non-First Nations Research Articles

The Abecedarian Approach in a Low-Resource Urban Neighborhood in Canada: An Impact Evaluation in a Child Care Setting

Despite the best efforts, persistent educational gaps remain between Indigenous and non-Indigenous children when they begin school. This evaluation explores the impact of the Abecedarian Approach for early education on the language development of First Nations and non-First Nations children, living in a low-resource, urban neighborhood in Canada. A treatment group received the Abecedarian Approach in a child care center, supplemented by home visiting, and comprised 20 families with 41 children of whom 51% were First Nations. The control group comprised 27 families with 39 children of whom 46% were First Nations. The analyses presented explore child language outcomes at the end of the second year of participation and take account of child and family characteristics, as well as the baseline language scores. Results indicate that children in the treatment group had stronger language outcomes than the control group. While First Nations children in the treatment group had lower levels of language development than non-First Nations children, at baseline, both groups progressed at about the same rate. While the findings do not guarantee that achievement gaps would close during the school years, improved language development in the years before school is likely to be associated with better achievement during school.

Welcome to the Peoples of the Mountains and the Sea: Evaluating an Inaugural Indigenous Cultural Festival

Welcome to the Peoples of the Mountains and the Sea: Evaluating an Inaugural Indigenous Cultural Festival

P115: Outcomes of out of hospital cardiac arrest in First Nations vs. non-First Nations patients in Saskatoon

Introduction: One in nine (11.7%) people in Saskatchewan identifies as First Nations. In Canada, First Nations people experience a higher burden of cardiovascular disease when compared to the general population, but it is unknown whether they have different outcomes in out of hospital cardiac arrest (OHCA). Methods: We reviewed pre-hospital and inpatient records of patients sustaining an OHCA between January 1st, 2015 and December 31st, 2017. The population consisted of patients aged 18 years or older with OHCA of presumed cardiac origin occurring in the catchment area of Saskatoon's EMS service. Variables of interest included, age, gender, First Nations status (as identified by treaty number), EMS response times, bystander CPR, and shockable rhythm. Outcomes of interest included return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge. Results: In all, 372 patients sustained OHCA, of which 27 were identified as First Nations. First Nations patients with OHCA tended to be significantly younger (mean age 46 years vs. 65 years, p < 0.0001) and had shorter EMS response times (median times 5.3 minutes vs. 6.2 minutes, p = 0.01). There were no differences between First Nations and non-First Nations patients in terms of incidence of shockable rhythms (24% vs. 26%, p = 0.80), ROSC (42% vs. 41%, p = 0.87), survival to admission (27% vs 33%, p = 0.53), and survival to hospital discharge (15% vs. 12%, p = 0.54). Conclusion: In Saskatoon, First Nations patients sustaining OHCA appear to have similar survival rates when compared with non-First Nations patients, suggesting similar baseline care. Interestingly, First Nations patients sustaining OHCA were significantly younger than their non-First Nations counterparts. This may reflect a higher burden of cardiovascular disease, suggesting a need improved prevention strategies.

NEEDLE, BEAD AND VOICELearning about Yukon First Nations Traditional Sewing from Mrs. Annie Smith and Ms. Dianne Smith

(Excerpt from Introduction) A pair of moccasins lies on its foam and tissue paper in a government art collection, or gets worn around the house. Sometimes the name of the artist who made them is known, but too seldom. What are the stories in those slippers? There is room for our collective understanding of traditional sewing as an art form to grow. Traditional sewing, like contemporary art, is a phrase that finds meaning in its context rather than its component words. Contemporary art, as understood in its circles, does not generally include, for example, that of today’s Sunday watercolour painters, although their art also takes place in our time. In the Yukon and many other places, traditional sewing is generally understood to refer to Indigenous sewing traditions, and usually takes the form of vests, moccasins, mukluks, gauntlet mitts, and so on. It includes an active art community in our contemporary world. This article comes out of a research project undertaken in 2014-15 to learn about traditional sewing from Kwanlin Dun First Nation Elders Mrs. Annie Smith and her daughter Ms. Dianne Smith who are both respected sewing teachers in their community. I believe that there is much to learn from these women, and from the artists who practice traditional sewing. Bringing their voices into company with their artworks will enrich all of us, in the Yukon and beyond, First Nations and non-First Nations alike. After the research process, I came across constructivist educational theory. It seems to define knowledge as that which “we constuct for ourselves as we learn” (Dewey, 1938, qtd in Hein, 2011, p. 44). This definition helped me realize that I wanted to learn about how Mrs. Smith and Dianne construct meanings from traditional sewing.

Occurrence of and referral to specialists for pain-related diagnoses in First Nations and non-First Nations children and youth.

Indigenous youth have higher rates of chronic health conditions interfering with healthy development, including high rates of ear, dental, chest and musculoskeletal pain, as well as headache, arthritis and mental health issues. This study explores differences in pain-related diagnoses in First Nations and non-First Nations children. Data from a study population of age- and sex-matched First Nations and non-First Nations children and youth were accessed from a specific region of Atlantic Canada. The primary objective of the study was to compare diagnosis rates of painful conditions and specialist visits between cohorts. The secondary objective was to determine whether there were correlations between early physical pain exposure and pain in adolescence (physical and mental health). Although ear- and throat-related diagnoses were more likely in the First Nations group than in the non-First Nations group (ear 67.3% v. 56.8%, p < 0.001; throat 89.3% v. 78.8%, p < 0.001, respectively), children in the First Nations group were less likely to see a relevant specialist (ear 11.8% v. 15.5%, p < 0.001; throat 12.7% v. 16.1%, p < 0.001, respectively). First Nations newborns were more likely to experience an admission to the neonatal intensive care unit (NICU) than non-First Nations newborns (24.4% v. 18.4%, p < 0.001, respectively). Non-First Nations newborns experiencing an NICU admission were more likely to receive a mental health diagnosis in adolescence, but the same was not found with the First Nations group (3.4% v. 5.7%, p < 0.03, respectively). First Nations children with a diagnosis of an ear or urinary tract infection in early childhood were almost twice as likely to have a diagnosis of headache or abdominal pain as adolescents (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1-3.0, and OR 1.7, 95% CI 1.2-2.3, respectively). First Nations children were diagnosed with more pain than non-First Nations children, but did not access specific specialists or mental health services, and were not diagnosed with mental health conditions, at the same rate as their non-First Nations counterparts. Discrepancies in pain-related diagnoses and treatment are evident in these specific comparative cohorts. Community-based health care access and treatment inquiries are required to determine ways to improve care delivery for common childhood conditions that affect health and development.

Agricultural injuries among farm and non-farm children and adolescents in Alberta, Canada.

Understanding of the specific risk of agricultural injury sustained by different populations of children and adolescents is needed for effective safety intervention. To compare the rates and patterns of agricultural injury incidence (fatal and non-fatal injury) between farm and non-farm children less than 18 years of age in Alberta, Canada. A total of 115 378 children (five subgroups: two groups of farm children and three groups of non-farm children) in Alberta were followed from 1999 to 2010 to examine injury incidence using the linkage of three administrative health databases. A recurrent event survival analysis using Cox proportional hazards regression was carried out. A total of 1 849 agricultural injury episodes (1 616 emergency department visits, 225 hospitalizations, and 8 deaths) were identified from 1999 to 2010. The age- and gender-adjusted rate (per 100 000 person years) of agricultural injury was 672.3 for rural-living farm children, 369.4 for urban-living farm children, 180.2 for rural non-First Nations (FN) children, 64.4 for rural FN children, and 23.7 for urban children in descending order. Specific strategies for different children's populations to prevent agricultural injuries and to extend agricultural injury controls to non-farming populations are needed.

Access and affordability of "healthy" foods in northern Manitoba? The need for Indigenous food sovereignty

Despite widespread concerns about household food insecurity experienced by Indigenous peoples, there is limited empirical evidence about the availability and prices of healthy foods in First Nations rural communities located in northern Manitoba, Canada. To fill this research gap, this study examines the availability and affordability of fresh milk, fruits, vegetables, and several other selected food items; investigates the determinants of food prices; and examines the implications of paying higher food prices for individuals and communities in northern Manitoba. The research findings are based on a survey of fifty-two food items conducted in twenty-two communities and six focus group discussions with mothers, service providers, and community leaders. Our research indicates that in addition to limited availability of healthy foods, food prices in First Nations communities were significantly higher than in Winnipeg or non-First Nations urban centers. We conclude by pointing to some policy implications emerging from this research while also signaling the need for a more substantial and profound transformation that includes decolonizing food systems and building Indigenous food sovereignty.

Equality of care between First Nations and non-First Nations patients in Saskatoon emergency departments.

Studies show that First Nations patients have worse health outcomes than non-First Nations patients, raising concerns that treatment within the healthcare system, including emergency care, is inequitable. We performed a retrospective chart review of Status First Nations and non-First Nations patients presenting to two emergency departments in Saskatoon, Saskatchewan with abdominal pain and a Canadian Triage and Acuity Scale score of 3. From 190 charts (95 Status First Nations and 95 non-First Nations), data extracted included time to doctor, time to analgesia, length of stay, specialist consult, bloodwork, imaging, physical exam and history, and disposition. Univariate comparisons and multiple regression modelling were performed to compare care outcomes between patient groups. Equivalence testing comparing time intervals was also undertaken. No statistically significant differences in presentation characteristics were observed, although Status First Nations subjects showed a greater tendency towards weekend presentation and younger age. Care parameters were similar, although a marginally significant difference was observed in Status First Nations versus non-First Nations subjects for imaging (46% versus 60%, p=0.06), which resolved on adjustment for age and weekend presentation. Time to physician was found to be similar among First Nations patients on equivalence testing within a 15-minute margin. In this study, First Nations patients presenting with abdominal pain did not receive delayed care. There were no detectable differences in the time-related care parameters/variables that were provided relative to non-First Nations patients. Meaningful and important qualitative factors need to be examined in the future.

Index coronary angiography use in Manitoba, Canada: a population-level descriptive analysis of First Nations and non-First Nations recipients

ObjectivesTo investigate recipient characteristics and rates of index angiography among First Nations (FN) and non-FN populations in Manitoba, Canada.SettingPopulation-based, secondary analysis of provincial administrative health data.ParticipantsAll adults 18 years or...

A Retrospective Study of Chronic Kidney Disease Burden in Saskatchewan's First Nations People.

Background:Chronic kidney disease is more prevalent among First Nations people than in non-First Nations people. Emerging research suggests that First Nations people are subject to greater disease burden than non-First Nations people.Objective:We aimed to identify the severity of chronic kidney disease and quantify the geographical challenges of obtaining kidney care by Saskatchewan’s First Nations people.Design:This study is a retrospective analysis of the provincial electronic medical record clinical database from January 2012 to December 2013.Setting:The setting involved patients followed by the Saskatchewan provincial chronic kidney care program, run out of two clinics, one in Regina, SK, and one in Saskatoon, SK.Patients:The patients included 2478 individuals (379 First Nations and 2099 non-First Nations) who were older than 18 years old, resident in Saskatchewan, and followed by the provincial chronic kidney care program. First Nations individuals were identified by their Indigenous and Northern Affairs Canada (INAC) Number.Measurements:The demographics, prevalence, cause of end-stage renal disease, severity of chronic kidney disease, use of home-based therapies, and distance traveled for care among patients are reported.Methods:Data were extracted from the clinical database used for direct patient care (the provincial electronic medical record database for the chronic kidney care program), which is prospectively managed by the health care staff. Actual distance traveled by road for each patient was estimated by a Geographic Information System Analyst in the First Nations and Inuit Health Branch of Health Canada.Results:Compared with non-First Nations, First Nations demonstrate a higher proportion of end-stage renal disease (First Nations = 33.0% vs non-First Nations = 21.4%, P < .001), earlier onset of chronic kidney disease (MFN = 56.4 years, SD = 15.1; MNFN = 70.6 years, SD = 14.7, P < .001), and higher rates of end-stage renal disease secondary to type 2 diabetes (First Nations = 66.1% vs non-First Nations = 39.0%, P < .001). First Nations people are also more likely to be on dialysis (First Nations = 69.7% vs non-First Nations = 40.2%, P < .001), use home-based therapies less frequently (First Nations = 16.2% vs non-First Nations = 25.7%; P = 003), and must travel farther for treatment (P < .001), with First Nations being more likely than non-First Nations to have to travel greater than 200 km.Limitations:Patients who are followed by their primary care provider or solely through their nephrologist’s office for their chronic kidney disease would not be included in this study. Patients who self-identify as Aboriginal or Indigenous without an INAC number would not be captured in the First Nations cohort.Conclusions:In Saskatchewan, First Nations’ burden of chronic kidney disease reveals higher severity, utilization of fewer home-based therapies, and longer travel distances than their non-First Nations counterparts. More research is required to identify innovative solutions within First Nations partnering communities.

The hefty fetal phenotype hypothesis revisited: high birth weight, type 2 diabetes and gestational diabetes in a Saskatchewan cohort of First Nations and non-First Nations women.

Although low birth weight (LBW) increases the risk for type 2 diabetes (T2DM), the relationship between high birth weight (HBW) and T2DM is less definitive and largely confined to North American Indigenous populations. We re-examined the relationship between LBW (4000 g) and both T2DM and gestational diabetes (GDM) among First Nations and non-First Nations women in Saskatchewan. We analyzed new data for female subjects from a 2001 case-control study that led to our hefty fetal phenotype hypothesis. Using survival analysis techniques and a validated algorithm for identifying diabetes in health care administrative data, we followed a 1950-1984 birth cohort of 2003 women until March 31, 2013. Cox regression analysis determined the time to occurrence of first episode of GDM and diagnosis of T2DM by birth weight and ethnicity. First Nations women with HBW demonstrated a greater risk for developing both T2DM [hazard ratios (HR) 1.568; 95% confidence interval (CI) 1.188, 2.069] and GDM (HR 1.468; 95% CI 1.016, 2.121) than those with normal birth weight (NBW). Non-First Nations women with LBW had a greater risk of developing GDM than those with NBW (HR 1.585; 95% CI 1.001, 2.512). HBW is a risk factor for GDM and T2DM among First Nations women. This is likely due to exposure of these women to their own mothers' diabetic pregnancies or gestational impaired glucose tolerance. This inter-generational amplification of T2DM risk mediated through prenatal exposures appears to play a substantial role in the epidemic of T2DM among First Nations peoples.

Risk factors for progression of diabetic retinopathy in Alberta First Nations communities

ObjectiveThe Screening for Limb, I-Eye, Cardiovascular, and Kidney Complications (SLICK) Program was implemented in 1999 to improve diabetic care for Alberta First Nations individuals living on reserve. The purpose of this review is to determine the rate and predictors of progression of diabetic retinopathy (DR) over a 10-year period. DesignCohort study. ParticipantsNine hundred and eighty First Nations patients with diabetes that underwent at least 2 teleophthalmology examinations during the study period. MethodsPatients underwent serial laboratory testing, and stereoscopic, mydriatic, retinal photography. Modified Early Treatment Diabetic Retinopathy Study grading of retinal images was performed via teleophthalmology. Progression was defined as an increase of 2 or more steps on the Diabetes Control and Complications Trial classification. ResultsAt baseline, most patients had no diabetic retinopathy (n = 777, 79.3%) whereas 203 people (20.7%) had either nonproliferative DR (n = 179, 18.3%) or proliferative DR (n = 24, 2.5%). Two-step progression occurred in 163 patients (16.6%), with only a minority of these individuals progressing to proliferative DR (n = 23). The median time to progression was 7.6 years. Multivariate Cox regression demonstrated that elevated hemoglobin A1C (hazard ratio [HR] = 1.42; p < 0.0001) and systolic blood pressure (HR = 1.24 per 10 mm Hg; p = 0.009) were independent predictors of progression of DR. ConclusionsThis population-based study has shown that the rate and predictors of progression of DR among First Nations individuals parallels non-First Nations populations, with HbA1C and systolic blood pressure being the strongest predictors. These findings suggest that targeted, individualized care to reduce blood pressure and control blood sugars could reduce progression of diabetic retinopathy, and possibly blindness in First Nations individuals living on reserve.

First Nations Community Well-Being Research and Large Data Sets: A Respectful Caution

Health researchers are increasingly encouraged to use large, community-level data sets to examine factors that promote or diminish health, including social determinants. First Nations people in Canada experience disparity in a range of social determinants of health that result in relatively low community well-being scores, when compared to non-First Nations people. However, First Nations people also possess unique protective factors that enhance well-being, such as traditional language usage. Large data sets offer First Nations a new avenue for advocating for supports and services to decrease health inequity while developing culture-based evidence. However, care must be taken to ensure that these data are interpreted appropriately. In this paper, we respectfully offer a cautionary note on the importance of understanding culture and context when conducting First Nations health research with large data sets. We have framed this caution through a narrative presentation of a simple and concrete example. We then outline some approaches to research that can ensure appropriate development of research questions and interpretation of research findings.

Projecting prevalence, costs and evaluating simulated interventions for diabetic end stage renal disease in a Canadian population of aboriginal and non-aboriginal people: an agent based approach

BackgroundDiabetes-related end stage renal disease (DM-ESRD) is a devastating consequence of the type 2 diabetes epidemic, both of which disproportionately affect Indigenous peoples. Projecting case numbers and costs into future decades would help to predict resource requirements, and simulating hypothetical interventions could guide the choice of best practices to mitigate current trends.MethodsAn agent based model (ABM) was built to forecast First Nations and non-First Nations cases of DM-ESRD in Saskatchewan from 1980 to 2025 and to simulate two hypothetical interventions. The model was parameterized with data from the Canadian Institute for Health Information, Saskatchewan Health Administrative Databases, the Canadian Organ Replacement Register, published studies and expert judgement. Input parameters without data sources were estimated through model calibration. The model incorporated key patient characteristics, stages of diabetes and chronic kidney disease, renal replacement therapies, the kidney transplant assessment and waiting list processes, costs associated with treatment options, and death. We used this model to simulate two interventions: 1) No new cases of diabetes after 2005 and 2) Pre-emptive renal transplants carried out on all diabetic persons with new ESRD.ResultsThere was a close match between empirical data and model output. Going forward, both incidence and prevalence cases of DM-ESRD approximately doubled from 2010 to 2025, with 250–300 new cases per year and almost 1300 people requiring RRT by 2025. Prevalent cases of First Nations people with DM-ESRD increased from 19% to 27% of total DM-ESRD numbers from 1990 to 2025. The trend in yearly costs paralleled the prevalent DM-ESRD case count. For Scenario 1, despite eliminating diabetes incident cases after 2005, prevalent cases of DM-ESRD continued to rise until 2019 before slowly declining. When all DM-ESRD incident cases received a pre-emptive renal transplant (scenario 2), a substantial increase in DM-ESRD prevalence occurred reflecting higher survival, but total costs decreased reflecting the economic advantage of renal transplantation.ConclusionsThis ABM can forecast numbers and costs of DM-ESRD in Saskatchewan and be modified for application in other jurisdictions. This can aid in resource planning and be used by policy makers to evaluate different interventions in a safe and economical manner.

B.07 Differences between Indigenous and non-Indigenous patients referred to a rural and remote memory clinic

Background: Jacklin et al. (2013) described a rising incidence and a younger onset of dementia in Albertan First Nations compared to non-First Nations patients. Canadian research is limited in Indigenous patients with dementia, leaving it difficult to understand factors contributing to the differences in incidence and prevalence. Methods: 375 patients (41 Indigenous) was seen at the clinic. The questionnaire given during initial assessments were reviewed and differences between groups (non-Indigenous patients versus Indigenous) were assessed. Results: Compared to the non-Indigenous patient, Indigenous patients were younger (p=0.007), were more likely to be female (p=0.033) and had less education (p=0.055). They were less likely to live solely with a partner (p&lt;0.001) and more likely to have a daughter as caregiver (p=0.004). The Indigenous patients were more likely to smoke (p&lt;0.001). Although no differences in diagnosis of mental health disorders were seen (p=0.735), the Indigenous patients scored significantly higher on the CES-D (p&lt;0.0001). Conclusions: This comparison highlights differences potentially affecting the health of Indigenous patients. Acknowledging these differences is critical to individualized patient care. Further research is required to explore how these factors affect dementia disease course and treatment, and how these factors play a role in the differences in incidence and prevalence demonstrated in previous studies.

Indigenous perspectives of ecosystem-based management and co-governance in the Pacific Northwest: lessons for Aotearoa

This article presents a case study of the ecosystem-based management model embedded within British Columbia’s Marine Plan Partnership for the Pacific North Coast and the Great Bear Initiative. These are two distinct, yet linked, examples of resource management and economic development that use ecosystem-based management in a way that incorporates indigenous perspectives and aspirations. The model potentially provides a framework that other countries, including Aotearoa (New Zealand), could examine and adapt to their own contexts using new governance structures and working with indigenous perspectives that include traditional ecological knowledge and aspirations. The case study is presented from a Māori perspective that represents both an insider (indigenous) and outsider (non-First Nations) view.

Sea otters, social justice, and ecosystem-service perceptions in Clayoquot Sound, Canada.

We sought to take a first step toward better integration of social concerns into empirical ecosystem service (ES) work. We did this by adapting cognitive anthropological techniques to study the Clayoquot Sound social-ecological system on the Pacific coast of Canada's Vancouver Island. We used freelisting and ranking exercises to elicit how locals perceive ESs and to determine locals' preferred food species. We analyzed these data with the freelist-analysis software package ANTHROPAC. We considered the results in light of an ongoing trophic cascade caused by the government reintroduction of sea otters (Enhydra lutris) and their spread along the island's Pacific coast. We interviewed 67 local residents (n = 29 females, n = 38 males; n = 26 self-identified First Nation individuals, and n = 41 non-First Nation individuals) and 4 government managers responsible for conservation policy in the region. We found that the mental categories participants-including trained ecologists-used to think about ESs, did not match the standard academic ES typology. With reference to the latest ecological model projections for the region, we found that First Nations individuals and women were most likely to perceive the most immediate ES losses from the trophic cascade, with the most certainty. The inverse was found for men and non-First Nations individuals, generally. This suggests that 2 historically disadvantaged groups (i.e., First Nations and women) are poised to experience the immediate impacts of the government-initiated trophic cascade as yet another social injustice in a long line of perceived inequities. Left unaddressed, this could complicate efforts at multistakeholder ecosystem management in the region.

Breastfeeding Initiation Associated With Reduced Incidence of Diabetes in Mothers and Offspring.

To examine associations between breastfeeding initiation and subsequent diabetes among First Nations (indigenous people in Canada who are not Métis or Inuit) and non-First Nations mothers and their offspring with and without gestational diabetes mellitus (GDM). This retrospective database study included 334,553 deliveries (1987-2011) in Manitoba with up to 24 years of follow-up for diabetes using population-based databases. Information of breastfeeding initiation before hospital discharge was obtained from hospital abstracts recorded by nurses in postpartum wards. Cox proportional hazard models were applied to examine the association between breastfeeding initiation and risk of diabetes in mothers and their offspring. Breastfeeding initiation was recorded in 83% of non-First Nations mothers and 56% of First Nations mothers (P<.001). Breastfeeding initiation was associated with a reduced risk of incident (later developed) diabetes in non-First Nations mothers without GDM (hazard ratio [HR] 0.73 [or -27% of risk], 95% confidence interval [CI] 0.68-0.79), non-First Nations mothers with GDM (HR 0.78 or -22% of risk, CI 0.69-0.89), First Nations mothers without GDM (HR 0.89 or -11% of risk, CI 0.81-0.98), and First Nations mothers with GDM (HR 0.82 or -18% of risk, CI 0.73-0.92) with 24 years of follow-up or less. With 24 years of follow-up or less, breastfeeding initiation was associated with a 17% lower risk of youth-onset type 2 diabetes in offspring (HR 0.83, CI 0.69-0.99, P=.038). The association between breastfeeding initiation and subsequent diabetes in mothers and offspring was independent of family income, rural residence, First Nations status, GDM, parity, gestational hypertension, and age of the mother. Breastfeeding initiation is associated with a reduced risk of diabetes among women and their offspring in Manitoba. The results suggest that breastfeeding might be a potentially modifiable factor to reduce the risk of diabetes in both First Nations and non-First Nations women and children.

Exposure to Gestational Diabetes Mellitus: Impact on the Development of Early-Onset Type 2 Diabetes in Canadian First Nations and Non-First Nations Offspring.

Type 2 diabetes is increasing in children worldwide, with Canadian First Nations (FN) children disproportionally affected. The prevalence of gestational diabetes mellitus (GDM) also is increasing. The objective of this study was to evaluate the impact of GDM exposure in utero and FN status on the subsequent risk of type 2 diabetes in offspring in the first 30 years of life. In this population-based historical prospective cohort study, we used administrative databases linked to a clinical database to explore the independent association and interaction between GDM and FN status on the subsequent development of type 2 diabetes in offspring. Among 321,008 births with a median follow-up of 15.1 years, both maternal GDM and FN status were independently associated with subsequent risk of type 2 diabetes in offspring in the first 30 years of life (hazard ratio 3.03 [95% CI 2.44-3.76; P < 0.0001] vs. 4.86 [95% CI 4.08-5.79; P < 0.0001], respectively). No interaction between GDM and FN status on type 2 diabetes risk was observed. FN status had a stronger impact on the development of type 2 diabetes in offspring than GDM. GDM is an important modifiable risk factor for type 2 diabetes, and its prevention may reduce the prevalence of subsequent type 2 diabetes in offspring. This study adds unique and rigorous evidence to the global public health debate about the impact of GDM on the long-term health of offspring.

Characteristics and residence of First Nations patients and their use of health care services in Saskatchewan, Canada: informing First Nations and Métis health services.

In Canada, Aboriginal people, particularly First Nations experience significant health disparities and a lower health status compared with the non-Aboriginal population. The purpose of this study was to examine the demographic and clinical characteristics of First Nations patients admitted to hospitals in Saskatchewan, and the acute care services used by First Nations compared with non-First Nations, specifically hospital length of stay. Primary residence of patients was also mapped to determine geographic patterns that would inform health service provision. A retrospective medical chart audit was carried out to collect data on patient demographics and clinical characteristics of 203 First Nations and 200 non-First Nations patients admitted to two urban hospitals in Saskatchewan from 2012 to 2014. The most common reason for admission of First Nations and non-First Nations patients was infection (24.6%) and cardiology conditions (19.5%), respectively. There was no significant difference in mean length of stay for First Nations (10.44 days) compared with non-First Nations (10.57 days). After adjusting for age, mean length of stay for First Nations was nearly 3 days longer than non-First Nations. First Nations patients' residence was from across the broad geography of Saskatchewan, with 45% living in rural communities or on reserve. The outcomes of this study are clinically meaningful and support the need for research, in collaboration with Aboriginal patients and families, to further examine and improve the care experience in order to decrease health disparities for Aboriginal patients in Canada.