Adaptación y validación de la Patient Health Questionnaire for Depression and Anxiety (PHQ-4) en una muestra de quechua hablantes peruanos

Introducción: El Patient Health Questionnaire for Depression and Anxiety (PHQ-4) es una medida de autoinforme ultrabreve de síntomas depresivos y ansiosos. El PHQ-4 no ha sido adaptado ni validado en la población quechua hablante. Objetivo: Este estudio tuvo como objetivo adaptar y validar el PHQ-4 en una muestra de población peruana quechua hablante en su variante Collao de Puno-Perú. Metodología: Participaron 221 personas hablantes de quechua variante collao (promedio de edad de 31,2 años, SD = 11,7, 47,1 % hombres y 52,9 % mujeres). Se evaluó la evidencia de validez basada en la estructura interna, mediante el análisis factorial confirmatorio (CFA), la fiabilidad con el método de consistencia interna y las características de dificultad y discriminación de los ítems en base a la Teoría de Respuesta al Ítem (IRT). Resultados: Los resultados indicaron que todos los ítems del PHQ-4 son relevantes, coherentes y claros para representar adecuadamente los síntomas de ansiedad y depresión. El resultado del AFC apoyó un modelo unifactorial, donde los ítems de ansiedad y depresión conforman una sola variable latente con una fiabilidad alta. Todos los ítems del PHQ-4 presentas buenos parámetros de discriminación y los parámetros de dificultad indican que los ítems son comparativamente difíciles. Por lo tanto, se necesita una mayor presencia del rasgo latente (ansiedad y depresión) para responder las categorías de respuesta más altas. Discusión: En conclusión, la PHQ-4 presentó buenas propiedades psicométricas como una medida de detección primaria rápida, confiable y válida para personas quechuahablantes que necesitan una evaluación profunda, monitoreo de los síntomas para diagnóstico y tratamiento para la ansiedad o depresión.

Introduction: The Patient Health Questionnaire for Depression and Anxiety (PHQ-4) is an ultra-brief self-report measure of depression and anxiety symptoms. The PHQ-4 has not been adapted or validated in the Quechua-speaking population. Objective: This study aimed to adapt and validate the PHQ-4 in a sample of the Peruvian Quechua-speaking population with its Collao variant from Puno-Peru. Methods: A total of 221 Quechua speakers of the Collao variant (mean age 31.2 years, SD = 11.7, 47.1% male and 52.9% female) participated. Evidence of validity based on internal structure was evaluated using confirmatory factor analysis (CFA), reliability using the internal consistency method, and item difficulty and discrimination characteristics based on Item Response Theory (IRT). Results: The results indicated that all items of the PHQ-4 were relevant, consistent, and clear enough to adequately represent anxiety and depressive symptoms. The CFA results supported a one-factorial model, in which anxiety and depression items form a single latent variable with high reliability. All items of the PHQ-4 had good discrimination parameters, and the difficulty parameters indicated that the items were comparatively difficult. Therefore, a higher presence of the latent trait (anxiety and depression) is needed to answer higher response categories. Discussion: In conclusion, the PHQ-4 presented good psychometric properties as a rapid, reliable, and valid primary screening measure for Quechua speakers in need of in-depth assessment and symptom monitoring for the diagnosis and treatment of anxiety and depression.

Translation and validation of the satisfaction with life scale in the native Quechua (Collao variant) language of southern Perú.

Research on life satisfaction in indigenous populations is limited due to language barriers. Therefore, this paper aimed to translate and validate the Life Satisfaction Scale into the original Quechua language (collao variant) of southern Peru. The research was classified as instrumental and transversal and was conducted with the voluntary participation of 242 Quechua adults speaking the collao variant. The instrument that was translated was the 5-item SWLS, previously adapted to Peruvian Spanish. The internal structure was analyzed under an analytical-factorial approach, and the discrimination and difficulty of the items were evaluated from the item response theory (IRT). Expert judgment was favorable for all items (V > 0.70), confirming the 1-dimensional structure of the scale (χ2 = 8.972, df = 5, p = .000; CFI = 0.985; TLI = 0.970 and RMSEA = 0.057), with acceptable reliability (ω = 0.65). All the items of the scale presented adequate discrimination indices; in addition, the results of the evaluation of factorial invariance as a function of gender demonstrated configurational equivalence but an absence of metric invariance. In conclusion, the SWLS translated into Collao Quechua (collao variant) has a stable factorial structure and adequate internal consistency, although it was not possible to completely demonstrate the invariance by gender, it can be used for initial investigations to measure satisfaction with life of the Quechua-speaking indigenous population of southern Peru.

Translation and validation of the WHO-5 General well-being index into native language Quechua of the Peruvian South.

To translate and validate the WHO-5 General Well-being Index for the people of the Peruvian South, a cross-sectional instrumental study was carried out with the voluntary participation of 186 people of both sexes between the ages of 18 and 65 years (M = 29.67 years old; SD = 10.94) living in the south region of Peru. The validity evidence was assessed based on the content using Aiken's coefficient V according to the internal structure through a confirmatory factor analysis, and reliability was calculated through Cronbach's alpha coefficient. The expert judgment was favorable for all items (V > 0.70). The unidimensional structure of the scale was confirmed (χ2 = 10.86, df = 5, p = 0.05; RMR = 0.020; GFI = 0.980; CFI = 0.990; TLI = 0.980 y RMSEA = 0.080), and it presents a suitable reliability range (α = > 0.75). This shows that the WHO-5 General Well-being Index for the people of the Peruvian South is a valid and reliable scale.

The native potato, a symbol of macho expression in the Quechua culture of Peru.

The present field research focuses on the native potato varieties, Wira pasña and Llumchuy waqachi, cultivated in the Peruvian highlands at roughly 4,000 m above sea level. The objective is to analyze the macho essence of the names assigned to the native potato, names that represent the social manifestation of women in Quechua culture. Participant observation and interviews about the different daily activities of the participants facilitated the research on the macho essence of the names of the native potato in the Quechua culture. The preponderant Quechua oral sources in the Peruvian Andes did not allow us to identify exactly how names associated with the macho way of social life were assigned to the native potatoes.

Crianza kichwa en Medellín: tensiones entre lo ancestral y lo occidental / Kichwa childrearing in Medellin: tensions between ancestral and western practices / Criação Kichwa em Medellín: tensões entre o ancestral e o occidental

Resumen (analítico) El abordaje de la crianza indígena en el ámbito científico y occidental es complejo e interesante, en un contexto de realidades diversas que requieren ser visibilizadas para ampliar la comprensión de la crianza infantil. La investigación es cualitativa, apoyada en el inter-accionismo simbólico, y cuenta con la participación de cuatro familias y cinco líderes de la comunidad kichwa. Los resultados dan cuenta de la noción de infancia y de las prácticas que implementa esta comunidad para mantener la identidad kichwa. Asimismo, se evidencian las tensiones que produce la crianza, según el entorno. Como conclusión, los kichwa han buscado mantener sus tradiciones en la crianza de los infantes; sin embargo, las dinámicas de la ciudad afectan su cotidianidad, en especial en entornos citadinos como el comercio y la educación.

Abstract (analytical) Addressing a topic such as indigenous child rearing using scientific and western concepts becomes complex and interesting in a context of diverse realities that need to be examined to broaden understanding of these practices. This research study is qualitative and uses a symbolic interactionism approach. It involved the participation of four families and five leaders from the Kichwa community living in the city of Medellin. The results capture the notion of childhood for this indigenous group and the practices they implement to maintain the Kichwa identity, as well as the complexities that a non-indigenous environment creates for raising their children. In conclusion, the Kichwa have sought to maintain their traditions for the upbringing of the children. However, the dynamics of the city affect these practices, especially in urban scenarios such as commerce and education.

Resumo (analítico) Abordar um tópico como a criação indígena em escopos científicos e ocidentais torna-se complexo e interessante em um contexto de diversas realidades que precisam ser tornadas visíveis para ampliar a compreensão da criação infantil. A pesquisa é qualitativa com foco no interacionismo simbólico, e contou com a participação de quatro famílias e cinco lideranças da comunidade Kichwa habitantes de Medellín. Os achados mostram a importância de manter a identidade Kichwa e a noção de infância partindo da própria cultura e a complexidade que traz um meio distinto de formação e acompanhamento familiar. Concluindo, o povo Kichwa tem procurado manter suas tradições desde a formação das crianças, porém, as dinâmicas da cidade e suas interações influenciam na sua cotidianidade particularmente nos meios comerciais e educativos.

Ser joven andino quechua cerca y lejos de sus comunidades de origen / Being young, Andean and Quechua and both near and far from communities of origin / Ser jovem andino quechua perto e longe de suas comunidades de origen

Resumen (analítico) La investigación se pregunta cómo las y los «jóvenes¼ procedentes de comunidades quechuas surandinas del Perú construyen su «ser joven¼ en contextos de imposición neocolonial/neoliberal y, a la vez, de resistencias cerca y lejos de sus lugares de origen. Se realizó desde la postura decolonial con la metodología investigación-acción participativa adaptada al mundo de jóvenes de comunidades de Apurímac, Huancavelica y Ayacucho. Se constata que son afectados por imposiciones de la sociedad nacional, que a través de servicios y políticas públicas les proyectan una manera homogénea y hegemónica de ser joven que tiende a distanciarlos de sus familias y comunidades. La crianza en su cosmovisión será fuente de sus resistencias y les permitirá recuperar sus raíces por la vía de la lengua originaria y de la espiritualidad andina.

Abstract (analytical) This study asks how "young people" from the Quechua communities in Southern Peru construct "being young" in contexts involving neocolonial / neoliberal imposition and, at the same time, of acts of resistance both near and far from their places of origin. It was carried out using a decolonial position through the Participatory Action Research methodology adapted to the worlds of "young people" in the communities of Apurímac, Huancavelica and Ayacucho. The research identified that these young people are affected by impositions from Peruvian society, as government services and public policies project a homogeneous and hegemonic way of being young that tends to distance them from their families and communities. An upbringing based on their worldview will be the source of their resistance and will allow them to recover their roots through native language and Andean spirituality.

Resumo (analítico) A pesquisa questiona como os "jovens" das comunidades quíchuas do sul do Peru constroem seu "ser jovem" em contextos de imposição neocolonial / neoliberal e, ao mesmo tempo, de resistência perto e longe de seus lugares de origem. Foi realizado a partir da posição descolonial com a metodologia da Pesquisa-Ação Participativa adaptada ao mundo dos jovens das comunidades de Apurímac, Huancavelica e Ayacucho. Constata-se que são afetados por imposições da sociedade nacional, que por meio de serviços e políticas públicas os projetam de uma forma homogênea e hegemônica de ser jovem que tende a distanciarse de suas famílias e comunidades. A formação em sua visão de mundo será a fonte de sua resistência e permitirá que recuperem suas raízes por meio da língua nativa e da espiritualidade andina.

The spectacle of feminism and machismo in two Peruvian cumbia singers: Marisol and Tony Rosado.

The objective of this research is to analyze and interpret the entertainment section of the most important media in Peru, concentrated on two private companies: Grupo La República and Grupo El Comercio, with great journalistic dominance of national information. The entertainment section is as old as the foundation of the newspapers themselves. The method of analysis with qualitative documents has allowed us to reach the conclusion that the fight for gender equality promoted by the government is a spectacle for the national press. The entertainment section of the Peruvian press has exposed the private lives of representative characters such as the singers Marisol, "La Faraona de la Cumbia" and Tony Rosado, "El Ruiseñor de la Cumbia", from there the differences in feminism tolerated in Marisol and machismo censored in Rosado are popularized. It is concluded that the exposure of the struggle for gender equality is entertainment news where machismo and feminism are underhandedly justified with the parameter established with these public figures, that is, Peruvian cumbia singer-songwriters, and that offers evidence of the tolerance to the feminine voice that incites machismo, justifies the mistreatment of men and makes the male complaint a synonym of cowardice.

Producción científica sobre depresión en poblaciones quechua hablantes: Una revisión narrativa / Scientific production on depression in Quechua-speaking populations: A narrative review

Resumen: Antecedentes: Las poblaciones quechua hablantes se extienden por siete países latinoamericanos y por sus características requieren de atención diferenciada sobre la depresión. Objetivo: Describir la atención y producción científica sobre depresión en poblaciones quechua hablantes. Método: Revisión narrativa realizada con búsqueda en PUBMED, WEB OF SCIENCE y SCOPUS, incluyendo estudios en inglés y/o español, la estrategia de búsqueda se desarrolló con descriptores para depresión y población quechua hablante, la búsqueda fue realizada por dos revisores, quienes organizaron los resultados de la búsqueda en Microsoft Excel. Se incluyeron estudios que consideraron a la depresión y que se haya estudiado en poblaciones quechua hablantes de cualquier variante del quechua. Resultados: Se encontró 7 estudios, la prevalencia de la depresión en quechua hablantes fue de 38.9 % en Ayacucho Perú y (4 de 7 estudios) emplearon instrumentos psicométricos para evaluar la depresión. Existen escasas investigaciones sobre depresión en poblaciones quechua hablantes, principalmente son de tipo transversal y el instrumento utilizado es válida solo para una variante del quechua. Conclusiones: Se encontraron escasas investigaciones en poblaciones quechua hablantes, las publicaciones son principalmente estudios transversales, aún no se tienen instrumentos adaptados y validados a todas las variantes del quechua. Los síntomas depresivos parecen ser mayores especialmente en las mujeres. Por otro lado, el acceso a los servicios de atención en salud es limitada por las dificultades de aculturación, dominio del idioma por parte del profesional de salud; así como por el estigma y desconocimiento de la depresión por esta población.

Abstract: Background: Quechua-speaking populations span seven Latin American countries and, due to their characteristics, require differentiated attention to depression. Objective: Describe the attention and scientific production on depression in Quechua-speaking populations. Method: Narrative review carried out with a search in PUBMED, WEB OF SCIENCE and SCOPUS, including studies in English and / or Spanish, the search strategy was developed with descriptors for depression and Quechua-speaking population, the search was carried out by two reviewers, who organized the search results in Microsoft Excel. Studies that considered depression and that have been studied in Quechua populations speaking any variant of Quechua were included. Results: 7 studies were found, the prevalence of depression in Quechua speakers was 38.9% in Ayacucho Peru and (4 of 7 studies) used psychometric instruments to evaluate depression. There is little research on depression in Quechua-speaking populations, they are mainly cross-sectional and the instrument used is valid only for a variant of Quechua. Conclusions: Little research was found in Quechua-speaking populations, the publications are mainly cross-sectional studies, and there are still no instruments adapted and validated for all variants of Quechua. Depressive symptoms seem to be greater especially in women. On the other hand, access to health care services is limited by the difficulties of acculturation, command of the language on the part of the health professional; as well as the stigma and ignorance of depression by this population.

HLA study in Bolivian Quechua Amerindians from Titikaka Lake Area.

Quechua Amerindians established Inca Empire and chose Cuzco as their capital. Their language is closely related to that of Aymara ethnic group and both of them were originated from Titikaka Lake Altiplano area. In the present study we have analyzed Bolivian Quechua HLA profile and found that it has common characters with other Andean and Pacific Amerindians (Uros, Aymaras, Lamas, Mapuches, Athabascan), and Pacific Islanders, including Easter Islanders: relatively high frequency of HLA-A*24 (:02), class II haplotypes DRB1*08:02-DQB1*04:02, and DRB1*04:03-DQB1* 03:02. Titikaka Lake area prehistoric populations: Quechua, Aymaras and Uros are closely related according to HLA Nei DA genetic distances and other HLA traits: they built up Tiwanaku culture, which resembles that of Easter Island (i.e.: similar giant heads); later, Quechuas also moved to Cuzco. This genetic reletedness together with Easter Island and Titikaka Lake Tiwanaku (Bolivia, Peru) cultural common similarities support a prehistoric Pacific people/Amerindians gene flow.

HLA study in Amerindian Bolivia La Paz Aymaras.

Aymara people has been a relatively homogeneous group since Spanish Conquest by 1,532 CE, even if previously represented a group of various cultural defined populations who gave rise to them. They were and are established in Andean Altiplano around Titikaka Lake (Bolivia, Peru), Argentina and Chile neighborhood, speak Aymara language and have been maintained after Europeans arrival at a lower social status than Quechua (Inca) speaking people. However, both Aymara and Quechua populations acknowledge Titikaka Lake as center of their origins; both languages are also related. Specific high frequencies of HLA-A*02, -A*24 and -A*68, HLA-B*35, -B*39 and -B*48, HLA-DRB1*08:02, -DRB1*09:01, and -DRB1*14:02, and HLA-DQB1*04:02, -DQB1*03:02 and -DQB1*03:01 alleles are found in Aymaras and HLA class II haplotypes common to Andean Amerindians (DRB1*08:02-DQB1*04:02 and DRB1*04:03-DQB1*03:02), like Quechua, Aymara, Uros, Lamas and Mapuche are also found in Easter and other Pacific Islands. Giant human head stone statues at Tiwanaku (Titikaka Lake, Bolivia) are also found at Easter Island. Thus, it is possible a gene and cultural flow between Andean Amerindians and Easter and other Pacific Islands, as it was demonstrated by Thor Heyerdahl in his Kon-Tiki expedition which reached Pacific Islands sailing from El Callao Harbour (Lima, Peru).

Study of HLA genes in Mexico Mayo/Yoremes Amerindians: Further support of gene exchange with Pacific Islanders.

Mexican Mayo Amerindians live in southern Sonora and North Sinaloa states. They probably come from North or are related to First American Inhabitants established further North. A non-related sample of them have volunteered to HLA study in order to achieve a profile useful for their epidemiology and future transplant interstate programs, in addition to ascertain ancestry and anthropological studies. HLA typing was carried out by a standard methodology. HLA-B*48 allele(s) was found, which is characteristic of Pacific Amerindians and Pacific Islanders/southern Asians. Also, HLA-A*24 (most likely HLA-A*24:02) shows specific high frequencies in this population and also in indigenous people, like Aleuts, Alaska Yupik, Japan, Taiwan, Australia, New Zealand, Papua New Guinea, southern China and other Pacific Islands. Other Andean Amerindians also show a high HLA-A*24:02 frequencies. This confirms our previous results of a possible direct gene flow between Pacific Islanders/southern Asians and Amerindians. In addition, typical Amerindian haplotypes have been found in high frequency like HLA-A*24-B*39-DRB1*04:07-DQB1*03:02, HLA-A*02-B*35-DRB1*04:07-DQB1*03:02 and HLA-A*24-B*35-DRB1*04:07-DQB1*03:02, and new haplotypes are also described like HLA-A*02-B*35-DRB1*14:06-DQB1*03:01, HLA-A*02-B*48-DRB1*04:04-DQB1*03:02, and HLA-A*02-B*08-DRB1*04:07-DQB1*03:02. This study also supports that Americas peopling was not only carried out through Bering Strait but also through Pacific and Atlantic Oceans in an earlier time than proposed.

Association of EGLN1 gene with high aerobic capacity of Peruvian Quechua at high altitude.

Highland native Andeans have resided at altitude for millennia. They display high aerobic capacity (VO2max) at altitude, which may be a reflection of genetic adaptation to hypoxia. Previous genomewide (GW) scans for natural selection have nominated Egl-9 homolog 1 gene (EGLN1) as a candidate gene. The encoded protein, EGLN1/PHD2, is an O2 sensor that controls levels of the Hypoxia Inducible Factor-α (HIF-α), which regulates the cellular response to hypoxia. From GW association and analysis of covariance performed on a total sample of 429 Peruvian Quechua and 94 US lowland referents, we identified 5 EGLN1 SNPs associated with higher VO2max (L⋅min-1 and mL⋅min-1⋅kg-1) in hypoxia (rs1769793, rs2064766, rs2437150, rs2491403, rs479200). For 4 of these SNPs, Quechua had the highest frequency of the advantageous (high VO2max) allele compared with 25 diverse lowland comparison populations from the 1000 Genomes Project. Genotype effects were substantial, with high versus low VO2max genotype categories differing by ∼11% (e.g., for rs1769793 SNP genotype TT = 34.2 mL⋅min-1⋅kg-1 vs. CC = 30.5 mL⋅min-1⋅kg-1). To guard against spurious association, we controlled for population stratification. Findings were replicated for EGLN1 SNP rs1769793 in an independent Andean sample collected in 2002. These findings contextualize previous reports of natural selection at EGLN1 in Andeans, and support the hypothesis that natural selection has increased the frequency of an EGLN1 causal variant that enhances O2 delivery or use during exercise at altitude in Peruvian Quechua.

Exhaled nitric oxide in ethnically diverse high-altitude native populations: A comparative study.

OBJECTIVES: Andean and Tibetan high-altitude natives exhibit a high concentration of nitric oxide (NO) in the lungs, suggesting that NO plays an adaptive role in offsetting hypobaric hypoxia. We examined the exhaled NO concentration as well as partial pressure of several additional high-altitude native populations in order to examine the possibility that this putative adaptive trait, that is, high exhaled NO, is universal. METHODS: We recruited two geographically diverse highland native populations, Tawang Monpa (TM), a Tibetan derived population in North-Eastern India (n = 95, sampled at an altitude of ~3,200 m), and Peruvian Quechua from the highland Andes (n = 412). The latter included three distinct subgroups defined as those residing at altitude (Q-HAR, n = 110, sampled at 4,338 m), those born and residing at sea-level (Q-BSL, n = 152), and those born at altitude but migrant to sea-level (Q-M, n = 150). In addition, we recruited a referent sample of lowland natives of European ancestry from Syracuse, New York. Fraction of exhaled NO concentrations were measured using a NIOX NIMO following the protocol of the manufacturer. RESULTS: Partial pressure of exhaled nitric oxide (PENO) was significantly lower (p < .05) in both high-altitude resident groups (TM = 6.2 ± 0.5 nmHg and Q-HAR = 5.8 ± 0.5 nmHg), as compared to the groups measured at sea level (USA = 14.6 ± 0.7 nmHg, Q-BSL = 18.9 ± 1.6 nmHg, and Q-M = 19.2 ± 1.7 nmHg). PENO was not significantly different between TM and Q-HAR (p < .05). CONCLUSION: In contrast to previous work, we found lower PENO in populations at altitude (compared to sea-level) and no difference in PENO between Tibetan and Andean highland native populations. These results do not support the hypothesis that high nitric oxide in human lungs is a universal adaptive mechanism of highland native populations to offset hypobaric hypoxia.

ATXN10 Microsatellite Distribution in a Peruvian Amerindian Population.

Spinocerebellar ataxia type 10 (SCA10) is a repeat expansion disease occurring mostly in Latin America, suggesting that the mutation spread with the peopling of the Americas, or that Amerindian populations, have a higher ATXN10 mutability. High frequency of large normal alleles is associated with prevalence and relative frequency of other repeat expansion diseases. To test whether the allele distribution of the SCA10-causing ATXN10 microsatellite in an Amerindian Peruvian population differs from that of other populations. The ATXN10 allele distribution in a Quechua Peruvian population from Puno, Peru, is similar to that of Finland. Mean allele size and mode were also similar to those of Mexico, Japan, and white Europeans. ATXN10 allele distribution in a healthy Amerindian population from Peru does not differ from that of other populations.

HLA in Colombia Wayu from Guajira Peninsula Amerindians: Pacific Ocean relationships.

Wayu Amerindians live around Guajira Peninsula shared by Colombia and Venezuela. Wayu from Colombia have been studied for their HLA profile and these data put in context with both genetic and cultural relatedness to Pacific Islanders. HLA-A*24 and HLA-B*35 (most likely HLA-A*24:02 and HLA-B*35:05) and HLA-DRB1*04:03 and HLA-DQB1*03:02 are shared both by Wayu and other Amerindians and Pacific Islanders in specific high frequency. Our findings further suggest a genetic relationship between Amerindians (also Wiwa/Arsario and Chimila from Colombia; Uros from Peru) and Pacific Islanders. Titikaka Lake (Peru/Bolivia) Amerindians (Aymara, Uros and Quechua) share also cultural traits, like Tiwanaku (Titikaka Culture giant statues) and Easter Island Culture giant statues or "Moais".

Elevated arsenic exposure and efficient arsenic metabolism in indigenous women around Lake Poopó, Bolivia.

Elevated concentrations of inorganic arsenic, one of the most potent environmental toxicants and carcinogens, have been detected in well water around Lake Poopó, Bolivia. This study aimed to assess human exposure to arsenic in villages around Lake Poopó, and also to elucidate whether the metabolism and detoxification of arsenic in this population is as efficient as previously indicated in other Andean areas. We recruited 201 women from 10 villages around Lake Poopó. Arsenic exposure was determined as the sum concentration of arsenic metabolites (inorganic arsenic; monomethylarsonic acid, MMA; and dimethylarsinic acid, DMA) in urine (U-As), measured by HPLC-HG-ICP-MS. Efficiency of arsenic metabolism was assessed by the relative fractions of the urinary metabolites. The women had a wide variation in U-As (range 12-407 µg/L, median 65 µg/L) and a markedly efficient metabolism of arsenic with low %MMA (median 7.7%, range: 2.2-18%) and high %DMA (80%, range: 54-91%) in urine. In multivariable-adjusted linear regression models, ethnicity (Aymara-Quechua vs. Uru), body weight, fish consumption and tobacco smoking were associated with urinary arsenic metabolite fractions. On average, the Uru women had 2.5 lower % (percentage unit) iAs, 2.2 lower %MMA and 4.7 higher %DMA compared with the Aymara-Quechua women. Our study identified several factors that may predict these women's arsenic methylation capacity, particularly ethnicity. Further studies should focus on mechanisms underlying these differences in arsenic metabolism efficiency, and its importance for the risk of arsenic-related health effects.

[Establishment of a trauma surgical department at the Diospi Suyana missionary hospital in Curahuasi, Peru]. / Aufbau einer unfallchirurgischen Abteilung am Missionsspital Diospi Suyana in Curahuasi, Peru.

The confusingly structured and in many areas corrupt health system in Peru even today provides only a fragmentary and insufficient medical treatment especially for the indigenous population (mainly Quechua Indians). Since October 2007 the Diospi Suyana missionary hospital in Curahuasi (State of Apurímac) has provided an affordable medical treatment at a high level mainly for these indigenous people of Peru; however, so far the hospital could only insufficiently meet the traumatological needs of the region. The establishment of a surgical trauma department aims to meet those needs but is also encumbered by special problems and challenges. Some patients, for example only present at the hospital after the fractures have already incorrectly healed, sometimes many weeks or even months after the trauma either due to a long journey through the country to different hospitals where treatment was not possible or they could not pay for the treatment and sometimes because of inadequate prior treatment, for example by traditional healers. Cultural and infrastructural particularities of the country must be included in the process of choosing the right method of treatment.

The Genetic History of Peruvian Quechua-Lamistas and Chankas: Uniparental DNA Patterns among Autochthonous Amazonian and Andean Populations.

This study focuses on the genetic history of the Quechua-Lamistas, inhabitants of the Lamas Province in the San Martin Department, Peru, who speak their own distinct variety of the Quechua family of languages. It has been suggested that different pre-Columbian ethnic groups from the Peruvian Amazonia, like the Motilones or "shaven heads", assimilated the Quechua language and then formed the current native population of Lamas. However, many Quechua-Lamistas claim to be direct descendants of the Chankas, a famous pre-Columbian indigenous group that escaped from Inca rule in the Andes. To investigate the Quechua-Lamistas and Chankas' ancestries, we compared uniparental genetic profiles (17 STRs of Q-M3 Y-chromosome and mtDNA complete control region haplotypes) among autochthonous Amazonian and Andean populations from Peru, Bolivia and Ecuador. The phylogeographic and population genetic analyses indicate a fairly heterogeneous ancestry for the Quechua-Lamistas, while they are closely related to their neighbours who speak Amazonian languages, presenting no direct relationships with populations from the region where the ancient Chankas lived. On the other hand, the genetic profiles of self-identified Chanka descendants living in Andahuaylas (located in the Apurimac Department, Peru, in the Central Andes) were closely related to those living in Huancavelica and the assumed Chanka Confederation area before the Inca expansion.

Predictors of completed childhood vaccination in Bolivia.

This project examines how access issues, ethnicity, and geographic region affect vaccination of children by two years of age in Bolivia. Bolivia's rich variation in culture and geography results in unequal healthcare utilization even for basic interventions such as childhood vaccination. This study utilizes secondary data from the 2008 Demographic and Health Survey for Bolivia to examine predictors of vaccination completion in children by two years of age. Using logistic regression methods, we control for health system variables (difficulty getting to a health center and type of health center as well as demographic and socio-economic covariates). The results indicated that children whose parents reported distance as a problem in obtaining health care were less likely to have completed all vaccinations. Ethnicity was not independently statistically significant, however, in a sub-analysis, people from the Quechua ethnic group were more likely to report 'distance as a problem in obtaining healthcare.' Surprisingly, living in a rural environment has a protective effect on completed vaccinations. However, geographic region did predict significant differences in the probability that children would be fully vaccinated; children in the region with the lowest vaccination completion coverage were 80% less likely to have completed vaccination compared to children in the best performing region, which may indicate unequal access and utilization of health services nationally. Further study of regional differences, urbanicity, and distance as a healthcare access problem will help refine implications for the Bolivian health system.

Respect and Autonomy in Children's Observation and Participation in Adults' Activities.

This chapter examines Peruvian Quechua children's learning by observing and pitching in. The children concentrate attentively when they observe the activities of the adults and they exercise autonomy in the context of adults' encouragement of measured behaviors while always showing respectful silence in the presence of their elders.