Drivers of access to cardiovascular health care for rural Indigenous Peoples: a scoping review.

INTRODUCTION: Māori (the Indigenous Peoples of Aotearoa New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD health care. Rural Māori experience additional barriers to treatment access, poorer health outcomes and a greater burden of CVD risk factors compared to Non-Māori and Māori living in urban areas. Importantly, these inequities are similarly experienced by Indigenous Peoples in other nations impacted by colonisation. Given the scarcity of available literature, a systematic scoping review was conducted on literature exploring barriers and facilitators in accessing CVD health care for rural Māori and other Indigenous Peoples in nations impacted by colonisation. METHODS: The review was underpinned by Kaupapa Māori Research methodology and was conducted utilising Arksey and O'Malley's (2005) methodological framework. A database search of MEDLINE (OVID), PubMed, Embase, SCOPUS, CINAHL Plus, Australia/New Zealand Reference Centre and NZResearch.org was used to explore empirical research literature. A grey literature search was also conducted. Literature based in any healthcare setting providing care to adults for CVD was included. Rural or remote Indigenous Peoples from New Zealand, Australia, Canada, and the US were included. Literature was included if it addressed cardiovascular conditions and reported barriers and facilitators to healthcare access in any care setting. RESULTS: A total of 363 articles were identified from the database search. An additional 19 reports were identified in the grey literature search. Following screening, 16 articles were included from the database search and 5 articles from the grey literature search. The literature was summarised using the Te Tiriti o Waitangi (Treaty of Waitangi) Framework principles: tino rangatiratanga (self-determination), partnership, active protection, equity and options. Themes elucidated from the literature were described as key drivers of CVD healthcare access for rural Indigenous Peoples. Key driver themes included input from rural Indigenous Peoples on healthcare service design and delivery, adequate resourcing and support of indigenous and rural healthcare services, addressing systemic racism and historical trauma, providing culturally appropriate health care, rural Indigenous Peoples' access to family and wellbeing support, rural Indigenous Peoples' differential access to the wider social determinants of health, effective interservice linkages and communication, and equity-driven and congruent data systems. CONCLUSION: The findings are consistent with other literature exploring access to health care for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the themes within the context of equity and rights for Indigenous Peoples. This review also highlighted the need for further research in this area to be conducted in the context of Aotearoa New Zealand.

Hysteroscopy needs of indigenous communities in Northern Quebec: a retrospective cohort study.

We aimed to determine the surgical output for patients from Nunavik undergoing transfer to an urban centre for hysteroscopy, and associated costs. We performed a retrospective chart review of all patients from the 14 villages of Nunavik transferred for hysteroscopic surgery from 2016 to 2021. Diagnoses, surgical intervention, and nature of the procedure were all extracted from the patient charts, and costs/length of stay obtained from logisticians and administrators servicing the Nunavik region. Over a 5-year period, 22 patients were transferred from Nunavik for hysteroscopy, of which all were elective save one. The most common diagnosis was endometrial or cervical polyp and the most common procedure was diagnostic hysteroscopy. The average cost for patient transfer and lodging to undergo hysteroscopy in Montreal ranged from $6,000 to $15,000 CDN. On average, 4-5 patient transfers occur annually for hysteroscopy, most commonly for management of endometrial polyps, at a cost of $6,000 to $15,000 CDN, suggesting the need to investigate local capacity building in Nunavik and assess cost-effectiveness.

Delivery of tobacco control programs by Aboriginal Community Controlled Health Organisations in New South Wales, Australia: A cross-sectional survey.

ISSUE ADDRESSED: To describe the characteristics of tobacco control programs (TCPs) delivered by Aboriginal Community Controlled Health Services (ACCHSs) in New South Wales (NSW), Australia. METHODS: A key informant from each ACCHS in NSW completed a 30-item online survey. For each TCP, ACCHSs were asked to provide: the target population group, program aims and activities, funding source, and whether the program had been monitored or evaluated and reflected principles of community control and engagement. RESULTS: Twenty-five of 38 eligible ACCHSs completed the survey (66% response rate). Overall, 64% of services reported currently delivering at least one TCP, almost all of which aimed to promote quitting (95%). Programs involved brief intervention for tobacco cessation (71%), referral to quit services (67%), or use of printed resources (67%). Funding sources included Local Health Districts (52% of programs), the Commonwealth Government (48%) and NSW Ministry of Health (43%). Most programs were aimed at all Aboriginal people who smoke (76%); 19% targeted women or families during pregnancy/birth. Many TCPs used culturally tailored resources (86%) and employed Aboriginal staff (86%), and 48% had been evaluated. CONCLUSIONS: A third of participating ACCHS did not have a specific TCP to address smoking among Aboriginal people, and delivery of programs was characterised by an uncoordinated approach across the state. Aboriginal staff and culturally tailored messages were a focus of existing TCP programs. SO WHAT?: Findings highlight the need for more investment in TCPs for Aboriginal people to ensure all ACCHSs can deliver evidence-based programs.

Assessing essential service provision for prevention and management of violence against women in a remote indigenous community in Amantaní, Peru.

BACKGROUND: Women living in indigenous communities in Peru currently experience extremely high rates of intimate partner violence (IPV). Over the past 10 years, there has been a large multi-sectoral initiative to establish a national network of Centros de Emergencia de la Mujer (Women's Emergency Centres) that integrate health and police services, and substantial increase in efforts from non-governmental organisations in supporting survivors of violence. However, there is currently little evidence on how existing services meet the needs of indigenous women experiencing violence in Peru. METHODS: As part of a broader mixed-methods participatory VAWG prevention study, we assessed existing service provision for women experiencing violence in an indigenous Quechua community from Amantaní, Peru. This involved 17 key informant interviews with legal, government, police, and civil society representatives. We used the UN Women Essential Services Package for Women and Girls Subject to Violence framework to guide our analysis. RESULTS: Participants identified major gaps in existing services for indigenous women survivors of violence in Peru. They discussed survivors and perpetrators not being identified by the health system, a lack of IPV response training for health professionals, IPV not being prioritised as a health concern, and a lack of health services that are culturally appropriate for indigenous populations. Survivors who report to police are often treated poorly and discriminated against. Legal systems were perceived as insufficient and ineffective, with inadequate legal measures for perpetrators. While legal and policy frameworks exist, they are often not applied in practice. Service provision in this region needs to adopt an intercultural, rights based, gendered approach to IPV response and prevention, considering cultural and linguistic relevance for indigenous populations. CONCLUSION: The role of structural violence in perpetuating indigenous women's experiences of violence and undermining their access to services must be central to designing and implementing appropriate policies and services if they are to meet the needs of indigenous women in Peru.

Adapting the Community Paramedicine at Clinic (CP@clinic) program to a remote northern first nation community: a qualitative study of community members' and local health care providers' views.

The views of community Elders and health care providers in a rural remote First Nation community in Ontario, Canada on their health care landscape and adapting the Community Paramedicine at Clinic (CP@clinic) Program to their community are presented. Key informant interviews took place between September 2020 and March 2021, and were thematically analysed using the Framework Hierarchical Analysis. There were seven themes that emerged with many subthemes: available services in the community, health care access, health challenges in community, causes of frailty, health care and community appreciations, community-specific benefits of CP@clinic, and CP@clinic program considerations for adaptation. CP@clinic program considerations for adaptation included defining the role of CP, refining referral processes to capture the target population, advertising and promoting, ensuring community awareness, determining clinic setting and composition, focusing on advocacy and timely continuity, adding to the program through time, managing resistance, engaging community and partners, deploying cultural training and language accommodations, leveraging community assets, and ensuring sustainability. Focusing on continuity, engagement, and leveraging available resources may support the success of the CP@clinic program implementation. Findings from this study may be useful to other underserved communities in Canada seeking health programming.

Canadian Northern and Indigenous health policy responses to the first wave of COVID-19.

Aims: This study aimed to compare COVID-19 health policy and programme responses in 16 Northern and Indigenous regions in Canada. The goal was to summarise strategies used to mitigate the initial spread of the pandemic while highlighting aspects that reflect Indigenous values. Methods: A scoping review of grey literature was completed, focusing on territorial, regional health authority, and community level websites. Further media analysis was conducted to reach saturation regarding policy changes and programmes implemented to prevent transmission, improve health communication, access testing, provide health services effectively, secure borders, and provide financial assistance. Common responses were mapped on the Women's College Hospital's Wholistic Framework for Safe Wellness to identify aspects that reflected Indigenous values. This framework utilises the medicine wheel to discuss physical health (body), ceremony (spirit), community health (heart), and assessment (mind). Results: The Women's College Hospital's Wholistic Framework for Safe Wellness quadrants of the body, spirit and heart were covered by most regions via health communication efforts, adaptations to traditional practices, and continuation of care during the pandemic, respectively. It was found that 13 regions had pandemic responses adapted for Indigenous populations. Conclusions: The responses in each Northern region show that protecting each community was a priority; however, policies and programmes were developed as a kaleidoscope of what can be done quickly and evaluated later. Assessment, risk, and prevention, covered by the mind quadrant of the Women's College Hospital's Wholistic Framework for Safe Wellness, were missing in initial emergency responses. Increasing capacity for emergency management in Northern and Indigenous regions will require contingency planning that acknowledges and builds off traditional knowledge.

Assessing community readiness to reduce consumption of sugary drinks in remote Aboriginal and Torres Strait Islander communities: A useful tool for evaluation and co-design.

ISSUE ADDRESSED: There is a need for culturally appropriate methods in the implementation and evaluation of Aboriginal and Torres Strait Islander health programs. A group of Indigenous and non-Indigenous practitioners culturally adapted and applied the Tri-Ethnic Research Centre's Community Readiness Tool (CRT) to evaluate change in community readiness and reflect on its appropriateness. METHODS: Aboriginal community-controlled health service staff informed the cultural adaptation of the standard CRT. The adapted CRT was then used at baseline and 12-month follow-up in three remote communities in the Cape York region, Queensland, Australia. Program implementation occurred within a pilot project aiming to influence availability of drinking water and sugary drinks. RESULTS: The adapted CRT was found to be feasible and useful. Overall mean readiness scores increased in two communities, with no change in the third community. CRT interview data were used to develop community action plans with key stakeholders that were tailored to communities' stage of readiness. Considerations for future application of the CRT were the importance of having a pre-defined issue, time and resource-intensiveness of the process, and need to review appropriateness prior to implementation in other regions. CONCLUSION: The adapted CRT was valuable for evaluating the project and co-designing strategies with stakeholders, and holds potential for further applications in health promotion in remote Aboriginal and Torres Strait Islander communities. SO WHAT?: This project identified benefits of CRT application not reported elsewhere. The adapted CRT adds a practical method to the toolkits of health promotors and evaluators for working in partnership with Aboriginal and Torres Strait Islander communities to address priority concerns.

Planejamento e gestão do processo de trabalho em saúde: avanços e limites no Subsistema de Atenção à Saúde Indígena do SUS / Planning and management of the health work process: advances and limits in the SUS-Indigenous Health Care Subsystem

Resumo O Subsistema de Atenção à Saúde Indígena (SasiSUS), como parte do Sistema Único de Saúde (SUS), é responsável pela atenção à saúde dos povos indígenas do Brasil. Em âmbito local, são os Distritos Sanitários Especiais Indígenas (DSEI) os responsáveis pela gestão, planejamento e organização do processo de trabalho das equipes multidisciplinares de saúde indígena (EMSI), que realizam a atenção primária à saúde para essa população. O objetivo do estudo foi analisar como ocorrem o planejamento e a gestão do processo de trabalho das EMSI. Foi realizado um estudo de casos múltiplos holístico, considerando sete DSEI como unidades de análise. A principal fonte de dados utilizada foi a entrevista e, de forma complementar, a observação direta. Os resultados indicaram que, de forma geral, o planejamento está presente na organização do processo de trabalho das equipes, com variações entre os DSEI. A efetivação das ações planejadas foi relacionada à disponibilidade de diferentes recursos: funcionamento adequado do sistema de informação e a articulação intra e intersetorial do SasiSUS. Como conclusão, apontou-se a necessidade de radicalização da participação no planejamento e na gestão, necessária a uma ação coordenada para garantia da atenção diferenciada e dos princípios do SUS.

Abstract The Indigenous Health Care Subsystem (SasiSUS), as part of the Brazilian National Health System (SUS), is responsible for health care for indigenous peoples in Brazil. At the local level, the Special Indigenous Health Districts (DSEI) are responsible for managing, planning, and organizing the work process of the multidisciplinary indigenous health teams (EMSI), which provide primary health care for this population. The objective of the study was to analyze how the planning and the management of the EMSI work process occurs. A holistic multiple-case study was carried out, considering seven DSEI as units of analysis. The main source of data used were interviews and, in a complementary way, direct observation. The results indicated that, in general, planning is present in the organization of the teams' work process, with variations between the DSEI. Carrying out the planned actions was related to the availability of different resources: adequate functioning of the information system and the intra and intersectoral articulation of SasiSUS. As a conclusion, the need to radicalize participation in planning and management, necessary for a coordinated action to guarantee differentiated care and the principles of SUS, was pointed out.

Prevalence of breastfeeding among indigenous peoples of the Triple Frontier: Brazil, Argentina and Paraguay / Prevalência do aleitamento materno entre povos Indígenas da Tríplice Fronteira: Brasil, Argentina e Paraguai

Abstract Objectives: to verify the prevalence of breastfeeding and the children's nutritional status of indigenous origin up to two years of age in the triple frontier region: Brazil, Argentina and Paraguay. Methods: data from the Sistema de Vigilância Nutricional e Alimentar Indígena (Indigenous Food and Nutrition Surveillance System) were analyzed, being a cross-sectional and descriptive study. The survey was carried out in 2018, with data referring to 2017. Registrations of indigenous children of both sexes,aged zero to two years old were included. Data were extracted from the indigenous children's follow-up map. The prevalence of breastfeeding and complementary feeding was evaluated. Results: the prevalence of exclusive breastfeeding in children under six months of age was 93.4% and complementary breastfeeding was 6.5%. The prevalence of complementary breastfeeding after six months was 71.6% and exclusive breastfeeding after six months was 28.3%. Regarding social benefits, 30.3% of the families accumulated two types of social benefits. Conclusions: the prevalence of exclusive breastfeeding was high and surpassed the national prevalence in the first semester of life, there was no early weaning.

Resumo Objetivos: verificar a prevalência do aleitamento materno e estado nutricional de crianças de origem indígena até dois anos de idade na região de tríplice fronteira: Brasil, Argentina e Paraguai. Métodos: foram analisados dados do Sistema de Vigilância Nutricional e Alimentar Indígena, sendo um estudo transversal e descritivo. A pesquisa foi realizada em 2018, com dados referentes à 2017. Foram incluídos registros de crianças indígenas de zero a dois anos de idade, de ambos os sexos. Os dados foram extraídos do mapa de acompanhamento de crianças indígenas. Foi avaliada a prevalência do aleitamento materno e alimentação complementar. Resultados: a prevalência de aleitamento materno exclusivo em menores de seis meses foi de 93,4% e do aleitamento materno complementado foi de 6,5%. A prevalência do aleitamento materno complementado após seis meses foi de 71,6% e do aleitamento materno exclusivo após seis meses foi de 28,3%. Com relação à classificação de peso para a idade, 80,5% dos registros mostraram crianças com peso adequado para a idade. Em relação aos benefícios sociais, 30,3% das famílias acumulavam dois tipos de benefícios sociais. Conclusões: a prevalência de aleitamento materno exclusivo foi alta e superam prevalência nacional no primeiro semestre de vida, não houve desmame precoce.

Benefits of Integrating Telemedicine and Artificial Intelligence Into Outreach Eye Care: Stepwise Approach and Future Directions.

Telemedicine has traditionally been applied within remote settings to overcome geographical barriers to healthcare access, providing an alternate means of connecting patients to specialist services. The coronavirus 2019 pandemic has rapidly expanded the use of telemedicine into metropolitan areas and enhanced global telemedicine capabilities. Through our experience of delivering real-time telemedicine over the past decade within a large outreach eye service, we have identified key themes for successful implementation which may be relevant to services facing common challenges. We present our journey toward establishing a comprehensive teleophthalmology model built on the principles of collaborative care, with a focus on delivering practical lessons for service design. Artificial intelligence is an emerging technology that has shown potential to further address resource limitations. We explore the applications of artificial intelligence and the need for targeted research within underserved settings in order to meet growing healthcare demands. Based on our rural telemedicine experience, we make the case that similar models may be adapted to urban settings with the aim of reducing surgical waitlists and improving efficiency.

Association between intergenerational solidarity involving elders and mental health of Indigenous people living off reserve.

BACKGROUND: Indigenous elders play an important role in transmitting knowledge, values and practices, hence fostering identity-building through intergenerational solidarity. We aimed to verify the association between intergenerational solidarity involving Indigenous elders and mental health of Indigenous people living off reserve. METHODS: We carried secondary analyses of data for a subsample from the cross-sectional 2012 Aboriginal Peoples Survey (total sample: n = 28,410 Indigenous persons aged ≥6 years old living off reserve; subsample: n = 13,020 aged 18-44 years old). Controlling for age as well as material and social deprivation, we used logistic regressions to verify the association between intergenerational solidarity (proxied as time spent with an elder and potential of turning to an elder or grandparent for support in times of need) and mental health (perceived mental health, mood disorders, anxiety, suicidal thoughts and attempts). RESULTS: About 39 and 9% of the respondents respectively reported having spent time with an elder and would have turned to an elder or grandparent for support in times of need. Women who would not turn to an elder or grandparent for support in times of need were more likely to report fair or poor perceived mental health (OR = 1.69, p = 0.03). Men not spending time with an elder were more likely to experience mood disorders (OR = 1.66, p = 0.004). Women who would not turn to an elder or grandparent for support in times of need were more likely to experience anxiety disorders (OR = 1.57, p = 0.04). Women not spending time with an elder or who would not turn to an elder or grandparent for support in times of need were respectively more likely to have suicidal thoughts (OR = 1.62, p = 0.04) or to have attempted suicide (OR = 3.38, p = 0.04). CONCLUSION: Intergenerational solidarity is associated with better mental health outcomes of Indigenous people living off reserve. These results could guide policies and practices that aim to enhance mental health and wellness in Indigenous populations.

Atuação da enfermagem na assistência a população indígena do polo base do interior do Amazonas / Rol de enfermería en la asistencia al población indígena del polo base del interior de la Amazonas / Nursing activities in the care of the indigenous population of the base pole of the interior of the Amazon

Objetivo: conhecer a atuação da equipe de enfermagem na assistência a população indígena do polo base Mamori. Método: estudo descritivo, exploratório e transversal com abordagem qualitativa, realizado no período de dezembro de 2019 a janeiro de 2020, com quatro enfermeiros e oito técnicos de enfermagem que prestam assistência no polo base de Mamori no município de Eirunepé do Estado do Amazonas. Os dados foram coletados através de um roteiro de entrevista, após foram transcritas na integra e submetida a análise dos dados, que seguiram as etapas da análise temática de Minayo. Resultados: foram identificadas duas categorias, desvelando-se as ações da equipe de enfermagem (1), os a atualização ao contexto social e cultural dos povos indígenas (2). Conclusão: a equipe de enfermagem desempenha uma ação atuante de acordo com as especificidades das duas etnias, ao possuir uma assistência criativa, fazendo uso de estratégias que se relacionam e respeitam os saberes tradicionais.(AU)

Objective: to understand the performance of the nursing team in assisting the indigenous population of the Mamori hub. Method: descriptive, exploratory and cross-sectional study with a qualitative approach, conducted in the period from December 2019 to January 2020, with four nurses and eight nursing technicians who provide care in the Mamori hub in the municipality of Eirunepé in the State of Amazonas. The data were collected through an interview script, after they were transcribed in full and subjected to data analysis, which followed the steps of Minayo's thematic analysis. Results: two categories were identified, unveiling the actions of the nursing team (1), and the update to the social and cultural context of indigenous peoples (2). Conclusion: the nursing team performs an active action according to the specificities of the two ethnicities, by having a creative assistance, making use of strategies that relate to and respect the traditional knowledge.(AU)

Objetivo: conocer la actuación del equipo de enfermería en la asistencia a la población indígena del núcleo de Mamori. Método: estudio descriptivo, exploratorio y transversal con enfoque cualitativo, realizado en el período de diciembre de 2019 a enero de 2020, con cuatro enfermeras y ocho técnicos de enfermería que prestan atención en el núcleo de Mamori en el municipio de Eirunepé en el Estado de Amazonas. Los datos se recogieron mediante un guión de entrevista, tras lo cual se transcribieron en su totalidad y se sometieron a un análisis de datos, que siguió los pasos del análisis temático de Minayo. Resultados: se identificaron dos categorías, revelando las acciones del equipo de enfermería (1), la actualización al contexto social y cultural de los pueblos indígenas (2). Conclusión: el equipo de enfermería desempeña una actuación acorde con las especificidades de las dos etnias, a fin de contar con una asistencia critica, haciendo uso de estrategias que se relacionan y se inspiran en los conocimientos tradicionales.(AU)

One Health and reconciliation: media portrayals of dogs and Indigenous communities in Canada.

This qualitative media analysis explores how the Canadian Broadcasting Corporation (CBC) portrayed 'dog problems' and their solutions in Indigenous communities in Canada from 2008 through 2018. We apply a One Health framework to demonstrate how human, animal, and the socio-environmental health are interconnected, which aligns more explicitly with Indigenous worldviews. Through this analysis, we respond to the Truth and Reconciliation Commission of Canada (TRC) Calls to Action, specifically Action 19 (health inequity) and Action 84 (media). We found that the CBC portrayed dogs as "strays" and focused mainly on the removal of dogs, whether rehoming by animal rescue groups or through culling, and that rescue groups were portrayed as 'animal lovers'. Meanwhile, journalists sometimes mentioned the lack of policies to support community-driven dog population control and veterinary services, but these policy deficits did not receive emphasis. The CBC coverage did not highlight systemic injustices that can impact dog health and welfare in Indigenous communities. This media analysis outlines ways forward for reconciliation with Indigenous communities when the media reports on dogs; we recommend journalists (i) focus on lack of veterinary services in communities and the impacts rather than the removal of dogs, (ii) discuss broader systemic structures and policies that limit access to veterinary services in Indigenous communities and (iii) how such resource constraints impact human and animal health.

Tuberculosis screening indicators in indigenous population in Colombia: a mixed methods research / Indicadores de tamizaje de tuberculosis en población indígena de Colombia: una investigación de métodos mixtos / Indicadores de triagem para tuberculose numa população indígena na Colômbia: uma pesquisa com métodos mistos

This study aims to evaluate, via a mixed methods study, the implementation of the screening process for pulmonary tuberculosis (PTB) within indigenous population of the Department of Cauca, Colombia, during the 2016-2018 period. Indicators assessing the PTB screening process were elaborated and estimated. Subsequently, an evaluation of the indicators were performed based on a sampling process from health care providers of the municipalities with the highest and lowest PTB incidence and from key agents' perspective. Screening indicators were estimated and thematic analysis was performed based on the interviews conducted with key agents. Finally, a triangulation of quantitative and qualitative findings was performed. From the total population expected to have respiratory symptomatics (n = 16,711), the health care providers were able to identify 42.3% of them. Out of the individuals identified as respiratory symptomatics (n = 7,064), they were able to examine 93.2% (n = 6,585) with at least one acid-fast bacilli smear test. The reported positivity index from acid-fast bacilli smear test was 1.87%. The explanations from key agents revolved around the possibility of an overestimated targeted amount of respiratory symptomatics; insufficient personnel for the search of symptomatic individuals; high costs for the search in areas of difficult access; the need to request permissions from indigenous authorities; culturally ingrained stigma; use of traditional medicine and self-medication; and patient's personal beliefs. This study revealed barriers in the implementation of the screening process for PTB within the indigenous population from the Department of Cauca, mainly in the identifying process of the respiratory symptomatics.

El objetivo fue evaluar la implementación del proceso y los indicadores en las pruebas para detectar tuberculosis pulmonar (TBP) en población indígena del Departamento de Cauca, Colombia, durante el periodo de 2016-2018, a través de un estudio de métodos mixtos. Fueron elaborados y estimados indicadores para el tamizaje de TBP. Posteriormente, a través de un proceso de muestreo de los proveedores de cuidados de salud de las municipalidades con las incidencias más altas y más bajas de TBP, y desde la perspectiva de actores clave, se intentó encontrar una explicación para los resultados de la primera fase. Se estimaron los indicadores de las pruebas y se realizó un análisis temático de las entrevistas dirigidas a los actores clave. Finalmente, se realizó la triangulación de los hallazgos cuantitativos y cualitativos. Del total de sintomáticos respiratorios esperados (n = 16.711), los proveedores de servicios de salud fueron capaces de identificar a un 42,3% de ellos, y de estos sintomáticos respiratorios identificados (n = 7.064) fueron capaces de examinar un 93,2% (n = 6.585) con al menos una prueba de frotis de bacilos ácidorresistentes. El índice de positividad informado en la prueba de la flema analizada en el microscopio, mediante la prueba de frotis de bacilos ácidorresistentes, fue 1.87%. Las explicaciones de los actores clave giraron alrededor de la percepción de un objetivo posiblemente sobreestimado de sintomáticos respiratorios; insuficiente personal para la consulta; altos costes para las consultas en áreas geográficas de difícil acceso; solicitud de permisos a las autoridades indígenas; estigma; medicina tradicional, automedicación y creencias. Este estudio reveló barreras en la implementación de las pruebas para la TBP en la población indígena del Departamento de Cauca, principalmente en el proceso de identificación de sintomáticos respiratorios.

O estudo teve como objetivo avaliar a implementação do processo e os indicadores de triagem para tuberculose pulmonar (TBP) numa população indígena do Departamento de Cauca, Colômbia, no período 2016-2018. Foi realizado um estudo com métodos mistos. Foram elaborados e estimados os indicadores para triagem da TBP. Em seguida, procurou-se explicar os achados da primeira fase, com base em um processo de amostragem de provedores de saúde dos municípios com os coeficientes mais altos e mais baixos de incidência de TBP, e da perspectiva dos atores-chave. Os indicadores de triagem foram estimados e a análise foi realizada das entrevistas com os atores-chave. Finalmente, foi feita a triangulação dos achados quantitativos e qualitativos. Do total de sintomáticos respiratórios esperados (n = 16.711), o provedor de saúde conseguiu identificar 42,3%, e destes sintomáticos respiratórios identificados (n = 7.064) conseguiram examinar 93,2% (n = 6.585) com pelo menos um exame de escarro (teste de BAAR). O índice de positividade do teste de BAAR foi de 1,87%. As explicações dos atores chave giraram em torno da percepção de uma proporção possivelmente superestimada de sintomáticos respiratórios, pessoal insuficiente para a busca, custos elevados da busca em áreas de difícil acesso geográfico, solicitação de autorização pelas autoridades indígenas, estigma, medicina tradicional, automedicação e crenças. O estudo revelou barreiras para a implementação da triagem para TBP na população indígena do Departamento de Cauca, principalmente no processo de identificação de sintomáticos respiratórios.

Arthritis liaison: a First Nations community-based patient care facilitator. / Agente de liaison avec les personnes atteintes d'arthrite : un rôle important dans la prestation de soins à des patients des collectivités des Premières Nations.

INTRODUCTION: Arthritis is a leading cause of disability in First Nations communities and is often accompanied by other chronic diseases. Existing care models prioritize accessibility to specialty care for treatment, whereas patient-centred approaches support broader health goals. METHODS: A patient care facilitator model of care, termed "arthritis liaison," was developed with the community to support culturally relevant patient-centred care plans. Following a one-year-long intervention, we report on the feasibility and acceptability of this care model from the perspectives of patients and health care providers. RESULTS: The arthritis liaison served as a bridge between the clinicians and patients, and fostered continuity, helping patients receive coordinated care within the community.

'It looks like a breadbox': a pilot study investigating implementation of the Pepi-Pod® program with Aboriginal families in metropolitan South Australia.

AIMS: To collaboratively explore the cultural acceptance of the Pepi-Pod® program as an alternate safe sleep space and to explore the process of implementing the Pepi-Pod® program in a mainstream health service for Aboriginal families living in urban South Australia. BACKGROUND: Aboriginal and Torres Strait Islander infants continue to die from sudden infant death syndrome (SIDS) and sudden unexpected death in infancy (SUDI) at rates three to four times greater than other infants born in Australia despite Council of Australian Governments commitment to halve the gap in the Indigenous infant mortality rate by 2018. The Pepi-Pod® program is evidenced in New Zealand and Queensland to provide a culturally appropriate safe sleep alternative that contributes to the reduction of SIDS and SUDI. We have no evidence of acceptability or feasibility when offered through mainstream services in metropolitan South Australia. METHODS: With a focus on decolonizing the research process through a two-way process for mutual learning between Aboriginal and non-Aboriginal team members and community, a novel qualitative design was employed including photo elicited yarning sessions (n = 7), focus groups (n = 2), and field notes (n = 15). RESULTS: Four themes emerged: 'you don't have to worry'; 'a way of sharing knowledge'; 'it looks like a bread box?' and 'need for consistent safe sleep messages'. The findings suggest that participants believe the Pepi-Pod® program may enrich Aboriginal families' lives evoking feelings of comfort and safety; however, the design could be improved to make them more culturally appropriate. There was confusion around safe sleep processes and education with a call for streamlining safe sleep messaging.

Selecting contextually appropriate performance indicators in a circumpolar context: a modified Delphi approach.

BACKGROUND: Meaningful performance measurement requires indicators to be scientifically robust and strategically focused. For many circumpolar states, indicators aligned with national strategies may ignore the priorities of northern, remote, or Indigenous populations. The aim of this project was to identify contextually appropriate performance indicators for maternity care in circumpolar regions. METHODS: Fourteen maternity care and health systems experts participated in a modified Delphi consensus process. The list of proposed indicators was derived from a previously published scoping review. Fourteen participants rated each proposed indicator according to importance, circumpolar relevance, validity, and reliability and suggested additional indicators for consideration. RESULTS: Consensus was achieved after two rounds, as measured by a Cronbach's alpha of 0.87. Eleven indicators, many of which represented physical health outcomes, were ranked highly on all four criteria. Twenty-nine additional indicators, largely focused on social determinants of health, health care responsiveness, and accessibility, were identified for further research. Travel for care, cultural safety and upstream structural determinants of health were identified as important themes. CONCLUSIONS: This study identified the important gaps between current performance measurement strategies and the context and values that permeate maternal-child health in circumpolar regions. The indicators identified in this study provide an important foundation for ongoing work. We recommend that future work encompass an appreciation for the intersectoral nature of social, structural, and colonial determinants of maternal-child health in circumpolar regions.

Acceptability of the culturally adapted ASQ-TRAK developmental screening tool to caregivers of Aboriginal children.

AIM: The Ages and Stages Questionnaire-Talking about Raising Aboriginal Kids (ASQ-TRAK) culturally adapted developmental screening tool is widely used in Australian Aboriginal communities. However, there has been limited exploration of the tool's acceptability to caregivers. The aim of the study is to determine the acceptability of the ASQ-TRAK developmental screening tool to caregivers of Aboriginal children in urban, regional and remote South Australia. METHODS: Caregivers of Aboriginal children completed a survey regarding acceptability of the ASQ-TRAK. Convenience samples of caregivers were invited to a telephone interview. RESULTS: Ninety-two caregivers completed the survey (96% response). Acceptability (92%) and caregiver satisfaction (73%) were high. Families perceived the screen as easy to use and understand, strengths-based and providing valuable information about their child's development. CONCLUSIONS: The ASQ-TRAK tool was highly acceptable to caregivers in Aboriginal communities in South Australia. The study highlights the importance of culturally safe practice and supports ASQ-TRAK implementation. Broader use and further evaluation of the ASQ-TRAK in Aboriginal communities needs consideration.

Reforma Sanitária e outros olhares para a saúde indígena: relato de experiência com os Potyguara / Health Reform and different perspectives for indigenous health: experience report with the Potyguara

RESUMO Quando se pensa em uma Reforma Sanitária como reforma da sociedade, outras questões demandam atenção, como colonização, genocídio e racismo. A colonização, forma de poder que balizou a tessitura da modernidade, organizou-se dentro de regimes de verdade e de autorizações que legitimam alguns saberes em detrimento de outros. A falta de clareza e a insuficiência das concepções de saúde, que são possíveis de serem construídas com os povos originários, promovem fragilidades na configuração institucional e no processo de gestão do Sistema Único de Saúde. Dada a invisibilidade em que a saúde indígena investida de sua multiplicidade vem sendo colocada na saúde coletiva, será realizado um relato das experiências dos encontros com os Potyguara de Monsenhor Tabosa, no estado do Ceará. Os modos de viver a saúde dos Potyguara expressam relações entre o se sentir saudável e o estar adoecido, bem como experimentações de um mundo em que a relação com a terra é de pertencimento e diz da produção do viver e da saúde.

ABSTRACT When one thinks about a Sanitary Reform as a reform of society, other issues demand attention, as colonization, genocide and racism. Colonization, a form of power that marked the texture of modernity, was organized within regimes of truth and authorizations that legitimize some knowledge to the detriment of others. The lack of clarity and insufficiency of the conceptions of health, that are possible to be build with the native peoples, promote weakenesses in the institutional configuration and the management process of the Unified Health System. Given the invisibility in which indigenous health has been placed in collective health, an account will be made of the experiences of the meeting with Potyguara de Monsignor Tabosa, in the state of Ceará. The ways of living health of the Potyguara express relationships between feeling healthy and being sick, as well as experimenting a world in which the relation with the earth is of belonging and tells about the production of living and health.

The Wequedong Lodge Cancer Screening Program: implementation of an opportunistic cancer screening pilot program for residents of rural and remote Indigenous communities in Northwestern Ontario, Canada.

INTRODUCTION: The rural and remote nature of many First Nations communities in Northwestern Ontario, Canada poses unique obstacles to physically accessing health care, in addition to other barriers. Indigenous peoples face similar challenges globally. First Nations communities experience significant health inequities, including cancer burden, which can be attributed to complex factors associated with colonization and Westernization. One potentially promising intervention to decrease the burden of advanced cancers is the provision of accessible, convenient and culturally sensitive cancer screening services, leading to early detection and treatment. The Wequedong Lodge Cancer Screening Program (WLCSP) was a pilot project aiming to provide cancer screening education and opportunistic cancer screening to residents from rural and remote First Nations communities while accessing health services in the urban center of Thunder Bay, Ontario, Canada. METHODS: Cancer screening education and opportunistic breast, cervical and colorectal cancer screening appointments were offered to individuals and their travel escorts already staying at Wequedong Lodge. Program uptake was determined primarily by education participation, and secondarily by client participation in screening. RESULTS: In total, the WLCSP booked 1033 appointments, with 841 being attended. Over the program's 3 years there was an increase in clients each year. Specifically, 22% (60/275) of age-eligible women completed a mammogram. Pap tests were provided to 8% (45/554) of age-eligible females. Finally, 32% (106/333) of all age-eligible service participants were given a fecal occult blood test kit. An evaluation survey (n=396) demonstrated overall client satisfaction with the program. CONCLUSION: The WLCSP aimed to provide education about, access to and uptake of cancer screening services for First Nations people from rural and remote communities in Northwestern Ontario by targeting inequalities in accessing cancer screening opportunities. Therefore, program uptake may provide helpful numerical comparisons for similar future programs globally. Other entities working to improve cancer screening rates in remote and/or rural populations and/or amongst Indigenous peoples may find consideration of the WLCSP processes, successes and challenges helpful to their efforts.