This qualitative study explored how people with experience of imprisonment and injecting drug use in Iceland understand drug-related harm in prison and the role of harm reduction. It adds qualitative evidence from a small prison system where social proximity, limited anonymity and concerns about trust and confidentiality shape understandings of harm, safety and support. Six participants aged 25-35 were interviewed, and the data were analysed thematically within an interpretive description framework. Participants described prison drug use as continuing dependence under hidden, unsafe and degrading conditions. Four themes were identified: (a) You always find a way; (b) Pushed into hiding; (c) Deepened suffering and shame; and (d) Seeking safety under surveillance. Together, these form the overarching interpretation, "Living with addiction in the shadow of punishment". Harm reduction went beyond access to sterile equipment. It was seen as humane, health-oriented care that could reduce injury and preserve dignity. The findings suggest that unmet harm reduction needs in prison may increase risk by pushing drug use further into secrecy and distancing people from care. In Iceland, where prisons are few, social worlds overlap and anonymity is limited, participants identified trust, confidentiality and independence from punitive authority as key conditions for harm reduction.

The COVID-19 pandemic disrupted healthcare access globally through restrictions aimed at limiting virus transmission. Using a cross-sectional design, this project explored perceived barriers to and facilitators of healthcare access during the pandemic in remote Indigenous communities in Northwest Territories (NWT), Canada. Convenience sampling was utilised to recruit self-identifying Indigenous adults (≥18 years) within 10 NWT communities. Information was collected through an interviewer-administered questionnaire exploring experiences with, barriers to, and facilitators of healthcare access during the COVID-19 pandemic. Among the 287 participants (mean age 41.63 years; 66.55% women), 17.42% reported having avoided healthcare service utilisation during COVID-19 due to the risk of exposure. Of participants with a current prescription, 15.73% reported difficulty accessing prescription medications. Some partcipants (7.69%) reported difficulty accessing traditional medicines and healers. The participants reported that many services were disrupted by shortages of healthcare providers, service delays and cancellations, public health measures, and medical travel disruptions. A total of 35.89% of participants utilised virtual care, and while many found it was convenient for certain needs, some reported that it was inadequate. The findings highlight the perceived challenges to healthcare access in NWT during the pandemic. These challenges are closely tied to the healthcare context in the region, which depends heavily on medical travel and visiting specialist clinics.

Disability is increasingly understood as a socially and culturally situated experience shaped by relationships, environments, and systems of recognition. However, limited research has examined how disability is perceived and experienced within Inuit communities. This paper draws on a secondary qualitative analysis of interviews with 126 Nunavummiut across 12 communities in Nunavut, conducted as part of a community-led study by Nunavummi Disabilities Makinnasuaqtiit Society. Guided by Inuit Qaujimajatuqangit and the Piliriqatigiinniq Research Model, the analysis explores how disability becomes visible, recognized, and responded to within Inuit social contexts. Findings reveal that disability is not experienced as a fixed or visible category but emerges through four dynamics: (1) invisibility as social and structural absence, (2) hypervisibility as exposure, (3) relational visibility through belonging and contribution, and (4) collective adaptation as shared responsibility. These dynamics show how disability shifts between institutional systems of diagnosis and relational community contexts of participation. The study highlights a central tension between structural invisibility, reinforced by limited services and colonial systems of classification, and relational inclusion, enacted through kinship networks and collective care practices. Findings challenge deficit-based models and support culturally grounded, community approaches to policy and service delivery. The study contributes to discussions of disability as culturally and relationally shaped.

This article presents a PhD protocol for an Indigenous-led qualitative study exploring protective factors and recovery processes among Indigenous Kalaallit Inuit (Greenlandic Inuit) youth in Kalaallit Nunaat (Greenland) following suicide attempts. The majority of the population in Kalaallit Nunaat is Indigenous Kalaallit Inuit. The study is grounded in Kalaallit Inuit values and inspired by selected principles of community-based participatory research. Thirty interviews will be conducted in Kalaallisut (Greenlandic) across five regions through in-person and online modalities, as structured through a culturally and linguistically grounded interview guide. The project centers the principle of "Nothing About Us Without Us," emphasizing community ownership, language-based access, and reciprocal accountability. The project methodologically explores the feasibility of trauma-informed, trust-based interviewing in small Arctic communities and investigates the importance of spirituality, land, and cultural revitalization in healing. In addition to methodological and thematic insights the project aims at creating a transferable model for ethical, community-engaged suicidology in Arctic Indigenous contexts. Thematic findings will be published in forthcoming articles. As this article presents a PhD protocol, no empirical findings are reported. The manuscript describes the study rationale, Indigenous theoretical foundations, methodology, ethical considerations, planned analyses, and dissemination strategy guiding the doctoral project.

While the category of "race" has no scientific foundation, race and subsequent racism continue to be determinants of access to health for Indigenous communities globally, including for Inuit in Canada. This scan raised concerns from community members voicing racial inequities in healthcare. The aim of this review was to scan Canadian Inuit experiences of racism in healthcare. To date, no such work has been done, and contemporary Inuit experiences of racism in the healthcare context have not been systematically documented. We hope that this review will serve as a foundation for scholars, policy makers and/or Inuit-community-based organisations to engage with this issue further. We conducted an environmental scan from 2000 to 2024 of peer-reviewed and grey literature to explore Canadian Inuit experiences of racism in healthcare. Our scan identified 16 sources. We analysed sources using the following: systemic or interpersonal racism, and then distinguishing if racism was explicitly mentioned or inferred by the authors. We found medical evacuation, women's health issues, cancer care and postoperative outcomes to be places where racism in healthcare has been documented. Overall, we hope that this review draws much-needed attention to this issue and contributes to the imagination of a new way of practice.

Ambulance services in sparsely populated circumpolar regions operate over large distances with limited access to alternative care, potentially expanding their role beyond transport to assessment, decision-making, and healthcare navigation. In such settings, conveyance decisions involving children and young people (CYP) may be complex for ambulance clinicians. This retrospective study examined factors associated with non-conveyance and subsequent healthcare contacts among CYP assessed by ambulance clinicians in northern Sweden and compared characteristics of conveyed and non-conveyed patients. Assessments of patients aged 0-17 during 2020-2023 were included. Logistic regression identified factors associated with non-conveyance, and unscheduled healthcare contacts within 72 hours were examined. Non-conveyance occurred in 39% of assignments. Non-conveyed patients were younger and more often assessed for respiratory conditions and infections, whereas conveyed patients more commonly presented with trauma and neurological conditions. Younger age, assignments outside office hours, and rural location were associated with non-conveyance. One quarter of non-conveyed patients had an unscheduled healthcare contact within 72 hours. The findings suggest that non-conveyance is part of a broader healthcare pathway rather than solely the end of an ambulance assignment. Child-specific guidance for assessment, referral, and follow-up, alongside strengthened decision support for ambulance clinicians, may contribute to safe non-conveyance decision-making in remote regions.

Small and geographically isolated societies face distinct challenges during a pandemic but may also possess advantages. This narrative literature review presents epidemiological, immunological and psychological studies conducted in the Faroe Islands during the SARS-CoV-2 pandemic, examining its effects on individuals in the Faroe Islands. The COVID-19 pandemic hit the Faroe Islands early in March 2020. With only around 55,000 inhabitants, the Faroe Islands' isolated, well-documented population enabled extensive epidemiological research and close monitoring of infection patterns. This resulted in studies on transmission, immunity, mental health and long COVID. Overall, the Faroese studies demonstrate how small, cohesive societies with robust infrastructure can conduct high-quality research during a crisis, contributing to both local and global knowledge.

American Indian/Alaska Native (AI/AN) peoples experienced some of the highest rates of coronavirus disease 2019 (COVID-19) disease in the United States. However, there are limited data on COVID-19 vaccine effectiveness in this population. We performed a test-negative case‒control study using electronic health record data to evaluate the effectiveness of the original three FDA-authorised vaccines to prevent COVID-19-associated hospitalisations among AI/AN adults during 2021-2022. COVID-19 vaccines were effective in preventing COVID-19-associated hospitalisation, intensive care unit admission, mechanical ventilation and death in this population. However, vaccine effectiveness waned over time and during the post-Omicron variant time period. Booster vaccination proved effective during a period when the Omicron variant was circulating. Waning effectiveness with time and the introduction of new variants supports the need to stay up-to-date with SARS-CoV-2 vaccination. Evaluating vaccine effectiveness using electronic health records proved to be a useful tool during a pandemic.

Primary healthcare (PHC) providers working in Manitoba First Nations (FNs) communities have anecdotally reported that the workload they face does not match staffing levels, leaving the care they provide comparable to a walk-in clinic, especially in communities with a population over 2,500. The purpose of this study was to evaluate the capacity of Nursing stations to deliver PHC services in FN communities with populations greater than 2,500, compared to smaller FN communities with populations less than 2,500, by analysing markers of chronic kidney disease (CKD) quality care among individuals living with CKD. We also assessed whether different models of care might reduce disparities in health outcomes. This partnership between researchers from the First Nations Health and Social Secretariat of Manitoba and the University of Manitoba used health administrative data held at the Manitoba Centre for Health Policy (2006-2019), linked to the Manitoba First Nations Research File to identify FNs. Data used included: Diagnostic Services Laboratory Data, Medical Claims, Hospital Discharge Abstracts, Drug Program Information Network Data, Public Canadian Census Files, Manitoba Health Insurance Registry and Physician Resource File. All records were de-identified. PHC visits and hospitalisation rates were higher in larger communities, suggesting a tendency to refer patients more readily to a higher level of care. In contrast, FNs living with CKD in smaller communities are more likely to receive follow up kidney function screening. Premature mortality rates for FNs living with CKD remain lower in larger communities. Our findings show that access to responsive PHC in Manitoba's rural and remote communities remains aspirational and may reflect pragmatic adaptations to workload pressures. There is an urgent need to assess the economic and health impact of these adaptations, to ensure that they result in optimal health results and progress equity for FNs, Manitobans, and those living in rural and remote communities.

Pilot whale has for centuries been part of the traditional diet in the Faroe Islands; however, since the late 1970s, concerns about contamination have resulted in ongoing dietary advisories. This cross-sectional survey examines consumption frequency, cultural importance, risk perception and awareness of contaminants and advisories related to pilot whale in the Faroese population among residents aged 18-70 years randomly selected from the Faroese Population Registry. In all 1,492 respondents were included in the final analysis. The results indicate that most participants consume pilot whale meat to some extent, with 78% consuming dried and 65% consuming cooked pilot whale meat, although consumption patterns vary across demographic characteristics. Older age groups demonstrated significantly higher awareness of official dietary advisories and contaminants compared to the youngest age group (2008 advisory: 97% vs. 60%; 2011 advisory: 85% vs. 52%; contaminants: 100% vs. 89%), while the youngest age group expressed more positive attitudes toward the cultural importance of pilot whale (80% vs. 68%). These findings provide important insights into dietary behaviour and contaminant-related risks associated with pilot whale consumption in the Faroe Islands and highlight the need for risk communication and public health messaging that account for demographic differences and cultural importance.

Emotional and behavioural problems in Indigenous Sámi and non-Sámi preschool children in Norway were examined in a sample, including 332 Sámi children and 4,777 non-Sámi children, from the Norwegian Mother, Father and Child Cohort Study (MoBa). Problems at 1.5, 3 and 5 years of age were measured by an abbreviated version of the Child Behaviour Checklist (CBCL). Linear mixed models were used to analyse differences in internalising and externalising symptoms over time with a focus on the influence of ethnicity, Sámi parental background and local community context. Overall, no significant differences in emotional and behavioural problems were found between Sámi and non-Sámi children. Minority/majority status and parental practices are discussed as possible explanations for the interaction effect of gender, Sámi parental background and community context on externalising problems. The results indicate the need for culturally sensitive interventions in health services, prevention strategies and further research in Indigenous children.

Supporting maternal mental health is a priority in circumpolar settings, where seasonality and constrained service availability can limit psychosocial support. This qualitative study explored pregnant women's and healthcare providers' experiences of a postpartum depression prevention programme and perspectives on integrating it into routine antenatal care in Arkhangelsk, Northwest Russia. Four focus group discussions with pregnant women (n = 17) and individual interviews with four healthcare providers were analysed using reflexive thematic analysis. Participants described the programme as providing trusting spaces for sharing, expert-led preparation for childbirth and the postpartum period, and brief individual follow-up after birth. Women reported greater confidence in identifying signs of vulnerability, articulating needs, and accessing support. Providers highlighted that these benefits depended on feasible scheduling, group formats, reusable materials, and coordinated delivery across professionals to avoid fragmentation. System-level factors (reach, retention, and cross-provider coordination) were seen as central for sustained uptake and routine integration. The findings suggest that the programme's contribution lies in the interaction between participant experiences of support and the organisational conditions needeed to sustain them in routine antenatal care. Preventive perinatal mental health programmes in circumpolar contexts can strengthen preparedness and help-seeking when designed for relational participation and supported by coordinated service structures.

Data from a population-based birth cohort of 4,208 individuals born in the Faroe Islands between 1927 and 1937 were linked to adult mortality records to examine the association between maternal parity and offspring mortality. Among men, a trend was observed between maternal parity ≥ 1 and risk of all-cause mortality (hazard ratio [HR], 1.247; 95% confidence interval [CI], 0.992-1.502; p = 0.088). No corresponding association was observed among women. When maternal parity was categorised into three levels, inverse associations were observed in women: those born to mothers with parity > 4 had borderline lower risk of all-cause mortality (HR 0.712; 95% CI 0.367-1.057; p = 0.055), a borderline lower risk of premature death (HR 0.655; 95% CI 0.198-1.111; p = 0.069), and a significantly reduced risk of cancer mortality (HR 0.457; 95% CI 0.000-0.915; p = 0.027). These findings indicate a potential sex-specific influence of maternal parity on adult offspring mortality.

Sauna bathing is a culturally significant practice in Nordic countries and is increasingly recogniced as a multidimensional health-promoting behavior. Although its physiological benefits are well-documented, less is known why people engage in sauna bathing and how they perceive its contribution to health and well-being. To investigate why Swedish women and men engage in sauna bathing and to describe their perceptions of sauna bathing as a health-promoting practice. A descriptive cross-sectional study was conducted using an online questionnaire completed by 588 regular sauna bathers (384 women and 204 men). The questionnaire included closed-ended items on health and sauna habits and open-ended questions exploring motivations for sauna bathing. Qualitative data were analysed using inductive thematic analysis, and quantitative data were analysed using descriptive and analytic statistics. Thematic analysis generated a conceptual model of sauna bathing as a health-promoting practice comprising four interconnected themes: mental recovery, social togetherness, purification and physical health. Mental recovery was the prominent motivation among women, whereas social togetherness ranked highest among men. Participants described sauna bathing as promoting relaxation, reflection, social connection, physical recovery, and a sense of cleanliness and renewal. Women reported significantly better perceived sleep quality and reduced perceived bodily pain following sauna bathing, whereas no corresponding significant changes were observed by men. Sauna bathing was perceived as a multidimensional health-promoting practice integrating psychological, social, cultural, and physical dimensions of health. The findings provide a conceptual understanding of why people engage in sauna bathing and support its potential role as a person-centered health promotion strategy. Prospective studies are needed to confirm these self-reported findings.

In Nunavut, public health management of tuberculosis (TB) remains a challenge due to social and economic inequities, geographic isolation, TB-related stigma, and distrust in healthcare linked to a history of colonialism. A TB outbreak was declared in Naujaat, Nunavut following an increase in reported cases starting in January 2023. In response to this outbreak, the Naujaat community-wide TB screening (CWS) clinic was held from April 15th to May 29th, 2024, with support from the Nunavut Tunavik Incorporated (NTI) leadership and community engagement teams. This article outlines the steps taken in the coordination and implementation of a large public health intervention in this remote, northern community. Despite significant logistical challenges, the CWS clinic screened 89.2% of the 1000-person target consisting of all previously unscreened individuals residing in the community. As a result, 31 individuals with latent TB infection and <5 active TB cases were diagnosed and offered treatment, representing nearly 4% of those undergoing 2-step testing. Although the screening outcomes suggested that community transmission was low at the time of community-wide screening, it nonetheless exceeded the WHO threshold of 0.5% prevalence for community-wide screening. Lessons learned through the Naujaat CWS can help inform future public health actions towards TB elimination in Nunavut and other circumpolar jurisdictions.