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Objectives. To review the DREAM studies and the role of participatory research using a Home and Community Care model in treating First Nations diabetes. Study Design. Population survey, pilot and prospective randomized trial Methods. Review documented history of these studies since inception. Collation of all data from the DREAM studies from 1998 to the present, including interviews with all providers and many of the participants.Results. The DREAM studies were a participatory process providing a needs assessment and became the foundation for this First Nation's Home and Community Care team involvement in providing community-based chronic-disease management. The findings motivated the community to find a process that would lead to needed changes. This participatory research enabled a culturally tailored algorithm of evidence-based management of hypertension and disease management strategies for people with diabetes. These studies demonstrated that in this community the Home and Community Care team could work together with primary care physicians and specialists to prevent the complications of diabetes. DREAM studies and participatory research involving multidisciplinary home careConclusions. The DREAM studies demonstrated in the first controlled trial that with participatory research a systems change is possible; a chronic-disease management model utilizing a trained multidisciplinary Home and Community Care team and informed patients can lead to lower blood pressure in a Canadian First Nations population with diabetes.

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California desert region has suitable temperatures for growing dates, producing' all but 10 per cent of the United States crop. This crop rose from 1 million pounds in 1926 to 33 million pounds in 1946, just twenty years later (Nixon, 1951). In 1924 a total of 546 acres was planted to dates; in 1950 this had increased to 5,114 acres, of which 4,140 acres were bearing' (Byrd and Blair, 1951). In the same period a tremendous increase took place in acreage of other crops grown in the date-producing' region. Irrigation projects now being' completed along the lower Colorado River are resulting' in an even greater expansion of agriculture in this area. Nitidulid beetles also find the Coachella Valley temperuture suitable for rapid gTo\vth and reproduction except for a f'ew winter months. Because of beetle infestation all dates are fumigated before entering the packing house. This necessitates the building of fumigation chambers, Uuder conditions of severe infestation, grading costs mount because of the added time necessary to segregate the infested dates from the sound ones. Although the larvae and adults feed directly on the fresh and dried fruit, the loss due to the amount of fruit actually consumed is insignificant in comparison with the loss due to the presence of excreta, larvae, adults, and the moulting skins in and on the infested dates. In many instances these dates are very difficult to segregate because there is no visible indication that the insects or their remains may be in the seed cavity. These are termed "hidden culls" by the industry. The beetles also serve as mechanical carriers of mold and souring organ-iS1l1S, which cause additional fruit spoilage. In 1945, a year of abnormally high humidity and rainfall, one half to three fourths of the date crop was lost because of molds, souring, and beetle infestation (Barnes and Lindgren, 1946). This paper is concerned with the four species of beetles that predominate on dates in the Coachella Valley. The four species, closely related members of the family Nitidulidae, are the corn-sap beetle, Carpophilus dimidiatus (Fab.); the dried-fruit beetle, C. h.emipterus (Linn.)-also called fig-or two-spotted beetle; the pineapple beetle, Urophorus humeralis (Fab.) ; and the yellowish nitidulid, Ho.ptoncus Luieolus (Er.).