Objectifs : Évaluer l’incidence de la macrosomie fœtale en fonction des différentes définitions (poids de naissance >4000g, >4500g, ≥90ième percentile de Kramer) en vigueur et comparer la prévalence de la morbidité maternelle et périnatale associée à la macrosomie entre les populations Cris et les populations du Québec. Des courbes postnatales spécifiques aux Cris de l’Est de la Baie-James seront proposées. Devis : Comparaison de deux cohortes prospectives Cris et Québec. La cohorte des populations Cris de l’Est de la Baie-James, comporte 2546 femmes recrutées de 2000-2010, au cours de l’étude sur la macrosomie fœtale chez les Cris de l’Est de la Baie James. La cohorte du Québec est composée de 97475 femmes et provient de l’essai clinique randomisé multicentrique QUARISMA, 2008-2010, cette étude promulguant la réduction du taux d’accouchement par  césarienne. Méthodes : Les risques de macrosomie fœtale et de la morbidité maternelle et périnatale sont évalués par des modèles de régression logistique d’équations d'estimation généralisées (EEG) ajustés et comparés selon l’ethnicité, Cris et Québec. GEE. Le groupe de référence étant les femmes du Québec. Les courbes de croissance spécifiques aux Cris sont construites par régression quantile. Résultats : Plus du tiers, soit 36,76%, des Cris et 9,329% des nouveau-nés du Québec, ont un poids de naissance >4000g. Les résultats attestent montrent que 10,92% des Cris de l’Est de la Baie-James ont un poids de naissance de plus de 4500g, ce taux est de 1,23% au Québec. La définition de la macrosomie fœtale, par un poids néonatal ≥90ième percentile de Kramer, identifie 40,02% des bébés Cris, pour 8,83% des nourrissons du  Québec, comme macrosomes. Les Cris sont plus à risque de macrosomie fœtale, comparativement à la population générale du Québec, ces associations sont statistiquement significatives : RC=5,22; 95% IC (4,66-6,05,98), pour un poids de naissance >4000g, RC=8,10; 95% IC (6,22-10,77), pour un poids de naissance >4500g et RC=6,22; 95% IC (5,77-6,72), pour un poids de naissance ≥90ième percentile de Kramer. Le risque de la morbidité périnatale majeure, de la macrosomie fœtale, est généralement moins important pour les Cris que pour la population générale du Québec : 0,76; 95% IC 0,62-0,94. La macrosomie fœtale devrait être décrite par un poids de naissance≥95ième percentile de Kramer, pour les Cris, mais préférablement au 90ième percentile des courbes postnatales spécifiques aux Cris de l’Est de la Baie-James. Les poids de naissance diagnostique spécifiques aux Cris de l’Est de la Baie-James, au 90ième percentile de la 40ième semaine d’aménorrhée, sont de 4 417g pour les filles et 4 488g pour les garçons. Conclusions : Les courbes de Kramer diagnostiquent systématiquement plus de macrosomes chez les Cris que dans la population du Québec. Par contre, le risque de morbidité périnatale majeure est inférieur pour ces communautés autochtones, aux différents seuils décrivant la macrosomie fœtale, ce qui suggère l’utilisation de courbes spécifiques aux Cris et permettrait de diminuer les interventions obstétricales non nécessaires chez les gros bébés Cris, donc non-macrosomes. / Objective: Assess the impact of fetal macrosomia based on definitions (birth weight> 4000 g,> 4500g, ≥90ième percentile Kramer) currently used in Quebec and compare the prevalence of maternal and perinatal morbidity associated with macrosomia between the Cree populations of Eastern James Bay and the general population of Quebec. Specific postnatal curves for the Cree will be constructed. Design: Comparison of two prospective cohort Cree and Quebec. Cohort of Cree populations of eastern James Bay, has recruited 2546 women from 2000 to 2010, during the study of fetal macrosomia in the Cree of eastern James Bay. Quebec cohort consisted of 97,475 women and comes from the multicenter randomized clinical trial QUARISMA 2008-2010, this study promulgates the reduction of caesarean delivery rate. Methods: The risk of fetal macrosomia, maternal and perinatal morbidity, by ethnicity, Cree and Quebec, are evaluated by generalized estimating equations models (GEE). GEE models were adjusted to control for potentially confounding factors. The reference group is Quebec women. The specific growth curves of the Cree are built by quantile regression. Results: More than a third, 36.8%, of Cree populations of Eastern James Bay and 9.3% of newborns in Quebec have a birth weight> 4000g. For a birth weight> 4500g, the results show that 10.9% of the Cree, have a birth weight of more than 4500g, the rate is 1.2% in Quebec. The definition of fetal macrosomia by neonatal birth weight≥90th percentile of Kramer identifies 40.02% Cree’s for 8.8% of infants of Quebec as macrosomic. The Cree population are more at risk of fetal macrosomia, compared to the general population of Quebec, these associations were statistically significant: OR = 5.2; 95% CI (4.6 to 6.0) for birth weight> 4000g, OR = 8.1; 95% CI (6.2 to 10.7) for birth weight> 4500g and OR = 6.2; 95% CI (5.7 to 6.7) for birth weight percentile ≥90th Kramer. The risk of major perinatal morbidity associated with fetal macrosomia, is generally less important for the Cree than for the general population of Quebec: 0.76; 95% CI 0.62-0.94. Fetal macrosomia should be described by birth weight ≥95th percentile of Kramer, for the Cree, but preferably at the 90th percentile of the specific postnatal curves of Cree populations of Eastern James Bay. The specific Cree birth weight thresholds for diagnosing fetal macrosomia, at the 90th percentile of the 40th week of gestation, are 4 417g for the girls and 4 488g for the boys. Conclusion: Kramer’s curves diagnose systematically too much macrosomic Cree babies compare to the general population of Quebec. Futhermore, the risk of major maternal and perinatal morbidity is lower for these indigenous communities, at the different definitions of fetal macrosomia, suggesting the use of specific curves for the Cree, to reduce obstetrics interventions not required in large, but non macrosomic, Cree babies.

Le diabète de type 2 affecte en moyenne 29% de la population adulte crie d’Eeyou Istchee (CEI). Afin d’identifier les plantes médicinales possédant un potentiel antidiabétique, des interviews ont été réalisés dans les communautés CEI de Wemindji et Oujé-Bougoumou. Utilisant une approche quantitative, les espèces mentionnées ont été classées et comparées à la pharmacopée des communautés avoisinantes. Seize et 25 plantes ont été mentionné à Wemindji et Oujé-Bougoumou, respectivement. Sept nouvelles espèces de plantes et une de champignon se sont ajoutées à la liste des espèces à potentiel antidiabétique, bien que la plupart de celles mentionnées pendant les interviews soit en communes à la pharmacopée CEI générale, démontrant ainsi leur importance culturelle. Des analyses phytochimiques sur deux de ces espèces, Rhododendron groenlandicum et Sarracenia purpurea, ont été réalisées à partir d’échantillons récoltés à différents endroits du territoire eeyouch. Bien qu’aucun patron n’ait été détecté dans la variation des composantes biologiquement actives chez S. purpurea, les composés phénoliques chez R. groenlandicum, particulièrement la (+)-catéchine, l’(-)-epicatéchine et la quercétine-3-galactoside, varient spatialement en fonction de paramètres d’insolation telles la radiation solaire ou la photopériode. Les échantillons de cette dernière espèce, testés in vitro dans le bioessai de l’adipogenèse des cellules adipocytes murines 3T3-L1, augmentent l’accumulation intracellulaire des triglycérides, leur conférant ainsi une activité diabétique semblable à la rosiglitazone. Cependant, cette activité était plus faible dans les échantillons à haute teneur en quercétine, cela pouvant ainsi avoir un impact sur la qualité d'un produit de santé naturel fabriqué à partir de cette espèce. / Type 2 diabetes has reached epidemic proportions among Canada’s aboriginal populations and affects on average 29% of adult Cree of Eeyou Istchee (CEI). In collaboration with the Cree Board of Health and Social Services of James Bay and the CIHR team in Traditional Antidiabetic Aboriginal Medicines, interviews were held in the CEI communities of Wemindji and Oujé-Bougoumou to identify potential antidiabetic plants. Using a quantitative approach, species mentioned were ranked and compared to the pharmacopoeia of other participating communities. Sixteen and 25 plants were mentioned in Wemindji and Oujé-Bougoumou respectively. Seven new plant and one fungal species were added to the list of potential antidiabetic species, although most of those mentioned were common to the general CEI pharmacopoeia, thus supporting the cultural importance that they hold. Phytochemical analyses of two of these species, Rhododendron groenlandicum and Sarracenia purpurea, were made from accessions harvested throughout Eeyou Istchee. While no pattern was detected in the variation of S. purpurea’s biologically active compounds, phenolic compounds from R. groenlandicum, specifically (+)-catchin, (-)-epicatechin and quercetin-3-galactoside, varied spatially as a function of insolation parameters such as solar radiation or photoperiod. Samples from the latter, tested in vitro in the 3T3-L1 murine adipocytes adipogenesis bioassay, increased the intracellular accumulation of triglycerides, thus conferring it a glitazone-like antidiabetic activity. This activity, however, was weaker in accessions with high quercetin content, which could have an impact on the quality of a natural health product made from this species.

A study was undertaken of plants used for treatment of diabetic symptoms by traditional healers of the Eeyou Istchee Cree (Canada), Lukomir Highlanders (Bosnia & Herzegovina), and Q’eqchi’ Maya (Belize). All antidiabetic plants were ranked by syndromic importance value (SIV) based on 15 symptoms, all of which were recognized by the Cree and Maya and 8 by the Highlanders. The Cree used only 18 species, the Highlanders 41, and the Maya 150, numbers which reflect the diversity of flora in their region. Vaccinium (Ericaceae) was one of the few genera in all three regions and the only consensus genus between the Cree and Highlander study sites. The Q’eqchi’ Maya ethnobotany did not present any cross-cultural consensus genera with Cree or Highlander medicinal plants, perhaps due to major biogeographic differences. In ethnopharmacological studies, Vaccinium species and Q’eqchi’ antidiabetic plants were tested in an assay relevant to diabetes, the advanced glycation endproduct (AGE) inhibition assay. Boreal and tropical Vaccinium species were potent inhibitors of AGEs and demonstrated concentration dependent inhibition, with a half maximal inhibitory concentration (IC50) range of 5.93–100 µg/mL. Phenolic content ranged from 80.3 to 201 µg/mL in boreal samples and from 1470 to 2170 µg/mL in tropical samples. Tropical species have a greater phenolic content and AGE inhibition. Seven Q’eqchi’ antidiabetic plant species were tested and all plant extracts showed AGE-inhibition. The IC50s ranged from 40.8 to 733 µg/mL, and the most active was Tynanthus guatemalensis Donn.. Tynanthus guatemalensis IC50 was about fives times greater (less active) than the mean ± SE IC50 reported for six tropical Vaccinium species of Vaccinium (8.77 ± 0.79 μg/mL). The highest consensus and most active Maya antidiabetic plant, Tynanthus guatemalensis Donn. Sm. was discovered to be an important plant recorded in archeological artifacts from the Late Classic Maya period (~750 CE). Ancient Maya used a cross shaped sign (k’an glyph) as a decorative element on Late Classic polychrome vessels and murals. The sign was believed to be the xylem template for a plant used as a flavouring in cacao drinks. However, the plant was incorrectly identified in the literature as Pimenta dioica (L.) Merr. (common name: Allspice) based on a common name and aromatic plant quality – not from a botanical voucher specimen. Pimenta dioica wood does not have a cross shape visible in the xylem but a unique character visible after a cross section of T. guatemalensis, is the xylem's cross shape organization. Wood of T. guatemalensis' also has an "allspice" aroma. Tynanthus guatemalensis is most likely the true botanical template behind the ancient Maya k’an glyph and this finding would show the continuity of use of this medicinal plant from ancient to modern times. Vaccinium was selected for an in depth phytochemical analysis using modern metabolomic methods. Nuclear magnetic resonance (1H NMR) was used to evaluate leaf extract spectra to provide information on (1) the taxonomic identity and (2) quantities of bioactive metabolites across multiple sites. Spectra clearly differentiated leaf samples of V. angustifolium, V. boreale, V. corymbosum, V. macrocarpon, V. myrtilloides, V. myrtillus, V. ovalifolium, and V. uliginosum according to generic, subgeneric, specific, phenotypic circumscriptions. Quantification of chlorogenic acid and hyperoside were replicated with a method that is highly reproducible across multiple sites with different NMR equipment. This methodology provides an important new approach to taxonomy and quality control for plants and natural health products.

A study was undertaken of plants used for treatment of diabetic symptoms by traditional healers of the Eeyou Istchee Cree (Canada), Lukomir Highlanders (Bosnia & Herzegovina), and Q’eqchi’ Maya (Belize). All antidiabetic plants were ranked by syndromic importance value (SIV) based on 15 symptoms, all of which were recognized by the Cree and Maya and 8 by the Highlanders. The Cree used only 18 species, the Highlanders 41, and the Maya 150, numbers which reflect the diversity of flora in their region. Vaccinium (Ericaceae) was one of the few genera in all three regions and the only consensus genus between the Cree and Highlander study sites. The Q’eqchi’ Maya ethnobotany did not present any cross-cultural consensus genera with Cree or Highlander medicinal plants, perhaps due to major biogeographic differences. In ethnopharmacological studies, Vaccinium species and Q’eqchi’ antidiabetic plants were tested in an assay relevant to diabetes, the advanced glycation endproduct (AGE) inhibition assay. Boreal and tropical Vaccinium species were potent inhibitors of AGEs and demonstrated concentration dependent inhibition, with a half maximal inhibitory concentration (IC50) range of 5.93–100 µg/mL. Phenolic content ranged from 80.3 to 201 µg/mL in boreal samples and from 1470 to 2170 µg/mL in tropical samples. Tropical species have a greater phenolic content and AGE inhibition. Seven Q’eqchi’ antidiabetic plant species were tested and all plant extracts showed AGE-inhibition. The IC50s ranged from 40.8 to 733 µg/mL, and the most active was Tynanthus guatemalensis Donn.. Tynanthus guatemalensis IC50 was about fives times greater (less active) than the mean ± SE IC50 reported for six tropical Vaccinium species of Vaccinium (8.77 ± 0.79 μg/mL). The highest consensus and most active Maya antidiabetic plant, Tynanthus guatemalensis Donn. Sm. was discovered to be an important plant recorded in archeological artifacts from the Late Classic Maya period (~750 CE). Ancient Maya used a cross shaped sign (k’an glyph) as a decorative element on Late Classic polychrome vessels and murals. The sign was believed to be the xylem template for a plant used as a flavouring in cacao drinks. However, the plant was incorrectly identified in the literature as Pimenta dioica (L.) Merr. (common name: Allspice) based on a common name and aromatic plant quality – not from a botanical voucher specimen. Pimenta dioica wood does not have a cross shape visible in the xylem but a unique character visible after a cross section of T. guatemalensis, is the xylem's cross shape organization. Wood of T. guatemalensis' also has an "allspice" aroma. Tynanthus guatemalensis is most likely the true botanical template behind the ancient Maya k’an glyph and this finding would show the continuity of use of this medicinal plant from ancient to modern times. Vaccinium was selected for an in depth phytochemical analysis using modern metabolomic methods. Nuclear magnetic resonance (1H NMR) was used to evaluate leaf extract spectra to provide information on (1) the taxonomic identity and (2) quantities of bioactive metabolites across multiple sites. Spectra clearly differentiated leaf samples of V. angustifolium, V. boreale, V. corymbosum, V. macrocarpon, V. myrtilloides, V. myrtillus, V. ovalifolium, and V. uliginosum according to generic, subgeneric, specific, phenotypic circumscriptions. Quantification of chlorogenic acid and hyperoside were replicated with a method that is highly reproducible across multiple sites with different NMR equipment. This methodology provides an important new approach to taxonomy and quality control for plants and natural health products.

This thesis relies on an interdisciplinary framework to conduct an investigation of seminal national policies and planning processes in New Zealand and Quebec Province, Canada related to sovereignty, indigenous land rights, and customary land tenure systems. Theoretical frameworks for this research include a comparative analysis of European legislative systems and traditional planning frameworks in relation to indigenous governance systems and land tenure systems for the Maori (NZ) and James Bay Cree (QC). Through interviews and experiential knowledge I will document tools and techniques that these indigenous communities use to navigate complex cross-cultural policy and planning processes for their own advocacy of cultural heritage values. From the Maori perspective, cultural heritage values include the concept and principles of kaitikatanga. James Bay Cree cultural heritage values include the concept and guiding principles embedded in Eeyou Iyihtiwin. These cultural heritage values represent abstract concepts and guiding principles that are embedded in and gain meaning from local context, cultural knowledge and customary traditions. The Maori and James Bay Cree share a similar orientation to the meaning and importance of land. Together these indigenous communities view land as the foundation for collective and individual identity and cultural traditions. From this perspective and meaning of land, the Maori and James Bay Cree recognize that people are a part of a greater interconnected system that spans across physical and metaphysical spaces. In practice, native or customary land tenure systems are based on cultural heritage values that support a spirit of reciprocity with an underlying expectation that a balanced system will provide for all life. This analysis may provide a new cross-cultural framework for policy and planning processes to provide opportunities for fair negotiation of sustainable land tenure systems and natural resource management.