Panagiotopoulos C, Rozmus J, Gagnon R E, Macnab A J
University of British Columbia, Vancouver, BC, Canada.
Rural Remote Health. 2007 Jul-Sep;7(3):771. Epub 2007 Aug 20.
Type 2 diabetes (T2D) and its precursor, impaired glucose tolerance (IGT), are now reaching epidemic proportions among Aboriginal Canadians. Of particular concern is the appearance and increasing prevalence of T2D and IGT among Aboriginal youth. At the request of three communities in the Tsimshian nation on the northern coast of British Columbia (with which the Department of Pediatrics, University of British Columbia, had a pre-existing partnership) a screening program was undertaken to determine the prevalence of T2D and IGT among the children. The long-term goal was the collaborative development of intervention programs for each community. The challenges of meeting this request included the sociological and ethical issues associated with research in First Nations communities, as well as the pragmatic issues of conducting complex research in remote communities. Three separate visits were undertaken to respect the cultural dynamics and capacity of the community to accommodate a project of this magnitude. The process began with dialogue, listening and presentations to the community. Only then began the planning of logistics and application for funding. Next, the team visited the communities to ensure understanding of exactly what was involved for the community, each child and family, and to be certain that consent was fully informed. For the diabetes screening visit, special arrangements including chartering a Beaver float plane were needed for the transport of the five-member team with all the necessary equipment, including a -20(o)C freezer to safeguard the integrity of blood samples. The 100% consent rate, successful conduct of study, and retention of community support achieved by the process, indicate that population-based clinical research is possible in remote First Nations communities. This is best achieved with appropriate dialogue, care, respect and planning to overcome the sociological, ethical and practical challenges.
2型糖尿病（T2D）及其前期状态——糖耐量受损（IGT），目前在加拿大原住民中呈流行趋势。尤其令人担忧的是，T2D和IGT在原住民青年中的出现及患病率不断上升。应不列颠哥伦比亚省北部海岸的辛姆西安族三个社区（不列颠哥伦比亚大学儿科学系此前已与其建立合作关系）的要求，开展了一项筛查项目，以确定儿童中T2D和IGT的患病率。长期目标是为每个社区联合制定干预项目。满足这一要求面临的挑战包括与原住民社区研究相关的社会学和伦理问题，以及在偏远社区开展复杂研究的实际问题。为尊重社区的文化动态及容纳如此大规模项目的能力，进行了三次单独访问。过程始于与社区的对话、倾听和展示。只有在此之后才开始规划后勤工作并申请资金。接下来，团队走访社区，以确保社区、每个儿童和家庭清楚了解所涉及的具体内容，并确保获得充分知情的同意。在糖尿病筛查访问中，需要做出特殊安排，包括包租一架海狸水上飞机，以运送由五名成员组成的团队及所有必要设备，包括一台-20℃的冰柜，以确保血样的完整性。该过程实现的100%同意率、研究的成功开展以及社区支持的维持，表明在偏远的原住民社区开展基于人群的临床研究是可行的。通过适当的对话、关怀、尊重和规划来克服社会学、伦理和实际挑战，能最好地实现这一点。
