[Psychomotor development from 0 to 4 years in indigenous children. A sistematic literature search]. / Desarrollo psicomotor de 0 a 4 años en infancia indígena. Revisión sistemática de la literatura.

INTRODUCTION: The objective of this study was to evaluate published articles regarding the development of indigenous children aged 0 to four years. SUBJECTS AND METHOD: Systematic literature search. Parti cipants: Primary studies with populations of indigenous children aged 0 to four years. Type of studies: Primary studies with qualitative or quantitative methodologies published in the last ten years until November 2015. Databases: MEDLINE, Digital Library of the University of Girona: CERCADOR, EMBASE, Scielo. SEARCH STRATEGY: sensitive and specific. Free terms, MeSH, and Boolean. RESULTS: Nine articles remain for analysis. There are six central subjects related to intracultural patterns of expected development in indigenous childhood: 1) physical, 2) language, 3) socio-cognitive, 4) emo tional, 5) teaching-learning, 6) psychosocial, which reveal the existence of categories of sociocultural and spiritual contents. There is no defined period of time associated with the education. Learning is through observation and participation. Development is understood as a whole, intertwining the social, cultural, natural and spiritual. CONCLUSION: Spirituality and nature are at the center. Time as a goal to gain skills does not have a cultural function to demonstrate the acquisition of the inherent va lues to the culture. To base the assessment of development exclusively on psychomotor development as monitoring guide is insufficient to assess the integrality and complexity of the advances, abilities, and skills of indigenous children.

Desarrollo psicomotor de 0 a 4 años en infancia indígena: revisión sistemática de la literatura / Psychomotor development from 0 to 4 years in indigenous children: a sistematic literature search

INTRODUCCIÓN: El objetivo de este estudio fue evaluar artículos publicados respecto al desarrollo de niños/niñas de 0 a 4 años en el curso de la infancia indígena. SUJETOS Y MÉTODO: Búsqueda sistemática de la literatura. Participantes: Estudios primarios cuya población correspondiera a niños/as de 0 a 4 años en el curso de la infancia indígena. Tipos de estudios: Se incluyeron aquellos estudios cuyas metodologías fueran cualitativas o cuantitativas publicados en los últimos 10 años hasta noviembre de 2015. Bases de datos: MEDLINE, Biblioteca Digital de la Universidad de Girona: CERCADOR, EMBASE, Scielo. Estrategia de búsqueda: sensible y específica. Términos libres, MeSH, y Boolean. RESULTADOS: Quedan 9 artículos para el análisis. Se presentan 6 temas centrales que se relacionan con patrones intraculturales del desarrollo esperado en la infancia indígena: 1) lo físico; 2) el lenguaje; 3)lo socio-cognitivo; 4) lo emocional; 5) la enseñanza-aprendizaje; 6) lo psicosocial, que permi ten ver la existencia de categorías de contenidos socioculturales y espirituales. No se muestra una temporalidad definida asociada a la formación. El aprendizaje es por observación y participación. El desarrollo es comprendido como un todo, entrelaza lo social, cultural, natural y espiritual. CONCLUSIÓN: La espiritualidad y naturaleza están en el centro. La temporalidad como meta para dominar destrezas no ejerce función cultural para demostrar la adquisición de valores propios de la cultura. Basar la valoración del desarrollo centrándose exclusivamente en el Desarrollo Psicomotor como guía de vigilancia es insuficiente para valorar la integralidad y complejidad de los progresos, habilidades y destrezas de los niños/niñas indígenas.

INTRODUCTION: The objective of this study was to evaluate published articles regarding the development of indigenous children aged 0 to four years. SUBJECTS AND METHOD: Systematic literature search. Participants: Primary studies with populations of indigenous children aged 0 to four years. Type of studies: Primary studies with qualitative or quantitative methodologies published in the last ten years until November 2015. Databases: MEDLINE, Digital Library of the University of Girona: CERCADOR, EMBASE, Scielo. Search strategy: sensitive and specific. Free terms, MeSH, and Boolean. RESULTS: Nine articles remain for analysis. There are six central subjects related to intracultural patterns of expected development in indigenous childhood: 1) physical, 2) language, 3) socio-cognitive, 4) emo tional, 5) teaching-learning, 6) psychosocial, which reveal the existence of categories of sociocultural and spiritual contents. There is no defined period of time associated with the education. Learning is through observation and participation. Development is understood as a whole, intertwining the social, cultural, natural and spiritual. CONCLUSION: Spirituality and nature are at the center. Time as a goal to gain skills does not have a cultural function to demonstrate the acquisition of the inherent va lues to the culture. To base the assessment of development exclusively on psychomotor development as monitoring guide is insufficient to assess the integrality and complexity of the advances, abilities, and skills of indigenous children.

Política de Salud Intercultural: perspectiva de usuarios mapuches y equipos de salud en la IX región, Chile / Intercultural health care policy from the perspective of health care providers and Mapuche clients

BACKGROUND: Intercultural health is becoming an emergent topic in the design of health care programs for Mapuche people of Chile. This process faces important challenges such as the scarce theoretical support about the meaning of intercultural health and their practical consequences for providers and clients. AIM: To explore the perception in providers and Mapuche clients about intercultural health. MATERIAL AND METHODS: A survey performed in 11 counties with the highest concentration of Mapuche people, of the IX region of Chile. The perception about the development of a new health policy specially designed for Mapuche patients was surveyed in 399 Mapuche patients and 64 providers of primary health care centers. RESULTS: Mapuche clients considered, as the main regional challenges, the indifference and discrimination of health care teams towards Mapuche patients, aggravated by the indifference of authorities. Providers considered that the main problem was a lack of knowledge about Mapuche culture and skills to deal with this ethnic group. Patients and providers agreed on the need to use Mapuche dialect in health care attentions, to coordinate actions with traditional healers and to accept ethnical therapeutic practices. CONCLUSIONS: There is scarce agreement between providers and Mapuche clients about the need for an special intercultural health policy, its contents, and the regional conditions for its implementation and development.

Salud intercultural: elementos para la construcción de sus bases conceptuales / Intercultural health: elements to the construction of its conceptual bases

Over the past few years, intercultural health has become an emerging issue in health policy. Intercultural health is an approach to create a better communication between patients and providers. In the short term, this approach incorporates patient's culture background in health care, improving intercultural communication strategies to generate, in the long term, a health system adapted to the medical culture of patients. This article explores the underlying concepts in the intercultural health approach, such as cultural diversity and medical systems as complex models of thoughts and behaviors.

Percent of oxygen saturation of arterial hemoglobin among Bolivian Aymara at 3,900-4,000 m.

A range of variation in percent of oxygen saturation of arterial hemoglobin (SaO2) among healthy individuals at a given high altitude indicates differences in physiological hypoxemia despite uniform ambient hypoxic stress. In populations native to the Tibetan plateau, a significant portion of the variance is attributable to additive genetic factors, and there is a major gene influencing SaO2. To determine whether there is genetic variance in other high-altitude populations, we designed a study to test the hypothesis that additive genetic factors contribute to phenotypic variation in SaO2 among Aymara natives of the Andean plateau, a population geographically distant from the Tibetan plateau and with a long, separate history of high-altitude residence. The average SaO2 of 381 Aymara at 3,900-4,000 m was 92+/-0.15% (SEM) with a range of 84-99%. The average was 2.6% higher than the average SaO2 of a sample of Tibetans at 3,800-4,065 m measured with the same techniques. Quantitative genetic analyses of the Aymara sample detected no significant variance attributable to genetic factors. The presence of genetic variance in SaO2 in the Tibetan sample and its absence in the Aymara sample indicate there is potential for natural selection on this trait in the Tibetan but not the Aymara population.

Hemoglobin concentration of high-altitude Tibetans and Bolivian Aymara.

Elevated hemoglobin concentrations have been reported for high-altitude sojourners and Andean high-altitude natives since early in the 20th century. Thus, reports that have appeared since the 1970s describing relatively low hemoglobin concentration among Tibetan high-altitude natives were unexpected. These suggested a hypothesis of population differences in hematological response to high-altitude hypoxia. A case of quantitatively different responses to one environmental stress would offer an opportunity to study the broad evolutionary question of the origin of adaptations. However, many factors may confound population comparisons. The present study was designed to test the null hypothesis of no difference in mean hemoglobin concentration of Tibetan and Aymara native residents at 3,800-4,065 meters by using healthy samples that were screened for iron deficiency, abnormal hemoglobins, and thalassemias, recruited and assessed using the same techniques. The hypothesis was rejected, because Tibetan males had a significantly lower mean hemoglobin concentration of 15.6 gm/dl compared with 19.2 gm/dl for Aymara males, and Tibetan females had a mean hemoglobin concentration of 14.2 gm/dl compared with 17.8 gm/dl for Aymara females. The Tibetan hemoglobin distribution closely resembled that from a comparable, sea-level sample from the United States, whereas the Aymara distribution was shifted toward 3-4 gm/dl higher values. Genetic factors accounted for a very high proportion of the phenotypic variance in hemoglobin concentration in both samples (0.86 in the Tibetan sample and 0.87 in the Aymara sample). The presence of significant genetic variance means that there is the potential for natural selection and genetic adaptation of hemoglobin concentration in Tibetan and Aymara high-altitude populations.

Ventilation and hypoxic ventilatory response of Tibetan and Aymara high altitude natives.

Newcomers acclimatizing to high altitude and adult male Tibetan high altitude natives have increased ventilation relative to sea level natives at sea level. However, Andean and Rocky Mountain high altitude natives have an intermediate level of ventilation lower than that of newcomers and Tibetan high altitude natives although generally higher than that of sea level natives at sea level. Because the reason for the relative hypoventilation of some high altitude native populations was unknown, a study was designed to describe ventilation from adolescence through old age in samples of Tibetan and Andean high altitude natives and to estimate the relative genetic and environmental influences. This paper compares resting ventilation and hypoxic ventilatory response (HVR) of 320 Tibetans 9-82 years of age and 542 Bolivian Aymara 13-94 years of age, native residents at 3,800-4,065 m. Tibetan resting ventilation was roughly 1.5 times higher and Tibetan HVR was roughly double that of Aymara. Greater duration of hypoxia (older age) was not an important source of variation in resting ventilation or HVR in either sample. That is, contrary to previous studies, neither sample acquired hypoventilation in the age ranges under study. Within populations, greater severity of hypoxia (lower percent of oxygen saturation of arterial hemoglobin) was associated with slightly higher resting ventilation among Tibetans and lower resting ventilation and HVR among Aymara women, although the associations accounted for just 2-7% of the variation. Between populations, the Tibetan sample was more hypoxic and had higher resting ventilation and HVR. Other systematic environmental contrasts did not appear to elevate Tibetan or depress Aymara ventilation. There was more intrapopulation genetic variation in these traits in the Tibetan than the Aymara sample. Thirty-five percent of the Tibetan, but none of the Aymara, resting ventilation variance was due to genetic differences among individuals. Thirty-one percent of the Tibetan HVR, but just 21% of the Aymara, HVR variance was due to genetic differences among individuals. Thus there is greater potential for evolutionary change in these traits in the Tibetans. Presently, there are two different ventilation phenotypes among high altitude natives as compared with sea level populations at sea level: lifelong sustained high resting ventilation and a moderate HVR among Tibetans in contrast with a slightly elevated resting ventilation and a low HVR among Aymara.

Efectos del consumo tradicional de hojas de coca sobre la respiración / Efectos del consumo tradicional de hojas de coca sobre la respiración

La historia documentada sobre las hojas de coca se inicia en 1504 con una carta en la que Américo Vespucio describe sus primeros contactos con los utilizadores de hojas de coa, que había tenido ocasión de conocer en 1499 durante un viaje por las costas de la actual Venezuela. Posteriores a este documento existen muchos otros escritos por los cronistas españoles de la conquista. A través de estos testimonios se sabe que para los Incas, la coca constituía el centro de sus actividades religiosas y sus ritos. En la mayoría de estos documentos históricos, la coca era considerada como una planta inútil, perniciosa y demoniaca que impedía la difusión del cristianismo; sin embargo, algunos escritos hacían referencia a sus cualidades, señalando entre sus virtudes ­transmitidas por la creencia popular- el uso con fines medicinales y antifatigantes. Entre las crónicas de la conquista, se encuentra la del religioso jesuita José de Acosta quién describió con precisión los síntomas del "Mal de Montaña" o "Mal de altura", al relatar sus experiencias acompañando a las tropas españolas durante una travesía por los andes. En su obra "Historia Natural y Moral de las Indias" (1590) se encuentra una descripción detalladas de las molestias que sufren los recién llegados a la altura, que Acosta atribuyó a "la textura del aire delicado y sutil, que no está adaptado a la respiración del hombre…". Ya en esa época, también se mencionaba el efecto benéfico de la utilización de hojas de coca para contrarrestar este mal (Garcilazo de la Vega, 1609). (AU)

Anthropometry and lung function of 10- to 12-year-old Bolivian boys.

Anthropometric measurements of 23 HAHSES, 44 HALSES, 43 LAHSES, and 28 LALSES boys (see Introduction to this Supplement) are presented here. They include body height (H), body weight (BW), upper arm circumference (UAC), and skinfold thickness taken at four locations. From these measurements, body fat, lean body mass, and body mass index (BMI = BW/H2) were calculated. The degree of maturation was assessed according to Tanner, orchidometry, and by quantification of testosterone in saliva. Lung function data include: vital capacity (VC), forced expired volume per 1 s (FEV1), functional residual capacity (FRC), residual volume (RV), and total lung capacity (TLC). The results show enhanced lung volumes in both HA groups in comparison to LA groups, with HALSES boys having the greatest increase, even though the LSES boys were significantly smaller compared to the HSES boys at both altitudes and their growth was delayed by approximately 2 years. From the anthropometric data it appears that physical growth of prepubertal boys is dependent on SES but not on high-altitude exposure. We tentatively conclude that chronic hypoxia per se does not affect physical growth in prepubertal boys in an Andean environment and that development of lung function is accelerated in relation to linear growth as has been suggested by other authors (15).