19 and institutional racism within the mainstream health service. Aboriginal health mentors with lived experience of chronic conditions can play an important role in supporting people and promoting cultural safety in health services. SO WHAT?: Further support and funding are needed to develop, evaluate and embed the mentor role into policy and practice to improve patient journeys, health promotion, transplant rates and health outcomes.

Factors That Influence Maternal Child Health Nurses’ Identification of Risk of Family Violence to First Nations Women in Australia

Aim: To understand the factors that influence family violence towards First Nations women, to inform practises and policies to support these women and improve their engagement in maternal child health services. Design: A qualitative study, using narrative inquiry integrated with the Indigenous philosophy ‘Dadirri’, and thematic analysis of the data. Materials and Methods: Survey of 10 Maternal Child Health nurses in 2019, and interviews of 35 Aboriginal mothers in 2021. Results: The nurses identified drugs, alcohol, socio-economic issues, the history of effects of colonisation on First Nations peoples, and stress as perceived factors influencing family violence, and acceptance, fear, cultural beliefs, and mistrust, for women’s low reporting of violence. Factors that influenced nurses’ ability to identify family violence were mistrust and understanding of Aboriginal culture. Low self-esteem, lack of belonging, and not being heard were identified by the mothers as factors that influence family violence. Fear of child protective services, shame, mistrust, and poor rapport with the nurses contributed to their low reporting of violence. The most significant factor for the mothers to disclose violence is fear of losing her child, mistrust, and the questioning process. Conclusions: Nurses’ understanding of Indigenous culture is critical to develop trust and improve the engagement of First Nations women. A significant difference in the synthesis of data between the nurses and their First Nations consumers was conspicuous. Research regarding the benefit of models and interventions that recognise the social determinants of health and well-being on health outcomes as well as the value of culturally strong health services aimed to encourage an earlier identification of risk, ideally from the antenatal period to the child’s fifth birthday, is imperative. The implications of this research are of international importance for First Nations families and challenge current nursing practises to address the human rights challenge of the inequity in health outcomes between First Nation and non-First Nation children, their exposure to family violence, and their over-representation in child protection services.

How well are researchers applying ethical principles and practices in Aboriginal and Torres Strait Islander health and medical research? A cross-sectional study.

Describe perceptions of how well researchers conducting Aboriginal and Torres Strait Islander health and medical research apply ethical research practices. Cross-sectional online survey. Researchers who included Aboriginal and Torres Strait Islander people or their data in their projects, and current or past members (previous 5 years) of a human research ethics committee that assessed Aboriginal and Torres Strait Islander research. Researchers' engagement with 15 ethical research practices (on a 5-point Likert scale, poor to excellent). 561 participants (382 researchers [68.1%] and 179 human research ethics committee members [31.9%]) completed the survey. Across all research practices, a rating of excellent was least frequently endorsed, with the highest frequency being for employing Aboriginal and Torres Strait Islander team members (38 participants [6.8%]). A rating of poor was most common for enacting Indigenous data sovereignty and governance principles (156 participants [27.8%]). Aboriginal and Torres Strait Islander respondents had significantly lower odds of perceiving high levels of adherence to ethical principles than non-Aboriginal and Torres Strait Islander respondents for all ethical principles, except employing Aboriginal and Torres Strait Islander team members. In particular, Aboriginal and Torres Strait Islander participants had 65% lower odds of perceiving that researchers have high rates of adhering to disseminating results back to the community (odds ratio [OR], 0.35; 95% CI, 0.22-0.57), 56% lower odds of perceiving that researchers have high rates of adhering to engaging Aboriginal community in research implementation (OR, 0.44; 95% CI, 0.27-0.73), and 54% lower odds of perceiving that researchers have high rates of adhering to engaging Aboriginal community in developing research questions (OR, 0.46; 95% CI, 0.28-0.75). Researchers are not consistently implementing all ethical practices outlined in guidelines for research involving Aboriginal and Torres Strait Islander people. We call for commitment from researchers, institutions and funding bodies to address shortfalls, embed processes, and hold researchers accountable to Aboriginal and Torres Strait Islander people, communities and the principles and guidelines they have established.

Researchers' self-reported adherence to ethical principles in Aboriginal and Torres Strait Islander health and medical research and views on improving conduct: a mixed methods study.

To examine researchers' reports of adherence to ethical principles in their most recent research project, including factors associated with higher self-reported adherence, and perceptions of how research conduct could be improved. Online cross-sectional survey. Researchers who had conducted any health or medical research that included Aboriginal and Torres Strait Islander people or their data. Researchers rated their adherence to 15 ethical principles extracted from ethical guidelines in their most recent research project on a 5-point Likert scale (poor to excellent), and reported what they believe is needed to improve the conduct of Aboriginal and Torres Strait Islander health and medical research. 391 researchers completed the survey. Those with > 10 years' experience in the field were significantly more likely to self-report adhering to all 15 key ethical principles compared with those with ≤ 5 years' experience. Compared with those with ≤ 5 years' experience, those with 6-10 years' experience were significantly more likely to self-report adhering to: engaging community in identifying research priorities (odds ratio [OR], 2.05; [95% confidence interval (CI), 1.23-3.40]); engaging community in developing the research questions (OR, 2.16; 95% CI, 1.32-3.55); and engaging community in research implementation (OR, 2.10; 95% CI, 1.25-3.54). Aboriginal and Torres Strait Islander participants were significantly more likely to self-report adhering to the following principles than non-Indigenous participants: engaging community in identifying research priorities (OR, 1.90; 95% CI, 1.16-3.10); engaging community in developing the research questions (OR, 2.16; 95% CI, 1.30-3.61); engaging community in research implementation (OR, 1.92; 95% CI, 1.14-3.20); embedding Aboriginal governance, advisory and decision making on the project (OR, 2.10; 95% CI, 1.26-3.50); embedding opportunities in the research for capacity building for communities (OR, 1.70; 95% CI, 1.04-2.77); and enacting Indigenous data sovereignty and governance principles (OR, 1.67; 95% CI, 1.02-2.70). Open-ended responses indicated research conduct could be improved by recognition of community as experts, genuine partnerships and engagement, and pathways for Aboriginal and Torres Strait Islander researchers and support to strengthen the field. Structural and individual change is required to accommodate community priority setting, governance, consultation, leadership and translation in the conduct of ethical Aboriginal and Torres Strait Islander health and medical research. Such changes should be flexible and responsive to calls made by Aboriginal and Torres Strait Islander researchers and communities.

Reported processes and practices of researchers applying for human research ethics approval for Aboriginal and Torres Strait Islander health research: a mixed methods study.

To examine self-reported practices for obtaining ethics approval and reflections on ethics application processes among researchers who have conducted Aboriginal and Torres Strait Islander health and medical research. Cross-sectional online survey. Australian-based researchers who conducted research that included Aboriginal and Torres Strait Islander people or their data. Results from a 74-item online survey that participants completed, which included questions on demographics, ethics processes, perceptions of engagement in Aboriginal and Torres Strait Islander research, and barriers to and enablers of conducting Aboriginal and Torres Strait Islander research. Of 553 eligible researchers who commenced the survey, 439 (79.4%) answered all of the questions and were included in the analysis. A total of 327 participants (74.5%) had obtained ethics approval from an Aboriginal human research ethics committee (AHREC), 254 (57.9%) had obtained multistate ethics approvals and 270 (61.5%) had not participated in ethics training specifically for Aboriginal and Torres Strait Islander research. Participants were significantly more likely to report being very or extremely confident in managing the ethics application process if they had ≥ 6 years of research experience, had participated in training, had obtained ethics approval from an AHREC, or dedicated > 50% of their time to Aboriginal and Torres Strait Islander research. Participants acknowledged the importance of ethics approval processes in improving research practices, however they identified time and costs as barriers. Aboriginal and Torres Strait Islander participants identified that ethics processes do not always uphold Indigenous approaches or methodologies. Processes for obtaining ethics approval for Aboriginal and Torres Strait Islander health and medical research do not meet contemporary research needs and would be strengthened by streamlining ethics application processes, reducing time and cost barriers, and enhancing cultural appropriateness. We join calls for the establishment of state-based AHRECs in every jurisdiction, and a national Aboriginal and Torres Strait Islander human research ethics committee to review cross-jurisdictional research.

Human research ethics committee processes and practices for approving Aboriginal and Torres Strait Islander health research: a mixed methods study.

To describe human research ethics committee (HREC) members' reports of: HREC membership structures; HREC processes for reviewing Aboriginal and Torres Strait Islander health and medical research; and experiences and perceptions of review operations. Cross-sectional 36-item survey and qualitative interviews with a subsample of survey participants. Current and past members (preceding five years) of HRECs who assessed Aboriginal and Torres Strait Islander research. Survey and interview results related to HREC structures, processes and functioning; challenges in review processes; and what is needed to improve ethical governance. 229 HREC members completed the survey and 13 were interviewed. Half the participants (115 of 221, 52%) reported having an Aboriginal and Torres Strait Islander representative position. Key issues identified related to assessment processes and resourcing, including burden on Aboriginal and Torres Strait Islander members, ability for Aboriginal and Torres Strait Islander HRECs to manage additional applications, lack of clarity around specific assessment criteria for general population studies, lack of cohesion across the application or complaints processes, and lack of resourcing and infrastructure to monitor ethical practice after approval. Aboriginal and Torres Strait Islander people carry an important role and burden in the review of applications and monitoring of health research. However, Aboriginal and Torres Strait Islander people are not presently involved in all aspects of ethical research governance within current HREC structures, including the review and monitoring of approved research. Standardised processes and guidelines that uphold Aboriginal and Torres Strait Islander rights and expert knowledges are required.

Integrating evidence from lived experience of Aboriginal people and clinical practice guidelines to develop arthritis educational resources: a mixed-methods study.

Globally, osteoarthritis, rheumatoid arthritis, and gout (arthritis conditions) result in considerable pain and suffering and disproportionately affect First Nations Peoples, who are more likely than non-First Nations Peoples to have an arthritis condition and to experience a higher burden of disease. Access to culturally appropriate health information supports the health and wellbeing of First Nations Peoples. The aim of this study was to identify evidence-based, culturally appropriate recommendations to inform the development of arthritis educational resources for Aboriginal and Torres Strait Islander Peoples (First Nations Peoples in Australia). This mixed-methods study using community-based participatory action research had three phases: interviews (research yarns) with Aboriginal people to explore their informational needs and preferences for arthritis educational resources; systematic reviews and synthesis of education recommendations from high-quality arthritis clinical practice guidelines; and integration and interpretation of datasets from the first two phases. Details of the three systematic reviews have been published previously. We only included clinical practice guidelines that met our inclusion criterion of high quality, assessed using the Appraisal of Guidelines for Research and Evaluation II instrument. Between Dec 24, 2020, and Nov 2, 2022, 30 Aboriginal people participated in research yarns. 21 (70%) participants were female and nine (30%) were male, with median age 60 years (range 22-75). All participants identified as Aboriginal and no participants identified as Torres Strait Islander. Research yarn data was combined with education recommendations from 18 clinical practice guidelines. Synthesis of the two datasets generated the following recommendations for inclusion in educational resources: the impact of arthritis on health and wellbeing, when and how to access care, management options (eg, benefits and risks), and disease knowledge (eg, prognosis and addressing misconceptions). In addition, educational resources should be jargon-free and include positive lived experience stories, flags, and colourful local art. Educational resources should be created by Aboriginal people and delivered by health professionals, family, or Aboriginal Community members in the form of brochures, videos, or yarning circles. The recommendations from this study will inform the development of arthritis educational resources for Aboriginal Peoples. The findings can also support health professionals to deliver evidenced-based arthritis care to Aboriginal Peoples. Internationally, a community-based participatory action research approach can be applied to develop educational resources for First Nations Peoples and communities. Australian Commonwealth Government through Arthritis Australia.

'Walking the journey' with pregnant and birthing women from remote Australian First Nations communities: A qualitative study in the Top End of the Northern Territory.

Australian First Nations people experience disproportionate burdens of poor outcomes compared to non-First Nations people. Further, women living in remote communities face more barriers to care-seeking in pregnancy. Despite work being done in some remote communities, there is limited data exploring women's experiences of pregnancy care, thus a limited understanding of specific barriers and enablers to care-seeking for these women. This study aimed to identify barriers and enablers to care-seeking during pregnancy for Australian First Nations women living in several remote communities in the Northern Territory, by listening to their stories. Yarning, highly regarded and rigorous qualitative approach developed by and for First Nations peoples, was undertaken in several settings with women living in remote First Nations communities. Using purposive sampling, nine women participated. Two themes emerged: (1) the importance of family and community for women's emotional wellbeing; (2). ways healthcare providers and services build trust with pregnant women. Women identified various family and community members as significant sources of support in community and while hospitalised, including having companions while away from home. Further, reduced access to community life impacted emotional wellbeing. Continuity-of-care throughout pregnancy was essential for building trust, as was responsive, clear communication. Intentional connection building by care providers enabled development of trust. Providing culturally safe care will likely facilitate enablers and reduce barriers to care-seeking in pregnancy in remote communities. It requires ongoing and sustained efforts to ensure true partnership and collaboration between First Nations peoples and health services.

"There was no services that I could access so I just stayed on the street…using until I went into labour.": A qualitative study of accessibility and cultural safety of services for perinatal substance use in British Columbia, Canada.

Perinatal substance use is a critical public health challenge, impacting both mother and fetus. Its prevalence has increased in British Columbia, Canada, disproportionately impacting First Nations people. For specialized perinatal substance use services to be effective, they must be accessible and safe. This study aimed to explore the accessibility and cultural safety of health services for perinatal substance use from the perspective of service users. We conducted a qualitative study from six focus group discussions, consisting of five in-person sharing circles for people with lived/living experience of pregnancy and substance use and one virtual focus group with inreach workers, for a total of 55 participants including 48 people with lived experience and seven inreach workers across the five health delivery regions in British Columbia. We interpreted results using thematic analysis and narrative inquiry to explore inductively and deductively derived themes. Participants identified a lack of perinatal substance use specific services, particularly supportive housing facilities and wrap-around community centres in the province but highlighted that community-based services they were able to access made participants feel safe and respected. Thematic analysis identified six themes related to accessibility and cultural safety: geographic disparities in access to care, importance of Indigenous culture for Indigenous client's healing, transitions as critical moments in service accessibility, safe services protect the mother-infant dyad, inconsistent access to opioid agonist treatment, and relationality as a crucial element of safe service delivery. This study suggests that services that preserve the mother-infant dyad, incorporate wholistic care including Indigenous culture, and are relationship-based are experienced as accessible and safe, and those that do not are often mistrusted and avoided. This study highlights needed improvements, particularly of acute care services, through supporting instead of reporting birthing parents with substance use, ensuring continuous access to opioid agonist treatment for pregnant people with opioid use disorder, and suffusing the client-provider relationship with empathy, respect, and connection.

Culture in practice

ABSTRACT This article provides readers with contextual background to the 2023 Cultural Studies Association of Australasia (CSAA) conference: ‘Culture in Practice’ and thus the papers in this edited collection. The contemporary realities of climate crisis, increasing inequality, multiplying communities of hate, in addition to growing geo-political insecurity demand cultural as well as political, social, and economic responses mean that now more than ever ‘culture’ is a contested site of exclusion and possibility. Thus the conference’s theme sought to explore how we might create an open and inclusive cultural space for collaboration especially in a country like Australia where sovereignty of the First Nations peoples has never been ceded. How do we decolonise culture? How do we re-create it? How do we mobilise it for inclusive ends? The Introduction argues for Cultural Studies as an act of politics as much as a theoretical or methodological approach, that resists acts of forgetting. The enduring politics that papers and scholars throughout this conference demonstrated in practice was this refusal to forget, and an insistence on the urgency of radical, decolonial, queer, powerful feminist practice in Cultural Studies in the contemporary moment.

Privileging the spirit, voices, and culture of Aboriginal and Torres Strait Islander peoples in dementia care: education for non-Indigenous health care providers

Privileging the spirit, voices, and culture of Aboriginal and Torres Strait Islander peoples in dementia care: education for non-Indigenous health care providers

From sandstone to screen: a culturally responsive arts-based approach to digital literacy in a remote Indigenous community in Australia

ABSTRACT Indigenous students in remote areas face challenges accessing technology and digital literacy, hindering their educational and career opportunities. However, a Queensland Cape York Peninsula community addresses this challenge by leveraging cultural heritage and innovative citizen science to cultivate the next generation of digital leaders. The region is home to some of the world’s most impressive rock art galleries, documenting the traditions of Aboriginal peoples over generations. This case study sheds light on how remote schools can address students’ inequities in accessing digital technologies by offering insights into the potential for combining local culture and arts-based pedagogies to enhance engagement and learning in digital literacy. Alongside identifying obstacles such as limited online resources, technical difficulties, time constraints, and inadequate staff development, this case study provides a model for seeding Indigenous digital literacy in remote educational settings.

Improving cardiometabolic risk factors in Aboriginal and Torres Strait Islander people in northeast Arnhem Land: single arm trial of a co-designed dietary and lifestyle program.

To evaluate the impact of a 4-month dietary and lifestyle program co-designed and led by Aboriginal and Torres Strait Islander people on weight and metabolic markers, diet, and physical activity in overweight and obese adults in a remote Indigenous community. Single arm, pre-post intervention study. Adult residents (18-65 years) of a remote Northern Territory community with body mass index (BMI) values of at least 25 kg/m2 or waist circumferences exceeding 94 cm (men) or 80 cm (women). Hope for Health, a culturally sensitive 4-month program supporting self-managed health improvement based on dietary and lifestyle change, 1 August to 30 November 2022. Weight loss of at least 5%; changes in BMI, waist circumference, other metabolic markers (blood pressure, biomarkers of metabolic health and inflammation), diet, and physical activity; participant perceptions of the program. We assessed outcomes for 55 participants who completedweight assessments at both baseline and program end(mean age, 42.5 years [standard deviation, 10.1 years]; 36 women [65%]). Forty participants lost and 15 gained weight; overall mean weight loss was 1.5 kg (95% confidence interval [CI], 0.5-2.4 kg), and ten participants (18%; 95% CI, 9-31%) achieved at least 5% weight reduction. The mean change in BMI (53 participants) was -0.60 kg/m2 (95% CI, -0.93 to -0.27 kg/m2), in waist circumference (53 participants) -3.2 cm (95% CI, -4.7 to -1.7 cm), and in low-density lipoprotein cholesterol level (37 participants) -0.28 mmol/L (95% CI, -0.47 to -0.08 mmol/L); the relative decline in the HbA1c level geometric mean (50 participants) was 11% (95% CI, 6-15%). The intake of breads and cereals (median change, -1.5 [95% CI, -2.0 to -1.0] serves/day) and sugar-sweetened beverages (-0.6 [95% CI, -1.4 to -0.1] serves/day) declined; the amount of moderate and vigorous physical activity increased by a median of 103 min/day (95% CI, 74-136 min/day; 19 participants). The program focus on integrating healthy bodies and networks of kin, healthy governance, vibrant language and ceremony, and a healthy environment were seen as central to its value and benefit. Community appreciation of the program and the improvements in cardiometabolic risk factors are encouraging, providing an example of a culturally sensitive, co-designed initiative led by Indigenous people for reducing the prevalence of chronic disease in remote areas. Australian New Zealand Clinical Trials Registry (ACTRN12622000174785; prospective: 2 February 2022).

Immigration modulates audiovisual emotional processing in adults: is this really an influence of the host culture?

Individuals from Western cultures rely on facial expressions during the audiovisual emotional processing of faces and voices. In contrast, those from East-Asian cultures rely more on voices. This study aimed to investigate whether immigrants adopt the tendency of the host culture or whether common features of migration produce a similar modification regardless of the destination. We examined how immigrants from Western countries to Japan perceive emotional expressions from faces and voices using MRI scanning. Immigrants behaviorally exhibited a decrease in the influence of emotions in voices with a longer stay in Japan. Additionally, immigrants with a longer stay showed a higher response in the posterior superior temporal gyrus, a brain region associated with audiovisual emotional integration, when processing emotionally congruent faces and voices. These modifications imply that immigrants from Western cultures tend to rely even less on voices, in contrast to the tendency of voice-dominance observed in native Japanese people. This change may be explained by the decreased focus on prosodic aspects of voices during second language acquisition. The current and further exploration will aid in the better adaptation of immigrants to a new cultural society.