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Clustering of animals at the level of pens, rooms, barns, or farms leads to statistical nonindependence of individual pigs. Failure to consider clustering when determining sample size will result in clinical trials that are too small to detect meaningful differences between intervention groups when clustering is controlled in the analysis. Failure to control clustering in the analysis will lead to inappropriately narrow confidence intervals and increases the probability of a false-positive finding. Thus, failure to consider clustering in trial design and analysis results in research that could misinform decision making on the use of interventions.

Researchers designing trials should implement design features intended to reduce bias. These include random allocation to intervention groups and blinding of caregivers and outcome assessors. The method of generating the random sequence should be reported, as well as methods for stratification or blocking if used. When blinding is not possible, objectively measured outcomes should be used. Allocation concealment may not be essential when all eligible pens or animals are enrolled and there is no preference for intervention group. An a priori trial protocol should be made publicly available, and results for all outcomes evaluated should be reported.

Researchers planning clinical trials should identify the primary trial outcome and adequately power the trial to detect clinically meaningful differences in this outcome. All primary and secondary outcomes and their measurement should be comprehensively described, and their results reported. There is evidence that trials on the same subject use different outcomes or measure the same outcome in different ways, making it difficult to compare intervention effectiveness across clinical trials. Consensus development of core outcome sets could improve consistency in outcome measures used across trials and aid in development of an evidence-based body of literature on intervention effectiveness in swine populations.

Researchers conduct a trial to compare an intervention of interest to a comparison group. Initially, researchers should determine whether a trial is evaluating superiority, equivalence, or noninferiority. This decision will guide the choice of a placebo versus active comparison group. Interventions, as well as baseline management, should be comprehensively reported to allow replication or clinical application. It is necessary to build a body of evidence across multiple trials to apply evidence-based decision-making. To achieve this, at least one intervention in every trial should be an intervention that has been used in at least one previously published trial.

To be useful for decision-making, research results need to be available. This means that full reports (methods and results) for trials need to be published, preferably in a journal. However, there is evidence that only a small proportion of swine trials presented at conferences are subsequently published in journals. This is problematic, as results may differ between a conference presentation and journal publication. Published results also need to be accessible, either through open-access or traditional journals or through other sources that do not violate copyright agreements. Researchers should strive to make full research reports widely available.

Indigenous women world-wide are diverse and heterogenous, yet many have similar experiences of colonization, land dispossession, and discrimination. These experiences along with inequitable access to, and quality of, maternal healthcare increase adverse maternal health outcomes. To improve health outcomes for Indigenous women, studies must be conducted with Indigenous involvement and reflect Indigenous research principles. Objectives/Aim: The aim of this review was to explore the range, extent, and nature of Indigenous maternal health research and to assess the reporting of Indigenous research principles in the global Indigenous maternal health literature.Following a systematic scoping review protocol, four scholarly electronic databases were searched. Articles were included if they reported empirical research published between 2000 and 2019 and had a focus on Indigenous maternal health. Descriptive data were extracted from relevant articles and descriptive analysis was conducted. Included articles were also assessed for reporting of Indigenous research principles, including Indigenous involvement, context of colonization, Indigenous conceptualizations of health, community benefits, knowledge dissemination to participants or communities, and policy or intervention recommendations.Four-hundred and forty-one articles met the inclusion criteria. While studies were conducted in all continents except Antarctica, less than 3% of articles described research in low-income countries. The most researched topics were access to and quality of maternity care (25%), pregnancy outcome and/or complications (18%), and smoking, alcohol and/or drug use during pregnancy (14%). The most common study design was cross-sectional (49%), and the majority of articles used quantitative methods only (68%). Less than 2% of articles described or reported all Indigenous research principles, and 71% of articles did not report on Indigenous People's involvement.By summarizing the trends in published literature on Indigenous maternal health, we highlight the need for increased geographic representation of Indigenous women, expansion of research to include important but under-researched topics, and meaningful involvement of Indigenous Peoples.

To assess the extent of pregnancy loss (i.e., miscarriage and/or stillbirth) and examine its association with socio-demographic characteristics among Bakiga and Indigenous Batwa women in Kanungu District, southwest Uganda.As part of a larger community-based, participatory project, a retrospective survey of maternal health histories was conducted in ten Batwa and ten Bakiga communities (n = 555 participants) collecting data on self-reported pregnancy loss (i.e., miscarriage and stillbirth) and socio-demographic characteristics. Socio-demographic associations with pregnancy loss (i.e., total miscarriages and stillbirths) were examined using multivariable Poisson and negative binomial regression.Batwa women experienced pregnancy loss more commonly than Bakiga women did (149.8/1000 vs. 96.3/1000 pregnancies). In the final adjusted model for Batwa women, being in the middle (RR 1.92; CI: 1.21-3.07) and highest (RR 1.79; CI: 1.14-2.82) wealth tertiles (compared to lowest wealth tertile) and living in Community X (RR 4.33; CI 2.27-8.28) (compared to all other communities) were associated with increased pregnancy loss. For Bakiga women, the proportion of pregnancy loss was higher for those who reported drinking alcohol during pregnancy (RR: 1.54; CI: 1.04-2.13) and being food insecure (RR 1.39; CI: 1.02-1.91).The proportion of, and the socio-demographic associations with, pregnancy loss differed for Bakiga and Indigenous Batwa women. These differences underscore the importance of collecting Indigenous health data to understand not only the extent of, but also the varied contextual circumstances that are associated with pregnancy loss. This nuanced and stratified information is critical for planning meaningful health programming to reduce pregnancy loss for Indigenous women.

The history of health research in Inuit communities in Canada recounts unethical and colonizing research practices. Recent decades have witnessed profound changes that have advanced ethical and community-driven research, yet much work remains. Inuit have called for research reform in Inuit Nunangat, most recently creating the National Inuit Strategy on Research (NISR) as a framework to support this work. The present study details the process undertaken to create a research program guided by the NISR to address food security, nutrition, and climate change in Inuit Nunangat. Four main elements were identified as critical to supporting the development of a meaningful and authentic community-led program of research: developing Inuit-identified research questions that are relevant and important to Inuit communities; identifying Inuit expertise to answer these questions; re-envisioning and innovating research methodologies that are meaningful to Inuit and reflect Inuit knowledge and societal values; and identifying approaches to mobilizing knowledge that can be applied to support food security and climate change adaptation. We also identify considerations for funding agencies to support the meaningful development of Inuit-led research proposals, including aligning funding with community priorities, reconsidering who the researchers are, and investing in community infrastructure. Our critical reflection on the research program development process provides insight into community-led research that can support Inuit self-determination in research, enhance local ethical conduct of research, privilege Inuit knowledge systems, and align Inuit-identified research priorities with research funding opportunities in health research. While we focus on Inuit-led research in Nunavut, Canada, these insights may be of interest more broadly to Indigenous health research.

Introduction Canadian health and social service systems need to adapt to new challenges posed by the unique primary health care (PHC) needs of recent immigrant families. Community-based service providers are the first to experience changing responsibilities. Providers in communities with limited experience in working with immigrants may benefit from shared skills and modeled cultural competencies when working with new arrivals. Purpose This case study describes how a set of community-based service organizations addressed the PHC needs of recent immigrant families with young children living within a mid-sized urban centre in Atlantic Canada. The roles of organizational brokers and of competence trust among service providers were examined to determine their influence on the capacities of the service network overall. Methods Methods from social network analysis and descriptive qualitative inquiry were applied in this study. Organizational ecology contructs framed the research questions and propositions. An intersectoral approach to PHC was adopted to define the services network. Results derived from the network survey and key informant interviews were triangulated to develop a final interpretation. Results The study network constituted a relatively cohesive group of service providers. Network participation became more selective depending on the issue experienced by families. Network interactions were facilitated by broker organizations; some brokers actively engaged in the development of cultural competency capacities among network members. Trust in the other provider organization’s cultural competencies (competence trust) with recent immigrant families positively influenced the quality of working relationships. Conclusions Broker organizations can play a significant role in network capacity development through the promotion of cultural competencies in partnering organizations and by making connections across service sectors. The cultural competence of partnering organizations is an important pre-condition of trust for service providers committed to the needs of recent immigrant families. Having trusting relationships among providers can facilitate exchange and enable access to services. Nurses have the potential to participate in the advancement of culturally competent service systems. Doctor of Philosophy (PhD)