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A systematic review was conducted to assess evidence on effectiveness of community-based interventions promoting wellbeing and prevention of type 2 diabetes (T2D) among Indigenous youth. A convergent, segregated, mixed methods approach was used, with six databases and four grey literature sites searched from inception to May 2022. Articles selected for inclusion were about community-based interventions related to T2D prevention with Indigenous youth that evaluated effectiveness or youth experience published in English. Reference lists were also searched for relevant sources. Seven quantitative research articles met the inclusion and quality assessment criteria. No qualitative articles were identified. The results were synthesised through narrative analysis, while meta-analysis was not possible due to heterogenous study designs. Common foci across interventions included promoting physical wellness, improving physical activity and healthy eating patterns, enhancing knowledge, and psychosocial wellness. Interventions deemed effective addressed multiple areas, were school-based, and operated for at least a year. Findings support multi-strategy, community-based interventions implemented over longer periods of time. However, gaps in research and reporting included the extent to which interventions are culturally informed and based on community-driven priorities. Future research should include Indigenous, mixed and qualitative methods and Indigenous-driven measures of success to better understand effectiveness in alignment with Indigenous worldviews.

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A challenge confronting northern nursing is delivery of equitable and culturally competent nursing education. Advances in technology support distributed approaches for decentralised learning and enhance the feasibility of nursing education in rural and remote regions. However, there is limited scholarship on distributed/decentralised technologies in nursing education, particularly in northern and circumpolar regions. The purpose of this constructivist grounded theory research was to develop an enhanced understanding of the unique experiences of students, faculty and administrators who use distributed/decentralised methods and technology. Open-ended interviews were completed in 2015-17 with nursing students (n = 8), faculty and administrators (n = 6) at two universities using distributed/decentralised educational strategies in northern and circumpolar regions. Interviews, journal entries, field notes and memos, were analysed using grounded theory procedures. Findings indicated that distributed/decentralised programs offered rural and remote students educational possibilities that "fit" which would not have otherwise existed. However, Balancing Two Worlds created a collision of roles resulting in the potential loss of balance. Students rectified the Fear of "Falling Off" of their program through four subprocesses: Being Disciplined, Having Realistic Expectations, Planning Ahead and Staying Motivated which provided structure and predictability. Findings support the development of empirical knowledge regarding distributed/decentralised technologies in nursing education and a foundation for future research.

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OBJECTIVE: To investigate the prevalence of undiagnosed prehypertension/hypertension and other associated comorbidities in adolescents living in rural and urban settings in a mid-Western Canadian province. DESIGN AND MEASURES: Data reported herein were derived from two cross-sectional studies, whereby adolescents attending either a rural (N = 143) or urban (N = 253) school were screened for blood pressure, anthropometric measures, and blood glucose measurements. Data analysis included descriptive and inferential statistics in addition to chi-square analyses. RESULTS: Notable prevalence of undiagnosed prehypertension/hypertension was found. Adolescents living in urban settings (49%, N = 123) were significantly more likely to have prehypertension/hypertension than rural (23%, N = 33) living adolescents. With regard to other comorbidities, the prevalence of elevated HbA1c in the urban group (32%) was significantly higher than the rural adolescents (19%); however, there was similar prevalence of overweight/obese adolescents between the urban (37%) and rural (36%) groups. CONCLUSIONS: The prevalence of adolescent undiagnosed prehypertension/hypertension, elevated blood glucose measurements, and overweight/obesity is concerning in both urban and rural settings. Public health nurses are uniquely positioned in health care to facilitate interventions focused on preventing and managing adolescent prehypertension/hypertension and its associated comorbidities.

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BACKGROUND: Canadian Indigenous populations experience significantly more chronic kidney disease (CKD) than the general population. Indigenous people who live in rural and remote areas may also have difficulty accessing both information and care for their CKD. Informed decision making about treatment options for advancing kidney disease may be delayed, which can result in poor health outcomes and decreased quality of life. Moreover, Indigenous people may experience marginalization within Western health care systems. OBJECTIVE: The objective of this scoping review is to identify culturally appropriate and co-developed Indigenous educational tools that will ultimately support CKD learning and end-stage kidney treatment decision making. DESIGN: Scoping Review. SETTING: Databases included Embase, CINAHL, Medline (OVID), ERIC, and the Canadian Agency for Drugs and Technology Gray Matters. STUDY PARTICIPANTS: Community-based Indigenous patients, families, health care workers, and community members. METHODS: We systematically reviewed the literature to explore the availability of co-developed Indigenous educational tools and material for CKD treatment options. Titles, abstracts, and full texts were reviewed independently by 2 reviewers with disagreements resolved through a third. All aspects of this project, including searching the databases were done in consultation with an Indigenous Elder. RESULTS: Only one retrieved article identified a comprehensive CKD tool co-developed by researchers, health care providers, and an Indigenous community. Three themes emerged from the scoping review that may inform characteristics of co-developed tools: cultural appropriateness; appraisal of utility and effectiveness and; content informed by co-development of traditional and Western chronic disease knowledge. LIMITATIONS: Consistent with scoping review methodology, the methodological quality of included studies was not assessed. In addition, it was difficult to synthesize the findings from the research and gray literature. CONCLUSION: Little is known about the co-development of Indigenous educational tools for CKD. Further in-depth understanding is required about how to best engage with Indigenous communities, specifically to co-develop contextualized CKD tools that are acceptable to Indigenous people.Trial registration: Not applicable as this review described secondary data.

CONTEXTE: Au Canada, l'insuffisance rénale chronique (IRC) touche les populations autochtones davantage que la population générale. Qui plus est, l'accès à des soins et de l'éducation sur l'IRC s'avère plus difficile pour les autochtones vivant en régions rurales et éloignées. Une situation susceptible de retarder la prise de décision informée quant aux options de traitement et donc, de compromettre les résultats de santé et la qualité de vie. Les autochtones pourraient également être marginalisés dans les systèmes de santé occidentaux. OBJECTIFS: L'étude visait à répertorier des outils de sensibilisation culturellement appropriés et développés conjointement avec les autochtones qui, en définitive, viendraient appuyer l'éducation sur l'IRC et la prise de décision quant au traitement de l'insuffisance rénale terminale. TYPE D'ÉTUDE: Étude de cadrage. SOURCES: Les bases de données Embase, CINAHL, Medline (OVID) et ERIC, et l'outil Matière grise de l'Agence canadienne des médicaments et des technologies de la santé (ACMTS). SUJETS: Des patients autochtone de la communauté et leurs familles, des travailleurs du secteur de la santé et des membres de la communauté. MÉTHODOLOGIE: Nous avons procédé à une revue systématique de la littérature pour vérifier la disponibilité d'outils d'éducation développés conjointement avec les autochtones et de matériel relatif aux options de traitement pour l'IRC. Les titres, abrégés et textes complets ont été révisés indépendamment par deux examinateurs; les désaccords ayant été résolus par un troisième. Un aîné autochtone a été consulté pour tous les aspects de ce projet, y compris la recherche dans les bases de données. RÉSULTATS: Parmi les articles retenus, un seul faisait état d'un outil complet développé conjointement par des chercheurs, des fournisseurs de soins et une communauté autochtone. L'étude a dégagé trois thèmes susceptibles d'éclairer les caractéristiques d'un outil co-développé: l'adaptation culturelle, l'évaluation de l'utilité et de l'efficacité, et un contenu éclairé par le co-développement des connaissances traditionnelles et occidentales sur les maladies chroniques. LIMITES: Conformément à la méthodologie d'une étude de cadrage, la qualité méthodologique des études incluses n'a pas été évaluée. De plus, il a été difficile de synthétiser les résultats provenant de la recherche et de la littérature grise. CONCLUSION: On en sait peu sur le développement d'outils d'éducation sur l'IRC conjointement avec les membres des communautés autochtones. Une compréhension plus approfondie des meilleures façons de collaborer avec les communautés autochtones est nécessaire, particulièrement pour l'élaboration d'outils d'éducation sur l'IRC contextualisés et acceptables pour les autochtones. ENREGISTREMENT DE L'ESSAI CLINIQUE: Sans objet puisque cette étude discute de données secondaires.

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BACKGROUND: An increased incidence of type 2 diabetes in youth is occurring worldwide. While diverse ethnic groups are disproportionately affected by type 2 diabetes, studies that explore ethnic differences and undiagnosed prediabetes/type 2 diabetes in adolescents are scarce. This paper compares the prevalence of undiagnosed prediabetes and type 2 diabetes and the associated risk factors among various ethnic groups of adolescents living in Western Canada. METHODS: The data for this study were derived from two previous studies in which 396 adolescents, aged 14 to 19 years and living in a western Canadian province, were screened for undiagnosed prediabetes, diabetes, and any associated risk factors. Risk was determined by demographics, family history, anthropometric measurements (body mass index, BMI), blood pressure (BP), and HbA1c. Descriptive and inferential statistics (SPSS) were used to establish both risk and prevalence for prediabetes and type 2 diabetes. Chi-square analyses were done to determine if the risk factors occurred at higher frequencies in certain ethnicities. RESULTS: Based on BP, BMI, and HbA1c measurements, several statistically significant differences were identified in relation to ethnicity. Many of the adolescents had increased HbA1c levels, with 27.3% considered high risk and 2.3% in the prediabetes range; these high risk and prediabetes groups were heavily represented by Filipino (46%), Indigenous (22%), and European (10%) adolescents. Notable prevalence of prehypertension (17.7%) and hypertension (21.7%) were reported in European (59%) followed by Filipino (50%) and Indigenous (26%) adolescents. Higher numbers of adolescents in the European and Filipino ancestry groups had two or more risk factors (BP, BMI, & HbA1c) for developing type 2 diabetes in relation to the adolescents from the Indigenous group. CONCLUSIONS: Ethnic adolescent groups demonstrate a notable prevalence of undiagnosed prediabetes and type 2 diabetes. Specifically, a significant number of Filipino adolescents had both increased HbA1c and blood pressure that has gone undetected. Earlier onset of type 2 diabetes is congruent with an increased risk of developing diabetes-associated complications and, ultimately, diabetes-related morbidity and mortality at a younger age. Future studies should explore how genetic and/or environmental factors among ethnic groups may contribute to early onset hypertension and prediabetes/type 2 diabetes.

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OBJECTIVES: To identify the presence of risk factors for type 2 diabetes (ethnicity, body mass index, blood glucose tolerance and blood pressure) and to determine the prevalence of prediabetes and type 2 diabetes in Canadian adolescents attending two multicultural urban high schools. METHODS: A total of 266 multicultural urban high school students who live in a mid-sized Western Canadian city, aged 14-21, were screened for risk factors of prediabetes and type 2 diabetes in March-April 2018. Data with respect to demographics, family history of diabetes, anthropometrics, blood pressure and haemoglobin A1c (HbA1c) were collected. Data analysis was done using descriptive and inferential statistics in addition to chi-square analyses. RESULTS: Based on body mass index, 38% of the adolescents were classified as either overweight or obese. Overweight rates for females (69.8%) were double than males (30.2%); however, males (52.2%) were more likely to obese than the females (47.8%). Based on HbA1c levels, 29.3% were at high risk to develop either diabetes or prediabetes and 2.6% were classified in the prediabetes range. Prehypertension/hypertension rates of 47% in the sample increased to 51% in those adolescents with elevated HbA1c; the majority of these prehypertensive/hypertensive participants were male. CONCLUSION: High rates of overweight/obesity and prehypertension/hypertension were found in the adolescents studied and indicated the presence of prediabetes and an increased risk to develop type 2 diabetes and associated complications. Obesity and hypertension are major risk factors for developing type 2 diabetes, resulting in earlier exposure to metabolic consequences and, ultimately, long-term complications. Thus, timely research is needed to identify age-appropriate strategies that address risks and to develop recommendations for routine screening of adolescents for prediabetes.

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Diabetic retinopathy is the most common cause of new cases of blindness and is pandemic among Aboriginal people around the world. To reduce health inequities, accessible vision screening among these high-risk populations is essential. To assess cardio-metabolic co-morbidities associated with type 2 diabetes and the use of a portable fundus camera as a novel approach for convenient, earlier and more accessible vision screening for Aboriginal peoples living with type 2 diabetes in northern and remote Canadian communities. This quantitative pilot study screened participants diagnosed with type 2 diabetes for commonly associated cardio-metabolic co-morbidities using anthropometrical measurements, blood pressure and a A1c (HbA1c) blood glucose test, followed by vision exams conducted first by a trained nurse and then by an ophthalmologist to screen for signs of retinopathy using fundus photography. Large numbers of the participants presented with overweight/obese (84.8%), pre-hypertension/hypertension (69.7%) and an elevated A1C (78.8%). Inter-rater reliability demonstrated substantial agreement between vision exam judgements made by the nurse and ophthalmologist (k = .67). Nurse-led vision screening in remote or northern communities can improve the standard of care by extending access to health services, lowering the costs to families by reducing travel expenses and preventing vision loss in a family member.

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BACKGROUND: A doctoral degree, either a PhD or equivalent, is the academic credential required for an academic nurse educator position in a university setting; however, the lack of formal teaching courses in doctoral programs contradict the belief that these graduates are proficient in teaching. As a result, many PhD prepared individuals are not ready to meet the demands of teaching. METHODS: An integrative literature review was undertaken. Four electronic databases were searched including the Cumulative Index to Nursing & Allied Health Literature (CINAHL), PubMed, Educational Resources Information Center (ERIC) and ProQuest. Date range and type of peer-reviewed literature was not specified. RESULTS: Conditions and factors that influenced or impacted on academic nurse educators' roles and continue to perpetuate insufficient pedagogical preparation include the requirement of a research focused PhD, lack of mentorship in doctoral programs and the influence of epistemic cultures (including institutional emphasis and reward system). Other factors that have impacted the academic nurse educator's role are society's demand for highly educated nurses that have increased the required credential, the assumption that all nurses are considered natural teachers, and a lack of consensus on the practice of the scholarship of teaching. CONCLUSIONS: Despite recommendations from nursing licensing bodies and a major US national nursing education study, little has been done to address the issue of formal pedagogical preparation in doctoral (PhD) nursing programs. There is an expectation of academic nurse educators to deliver quality nursing education yet, have very little or no formal pedagogical preparation for this role. While PhD programs remain research-intensive, the PhD degree remains a requirement for a role in which teaching is the major responsibility.

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PURPOSE: To identify the risk factors and prevalence rates of prediabetes and type 2 diabetes among northern Canadian Aboriginal adolescents. DESIGN AND METHODS: In this novel exploratory, quantitative study, 160 high school students (aged 13-21) from three northern, predominantly Canadian Aboriginal communities were screened for risk for prediabetes and type 2 diabetes including demographic data, family medical history, anthropometric measurements, blood pressure, and hemoglobin A1c (HbA1c). Descriptive and inferential statistics, in addition to chi-square analysis, were used to establish risk and prevalence rates for prediabetes and type 2 diabetes in Aboriginal adolescents. RESULTS: At least half of the adolescents presented with multiple risk factors for type 2 diabetes. In this sample, 10% had an HbA1c>5.7%, 22.5% were overweight, 17.5% were obese, and 26.6% had prehypertension or hypertension. CONCLUSIONS: Prediabetes and type 2 diabetes are emerging as serious health concerns for young Aboriginal Canadians. This is troubling because both result from modifiable risk factors. As this study is the first to examine the prevalence of prediabetes in Canadian Aboriginal adolescents in the last decade, the findings underscore the necessity for early screening of Aboriginal adolescents for both prediabetes and type 2 diabetes. PRACTICE IMPLICATIONS: Recommendations toward positive health outcomes include the introduction of early age screening programs, followed by culturally relevant interventions, specific to the modifiable risk factors (overweight/obesity and hypertension), and developed in collaboration with the communities. Such approaches have the potential to prevent the progression of prediabetes to diabetes and reduce complications related to type 2 diabetes.

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