The demise of a planned randomised controlled trial in an urban Aboriginal medical service

To fill a gap in knowledge about the effectiveness of brief intervention for hazardous alcohol use among Indigenous Australians, we attempted to implement a randomised controlled trial in an urban Aboriginal Medical Service (AMS) as a joint AMS-university partnership. Because of low numbers of potential participants being screened, the RCT was abandoned in favour of a two-part demonstration project. Only 16 clients were recruited for follow-up in six-months, and the trial was terminated. Clinic, patient, Aboriginal health worker, and GP factors, interacting with study design factors, all contributed to our inability to implement the trial as designed. The key points to emerge from the study are that alcohol misuse is a difficult issue to manage in an Indigenous primary health care setting; RCTs involving inevitably complex study protocols may not be acceptable or sufficiently adaptable to make them viable in busy, Indigenous primary health care settings; and gold-standard RCT-derived evidence for the effectiveness of many public health interventions in Indigenous primary health care settings may never be available, and decisions about appropriate interventions will often have to be based on qualitative assessment of appropriateness and evidence from other populations and other settings.

La gouvernance autochtone en milieu urbain: le cas de Montréal

Au fil des années, les Autochtones ont obtenu la reconnaissance par l’État canadien de certains droits inhérents, soit le droit à l’autodétermination et le droit à l’autonomie gouvernementale. Cependant, lors de la mise en places d’initiatives de gouvernance autochtone, les différents niveaux de gouvernement ont présumé que les groupes revendicateurs disposaient d’une assise territoriale pour réaliser ces objectifs, telles les communautés d’origine des Premières nations, Inuites ou métisses. Or, ces modèles sont inadéquats pour la majorité des Autochtones au pays qui vivent en milieu urbain, une population hétérogène, disparate, très mobile et surtout sans assise territoriale. Pour tenter de concilier l’exercice de l’autonomie gouvernementale avec l’urbanité, certains modèles théoriques de gouvernance ont été élaborés afin de permettre une meilleure représentation politique aux Autochtones en milieu urbain. En gardant à l’esprit la situation de Montréal, c’est-à-dire le problème de l’identité du titulaire du droit à l’autodétermination, le territoire et la nature des pouvoirs à exercer, nous tenterons au cours de ce mémoire de déterminer quel modèle de gouvernance autochtone serait le plus approprié pour les Autochtones de Montréal.

La resignificación cultural mediante la acción colectiva frente a la expansión urbana. Un estudio diagnóstico sobre la problemática del territorio del cabildo indígena muisca-bosa periodo 1999-2013

El propósito del presente estudio diagnóstico, es el de analizar el proceso de reconstrucción de la identidad del Pueblo Indígena Muisca de la Localidad de Bosa, en la ciudad de Bogotá D.C desde el año de 1999 hasta el 2013. Este diagnóstico tiene como punto de partida, el análisis de la pérdida del territorio ancestral por parte de esta comunidad de indígenas urbanos, debido a los proceso de expansión y de urbanización legales e ilegales que tienen lugar en el territorio. Con base en el análisis de los anteriores fenómenos, se estudian las características principales de las comunidades e individuos indígenas presentes en las ciudades, y los retos que enfrentan las instituciones oficiales en materia de desarrollar políticas de reconocimiento con base en modelos de planificación indígena.

(FAB07_002) From the 'Curry to the 'Weal: Aboriginal town camps and compounds of the back-blocks

My involvement with Aboriginal people began in 1972 in my final year of architecture, when a small group of students were asked to advise on some Aboriginal building projects in Mt Isa and Cloncurry. This led to my Doctoral research and grew into the Aboriginal Environments Research Centre now well established at the university of Queensland. Although the personnel of this Centre have completed over 140 field trips in the last 20 years, it is a set of data collected largely from the first ten field trips in 1972-76 that will be presented in this paper.

Aboriginal and Torres Strait Islander health research and the conduct of longitudinal studies: issues for debate

The National Health and Medical Research Council, Research Agenda Working Group (RAWG), and the literature on Indigenous health have identified the need to fill gaps in descriptive data on Aboriginal and Torres Strait Islander health and noted both the lack of research with urban populations and the need for longitudinal studies. This paper presents some of the broad ethical and methodological challenges associated with longitudinal research in Indigenous health and focuses particularly on national studies and studies in urban areas. Our goal is to advance debate in the public health arena about the application of ethical guidelines and the conduct of longitudinal studies in Aboriginal and Torres Strait Islander communities. We encourage others to offer their experiences in this field.

A Home at School: Building Stronger Indigenous People through Cultural Resurgence in an Urban Ontario Public School Context.

In this thesis, I work through the educational narratives of young Aboriginal women and men as I explore the relationship between cultural programming and student engagement. My analysis is structured through a collaborative Indigenous research project. My overarching task is to explore how a cultural support program, the Native Youth Advancement with Education Hamilton (NYA WEH) Program, offered at Sir John A. Macdonald Secondary School, located in Hamilton, Ontario, Canada, attempts to re-imagine Aboriginal education in ways that directly challenge the residential school legacy. In particular, I work to illuminate how particular forms of Aboriginal education are connected to the graduation rates of Aboriginal youth. I argue that the ways in which the NYA WEH Program navigates Native Studies curriculum, relationships, and notions of culture and tradition are significant to the engagement of Aboriginal youth. This research develops theoretical connections between the contemporary experience of Aboriginal social inequality and educational initiatives which attempt to reverse that legacy. By placing the NYA WEH Program narratives side-by-side with literature supporting Aboriginal education for Self-determination, I work to learn how to best support and encourage Aboriginal student engagement in secondary schools across Ontario.

Aboriginal Parental Involvement/Engagement for Student Success

An increasing body of knowledge links parental involvement with student success but few studies address Aboriginal parental involvement in urban settings. While some critics argue traditional Aboriginal knowledge is best delivered at home, Aboriginal children who share parents’ stories in the classroom benefit other children who draw connections to these stories. Moreover, Aboriginal learners need to function in mainstream Western society and in public school settings in which educators often have a difficult time engaging Aboriginal parents. Consequently, this research sought to explore the perceptions and sense of engagement of parents/caregivers in the Aboriginal Student Program (ASP) in a publicly funded secondary school in Ontario. The study was an extension of the researcher’s existing work and focused specifically on a sample of parents/caregivers taking part in an Aboriginal feast at an Ontario secondary school. Nine individuals accepted an invitation to participate in a Talking Circle and shared perceptions of their children’s educational experiences. Data were collected and coded, and findings indicated that parental involvement in children’s educational journeys contributed significantly to a sense of parental engagement in the school and in Aboriginal programs. Results also suggest that Eurocentric pedagogy can be modified in mainstream secondary schools to directly involve Aboriginal parents/caregivers. Although many participants’ stories revealed they experienced racism during their own schooling, study findings demonstrate that the parents/caregivers want to be involved in their children’s education nonetheless. This thesis discusses the data that were grounded in the participants’ voices that in turn led to several key recommendations.

Carotid intima-media thickness, cardiovascular risk factors and albuminuria in a remote Australian Aboriginal community

Background: Rates of cardiovascular disease and renal disease in Australian Aboriginal communities are high, as is the prevalence of some 'traditional' cardiovascular (CV) risk factors, such as diabetes and cigarette smoking. Recent work has highlighted the importance of markers of inflammation, such as C-reactive protein (CRP), homocysteine and albuminuria as predictors of cardiovascular risk in urban westernised settings. It is not clear how these factors relate to outcome in the setting of these remote communities, but very high CRP concentrations have been shown in this and other Aboriginal communities. Methods and results: In a cross-sectional survey including 237 adults in a remote Aboriginal community in the Northern Territory of Australia, we measured carotid intima-media thickness (IMT), together with blood pressure, diabetes, lipid levels, smoking and albuminuria, CRP and fibrinogen, serum homocysteine concentration, and IgG titres for Chlamydia pneumoniae, Helicobacter pylori and cytomegalovirus. Median carotid IMT was 0.63 [interquartile range 0.54-0.71] mm. As a categorical outcome, the prevalence of the highest IMT quartile ('increased IMT', greater than or equal to0.72 mm) was compared with the lower three quartiles. Increased IMT was associated in univariate analyses with greater waist circumference, systolic BP, fibrinogen and serum albumin concentrations, urine albumin/creatinine ratio and older age as continuous variables. Associations of increased IMT with some continuous variables were not linear; univariate associations were seen with the highest quartile (versus all other quartiles) of CRP and homocysteine concentration and CMV IgG titre. In a multivariate model age, smoking, waist circumference and the highest quartile of CRP concentrations (greater than or equal to14 mg/l) remained significant predictors of IMT greater than or equal to0.72 mm. Conclusions: Measurement of carotid IMT was possible in this remote setting. Increased IMT (greater than or equal to0.72 mm) was associated with increased CRP concentrations over a range that suggests infection/inflammation may be important determinants of cardiovascular risk in this setting. The associations of IMT with markers of renal disease seen in univariate analyses were explained in this analysis by confounding due to the associations of urine ACR with other risk factors. (C) 2004 Published by Elsevier Ireland Ltd.

The practice of participatory planning at Mapoon Aboriginal settlement: Towards community control, ownership and autonomy

The practice of participatory planning in discrete Indigenous settlements has been established since the early 1990s. In addition to technical and economic goals, participatory planning also seeks community development outcomes, including community control, ownership and autonomy. This paper presents an evaluation of one such planning project, conducted at Mapoon in 1995. The Plan successfully improved physical infrastructure and housing, but had mixed success in terms of community development. Despite various efforts to follow participatory processes, the Plan was essentially a passing event, community control progressively diminished after its completion, and outcomes fell short of notions of ownership and autonomy. This suggests some misunderstandings between the practice of participatory planning and the workings of governance.