Efeitos simbólicos da implantação da casa de saúde indígena: um estudo histórico / Symbolic effects of the implantation of the indigenous health home: a historical study

Resumo Objetivo: Descrever os efeitos simbólicos da implantação da Casa de Saúde Indígena no campo da saúde no período de 1973 a 1983 em Boa Vista, Roraima, Brasil. Metodologia: Trata-se de um estudo histórico com abordagem da micro história orientado por análises documentais e a teorização dos resultados balizada nos conceitos do sociólogo Pierre Bourdieu. Resultados: Ao todo o corpus documental foi representado por quatro registros imagéticos. As imagens foram analisadas com o intuito de produção de reflexões que versam sobre os efeitos simbólicos de implantação da Casa de Saúde Indígena. Conclusão: A Casa de Saúde Indígena de Boa Vista-RR emerge como pano de fundo no cenário desenvolvimentista da época, como (e representou) moeda de troca simbólica entre os governantes e os indígenas que sofriam com a entrada de doenças em suas comunidades pela ação direta do processo migratório devido ao garimpo em suas terras.

Resumen Objetivo: Describir los efectos simbólicos de la implantación de hogar de salud indígena en el campo de la salud en el período de 1973 a 1983 en Boa Vista, Roraima, Brasil. Metodología: Se trata de un estudio histórico con un enfoque de microhistoria, guiado por el análisis documental. La teorización de los resultados fue guiada por los conceptos del sociólogo Pierre Bourdieu. Resultados: En total, el corpus documental estuvo representado por cuatro registros de imágenes. Las imágenes fueron analizadas con el fin de producir reflexiones sobre los efectos simbólicos de la implantación del hogar de salud indígena. Conclusión: El hogar de salud indígena en Boa Vista-RR surge como telón de fondo en este escenario de desarrollo, asimismo como una moneda simbólica (y representada) de intercambio entre gobernadores y pueblos indígenas, que sufrieron con el ingreso de enfermedades en sus comunidades a través de acción directa del proceso migratorio, debido a la minería en sus tierras.

Abstract Aim: To describe the symbolic effects of the implementation of the indigenous health home in the field of health in the period from 1973 to 1983 in Boa Vista, Roraima, Brazil. Methods: This was a historical study with a microhistory approach guided by a documentary analysis; the theorization of the results was guided by the concepts of the sociologist Pierre Bourdieu. Results: The documentary corpus was represented by four imagery records. The images were analyzed in order to produce reflections on the symbolic effects of the implantation of the indigenous health home. Conclusion: The indigenous health home in Boa Vista-RR emerges as a backdrop in this developmental scenario; it represents a symbolic currency of exchange between the government and the indigenous people who suffered from the entry of diseases in their communities through the direct action of the migratory process and the mining in their lands.

Caries experience in children under 5 years old in the Xingu indigenous park in Brazil

Aim: The present study sought to investigate dental caries experience and its association with sociodemographic, postnatal and breastfeeding variables in children in the agerange from 6 to 71 months of age, in the Xingu Indigenous Park, Mato Grosso, Brazil. Methods: This was an analytical cross-sectional study that used secondary data pertaining to 402 indigenous children of the Low, Middle and Eastern Xingu regions, who participated in the Oral Health Epidemiological Survey in 2013. The dependent variable was dental caries, dichotomized by the median (dmf-t≤1 and dmf-t>1). The data of independent variables were obtained by means of instruments of the Local Health Information System of the Xingu Indigenous Special Sanitary District (DSEI). Raw analyses were performed to test the association of the independent variables with the dependent variable. The variables were tested in the multiple logistic regression model. Results: The mean value of the dmf-t index was 2.60 and the prevalence of affected children was 51%. In the multiple analysis, only children older than 36 months (OR: 6.64; CI95%: 4.11 to 10.73) and those that were breastfed for a longer period of time (OR: 1.88; CI95%: 1.16 to 3.02) showed significant association with the dmf-t>1 index. Conclusion: Childhood dental caries among indigenous children was associated with age and breastfeeding prolonged for over 26 months, therefore, pointing out the need to offer dental follow-up care at earlier ages

Sexually transmitted infections in indigenous communities of the Alto Rio Solimões / Infecções sexualmente transmissíveis em comunidades indígenas do Alto Rio Solimões

Introduction: The prevalence of sexually transmitted infections (STI) among indigenous communities is an appalling issue related to Brazilian public health, as there is an increasing underreporting and neglect related to the study and care of these people. Objective: To determine the prevalence of STI in the indigenous population of the Alto Rio Solimões. Methods: STI diagnostic records from the database of the Indigenous Health Care Information System - SIASI, of the indigenous communities of the Alto Rio Solimões, belonging to the Nova Itália base, in Amazonas, were evaluated during the period from January 2010 to August 2020. Sociodemographic data were also evaluated to determine the profile of the diagnosed indigenous population and the geographical and temporal distribution of cases. Results: The overall prevalence rate of STIs was 3.91% (113 notifications of STI in the population of 2890 indigenous people). The largest number of diagnosed cases was in Nova Itália (60.17%). The ethnic group with the highest number of cases was Tikuna (92.03%). Among the STI studied, gonorrhea / chlamydia had the highest prevalence (68.14%), followed by Hepatitis B (13.27%) and Syphilis (10.61%). Most cases were found among women (71.7%), aged 30­34 years. Conclusion: A higher prevalence of STIs was observed in indigenous women, mainly from the Nova Itália town and the Tikuna ethnic group.

Introdução: A prevalência das infecções sexualmente transmissíveis (IST) entre comunidades indígenas é um tema consternador relacionado à saúde pública brasileira, pois há crescente subnotificação e negligência relacionada ao estudo e ao cuidado desses povos. Objetivo: Determinar a prevalência de IST na população indígena do Alto Rio Solimões. Métodos: Foram avaliados os registros diagnósticos de IST da base de dados do Sistema de Informação da Atenção à Saúde Indígena (SIASI), das comunidades indígenas do Alto Rio Solimões, pertencentes ao polo-base de Nova Itália, no Amazonas, durante o período de janeiro de 2010 a agosto de 2020. Também foram avaliados dados sociodemográficos para determinação do perfil da população indígena diagnosticada e a distribuição geográfica e temporal dos casos. Resultados: A taxa de prevalência geral de IST foi de 3,91% (113 notificações de IST na população de 2.890 indígenas). O maior número de casos diagnosticados foi em Nova Itália (60,17%). A etnia com maiores números de casos foi a Tikuna (92,03%). Entre as IST estudadas, gonorreia/clamídia tiveram a maior prevalência (68,14%), seguidas por hepatite B (13,27%) e sífilis (10,61%). A maioria dos casos ocorreu entre mulheres (71,7%) e na faixa de 30­34 anos. Conclusão: Observou-se maior prevalência de IST em mulheres indígenas, principalmente do município de Nova Itália e da etnia Tikuna

Las epidemias en La Pampa (Argentina), en perspectiva histórica* / The epidemics in La Pampa (Argentina), from a historical perspective

Resumen Este artículo describe el inicio de las preocupaciones sanitarias vinculadas a las epidemias ocurridas durante el siglo XX en La Pampa, provincia argentina. Las epidemias, como las de la viruela, fueron un estímulo para estas políticas que frecuentemente tuvieron origen en Buenos Aires, la capital del país. El contagio de muchas epidemias dependía de carencias de infraestructura: agua, desagüe y desecho adecuado de basuras, de la ausencia de un número suficiente de trabajadores de salud, de la presencia de vectores transmisores de enfermedades como los mosquitos y, en última instancia, de la pobreza. La experiencia histórica descrita en este texto resalta la importancia de analizar el impacto del SARS-CoV-2 más allá de las grandes ciudades.

Abstract This article describes the emergence of health concerns relating to the epidemics that occurred during the twentieth century in La Pampa, a province in Argentina. Epidemics such as smallpox drove such policies, which frequently originated in Buenos Aires, the country's capital. The spread of many epidemics was due to shortages: water, sewage and adequate refuse disposal, an insufficient number of health care workers, the presence of disease transmission vectors such as mosquitos, and, ultimately, poverty. The historical experience described in this text highlights the importance of analyzing the impact of SARS-CoV-2 beyond the big cities.

A interiorização da covid-19 na Amazônia: reflexões sobre o passado e o presente da saúde pública / The interiorization of covid-19 in the Amazon region: reflections on the past and present of public health

Resumo A partir de contribuições teóricas do campo da história das ciências, o presente texto debate aspectos das etapas das pandemias entendidas como fenômeno social e como tem ocorrido o processo de interiorização da covid-19 na Amazônia. A chegada da doença aos vastos territórios da floresta tem deixado mais evidente o processo de acesso diferenciado à saúde pública, com concentração de serviços e profissionais nas maiores cidades da região Norte. O crescimento dos índices do coronavírus na floresta evidencia, portanto, as desigualdades sociais históricas da região e os problemas no acesso à cidadania na sociedade brasileira.

Abstract This text uses theoretical contributions from the history of science to discuss aspects of the stages of pandemics understood as social phenomena and how covid-19 moved into the interior of the Amazon region. The arrival of this disease in the vast forest territory made differentiated access to public health more evident, with services and professionals concentrated in the larger cities in the north of Brazil. The rise in coronavirus rates within the forest consequently highlights the history of social inequalities in the region and problems accessing citizenship in Brazilian society.

Tuberculosis care cascade for the indigenous population in Colombia: an operational research study / Cascada de atención de la tuberculosis para la población indígena en Colombia: una investigación operativa / Cascata de atenção da tuberculose para os povos indígenas na Colômbia: pesquisa operacional

ABSTRACT Objective. Construct and evaluate the care cascade for pulmonary tuberculosis in the indigenous population of the department of Cauca (Colombia) and identify existing gaps. Methods. Mixed-methods sequential explanatory design. In the first phase, the pulmonary tuberculosis care cascade for the indigenous population of Cauca was evaluated. Data were obtained from secondary sources and all cases diagnosed from 1 January 2016 to 31 December 2017 were included. In the second phase, semi-structured interviews were done with nine program coordinators and 11 nursing auxiliaries to explain identified gaps. Absolute and percentage values were estimated for each of the steps and gaps in the care cascade. Quantitative and qualitative results were triangulated. Results. In 2016 and 2017, an estimated 202 patients with respiratory symptoms were expected to be positive and 106 cases of pulmonary tuberculosis were reported among the indigenous population of the department of Cauca. A gap of 47.5% was found for diagnosis, since only 52.5% of subjects were diagnosed in health services. This gap was explained by poor quality of samples and flawed smear techniques; flaws in correct identification of patients with respiratory symptoms; limited access to diagnostic methods, such as culture and molecular tests; and limited training and high turnover of personnel in health service provider institutions. Conclusions. The tuberculosis control program should focus actions on bridging the gap in case detection in the indigenous population.

RESUMEN Objetivo. Construir y evaluar la cascada de atención de la tuberculosis pulmonar en la población indígena del departamento del Cauca (Colombia) e identificar las brechas existentes. Métodos. Metodología mixta con diseño secuencial explicativo. En la primera fase se evaluó la cascada de atención de la tuberculosis pulmonar para la población indígena del Cauca. Se obtuvieron datos de fuentes secundarias y se incluyeron todos los casos diagnosticados entre el 1 de enero del 2016 y el 31 de diciembre de 2017. En la segunda fase, se aplicaron entrevistas semiestructuradas a nueve coordinadores de programa y 11 auxiliares de enfermería para explicar las brechas identificadas. Se estimaron los valores absolutos y porcentuales en cada uno de los pasos y las brechas de la cascada de atención. Se triangularon los resultados cuantitativos y cualitativos. Resultados. Durante 2016 y 2017 se estimaron 202 sintomáticos respiratorios esperados positivos y se notificaron 106 casos de tuberculosis pulmonar en la población indígena del departamento del Cauca. Se encontró una brecha de 47,5% para el diagnóstico, ya que solo 52,5% de los sujetos recibieron el diagnóstico en los servicios de salud. Las explicaciones a esta brecha fueron la mala calidad de muestras y fallas en la técnica del extendido, fallas en la correcta identificación del sintomático respiratorio, acceso limitado a métodos diagnósticos como cultivo y pruebas moleculares, así como capacitación escasa y rotación alta de personal al interior de las instituciones prestadoras de servicios de salud. Conclusiones. Las acciones del programa de control de tuberculosis deben enfocarse en reducir la brecha de detección de casos en la población indígena.

RESUMO Objetivo. Elaborar e avaliar a cascata de atenção da tuberculose pulmonar na população indígena do Departamento de Cauca (Colômbia) e identificar as lacunas existentes. Métodos. Metodologia mista com desenho sequencial explicativo. Na primeira fase, avaliamos a cascata de atenção da tuberculose pulmonar para a população indígena de Cauca. Os dados foram obtidos de fontes secundárias, incluindo todos os casos diagnosticados entre 1 de janeiro de 2016 e 31 de dezembro de 2017. Na segunda fase, realizamos entrevistas semiestruturadas com nove coordenadores do programa e 11 auxiliares de enfermagem para explicar as lacunas identificadas. Estimamos os valores absolutos e percentuais em cada uma das etapas e as lacunas na cascata de atenção. Os resultados quantitativos e qualitativos foram triangulados. Resultados. Nos anos de 2016 e 2017, foi estimada a ocorrência de 202 casos com sintomas respiratórios com diagnóstico esperado positivo; no entanto, os serviços de saúde só diagnosticaram e notificaram 106 casos de tuberculose pulmonar na população indígena do Departamento de Cauca. Portanto, identificamos uma lacuna diagnóstica de 47,5%, já que apenas 52,5% dos casos receberam um diagnóstico nos serviços de saúde. As explicações para esta lacuna foram a má qualidade das amostras e falhas na técnica de esfregaço, falhas na identificação correta dos sintomas respiratórios, acesso limitado aos métodos de diagnóstico, tais como cultura e testes moleculares, bem como capacitação deficiente e alta rotatividade de pessoal nas instituições de saúde. Conclusões. As ações do programa de controle da tuberculose devem se concentrar em reduzir a lacuna na detecção de casos na população indígena.

Evolução da infecção pelo HIV entre os povos indígenas do Brasil Central / Evolution of HIV infection in indigenous peoples in Central Brazil / Evolución de la infección por VIH entre los pueblos indígenas de Brasil Central

A distribuição da epidemia de aids no Brasil está associada a uma ampla gama de fatores que definem maior ou menor vulnerabilidade de grupos populacionais. O estudo teve como objetivo analisar as características clínicas e laboratoriais dos casos de infecção pelo HIV/aids em indivíduos com 13 anos de idade ou mais, e sua evolução para o óbito na população indígena assistida pelo Distrito Sanitário Especial Indígena de Mato Grosso do Sul. Realizou-se um estudo descritivo e retrospectivo sobre a condição clínica e evolução da doença entre 2001 e 2014, a partir de três bases de dados secundários. Foram avaliados o tempo de evolução para a aids, o tempo de evolução ao óbito, a carga viral, a contagem de linfócitos T-CD4+ e o tempo de sobrevida. Foram identificados 103 casos de infecção pelo HIV, dos quais 48,5% evoluíram para aids, sendo 60% em menos de um ano desde o diagnóstico. Foram registrados 40 óbitos, sendo 77,5% em decorrência da infecção pelo HIV. Desses que morreram, apenas 30% tiveram sobrevida maior do que um ano. Este estudo sugere que o diagnóstico da infecção pelo HIV se deu nas fases avançadas da doença, revelando-se tardio e apontando uma cobertura diagnóstica deficiente. A rápida evolução ao óbito e curto período de sobrevida também podem indicar fragilidade no acesso aos serviços de saúde de referência, assim como desarticulação e pactuações insuficientes entre Distrito, municípios e estado.

Distribution of the AIDS epidemic in Brazil is associated with a wide range of factors that determine different population groups' greater or lesser vulnerability. The study's objective was to analyze clinical and laboratory characteristics of HIV/AIDS in individuals 13 years or older and the evolution to death in the indigenous population assisted by the Special Indigenous Health District of the State of Mato Grosso do Sul, Brazil. A descriptive and retrospective study was performed on the clinical conditions and evolution of the disease from 2001 to 2014, based on three secondary databases. The study assessed time in progression to AIDS, time in progression to death, viral load, CD4+ T-lymphocyte count, and survival time. A total of 103 cases of HIV infection were identified, of which 48.5% progressed to AIDS, 60% in less than a year since diagnosis. Forty deaths were recorded, 77.5% of which due to HIV infection. Of those who died, only 30% had survived for more than a year. The study suggests that diagnosis of HIV infection occurred in advanced stages of the disease (i.e., late), and points to deficient diagnostic coverage. Rapid progression to death and short survival time are indicative of insufficient access to specialized health services, as well as disconnection and deficient collaboration between the Indigenous Health District, municipalities, and the state.

La distribución de la epidemia de sida en Brasil está asociada a una amplia gama de factores que definen mayor o menor vulnerabilidad de grupos poblacionales. El objetivo del estudio fue analizar las características clínicas y de laboratorio de los casos de infección por el VIH/sida en individuos con 13 años de edad o más, y su evolución hacia el óbito en la población indígena, asistida por el Distrito Sanitario Especial Indígena de Mato Grosso do Sul. Se realizó un estudio descriptivo y retrospectivo sobre la condición clínica y la evolución de la enfermedad entre 2001 y 2014, a partir de tres bases de datos secundarios. Se evaluó el tiempo de evolución para el sida, el tiempo de evolución para el óbito, la carga viral, el cálculo de linfocitos T-CD4+ y el tiempo de supervivencia. Se identificaron 103 casos de infección por VIH, de los cuales un 48,5% evolucionaron hacia sida, siendo 60% en menos de un año desde el diagnóstico. Se registraron 40 óbitos, siendo un 77,5% derivados de la infección por VIH. De esos que murieron, solamente un 30% tuvieron una supervivencia mayor que un año. Este estudio sugiere que el diagnóstico de la infección por VIH se produjo en fases avanzadas de la enfermedad, revelándose tardío y apuntando una cobertura diagnóstica deficiente. La rápida evolución al óbito y corto período de supervivencia, también pueden indicar fragilidad en el acceso a los servicios de salud de referencia, así como la descoordinación y acuerdos insuficientes entre distrito, municipios y estado.

Povos indígenas no Brasil e a descolonização da psicologia / Indigenous people in Brazil and the decolonization of psychology / Los pueblos indígenas en Brasil y la descolonización de la psicología

Resumo Apesar do incremento de estudos e discussões sobre os povos indígenas no Brasil, a relação da Psicologia, enquanto ciência e profissão, com a temática ainda é pouco abordada nos cursos de graduação e pós-graduação e nas produções acadêmicas. Com o propósito de realizar um balanço sobre a aproximação da produção do conhecimento em Psicologia com a temática indígena, este ensaio buscará apresentar as principais categorias teóricas e analíticas que possam contribuir com o diálogo entre esses dois campos. O método tomou como base a revisão integrativa, em que primeiramente destacamos as principais contribuições teóricas e analíticas acerca da produção acadêmica brasileira sobre os povos indígenas para, em seguida, situarmos a produção científica da Psicologia sobre o tema no Brasil. Ao final, sinalizamos para a importância de se construir um recorte crítico capaz de fortalecer a Psicologia nos estudos sobre os povos indígenas. Também destacamos os estudos pós-coloniais e decoloniais críticos ao eurocentrismo enquanto organizador e regulador da visão de mundo, da história e da concepção de ser humano.(AU)

Abstract Despite the increase in studies and discussions about indigenous peoples in Brazil, the relationship between psychology, as a science and profession, and the subject is still little addressed in undergraduate/postgraduate courses and academic productions. Aiming to assess the approximation of the production of knowledge in Psychology with the indigenous theme, this essay will present the main theoretical and analytical categories that can contribute to the dialogue between these two fields. To this end, this study comprises an integrative review that both highlights the main theoretical and analytical contributions of the Brazilian literature on indigenous peoples and situates the Brazilian scientific production in Psychology on the theme. This research signals the importance of building a critical cutout capable of strengthening Psychology in studies addressing indigenous peoples, stressing post-colonial and decolonial studies criticizing the role of Eurocentrism as an organizer and regulator of worldview, history, and the conception of the human being.(AU)

Resumen A pesar del aumento de los estudios y debates sobre los pueblos indígenas en Brasil, la relación entre la psicología, como ciencia y profesión, y el tema sigue siendo poco abordado en los cursos de grado y posgrado y en las producciones académicas. Con el propósito de hacer un balance sobre la aproximación de la producción de conocimiento en Psicología con el tema indígena, este ensayo se propone presentar las principales categorías teóricas y analíticas que pueden contribuir al diálogo entre estos dos campos. El método se basó en una revisión integradora en la que, en primer lugar, destacamos las principales contribuciones teóricas y analíticas acerca de la producción académica brasileña sobre los pueblos indígenas y, a continuación, situamos la producción científica de la Psicología en Brasil sobre el tema. Al final, señalamos la importancia de construir un recorte crítico capaz de fortalecer la psicología en los estudios sobre los pueblos indígenas. En esta ocasión, destacamos los estudios críticos postcoloniales y decoloniales del eurocentrismo mientras organizador y regulador de la visión del mundo, la historia y la concepción del ser humano.(AU)

"As glebas bárbaras do Brasil Central": os sertões de Mato Grosso e Goiás nas narrativas de viagem de Hermano Ribeiro da Silva, 1935-1936 / "The barbarous glebes of Central Brazil: " the hinterlands of Mato Grosso and Goiás in the travel narratives of Hermano Ribeiro da Silva, 1935-1936

Resumo O artigo analisa as narrativas de viagem ao interior de Mato Grosso e Goiás publicadas em 1935 e 1936 pelo explorador paulista Hermano Ribeiro da Silva, que obtiveram considerável sucesso editorial e impacto no meio letrado brasileiro. Concentramo-nos em suas ideias sobre a relação entre o ambiente do Brasil Central e o homem sertanejo, sobre as potencialidades de exploração econômica da região e sobre o papel do Estado na condução de iniciativas capazes de promover sua incorporação efetiva à nacionalidade. Buscamos também compreender a fundamentação de seu discurso em conceitos e esquemas científicos genéricos dotados de poder retórico e argumentativo.

Abstract The article analyzes the travel narratives to the hinterlands of the states of Mato Grosso and Goiás published in 1935 and 1936 by the São Paulo-based explorer Hermano Ribeiro da Silva, which proved a great publishing success and had a considerable impact on lettered society in Brazil. The analysis focuses on his ideas about the relationship between the environment in Central Brazil and the man who inhabited it, the potential economic exploitation of the region, and the role of the State in orchestrating initiatives capable of promoting its effective incorporation into the nationhood. It also seeks to understand how he grounded his discourse on generic scientific concepts and schemas endowed with rhetorical and argumentative power.

Association between NDO-LID and PGL-1 for leprosy and class I and II human leukocyte antigen alleles in an indigenous community in Southwest Amazon

The frequencies of the Human leukocyte antigen (HLA) alleles in the Puyanawa indigenous reserve population and their association with the NDO-LID and ELISA PGL-1 rapid serological test was assessed. This was a cross-sectional study with an epidemiological clinical design conducted in two indigenous communities in the state of Acre, Brazil. Blood was collected in a tube with EDTA to identify HLA alleles and perform serological tests. DNA was obtained using the salting out procedure. The LabType™ technique (One-Lambda-USA) was used for HLA class I (loci A*, B* and C*) and II (loci DRB1*, DQA1* and DQB1*) typing. Allele frequency was obtained by direct count, and the chi-square test was used to assess the association with the NDO-LID and PGL-1 tests. The most frequent alleles in the two communities were: HLA-A*02:01, HLA-B*40:02, HLA-DRB1*16:02, HLA-DQA1*05:05 and HLA-DQB1*03:01. The allele HLA-C*04:01 was the most common in the Barão community, and the allele HLA-C*07:01 in Ipiranga. Among individuals who presented seropositivity to the NDO-LID test, the association with alleles HLA-A*02 (43.18% vs 24.8%, p = 0.03, OR = 2.35) and HLA-B*53 (6.83% vs 0.0%, p = 0.03, OR = 8.95) was observed in the Barão community. HLA-B*15 was associated with non-seroconversion to the NDO-LID test in Ipiranga. In both communities, HLA-B*40 and HLA-C*03 were associated with positive serological response to ELISA PGL-1. The HLA class I and II alleles most frequently found in this study have already been described among Terena indigenous groups, and HLA class I contributes to seroconversion to NDO-LID and PGL-1 tests in inhabitants of the Barão and Ipiranga communities(AU).

Prevalence of malocclusion and dental caries among Aymara children in Colchane, Chile / Prevalencia de maloclusión y caries dental en niños Aymaras de Colchane, Chile

Describe the prevalence of malocclusions, dental caries and the need for orthodontic treatment according to the Index of Orthodontic Treatment Need (IOTN) among Aymara schoolchildren, Indian group has lived in the highlands of the Andes Mountains. 76 Aymara schoolchildren between 5 and 15 years old in Colchane, Chile, where a cross-sectional study was conducted. DMFT/dmft index, Dental component (DHC) of IOTN and demographics were determined. Frequencies and mean (SD) were calculated. Bivariate analyses were conducted using Fisher's exact to test the association between sex and stage of dentition (p<0.05). Stata version 14 was used for all analyses. Among the 76 participants, 47.4 % (N=36) were male. Participants were on average 9.96 years old (SD=2.5). Over half presented dental caries (61.8 %, n=47) and 36.8 % (N=28) had missing teeth due to caries. The DMFT index was 2.1 (SD=1.9). The most frequent biotype was brachyfacial 88.2 % (N=67). Malocclusion was observed in 81.6 % (N=62) of participants. Class I, was the most frequent (67 %, N=51) malocclusion in the different stages of dentition. The most prevalent treatment need was grade 4 and 5 "need treatment" of the IOTN, observed in 71 % (N=54) of the sample with significant differences according to the stage of dentition (p<0.05). In this study, a high prevalence of malocclusion and a high percentage of dental caries was observed in Aymara children.

Describir la prevalencia de maloclusiones, caries dental y la necesidad de tratamiento de ortodoncia según el Índice de Necesidad de Tratamiento de Ortodoncia (IOTN), en escolares Aymaras, grupo indígena que vive en el altiplano de la Cordillera de los Andes. Estudio transversal de 76 escolares Aymaras de 5 a 15 años de Colchane, Chile. Se determinó el índice COPD/ceod, el componente dental (DHC) del IOTN y la demografía. Se calcularon las frecuencias y la media (DE). Se realizaron análisis bivariados utilizando el exacto de Fisher para probar la asociación entre el sexo y la etapa de la dentición (p<0,05). Se utilizó la versión 14 de Stata para todos los análisis. Entre los 76 participantes, 47,4 % (N = 36) eran hombres. Los participantes tenían un promedio de 9,96 años (DE = 2,5). Más de la mitad presentó caries dental (61,8 %, n = 47) y 36,8 % (N = 28) tenían dientes perdidos por caries. El índice DMFT fue 2,1 (DE = 1,9). El biotipo más frecuente fue el braquifacial 88,2 % (N = 67). Se observó maloclusión en el 81,6 % (N = 62) de los participantes. La Clase I fue la maloclusión más frecuente (67 %, N = 51) en las diferentes etapas de la dentición. La necesidad de tratamiento más prevalente fue la definida con los grados 4 y 5 de "necesidad de tratamiento" del IOTN, observada en el 71 % (N = 54) de la muestra con diferencias significativas según la etapa de la dentición (p <0,05). En este estudio, se observó una alta prevalencia de maloclusión y un alto porcentaje de caries dental en niños aymaras.

Description of acoustic and articulatory parameters of vowels in mapudungun speakers: pilot study / Descripción de parámetros acusticos y articulatorios de las vocales en hablantes de mapudungun: estudio piloto

Mapudungun is a language used by Mapuche people in some regions of Chile and Argentina. The aim of this study was to describe the vowel phonemes with regard to the articulatory parameters (position of the tongue with respect to the palate and jaw opening) and acoustic parameters (f0, F1, F2 and F3) in Mapudungun speakers in the Region of La Araucanía. The vocalic phonemes of Mapudungun are six, where the first five are similar to those used in Spanish (/a e i o u/), to which is added a sixth vowel (/ɨ/) with its vocalic allophones (/ɨ/) and [Ә]. Three Mapudungun speakers were evaluated. The tongue movements were collected by Electromagnetic Articulography 3D and the data were processed with MATLAB and PRAAT software. It was possible to describe the trajectory of each third of the tongue during the production of the vowels. It was observed that the sixth vowel /Ә/ had minimal jaw opening during its pronunciation. In addition, the characteristic of /Ә/ as an unrounded mid-central vowel was corroborated. In this study, the tongue of mapudungun speakers was in a more posterior position than the found in other studies.

El Mapudungun es un lenguaje utilizado por los mapuches en algunas regiones de Chile y Argentina. El objetivo de este estudio fue describir los fonemas vocálicos respecto a los parámetros articulatorios (posición de la lengua respecto al paladar y apertura mandibular) y los parámetros acústicos (f0, F1, F2 y F3) en hablantes de Mapudungun en la Región de La Araucanía, los fonemas vocálicos de Mapudungun son seis, donde los primeros cinco son similares a los utilizados en español (/a e i o u /), a los que se agrega una sexta vocal (/ɨ/) con sus alófonos vocálicos [ɨ] y [Ә]. Se evaluaron tres hablantes de Mapudungun. Los movimientos de la lengua fueron registrados por Articulografía Electromagnética 3D y los datos fueron procesados con el software MATLAB y PRAAT. Fue posible describir la trayectoria de cada tercio de la lengua durante la producción de las vocales. Se observó que la sexta vocal /Ә/ tenía una apertura mínima de la mandíbula durante su pronunciación. Además, se corroboró la característica de /Ә/ como vocal central media no redondeada. En este estudio, la lengua de los hablantes de mapudungun estaba en una posición más posterior que la encontrada en otros estudios.

Reducción en la infección por VHB y VHD en dos poblaciones indígenas de la Amazonia peruana después de la vacunación contra la hepatitis B / Reduction of HBV and HDV infection in two indigenous peoples of Peruvian Amazon after the vaccination against hepatitis B

Resumen: Objetivo: Conocer el resultado de la vacunación contra la hepatitis B en las comunidades hiperendémicas Kandozi y Chapra de la Amazonia Peruana a partir de la prevalencia de infecciones por los virus de la hepatitis B (VHB) y Delta (VHD), ocho años después de iniciada la vacunación. Material y métodos: Se realizó un estudio transversal en 2 944 pobladores de 67 comunidades indígenas Kandozi y Chapra en abril de 2010. El tamizaje serológico para el antígeno de superficie del VHB (HBsAg), anticuerpos anti-HBc IgM e IgG, anticuerpos anti-HBs y anti-VHD se determinaron mediante pruebas de ELISA. Resultados: Las tasas de prevalencia del HBsAg, anti-HBc IgG, anti-HBs ≥10 mlUI/ml y anti-VHD fueron 2.3, 39.13, 50.95 y 2.11%, respectivamente. La prevalencia del HBsAg en niños <11 años fue cero. Entre los portadores del HBsAg, las tasas de prevalencia de sobreinfeccion por el VHD e infección aguda por el VHB fueron 2.11% (todos fueron >14 años) y 11.94%, respectivamente. Conclusiones: Estos hallazgos muestran la eliminación de portadores de VHB en niños <11 años, ocho años después de iniciada la vacunación contra el VHB.

Abstract: Objective: To determine the outcome of the vaccination against hepatitis, we determined the prevalence of hepatitis B virus (HBV) and hepatitis D virus (HDV) infections, eight years after introduction of the vaccination. Materials and methods: A cross-sectional study was performed in 2 944 participants of 67 Kandozi and Chapra indigenous peoples in April 2010. Serological screening for hepatitis B surface antigen (HBsAg), antibody anti-HBc IgM and IgG, antibody anti-HBs and anti-HDV were determined by ELISA tests. Results: The prevalence rates of HBsAg, anti-HBc total, anti-HBs ≥10 mlUI/ml and anti-HDV were 2.3, 39.13, 50.95 and 2.11%, respectively. The prevalence rate of HBsAg in children <11 years was 0%. Among carriers of HBsAg, the prevalence rates of HDV and acute HBV infections were 2.11% (all were >14 years) and 11.94%, respectively. HBsAg and anti-HBc total were associated with individuals ≥10 years (p<0.001). Conclusions: These findings show the elimination of HBV carriers in children <11 years, eight years following introduction of the vaccination against HBV.

Oxygen saturation and heart rate in children at high altitude: a different response of Aymaras and non-Aymaras with chronic exposure at 3500 m / Saturación de oxígeno y ritmo cardiaco de niños en zonas de gran altitud: una respuesta distinta entre Aymaras y no Aymaras con exposición crónica a 3500 m

This work aims to determine if there is a difference between the cardiorespiratory response of children who chronically live at high altitude (Aymaras and non-Aymaras) compared to children that arrive as tourist at a high altitude of 3500 m (Putre, Chile). The subjects were children (Aymaras and non-Aymaras) who were born and live in Putre and children who came to the same location for a tourist visit. We used Oxygen saturation (%) and heart rate (HR, bpm) were evaluated by pulse oxymetry in children from Putre. The results showed similar levels of oxygen saturation were observed among chronic Aymaras and non-Aymara children. A lower oxygen saturation was found in children with acute exposure when compared with chronic children (p<0.0001). The HR of Aymaras and non-Aymara chronic children was lower than that observed in the non-native children (p<0.05). In contrast acute children had a higher HR than chronic children (p<0.001). Negative relationships were observed with correlation values (p<0.01) between oxygen saturation and HR in all groups. We concluded that chronic Aymara children exhibited a higher slope and correlation between oxygen saturation vs HR compared to chronic children who are non-Aymaras, suggesting that chronic natives are more sensitive to hypoxia. And, chronic non-Aymara children have an early blunting response to hypoxia. Further studies are needed to understand the physiological mechanisms in this population group.

El objetivo de este trabajo es determinar si existe alguna diferencia entre la respuesta cardiorespiratoria de niños que han vivido crónicamente a gran altitud (Aymaras y no Aymaras) comparados con niños llegados como turistas en grandes alturas de 3500m (Putre, Chile). Los sujetos fueron niños (Aymaras y no Aymaras) que nacieron y vivieron en Putre y niños que llegaron a la zona por una visita turística. Utilizamos saturación de oxígeno (%) y ritmo cardíaco (HR, bpm). Los niños de Putre fueron evaluados utilizando la pulsioximetría. Los resultados mostraron niveles similares de saturación de oxígeno entre los niños crónicos Aymaras y no Ayamaras. En los niños con exposición aguda se encontró una baja saturación de oxígeno al compararse con los niños crónicos (p<0.0001). El HR de los niños crónicos Aymaras y no Aymaras fue menor que el observado en niños no nativos (p<0.05). En cambio, los niños con síntomas agudos tenían una mayor HR que los niños crónicos (p<0.001). Se observaron relaciones negativas con los valores de correlación (p<0.01) entre la saturación de oxígeno y HR en todos los grupos. Concluimos que los niños crónicos Aymaras mostraban una gran pendiente y correlacion entre la saturación de oxígeno contra el HR comparado con los niños crónicos no Aymaras, sugiriendo que los nativos crónicos son más susceptibles a la hipoxia, y que los niños crónicos no Aymaras tiene una respuesta temprana a la hipoxia. Se necesitan estudios posteriores para entender los mecanismos fisiológicos en este grupo de población.

La naturaleza en la Constitución: visiones indígenas y propuestas ante la crisis / Nature and the Constitution: indigenous perspectives and proposals for the crisis / A natureza na Constituição: visões indígenas e propostas diante da crise

Este trabajo analiza la forma en que el derecho y la Constitución del 80 tratan a la naturaleza. Esta visión se contrapone con los enfoques de las filosofías de los pueblos indígenas andinos y mapuche, las cuales apuntan a la interrelación, interdependencia y reciprocidad en las relaciones entre sociedad y naturaleza. A partir de los problemas ambientales que la ciencia ha sistematizado y que afectan al mundo y al país, este trabajo elabora propuestas para una nueva configuración de lo ambiental y la naturaleza en la Constitución.

This paper assesses how the law and the 1980 Constitution deal with nature. This view contrasts with the perspective of the philosophies of the indigenous Andean and Mapuche peoples which consider the interrelation, interdependence and reciprocity in the relationships between society and nature. From the standpoint of the environmental problems that science has systematized and that affect the world and the country, this paper puts forward proposals for a new configuration for issues concerning the environment and nature in the Constitution.

Este trabalho analisa a forma como o Direito e a Constituição dos anos 80 tratam a natureza. Esta visão se contrapõe com o enfoque das filosofías dos povos indígenas andinos e mapuche, as quais apontam para a interrelação, interdependencia e reciprocidade nas relações entre sociedade e a natureza. A partir dos problemas ambientais que a ciencia sistematizou e que afetam o mundo e o país, este trabalho elabora propostas para uma nova configuração do ambiental e da natureza na Constituição.

Hitupmã'ax: educação intercultural e atendimento diferenciado à saúde do povo maxakali / Hitupmã'ax: intercultural education and specific health care for the Maxakali people

Resumo Este trabalho analisou um artefato (um livro de saúde) concebido pelo povo maxakali, denominado Hitupmã'ax: curar (2008). Tangenciado o projeto de produção do livro, o objetivo foi entender o processo de negociação da saúde pública no Brasil, dentro de uma perspectiva histórica e intercultural das epistemologias não ocidentais. Constatamos que a construção da obra maxakali representa um esforço para diminuir a distância da percepção e dos cuidados de saúde entre indígenas e não indígenas, e por essa via demonstramos a importância desse projeto intercultural para a efetivação de políticas públicas voltadas para o público indígena em geral e, especificamenete, para a promoção da história, dos saberes e da cultura maxakali.

Abstract This study analyzed an artifact (a book on health) conceived by the Maxakali people, called Hitupmã'ax: curar (2008). Parallel to the project for the production of this book, the aim was to understand the negotiation of public health in Brazil from a historical and intercultural perspective of non-Western epistemologies. It was found that the construction of the Maxakali work represented an effort to bridge the gap in the perception of health and health care between indigenous and non-indigenous people. This was then used to demonstrate the importance of this intercultural project for the shaping of public policies for indigenous people in general and particularly for the promotion of the history, knowledge, and culture of the Maxakali people.

Evidencia científica de las propiedades medicinales de plantas para su uso en la medicina intercultural de Chile / Scientific evidence of the medicinal properties of plants for use in intercultural medicine in Chile

Este estudio tuvo como objetivo confirmar la evidencia científica existente de las propiedades terapéuticas de plantas chilenas que son utilizadas como medicamento por Machis de las regiones de La Araucanía y Los Ríos. El estudio se realizó en dos períodos en cuatro comunidades mapuches de esas regiones, entre Julio 2015 a marzo 2016 y segunda etapa entre agosto a diciembre 2017. Se realizaron entrevistas semiestructuradas con las Machis, donde las informaciones entregadas sobre las aplicaciones medicinales fueron consensuadas entre los participantes. Las plantas identificadas fueron comparadas en sus propiedades con la evidencia experimental conocida, verificando científicamente las propiedades indicadas. Los resultados ofrecen un criterio adicional para la selección y uso de plantas en dolencias existentes en la población chilena. Los resultados de este estudio corroboran para algunas especies de plantas utilizadas, sus propiedades medicinales declaradas en enfermedades oncológicas. Dichos efectos exigen un estudio clínico necesario para su uso terapéutico.

The objective of this study was to confirm the existing scientific evidence of the therapeutical properties of Chilean plants to be used as medicine by Machis of the Araucanía and Los Ríos Chilean regions. The study was performed in two periods at four mapuche communities of these regions, between July 2015 to March 2016 and the second stage from August to December 2017. Semi-structured interviews were conducted with the Machis, where the information delivered on the medicinal applications it was agreed among all participants. The identified plants were compared in their properties with the experimental evidence reported, verifying the indicated properties. The results offer an additional criteria for selecting plants to be used in the corresponding diseases of Chilean population. The results of this study support for some species of plants used their medicinal properties on oncological diseases. These facts require the necessary clinical support in order to prove as therapeutic treatment.

Actitudes y prácticas de alimentación de cuidadores principales de escolares de origen Mapuche y no Mapuche según estado nutricional / Attitudes and feeding practices of primary caregivers of Mapuche and non-Mapuche schoolchildren according to nutritional status

Este estudio tuvo como objetivo asociar actitudes y prácticas de alimentación infantil de cuidadores con el estado nutricional de niños de origen mapuche y no mapuche. Participaron 200 escolares de primero a cuarto básico y sus cuidadores. Se realizó medición de peso y talla en los niños, y cuidadores respondieron el Child Feeding Questionnaire y un instrumento de caracterización sociodemográfica. Los resultados indicaron presencia de sobrepeso y obesidad en 56% del total de niños evaluados, cifra superior al promedio nacional, con un porcentaje significativamente superior (p≤0.001) en el grupo de origen mapuche (71,9%). Las asociaciones más fuertes del puntaje z de IMC del niño se encontraron con peso percibido d (r= 0,56, p= <0,001) y preocupación por el peso (r= 0,34, p= <0,001). Lo mismo ocurrió al segmentar la muestra por etnia. La única actitud que demostró diferencias entre grupos fue la responsabilidad percibida (p=0,018), resultando inferior en el grupo mapuche. No obstante, las diferencias según etnia, ésta no resultó predictora del estado nutricional del niño, pero sí el peso percibido (β= 3,778, p< 0,001) y la preocupación por el peso (β= 0,944, p= 0,018). Lo anterior refuerza el rol de actitudes y prácticas de padres y cuidadores en el estado nutricional del niño con independencia de los factores culturales implicados.

This study aims to associate child feeding attitudes and practices of caregivers with the nutritional status of Mapuche and non-Mapuche children. Two hundred schoolchildren from first to fourth grade and their caregivers participated. Measurement of weight and height was performed in children; caregivers completed the Child Feeding Questionnaire and a sociodemographic characterization instrument. Fifty six percent of the children assessed were overweight or obese, with a significantly higher percentage (p≤0,001) in the Mapuche group (71.9%). Child's BMI z-score was strongly related with perceived weight (r= 0,56 p= <0.001) and weight concern (r= 0,34, p= <0,001). The same results were found when segmenting the sample by ethnicity. The only attitude that showed differences between groups was perceived responsibility (p= 0,018), being lower in the Mapuche group. Despite the differences according to ethnicity, this variable was not predictive of the nutritional status of the child, unlike perceived weight (β= 3,778, p<0,001) and weight concern (β= 0,944, p= 0,018). These findings reinforce the role of attitudes and practices of parents and caregivers in the nutritional status of the child, regardless of the cultural factors involved.

Prácticas y creencias de enseñanza y estimulación del lenguaje desde la Cultura Mapuche en niños y niñas rurales en la Región de La Araucanía / Teaching practices and beliefs and language stimulation from the Mapuche Culture in rural children in the Araucanía Region

Resumen: Introducción: El lenguaje es una de las tareas cognitivas más relevantes en el desarrollo infantil cuya adquisición está mediada, entre otros, por factores étnicos y culturales. Objetivo: Caracterizar las prácticas y creencias sobre la enseñanza y estrategias de estimulación del lenguaje de niños/as Mapuche rurales de 0 a 4 años desde una perspectiva intracultural. Sujetos y Método: Estudio cualitativo basado en Teoría Fundamentada que produce una comprensión del problema a partir de las percepciones de los suje tos de investigación. Se utilizaron técnicas etnográficas como observación y notas de campo además de 20 entrevistas en profundidad y 4 grupos focales con cuidadores (madres, padres, abuelos/as), educadores interculturales, asesores culturales y agentes ancestrales de la cultura (longko y machi). Participaron 41 personas Mapuche de los territorios rurales de Ercilla, Curarrehue, Puerto Saave dra, Cholchol y Boroa de la región de La Araucanía/Chile. Resultados: Se obtuvieron 4 dimensiones que caracterizaban las prácticas y creencias en torno a la adquisición y uso del lenguaje en niños/as Mapuche: a) los/as niños/as y el aprendizaje de la lengua representan la mantención de la identidad Mapuche; b) el habla es un proceso concreto y pragmático; c) existen técnicas tradicionales para estimulación del habla, y d) existen dificultades y facilidades para el desarrollo de la lengua indígena en los niños/as pequeños. Conclusiones: La mantención y recuperación de la lengua indígena es un proceso de reforzamiento de la identidad cultural para el pueblo Mapuche, que no ha sido valorado como un patrimonio cultural en la sociedad nacional.

Abstract: Introduction: Language is one of the most relevant cognitive tasks in child development and its acquisition is me diated, among others, by ethnic and cultural factors. Objective: To characterize the practices and be liefs about language teaching and stimulation strategies of rural Mapuche Children aged between 0 to 4 years from an intracultural perspective. Subjects and Method: Qualitative study based on Groun ded Theory, which generates an understanding of the study issue from the perceptions of the research subjects. Ethnographic techniques such as observation and field notes were used, and 20 in-depth in terviews and four focus groups were conducted with caregivers (mothers, fathers, and grandparents), intercultural teachers and people with cultural roles (longkos, machis, and intercultural facilitators). 41 Mapuche people from the Ercilla, Curarrehue, Puerto Saavedra, Cholchol and Boroa territories of the Araucanía region, Chile participated. Results: Four dimensions were obtained that characte rized the practices and beliefs regarding the acquisition and use of language in Mapuche children: a) Mapuche culture transcends through children and language, b) speech is a concrete and pragmatic process, c) there are traditional techniques for speech stimulation, and d) there are difficulties and easiness for the development of the indigenous language in young children. Conclusions: The preser vation and recovery of the indigenous language is a process of reinforcing the cultural identity for the Mapuche people, which has not been valued as a cultural heritage in the national society.

Desafios na formação de enfermeiros indígenas em Mato Grosso, Brasil / Challenges in the training of indigenous nurses in Mato Grosso, Brazil

Resumo A formação do enfermeiro no Brasil, ainda se apresenta como um desafio para as universidades, face as diversidades étnicas e as particularidades regionais existentes. Assim, o objetivo do estudo foi identificar os desafios no processo de formação de enfermeiros indígenas em Mato Grosso, Brasil. Trata-se de estudo exploratório e qualitativo, junto a 11 enfermeiros indígenas. A análise dos dados, baseou-se na interculturalidade de Paulo Freire. Verificou-se que todos participantes, buscam a integração dos saberes tradicionais indígenas com os conhecimentos técnico científicos, durante suas práticas, o que facilita a interação satisfatória com a comunidade. Durante a graduação de Enfermagem tiveram pouco ou nenhum contato com conteúdos relacionados à saúde indígena e ao término da formação vislumbravam despreparo para atender as variadas demandas em saúde. Historicamente, apresentam-se subalternizados em relação aos não indígenas, o que reflete em desvantagens no processo de ensino-aprendizagem, tanto relacionados aos aspectos técnicos/tecnológicos como sociais.

Abstract The training of nurses in Brazil remain a challenge for the university, given the existing ethnic diversity and regional particularities. Thus, the aim of this study was to identify the challenges in the training process of indigenous nurses in Mato Grosso, Brazil. It is an exploratory and qualitative study, carried out with 11 indigenous nurses. Data analysis was based on Paulo Freire's interculturality. It was verified that both participants sought the integration of indigenous traditional knowledge with scientific technical knowledge during their practices, which facilitates a satisfactory interaction with the community. During nursing undergraduate school, they had little or no contact with contents related to indigenous health and at the end of the training they observed they were not prepared to meet the diverse health demands. Historically, they are subordinated in relation to non-indigenous people, which manifests as disadvantages in the teaching-learning process, related to technical / technological as well as social aspects.