Guidance for ethical research in Indigenous communities
Cultural competence and collaboration necessary to encourage trust, ethical data collection and use (Issue number 221; 1,500 words, 7 minutes)
For too long, research on Indigenous communities has been conducted by outside groups, often sidelining Indigenous perspectives and offering little in return. Today, there’s a clear call for a new approach: culturally respectful, Indigenous-led studies that foster transparency and empower the communities they seek to understand.
Dr. Rachel Asiniwasis explored this idea during a presentation at the 4th annual Indigenous Skin Spectrum Summit.
“We have to be able to, as researchers, commit to respectful relationships,” said Dr. Asiniwasis, a dermatologist in Regina. Since 2015, she and her team have expanded to service several remote and northern First Nations communities around Saskatchewan through in-person and teledermatology clinics.
During her talk, she discussed a strategic plan developed by three agencies—the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council of Canada, and the Social Sciences and Humanities Research Council—to improve and promote research on Indigenous peoples and communities.
Key principles of the strategic plan mentioned by Dr. Asiniwasis include:
Self-determination. Indigenous communities have a right to determine their research priorities.
Decolonization of research. Investigators should ensure that research engages with the peoples and communities being studied.
Accountability. When conducting research on communities, investigators should identify the benefits and impacts on the community. The communities should be engaged in that context when developing research protocols and ethics.
Equitable access. Stakeholders should ensure fair access to research and reconciliation grants, student support and researchers, tools and funding opportunities for Indigenous researchers, and foster the next generation of investigators.
Bottom line: Several principles support fairness and trust in research with Indigenous communities. These principles should guide plans for research conducted on Indigenous lands when recruitment criteria include Indigenous identity as a factor, when researchers seek input on culture, traditional knowledge or other unique characteristics, and when those characteristics are variable for analysis.
From the literature on dermatology in skin of colour
Systematic review of the evidence for treatment and management of common skin conditions in resource-limited settings: An update
This systematic review assessed the evidence for treating skin infections, including impetigo, scabies, crusted scabies, and tinea, in resource-limited settings where skin infections are endemic.
The investigators also assess treatment evidence for atopic dermatitis, molluscum contagiosum, and head lice in endemic settings. Data from this systematic review have supported an update to the Australian National Healthy Skin guidelines.
Researchers conducted two separate searches in the MEDLINE, PubMed, Embase, CINAHL, Cochrane, and Web of Science databases for the review. The first search was an update of a 2018 systematic review using the same search strategy for the same skin conditions to identify emerging literature from 2018 to 2022. The second search strategy used the same key terms but with the addition of atopic dermatitis, head lice, and molluscum contagiosum from 1960 to 2022. Eligible studies included Indigenous peoples and populations in resource-limited settings. Researchers excluded studies conducted in high-income countries. Of 1,466 original articles identified, 68 studies were included.
In the open-access paper, the authors outline key findings for impetigo, scabies, crusted scabies, atopic dermatitis, head lice, and molluscum contagiosum and make recommendations for each condition based on the available evidence.
Geospatial assessment of American Indian/Alaskan Native access to dermatologists: Distances and travel times from reservations
Researchers cross-sectionally assessed potential geospatial barriers from American Indian/Alaskan Native (AIAN) reservation headquarters across the United States to the nearest board-certified dermatologist. They examined how community poverty rates impacted such barriers.
To do this, the investigators gathered data from the Bureau of Indian Affairs on the AIAN reservation headquarters' addresses. They compared those addresses with the American Academy of Dermatology directory and Google Maps to determine distances and travel times to the nearest board-certified dermatologist. The researchers also accessed poverty rates from the U.S. Department of Agriculture for a comprehensive analysis.
A total of 347 of 479 AIAN reservations with a publicly available headquarters address resulted in a successful search via the American Academy of Dermatology. Reservations with total poverty rates below the U.S. national average (12.8%) had a median travel distance to dermatology clinics of 18.08 miles and a median travel time of 22.78 minutes. In contrast, reservations with total poverty rates exceeding this threshold demonstrated a significantly increased median travel distance of 34.70 miles (p<0.000001) and a median travel time of 43.80 minutes (p<0.00001). The researchers uncovered similar results when accounting for child poverty rates.
The authors note that their study's limitations include not accounting for access to teledermatology or volunteer dermatologists at Indian health service clinics and whether the nearest dermatologist accepts specific insurance types. Additionally, they noted that they calculated data based on a fixed time without adjusting for potential traffic fluctuations or using any method to regularize geographic distances.
Actinic conjunctivitis and its relationship with prurigo in an Indigenous population from the highlands of Chiapas, Mexico
The authors of this paper note actinic conjunctivitis (AC), along with cheilitis (AChe), is part of the clinical spectrum of actinic prurigo (AP). This rare photodermatosis affects high-risk populations.
They analyzed the clinical manifestations and onset of AC and its relationship with AP in a susceptible population of Indigenous people in the highlands of Chiapas, Mexico.
For this study, researchers conducted thorough dermatologic and ophthalmologic examinations in patients attending a primary health care centre. Investigators analyzed these patients' clinical features, labour and environmental factors, onset timing, and clinical staging of AC and AP.
Of the 2,913 patients studied, 54 patients (108 eyes) (1.8%) had AC, and 14 patients (25.9%) had AP. The mean age at diagnosis was 36.18±18.52 years (6-70 years). The mean residential altitude was 1,884±434.2 m above sea level. Mean self-reported sun exposure was 5.14±3.1 hours a day (0.5-12 hours). A total of 90.7% of participants reported exposure to biomass fuels during cooking and 50% to farm animals. AC was the sole manifestation in 70% of the cases. All patients had nasal and temporal photo-exposed conjunctiva. Among the eyes, 12.9% were classified as stage 1, 64.8% as stage 2, and 22.2% as stage 3. A total of 83.3% of the patients had hyperpigmented lesions, and 35.1% had evaporative dry eye disease.
The authors conclude AC may be the initial or sole manifestation of AP. Most AC cases (87%) were initially observed at the advanced stages of the disease. Of note, they say evaporative dry eye associated with meibomian gland dysfunction has not been previously reported in patients with AC.
Registration is still open for this weekend’s Great Lakes Immunodermatology Exchange 6.0
There is still time to register for the Great Lakes Immunodermatology Exchange (GLIDE) 6.0 meeting, which will be held on Nov. 1 and 2, 2024, at the Queen’s Landing Hotel in Niagara-on-the-Lake, Ont.
GLIDE is a forum featuring renowned experts in immunodermatology. The meeting allows community and academic dermatologists from Ontario and Canada to benefit from expert insight and opinion and discuss best practices and clinical issues with their peers and international opinion leaders in immunodermatology.
The theme of GLIDE 6.0 is “Immunodermatology: It’s Complicated.”
Drs. Neil Shear (Toronto) and Perla Lansang (Toronto) will co-chair the event, which will include presentations covering topics such as JAK inhibitors, Severe Cutaneous Adverse Reactions (SCARs), itch, artificial intelligence, skin of colour, interpreting data, and other highly relevant topics in immunodermatology.
Faculty include:
Dr. Aaron Drucker (dermatologist, Toronto)
Dr. Raj Chovatiya (dermatologist, Chicago)
Dr. Ruud Verstegen (pediatric rheumatologist and clinical pharmacologist, Toronto)
Dr. Trevor Champagne (dermatologist, Kamloops, B.C.)
Dr. Marissa Joseph (pediatrician, dermatologist, Toronto)
Dr. Shawn Kwatra (dermatologist, Baltimore)
Dr. Melinda Gooderham (dermatologist, Peterborough, Ont.)
Registration and more details for the meeting, including the full agenda, are available at this link.
At the intersection of skin and society
On Oct. 23, 2024, National Indigenous Collaborative Housing Incorporated (NICHI) announced the recipients of NICHI's expression of need process to address the critical need for safe and affordable urban, rural, and northern Indigenous housing projects in Ontario.
According to a press release from NICHI, the announcement includes more than $58 million in funding for 12 projects in Ontario led by:
Seven Generations Education Institute
Brantford Native Housing
Kekekoziibii Development Corporation
Na-Me-Res (Native Men's Residence)
Thunder Woman Healing Lodge Society
Endaayaan Awejaa
Fort Albany Women's Shelter (2 projects)
Thunder Women Healing Lodge Society
Ontario Federation of Indigenous Friendship Centres
Reverend Tommy Beardy Memorial Family Treatment Center
Nahnahda-Wee-ee-Waywin
Through the national process, $277.8 million out of a total funding amount of $281.5 million is being distributed to 75 projects across Canada to build more than 3,800 units. This funding was provided to Indigenous Services Canada through Budget 2022 and was distributed by NICHI, applying its "For Indigenous, By Indigenous" approach.
This funding initiative is part of the Government of Canada's commitment to address the social determinants of health and advance self-determination in alignment with the United Nations Declaration on the Rights of Indigenous Peoples Articles 21 and 23.
This week
Oct. 29 is World Psoriasis Day
November is National Native American Heritage Month in the U.S.
November is National Diabetes Month in the U.K.
Something to think about in the week ahead . . .
—Robert F. Kennedy, former U.S. senator (1925 to 1968).
Next week
Researchers from the University of Arizona College of Medicine surveyed first- and second-year medical students to assess their ability and confidence in identifying correct diagnoses of dermatologic conditions on either White skin or skin of colour.
If you value Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dr. Jennifer Beecker (Ottawa) shares her thoughts on treating alopecia areata, including a range of therapies recently approved in Canada.
Dr. Cathryn Sibbald (Toronto) reviews the treatment of atopic dermatitis in children, with special attention to the biologics and other systemic agents approved in Canada for use in young patients.
Drs. Jenn Tran (Toronto), Jen Lipson (Ottawa), Jessica Asgarpour (Toronto), and Maxwell Sauder (Toronto) provide an overview of essential news in acne therapy, including a new topical hormonal therapy and new combination treatments.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender.
You can read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary subscription or to request a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
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