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A sustainable primary prevention strategy for infant iron deficiency anemia (IDA) was implemented and evaluated in a community with at-risk infants in northern Quebec, Canada. Communication strategies were used to promote iron-rich complementary food rather than iron-fortified formula, which can interfere with breastfeeding practice. This food-based approach has been successfully implemented in developing countries, but has not been applied in an industrialized country setting. / Mass media (i.e., radio dialogues, key messages, print material, point-of-purchase grocery store display) and interpersonal (i.e., homemade baby food cooking activity) communication strategies were developed in collaboration with community members and implemented in partnership with an existing community program. Reach and exposure of the strategies were measured using a questionnaire administered to a post-intervention sample (n = 45). Sales of promoted iron-rich infant food were examined pre- and post-intervention period. A repeat cross-sectional design was used for the impact evaluation. Two groups of mothers with infants, aged 7-10 months at Time 1 (n = 32) and Time 2 (n = 22) were interviewed. Outcome variables were infants' total iron and complementary food iron intakes measured by two 24-hour recalls. Secular trends in infants' hemoglobin values and milk type consumption were examined in the study community and two comparison communities. / Multiple communication channels increased awareness of IDA and influenced self-reported use of iron-rich infant food. Iron-rich infant food sales increased from pre- to post-intervention (p < 0.05). Complementary food intake iron increased between Time 1 (3.2 +/- 0.8 mg) and Time 2 (4.4 +/- 1.1 mg) (p < 0.05). The proportion of infants with anemia (hemoglobin < 110 g/L) significantly decreased from the period before (37.2%) to during (14.3%) the intervention (p < 0.05). No significant difference was found for this variable within the comparison communities. The proportion of infants receiving iron-fortified formula in the study community did not differ between Time 1 and Time 2, but increased from Time 1 (55%) to Time 2 (73%) (p < 0.05) in the comparison communities, indicating an erosion of breastfeeding practice. / These results suggest the effectiveness of communication strategies to improve infant iron nutrition in a community with good access to iron-rich infant food. The potential for this strategy in other communities warrants further investigation.

Gestational diabetes mellitus (GDM) and infant macrosomia are important obstetric health concerns for Aboriginal populations in Canada. Previous research in non-Aboriginal populations has established that GDM and macrosomia are associated with increased risk of fetal morbidity. Specifically, GDM is a risk factor for infant macrosomia, hypoglycemia, polycythemia, hypocalcemia, and hyperbilirubinemia. Furthermore, macrosomia is an independent risk factor for shoulder dystocia, clavicular fracture, brachial plexus injury, birth asphyxia and operative delivery. The main objectives of this study were to determine prevalence rates of GDM and macrosomia related neonatal complications for the James Bay Cree population of northern Quebec, and to identify risk factors for specific birth trauma injuries and metabolic complications in the population. The prevalence of macrosomia (≥4500 g) was 10.4%, and the estimated prevalence of GDM was 16.6% (95% CI 14.6-18.6) (n = 229/1379). Shoulder dystocia was the most common birth trauma event among the Cree, affecting 2.5% (n = 42/1650) of all Cree births, and 9.3% (n = 16/172) of macrosomic deliveries ≥4500 g. The prevalence of neonatal hypoglycemia was also high, affecting 8.8% (n = 144/1650) of all Cree newborns, and 18.1% (n = 34/192) of GDM deliveries. Macrosomia (BW ≥ 4500 g) was a significant risk factor for shoulder dystocia, clavicular fracture, hypoglycemia, and caesarean section delivery. After adjusting for maternal age, parity, and gestational age, GDM was identified as a significant risk factor for macrosomia (≥4500 g), hypoglycemia, polycythemia, and hypocalcemia. In summary, this study identified a high incidence of neonatal complications among the James Bay Cree compared with rates in the general North American population. These outcomes can be explained, in part, by high prevalence rates of gestational diabetes and infant macrosomia. Further studies to investigate the long-term consequences of GDM and

Cree communities in Northern Quebec have been going through rapid changes since the first arrival of the Eurocanadians on their lands. Their customs, their houses and their eating habits have been deeply influenced by western living patterns. Today, the houses and the community designs remind more of the suburban Canadian landscape. Yet, Native social, cultural and natural environment still differs from non-Native communities in Canada. / Traditionally, women used to play an important role in the domestic area. Due to colonization, Native women have lost their status and are not part of the decision making process of their homes. Despite that, Native women have continued to play a special role in fostering a sense of identity in their communities. It is therefore important to involve them in housing projects in order to find designs more adapted to the needs of their families. / The case study took place in Chisasibi, a Cree village at the North of James Bay, which has been relocated 17 years ago, and been living in fully equipped houses based on western designs. This thesis aimed at revealing the opinion of Native women about their domestic environment and collect their suggestions for future improvements. The results showed that Native families' lifestyles have become more and more diversified: some want to incorporate traditional behavior patterns, other on the contrary, are more inclined in living the western way. Of course age and social background play an important role in their opinions. Still, the major critic concerns the inappropriate designs, the lack of space and storage which tend to influence the way people use the space in the house. The thesis pointed out the importance of defining housing layouts in accordance to the Native families' choices and sense of identity.

The objectives of this research were to determine the prevalence of anemia, and identify risk factors for anemia, in 9-month-old Cree infants living in northern Quebec. The prevalence of anemia (hemoglobin <110 g/L) was 25--32%, depending on the study sample. Iron deficiency was present in 28.2% of infants who could be classified and 14.4% had iron deficiency anemia. Fewer than 2% of infants had low birth weight (<2500 g) so most infants should have been born with adequate iron stores. One cause of anemia that was identified was a diet that was low in iron. Only 15.1% of infants were reported by guardians to eat meat daily and 28.5% were reported to never eat meat. Infants who were breastfed or cow's milk fed did not obtain sufficient iron for effective erythropoiesis. Compared with formula that was predominantly iron fortified, the odds ratio (OR) for anemia was 7.9 (95% CI 3.4--18.2) for breast milk and 5.0 (95% CI 2.0--12.7) for cow's milk. When milk type was controlled for, weight gain since birth was significantly associated with microcytic erythrocytes (OR comparing the highest tertile of weight gain to the lowest tertile 2.9, 95% CI 1.2--6.6). This indicates that fast-growing infants were not meeting their iron needs for growth. Another risk factor for anemia that was identified was common childhood infections. The prevalence of anemia among infants reported as recently unwell with an infection was higher than among infants reported as recently well (31.1% vs. 19.0%, chi2 = 4.27, p = 0.039). The prevalence of elevated blood lead was 2.7% and is not a major public health problem. No evidence for vitamin A deficiency was found. Serum retinol was positively associated with all iron status indicators. Cree infants who were given supplements containing vitamin A had a lower prevalence of anemia (hemoglobin <105 g/L) (10.8% vs 23.2%, chi2 = 5.97, p = 0.015). These results suggest a role for vitamin A in iron metabolism. To prevent anemia in aboriginal i

Through a qualitative, interdisciplinary inquiry of six Indigenous scholars who had completed or were currently enrolled in Education. Social Work or Family Studies doctoral programs, this study explores Indigenous methodologies with a specific focus on methodologies flowing from a Nehiyaw Kiskeyihtamowin (Plains Cree knowledges). The study asked six scholars. four being of Cree ancestry, if they believed that there was a distinctive Indigenous methodological approach to research and if so what did it entail. Secondly, the study inquired into how Indigenous knowledges informed their research decisions and the applications of those decisions. Finally, given that each of these individuals were, or had been, enrolled in western doctoral programs this inquiry asks what were the challenges of using Indigenous methodologies based on an Indigenous worldview. Findings from this study include an assertion of Indigenous methodologies and that this is a relational approach to research: that Indigenous methodologies flow from an Indigenous worldview while needing to be congruent with specific cultural ways and protocols of the differing nations; that Indigenous methodologies encompass an inclusive, broad range of knowing which demands a holistic interpretation of ethical considerations; and that Indigenous methodologies includes decolonizing theory and action. In terms of application, the six individuals of this study affirm that research decisions (e.g. research methods) need to be congruent with the respective cultural epistemologies. Through their research stories. they provide examples of how they achieved this congruency in their methodology. Further, the study illustrates significant factors, such as allies, in nurturing the advancement of this approach to research in western universities. To inquire into this topic, an Indigenous methodology flowing from a Nehiyaw epistemology was used. This approach honours a relational worldview involving both the stories of the research participants as well as a reflective analysis of the researcher's experiences in relationship to kin, kith and community during this journey. To ensure congruency with Nehiyaw epistemology, internal and external efforts were made by the researcher involving her own preparations to undertake this research including adherence to cultural values and protocols. The findings of the research are presented in two manners. The primary presentation is through story which honours the interpretive, oral tradition of Nehiyaw culture. Secondly, to identify recommendations from this research, emergent themes were identified and thematically grouped.

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