Percepções e ações da equipe multiprofissional em saúde sobre a medicina tradicional indígena / Perceptions and actions of the multi-professional health team on traditional indigenous medicine / Percepciones y acciones del equipo multidisciplinario de salud sobre la medicina tradicional indígena

Objetivo: compreender as percepções e as ações de uma equipe multiprofissional em saúde quanto à prática da medicina tradicional indígena em uma Casa de Atenção à Saúde Indígena. Método: estudo qualitativo descritivo, realizado em uma de Casa de Apoio à Saúde Indígena em um município do Pará, que incluiu oito profissionais de uma equipe multiprofissional. A coleta de dados foi realizada no ano de 2018 e estes foram examinados pelo método da análise de conteúdo. Resultados: inserção e prática do cristianismo; ritos e lideranças xamânicas; e postura da equipe de multidisciplinar foram as categorias elencadas, que apontam os entendimentos e atuações da equipe multiprofissional e da organização espacial da Casa de Saúde do município. Considerações finais: há novos costumes e valores entre as etnias, em virtude da aproximação de grupos religiosos, cujas ações foram registradas e apreendidas pela equipe de trabalhadores em saúde.

Objective: understanding the perceptions and actions of a multi-professional health team regarding the practice of traditional indigenous medicine in an Indigenous Health Care Center. Method: this is a descriptive qualitative study carried out in an Indigenous Health Support Center in a municipality in the state of Pará, which included eight professionals from a multi-professional team. Data was collected in 2018 and examined using the content analysis method. Results: insertion and practice of Christianity; shamanic rites and leadership; and the attitude of the multidisciplinary team were the categories listed, which point to the understandings and actions of the multi-professional team and the spatial organization of the Health Center in the municipality. Final considerations: there are new customs and values among ethnic groups, due to the approach of religious groups, whose actions were recorded and apprehended by the team of health workers.

Objetivo: comprender las percepciones y acciones de un equipo multidisciplinario de salud sobre la práctica de la medicina tradicional indígena en una Casa de Atención para la Salud Indígena. Método: estudio descriptivo cualitativo, realizado en una Casa de Apoyo a la Salud Indígena de un municipio de Pará, que incluyó ocho profesionales de un equipo multidisciplinario. La recolección de datos se realizó en 2018 y los datos fueron sometidos al método de análisis de contenido. Resultados: inserción y práctica del cristianismo; ritos y líderes chamánicos; y actitud del equipo multidisciplinario fueron las categorías enumeradas, que indican la percepción y las acciones del equipo multidisciplinario y la organización espacial de la Casa de Salud del municipio. Consideraciones finales: existen nuevas costumbres y valores entre las etnias, debido a la presencia de grupos religiosos, el equipo de los trabajadores de la salud registró y aprendió las acciones de los indígenas.

Factors associated with hepatitis B virus infection in indigenous communities of Colombia / Factores asociados con la infección por el virus de la hepatitis B en comunidades indígenas de Colombia.

Introduction. Colombia is home to 2 million indigenous people who live in conditions of poverty and with health deficiencies, making them vulnerable to contracting hepatitis B (HBV). Amazonas has a high virus prevalence, and there are barriers to accessing vaccination; thus, part of the population is susceptible to infection. Objective. To identify factors associated with HBV in Colombian indigenous people. Materials and Methods. A case-control study of people over 18 years from four departments of Colombia. Cases were identified through the national hepatitis B notification registry (2015-2022). Controls were selected and matched to cases (2:1) by age, sex, ethnicity, and department. Sociodemographic characteristics, factors associated with contact with body fluids, cultural practices, and vaccination history were identified by means of a survey. The ethics committee of the Universidad de Antioquia approved the project. Results. Seventy five cases and 150 controls from 13 ethnic groups were surveyed. Amazonas contributed 49% of participants, 83% were women, and the median age of cases was 30 years (IQ range: 27-37). The associated factors were a family history of hepatitis B [adjusted OR: 2.61 (95% CI: 1.09-6.27)] and, in women, the number of pregnancies [adjusted OR: 1.61 (95% CI 1.02- 2.54)]. The vaccination history showed a protective effect, but the association was not significant. Conclusion. Aspects associated with family life and unprotected sexual relations seem to be responsible for the potential transmission of the virus. It was not possible to identify associated cultural practices. Innovative and differential strategies are required for indigenous people to achieve a reduction of HBV.

Introducción. Colombia alberga dos millones de indígenas, que viven en condiciones de pobreza y tienen deficiencias en salud, por lo cual están expuestos a contraer infecciones virales como la hepatitis B. El departamento del Amazonas presenta una gran prevalencia del virus y barreras para acceder a la vacunación; por esto, parte de la población es propensa a la infección. Objetivo. Identificar factores asociados con la infección por el virus de la hepatitis B en indígenas colombianos. Materiales y métodos. Se llevó a cabo un estudio de casos y controles en mayores de 18 años de cuatro departamentos del país. Los casos se identificaron mediante el registro nacional de notificación de hepatitis B (2015-2022). Los controles seleccionados de manera concurrente fueron pareados con los casos por edad, sexo, etnia y departamento. En una encuesta se consignaron las características sociodemográficas, los factores asociados con el contacto con sangre y fluidos, las prácticas socioculturales y los antecedentes de vacunación. El proyecto fue aprobado por Comité de Ética de la Universidad de Antioquia. Resultados. Participaron 75 casos y 150 controles de 13 grupos étnicos. El departamento del Amazonas aportó el 49 % de los participantes (83 % mujeres) con una mediana de edad de 30 años (RIC = 27-37). Los factores asociados con una mayor probabilidad de contraer la infección fueron el antecedente de algún familiar infectado con el virus de la hepatitis B (OR ajustado = 2,61) (IC95%: 1,09-6,27) y número de embarazos en mujeres, (OR ajustado = 1,61) (IC95%: 1,02-2,54). La vacunación mostró un efecto protector sin asociación significativa. Conclusión. Los aspectos asociados con la convivencia familiar y el número de embarazos contribuyen a una potencial transmisión vertical y horizontal del virus. No se identificaron prácticas culturales asociadas. Se requieren estrategias novedosas y diferenciales para reducir la transmisión del virus de la hepatitis B en poblaciones indígenas.

Effect of Education on Adherence to Recommended Prenatal Practices among Indigenous Ngäbe-Buglé Communities of Panama.

Background and Objectives: The primary objective of this study was to assess the adherence of Ngäbe-Buglé women to WHO-recommended prenatal practices. The secondary objective was to compare adherence levels between women who received prenatal education from official medical providers and those educated through traditional or community-based sources within Ngäbe-Buglé communities. Materials and Methods: An eight-question survey was verbally administered to 137 Ngäbe-Buglé women at clinics set up by the non-profit NGO Floating Doctors in eight communities. A two-sided Fisher's Exact test with a p = 0.05 was used to compare the results of mothers who received prenatal education from evidence-based sources to other groups. Results: Out of the 137 surveyed women, 65 reported taking prenatal vitamins, 21 had prenatal check-ups, 136 avoided alcohol, 31 increased caloric intake, and 102 maintained their activity levels. Significant differences were observed in prenatal vitamin adherence between those educated by official sources versus unofficial sources (p = 0.0029) and official sources compared to those with no prenatal education (p < 0.0001). The difference was also significant for education from an unofficial source versus no education (p = 0.0056). However, no significant differences were found in other prenatal practices based on education sources. Conclusions: Our findings highlight deficiencies in both prenatal education and adherence to recommended practices among Ngäbe-Buglé women. Prenatal education significantly improved adherence to taking prenatal vitamins, suggesting its effectiveness as an intervention. Future interventions should prioritize culturally competent prenatal education and address barriers to accessing prenatal healthcare in Ngäbe-Buglé communities.

Health Care Delays and Social Suffering Among Indigenous People with Diabetic Foot Complications in Mexico.

Diabetic foot (DF) is a leading cause of nontraumatic lower-extremity amputations, premature death, and a sign of social inequality in diabetes treatment. In Mexico, the incidence of DF is on the rise yet little is known about its impact among indigenous people, a disadvantaged group. Based on ethnographic research conducted in Oaxaca and analysis of institutional health-data, in this article we show the health care delays that rural indigenous people face when dealing with DF. Indigenous people's uncertainty regarding their right to health and the structural barriers to medical care favor DF complications, a phenomenon that should be read as social suffering. Since health data concerning indigenous health care service users is patchy and imprecise, indigenous people's social suffering is invisibilized. This omission or partiality in the official records limits public health decision-making and undermines the human rights of the population.

Corrigendum: Implementing a provisional overarching intervention for COVID-19 monitoring and control in the Brazil-Colombia-Peru frontier.

[This corrects the article DOI: 10.3389/fpubh.2023.1330347.].

Perspectivas comunitarias e institucionales acerca del cáncer cervicouterino en indígenas del Amazonas colombiano / Community and Institutional Perspectives on Cervical Cancer in Indigenous People of the Colombian Amazon / Perspectivas comunitárias e institucionais sobre o câncer de colo de útero em indígenas da Amazônia colombiana

Introducción: la información en cáncer en poblaciones indígenas colombianas es escasa; de ahí que el objetivo de este estudio sea conocer las perspectivas comunitarias y de los prestadores de servicios de salud acerca del cáncer de cuello uterino (CaCU) en mujeres indígenas del Amazonas colombiano. Materiales y métodos: estudio cualitativo, derivado de una investigación de métodos mixtos de triangula-ción convergente. Se realizaron 40 entrevistas semiestructuradas que incluían profesionales de la salud y actores clave comunitarios representados en curacas, médicos tradicionales o chamanes, parteras, pro-motores de salud, auxiliares de salud pública, líderes y lideresas, abuelos, abuelas y mujeres indígenas en general. Para el análisis se utilizó la técnica de análisis de contenido. Resultados: emergieron cuatro categorías:1) concepciones y factores de riesgo alrededor del cáncer en general y el CaCU, 2) prácticas de cuidado y de atención occidentales y ancestrales para el CaCU, 3) dificultades socioculturales y del sistema de salud para la prevención y atención del CaCU y 4) recomendaciones para el fortalecimiento de la de prevención del CaCU. Conclusión: los participantes reconocen la citología cervicouterina como una forma de prevenir el cáncer y aunque los participantes mencionaron algunos aspectos culturales y personales que podrían constituirse en una barrera para la prevención y control del CaCU, se hizo hinca-pié en los problemas estructurales del sistema de salud, la falta de integración cultural y las dificultades de acceso al tamizaje, diagnóstico y tratamiento.

Introduction: Information on cancer in Colombian indigenous populations is scarce, the objective of this study was to know the community and health care providers' perspectives on cervical cancer (CaCU) in indigenous women of the Colombian Amazon. Materials and methods: Qualitative study, derived from a mixed methods research of convergent triangulation, 40 semi-structured interviews were conducted, including health professionals and key community actors represented by curacas, traditional doctors or shamans, midwives, health promoters, public health assistants, leaders, grandfathers, grandmothers, and indigenous women in general. The content analysis technique was used for the analysis. Results:Four categories emerged: (a) conceptions and risk factors surrounding cancer in general and CaCU; (b) western and ancestral care and attention practices for CaCU; (c) sociocultural and health system diffi-culties for the prevention and attention of CaCU, and (d) recommendations for strengthening CaCU pre-vention. Conclusion: Participants recognize cervical cytology as a way to prevent cancer and although participants mentioned some cultural and personal aspects that could constitute a barrier to cervical cancer prevention and control, the greatest emphasis was given to structural problems of the health system, lack of cultural integration and difficulties of access to screening, diagnosis and treatment.

Introdução: a informação sobre o câncer nas populações indígenas colombianas são escassas, o objetivo deste estudo foi conhecer as perspectivas da comunidade e dos prestadores de serviços de saúde sobre o câncer do colo do útero (CaCU), em mulheres indígenas da Amazônia colombiana. Materiais e méto-dos: estudo qualitativo, derivado de uma investigação de métodos mistos de triangulação convergente. Foram realizadas 40 entrevistas semiestruturadas que incluíram profissionais de saúde e principais atores comunitários representados em curacas, médicos tradicionais ou xamãs, parteiras, promotores de saúde, assistentes de saúde pública, lideranças, avôs, avós e mulheres indígenas em geral. Para a análise foi uti-lizada a técnica de análise de conteúdo. Resultados: emergiram quatro categorias, a) concepções e fatores de risco em torno do câncer em geral e do CaCU; b) cuidados e práticas de cuidado ocidentais e ancestrais para CaCU; c) dificuldades socioculturais e do sistema de saúde para a prevenção e cuidado do CaCU, e d) recomendações para fortalecer a prevenção de CaCU. Conclusão: as participantes reconhecem a citolo-gia cervical como forma de prevenção do câncer e embora as participantes tenham mencionado alguns aspectos culturais e pessoais que poderiam constituir uma barreira para a prevenção e controle do câncer do colo do útero, a maior ênfase foi dada aos problemas estruturais do sistema de saúde, a falta de integra-ção cultural e as dificuldades de acesso ao rastreio, ao diagnóstico e ao tratamento

Maternal deaths among Brazilian indigenous women-Analysis from 2015 to 2021.

OBJECTIVE: This study examines maternal mortality among Brazilian indigenous women from 2015 to 2021, contrasting their causes of death with non-indigenous women. METHODS: An observational study utilizing Ministry of Health data analyzed maternal deaths' characteristics, comparing indigenous and non-indigenous groups based on death certificates and live-birth records. Variables included age, region, location, time, and cause of death. Maternal mortality ratios (MMR) were calculated with linear regression and outliers identified with Grubbs test. Prevalence ratios compared MMR and causes of death. RESULTS: Between 2015 to 2021, Brazil recorded 13 023 maternal deaths. Among these, with 205 among indigenous women (1.60% of total). Indigenous women had higher MMR (115.14/100 000), than non- indigenous women (66.92/100 000), consistently across years. Hemorrhagic causes notably contributed to the indigenous women's elevated MMR. CONCLUSION: Indigenous Brazilian women face elevated maternal mortality rates across all causes, primarily due to hemorrhage, contrasting wih national trends.

Long-Term Environmental Methylmercury Exposure Is Associated with Peripheral Neuropathy and Cognitive Impairment among an Amazon Indigenous Population.

Widespread contamination of the Amazon basin with mercury has been reported to occur since at least the mid-80s due to heavy gold mining activity. Although initial studies have indicated that this may lead to deleterious neurological consequences to the indigenous populations living in the region, further research is needed to better characterize the neurological burden of such long-term exposure. With this aim, a cross-sectional exploratory study has been conducted with the Yanomami indigenous population residing in a northern Amazon region. All participants underwent a structured interview; detailed neurological examination, including assessment for cognitive, motor, coordination, and sensory functions; and laboratorial testing for serum hemoglobin, blood glucose, and methylmercury levels in hair samples. This study enrolled 154 individuals of 30.9 ± 16.8 years of age, of which 56.1% were female. Mean methylmercury levels in hair were 3.9 ± 1.7 µg/g. Methylmercury levels in hair > 6.0 µg/g were found in 10.3%. Among participants with hair methylmercury levels ≥ 6.0 µg/g, the prevalences of peripheral neuropathy and reduced cognitive performance were, respectively, 78.8% (95%CI 15-177%, p = 0.010) and 95.9% (95%CI 16-230.8%, p = 0.012) higher than those of individuals with lower levels. These results suggest that chronic mercury exposure may lead to significant and potentially irreversible neurotoxicity to Yanomami population living in the northern Amazon basin.

Host genetics and the profile of COVID-19 in indigenous people from the Brazilian Amazon: A pilot study with variants of the ACE1, ACE2 and TMPRSS2 genes.

This pilot study aimed to investigate genetic factors that may have contributed to the milder clinical outcomes of COVID-19 in Brazilian indigenous populations. 263 Indigenous from the Araweté, Kararaô, Parakanã, Xikrin do Bacajá, Kayapó and Munduruku peoples were analyzed, 55.2% women, ages ranging from 10 to 95 years (average 49.5 ± 20.7). Variants in genes involved in the entry of SARS-CoV-2 into the host cell (ACE1 rs1799752 I/D, ACE2 rs2285666 C/T, ACE2 rs73635825 A/G and TMPRSS2 rs123297605 C/T), were genotyped in indigenous peoples from the Brazilian Amazon, treated during the SARS-CoV-2 pandemic between 2020 and 2021. The distribution of genotypes did not show any association with the presence or absence of IgG antibodies. Additionally, the influence of genetic variations on the severity of the disease was not examined extensively because a significant number of indigenous individuals experienced the disease with either mild symptoms or no symptoms. It is worth noting that the frequencies of risk alleles were found to be lower in Indigenous populations compared to both continental populations and Brazilians. Indigenous Brazilian Amazon people exhibited an ethnic-specific genetic profile that may be associated with a milder disease, which could explain the unexpected response they demonstrated to COVID-19, being less impacted than Brazilians.

Advancing ethnobiology for the ecological transition and a more inclusive and just world: a comprehensive framework for the next 20 years.

This opinion piece, written by ethnobiologists from different parts of the world, emphasizes the importance of ethnobiology research in advancing contemporary biology, natural resource management, biodiversity conservation, sustainable development, and, especially, contributing to the ecological transition and more just and inclusive world. To achieve these goals, it is essential to develop research and collaborate with social groups that live in close relationship with nature in research activities, such as Indigenous Peoples and Local Communities (IPLC), as well as Afro-descendants and other Marginalized, Minority or Minoritized Communities (AMMC). Ethnobiology can identify and provide locally appropriate solutions to local problems, enabling sustainable resource management at the landscape level. The text explores important aspects that need to be considered to guide the future of ethnobiology in the next 20 years, aiming to integrate and amplify previous discussions held in the discipline and identify points that demand ongoing attention. This paper highlights reflections from diverse researchers, emphasizing how ethnobiology can embrace different perspectives and employ rigorous analysis of complex phenomena toward effective policies and practices. This approach holds the potential to address the challenges the planet is currently facing in the coming decades.

La cosmovisión indígena en políticas públicas medioambientales para reducir la contaminación durante la pandemia del coronavirus / coronavirusIndigenous Worldview in Environmental Public Policies to Reduce Pollution during the Coronavirus Pandemic / A cosmovisão indígena nas políticas públicas ambientais de redução da poluição durante a pandemia do coronavírus

Introducción: consecuencia de la pandemia a causa del coronavirus (SARS-CoV-2), desde el 2020 ha aumen-tado la generación de los residuos con riesgo biológico o infeccioso, usados en los protocolos de biosegu-ridad por parte de la ciudadanía en general y el talento humano en salud. Ello generó un alto riesgo para salud y un aumento en el índice de contaminación ambiental y degradación de los recursos naturales, que hasta el momento ha superado las expectativas para su mitigación. Desarrollo: para contrarrestar el impacto del aumento en el índice de contaminación ambiental, se reflexiona sobre la necesidad de buscar acciones medioambientales para mitigar el daño y ampliar el concepto sobre el medio ambiente y la importancia de la interacción y codependencia del ser humano con la naturaleza. Se plantea la idea de retomar elementos conceptuales del conocimiento de las culturas indígenas sobre la visión holística del ambiente, partiendo de una cosmovisión indígena del buen vivir, donde el ambiente y el ser humano se encuentran en constante equilibrio y armonía. Conclusión: se pretende encontrar, desde la cosmovisión indígena, posibles abordajes conceptuales que mitiguen el impacto de la contaminación ambiental a causa del coronavirus, así como la formulación de acciones estratégicas para la adecuada gestión de estos residuos

Introduction: Since 2020, due to the the Coronavirus (SARS-CoV-2) pandemic, there has been an increase in generation of waste with biological or infectious risk used in biosafety protocols by the community and human resources in health, which, in turn, generates a high rate of pollution and environmental degradation of natural resources that has so far exceeded expectations for mitigation.Development: To reduce the impact of this problematic situation, a reflection was made to strengthen the current public policies and implement environmental actions that seek to mitigate the damage, but, above all, to change the concept of the environment and increase awareness about the importance of interac-tion and codependency of human beings with nature. The idea of retaking conceptual elements of the knowledge of indigenous cultures regarding the holistic vision of the environment is proposed, starting from a Quechua worldview of good living, where the environment and the human being are in constant balance and harmony. Conclusions:This study is intended to determine, from the indigenous worldview, the possible conceptual approaches that mitigate the environmental impact, as well as to formulate strategic actions for the adequate management of the resultant waste.

Introdução: como consequência da pandemia causada pelo Coronavírus (SARS-CoV-2), desde 2020 houve um aumento na geração de resíduos com risco biológico ou infeccioso utilizados em protocolos de bios-segurança pelo público em geral e talentos humanos em saúde; o que gerou um alto risco à saúde e um aumento no índice de contaminação ambiental e degradação dos recursos naturais que até agora tem superado as expectativas para sua mitigação. Desenvolvimento: para neutralizar o impacto do aumento do índice de contaminação ambiental, é feita uma reflexão sobre a necessidade de buscar ações ambien-tais para mitigar os danos, e ampliar o conceito de meio ambiente e a importância da interação e code-pendência do ser humano com a natureza. Propõe-se a ideia de retomar elementos conceituais do conhe-cimento das culturas indígenas sobre a visão holística do meio ambiente, partindo de uma cosmovisão indígena do bem viver, onde o meio ambiente e o ser humano estão em constante equilíbrio e harmonia. Conclusão: pretende-se encontrar a partir da visão de mundo indígena, possíveis abordagens conceituais que mitiguem o impacto da contaminação ambiental devido ao coronavírus, bem como a formulação de ações estratégicas para o gerenciamento adequado desses resíduos

Variations in the Prevalence of Childhood Anemia by Ethnicity Before and During the COVID-19 Pandemic in Peru.

We aimed to determine the variations in the prevalence of childhood anemia according to the ethnic group before and during the COVID-19 pandemic in Peru. Secondary analysis of the Demographic and Family Health Survey during 2016-2021. The outcome variable was anemia, and the exposure variable was maternal ethnicity. Also, we included sociodemographic and clinical confounding variables. We constructed generalized linear models of the Poisson family with a logarithmic link function. We evaluated 85,905 records; 30.34% had anemia, 50.83% were mestizo, 25.98% were Quechua, and 2% were Aymara. Compared with mestizos, Quechua children (PR: 1.11; 95% CI: 1.07-1.15; p < 0.001), Aymara (PR: 1.35; 95% CI: 1.27-1 .44; p < 0.001), natives of the Amazon (PR: 1.20; 95% CI: 1.12-1.28; p < 0.001) and those who belonged to other indigenous peoples (PR: 1.29; 95% CI: 1.05-1.57; p = 0.013) had a higher prevalence of childhood anemia. On the contrary, compared to mestizos, white children had a lower prevalence of anemia (PR: 0.93; 95% CI: 0.89-0.99; p = 0.019). During the COVID-19 pandemic, compared to mestizos, only Quechua (PR: 1.15; 95% CI: 1.08-1.23; p < 0.001) and Aymara (PR: 1.38; 95% CI: 1.23-1.55; p < 0.001) had a higher prevalence of childhood anemia. Except for Afro-descendants, children from 6 to 59 months of age who belong to an ethnic minority had a higher probability of having childhood anemia than mestizos. However, only Quechua and Aymara children had higher odds of anemia during the COVID-19 pandemic than mestizos.

Cultural adaptation to Bolivian Quechua and psychometric analysis of the Patient Health Questionnaire PHQ-9.

OBJECTIVE: Cultural adaptation of the Patient Health Questionnaire-PHQ-9 to Bolivian Quechua and analysis of the internal structure validity, reliability, and measurement invariance by sociodemographic variables. METHODS: The PHQ-9 was translated and back-translated (English-Quechua-English) to optimise translation. For the cultural adaptation, experts, and people from the target population (e.g., in focus groups) verified the suitability of the translated PHQ-9. For the psychometric analysis, we performed a Confirmatory Factor Analysis (CFA) to evaluate internal validity, calculated α and ω indices to assess reliability, and performed a Multiple Indicator, Multiple Cause (MIMIC) model for evaluating measurement invariance by sex, age, marital status, educational level and residence. We used standard goodness-of-fit indices to interpret both CFA results. RESULTS: The experts and focus groups improved the translated PHQ-9, making it clear and culturally equivalent. For the psychometric analysis, we included data from 397 participants, from which 73.3% were female, 33.0% were 18-30 years old, 56.7% reported primary school studies, 63.2% were single, and 62.0% resided in urban areas. In the CFA, the single-factor model showed adequate fit (Comparative Fit Index = 0.983; Tucker-Lewis Index = 0.977; Standardized Root Mean Squared Residual = 0.046; Root Mean Squared Error of Approximation = 0.069), while the reliability was optimal (α = 0.869-0.877; ω = 0.874-0.885). The invariance was confirmed across all sociodemographic variables (Change in Comparative Fit Index (delta) or Root Mean Square Error of Approximation (delta) < 0.01). CONCLUSIONS: The PHQ-9 adapted to Bolivian Quechua offers a valid, reliable and invariant unidimensional measurement across groups by sex, age, marital status, educational level and residence.

Local and traditional knowledge systems, resistance, and socioenvironmental justice.

In this essay, for the debate series of Journal of Ethnobiology and Ethnomedicine, I argue against the oversimplified causal argument that the maintenance of local and traditional knowledge systems is related to less advantaged circumstances. This statement is based on a colonialist perspective of what a less advantageous circumstance is, which is being questioned by several authors. It also ignores the struggles and resistance of traditional knowledge holders and the urgent call for socioenvironmental justice. As an ethnobiologist, I argue that we must face this reality to build science with justice and inclusiveness.

Prevalence and risk factors for intimate partner violence and indigenous women: A scoping review.

AIM: This study aims to map intimate partner violence evidence among indigenous women and explore the prevalence, social and systemic factors contributing to this occurrence. METHODS: This is a scoping review following the steps recommended by the JBI. We searched the MEDLINE/PubMed®, Web of Science™, Embase, CINAHL and LILACS databases on March 2023. Studies that addressed the intimate partner violence topic among indigenous women and risk factors, without time and language limitations, were included. Detailed information was extracted, standardized by JBI. RESULTS: Twenty studies of different designs were included, all published in English, between 2004 and 2022. A high intimate partner violence prevalence among indigenous women was identified, associated with a great diversity of risk factors. CONCLUSION: The great diversity of identified factors associated with its occurrence shows the complexity of this problem and the vulnerability of indigenous women.

An urgent call-to-action to protect the nonhuman primates and Indigenous Peoples of the Brazilian Amazon.

Primates are facing an impending extinction crisis. Here, we examine the set of conservation challenges faced by the 100 primate species that inhabit the Brazilian Amazon, the largest remaining area of primary tropical rainforest in the world. The vast majority (86%) of Brazil's Amazonian primate species have declining populations. Primate population decline in Amazonia has been driven principally by deforestation related to the production of forest-risk commodities including soy and cattle ranching, the illegal logging and setting of fires, dam building, road and rail construction, hunting, mining, and the confiscation and conversion of Indigenous Peoples' traditional lands. In a spatial analysis of the Brazilian Amazon, we found that 75% of Indigenous Peoples' lands (IPLs) remained forested compared with 64% of Conservation Units (CUs) and 56% of other lands (OLs). In addition, primate species richness was significantly higher on IPLs than on CUs and OLs. Thus, safeguarding Indigenous Peoples' land rights, systems of knowledge, and human rights is one of the most effective ways to protect Amazonian primates and the conservation value of the ecosystems they inhabit. Intense public and political pressure is required and a global call-to-action is needed to encourage all Amazonian countries, especially Brazil, as well as citizens of consumer nations, to actively commit to changing business as usual, living more sustainably, and doing all they can to protect the Amazon. We end with a set of actions one can take to promote primate conservation in the Brazilian Amazon.

Use of an application on the measles vaccine for Warao indigenous refugees in Brazil / Uso de una aplicación sobre la vacuna contra el sarampión para los indígenas Warao refugiados en Brasil / Uso de um aplicativo sobre a vacina antissarampo para os indígenas Warao refugiados no Brasil

ABSTRACT Objective: To evaluate the need to develop an application with information about the measles vaccine for Warao indigenous people. Methods: This was a quantitative study conducted at the Espaço de Acolhimento Tapanã refugee shelter in the city of Belém, Pará, Brazil. The study sample was selected for convenience. Data were analyzed descriptively using Bioestat 5.0 software. Results: Twenty-one Warao indigenous individuals were interviewed. It was identified that 91% (n=20) had lost their vaccination card; 91% (n=20) stated they had lost their vaccination card more than three times, and 91% expressed interest in an application to store their vaccination information. Conclusions: The research provided important information for the development of a health application named WaraoMedI (Warao Measles Diversity Indigenous), as well as offered nursing professionals evidence about the challenges Warao indigenous refugees face in self-managing their vaccination information.

RESUMEN Objetivo: evaluar la necesidad de desarrollar una aplicación con información sobre la vacuna contra el sarampión para los indígenas Warao. Métodos: Estudio cuantitativo, realizado en el refugio de refugiados llamado Espacio de Acolhida Tapanã, en la ciudad de Belém, Pará, Brasil. La muestra del estudio fue por conveniencia. Los datos fueron analizados de forma descriptiva, mediante el software Bioestat 5.0. Resultados: se entrevistaron a 21 indígenas Warao. Se identificó que el 91% (n=20) perdieron su tarjeta de vacunación; el 91% (n=20) afirmó que perdió la tarjeta de vacunación más de 3 veces y el 91% afirmó que les gustaría una aplicación para guardar su información de vacunación. Conclusiones: La investigación proporcionó información importante para la construcción de una aplicación de salud llamada WaraoMedI (Warao Measles Diversity Indigenous), así como proporcionó a los profesionales de enfermería evidencia sobre las dificultades de los indígenas Warao refugiados para autogestionar información sobre vacunación

RESUMO Objetivo: avaliar a necessidade de desenvolver um aplicativo com informações sobre a vacina antissarampo para indígenas Warao. Métodos: Estudo quantitativo, realizado no abrigo de refugiados chamado Espaço de Acolhimento Tapanã, na cidade de Belém, Pará, Brasil. Amostra do estudo foi por conveniência. Os dados foram analisados de forma descritiva, por meio do software Bioestat 5.0. Resultados: foram entrevistados 21 indígenas Warao. Identificou-se que 91% (n=20) perderam o cartão de vacina; 91% (n=20) afirmaram que perderam o cartão de vacina mais de 3 vezes e 91% afirmaram que gostariam de um aplicativo para guardar suas informações de vacina. Conclusões: A pesquisa ofereceu informações importantes para a construção de um aplicativo em saúde chamado WaraoMedI (Warao Mesles Diversity Indigenous), assim como disponibilizou aos profissionais de enfermagem evidências sobre as dificuldades de os indígenas Warao refugiados autogerenciarem informações sobre vacina.

Profile of Dental Caries in Eastern and Western Parakanã Children at Amazônia Paraense, Brazil

ABSTRACT Objective: To evaluate the prevalence of dental caries in children from 18 months to 5 years of age in eastern (near urban centers) and western (far from urban centers) Parakanã, verify the influence of proximity to non-indigenous cultures, and compare with other ethnicities and non-indigenous. Material and Methods: The universe of children was examined by one researcher in a cross-sectional study. Descriptive analysis and the Mann-Whitney test (p<0.05) were performed. Results: It was observed that 68.8% (N = 53) of children from 18 to 36 months of age presented dmft = 0 (without caries), while 12.5% (N = 6) of children of five years of age presented this condition. For children between 18 and 36 months, the average dmft values were 0.74 (SD=1.91) for eastern children and 1.25 (SD=1.65) for western children. At five years of age, the average dmft values were 4.35 (SD=3.29) and 3.75 (SD=2.05) for eastern and western, respectively. Mann-Whitney test (p<0.05) showed no difference between East and Western children. When compared with non-indigenous Brazilian children, the values behaved similarly. Conclusion: Knowledge of the epidemiological profile of dental caries in Indigenous Parakanã children is relevant both in planning oral health actions for this population and for aggregating information, which is still scarce for Indigenous.

A snapshot of a representative Brazilian state of illegal mining in indigenous areas during the era of malaria elimination / Um retrato de um estado brasileiro representativo do garimpo ilegal em áreas indígenas durante a campanha de erradicação da malária / Un retrato de un estado brasileño representativo de la minería ilegal en zonas indígenas durante la campaña de erradicación de la malaria

Abstract: Malaria is a public health problem and the cases diagnosed in the capital of Roraima, Brazil, show potential to characterize the burden of the disease in the state. This study aimed to describe the epidemiological, clinical, and laboratory aspects of malaria cases diagnosed in Boa Vista. For this purpose, a descriptive, cross-sectional study was conducted in two health units in the city, with individuals diagnosed and who agreed to respond the questionnaire. Of the total of 206 participants, characterized as men, mixed-race, and young, 96% (198) reported participating in illegal mining activity. Among the group of miners, 66% (131) came from other states of Brazil or other countries. The mines were mainly located in the Yanomami territory in Roraima. Plasmodium vivax infection occurred in 74% (153) of participants. In the miner's group, hospitalizations for severe malaria, previous malaria attacks, and delays in treatment after the onset of symptoms were reported. Although 73% (145) of miners reported knowing how malaria was transmitted, only 54% (107) used mosquito nets or repellents. The use of Artecom and chloroquine by miners is not for the complete treatment but only to relieve symptoms for returning to gold mines, highlighting the importance of molecular surveillance to antimalarial resistance. Indigenous peoples are considered vulnerable to malaria and miners promotes the increase of malaria in Roraima Indigenous Lands. Therefore, access to diagnosis and treatment in Indigenous areas invaded by miners is imperative to confront this disease that ravages Indigenous communities and threatens public health on a large scale to achieve the goal of eliminating malaria in the state.

Resumo: A malária é um problema de saúde pública e os casos diagnosticados na capital de Roraima, Brasil, têm potencial para caracterizar a carga da doença em todo o estado. O objetivo deste estudo foi descrever os aspectos epidemiológicos, clínicos e laboratoriais dos casos de malária diagnosticados em Boa Vista. Para tanto, foi realizado um estudo descritivo e transversal em duas unidades de saúde do município, com indivíduos diagnosticados com malária e que concordaram em responder ao questionário. De 206 participantes, caracterizados como homens, pardos e jovens, 96% (198) relataram atividade de garimpo ilegal. Entre garimpeiros, 66% (131) vieram de outros estados do Brasil ou de outros países. As minas estavam localizadas principalmente no território Yanomami, em Roraima. A infecção por Plasmodium vivax ocorreu em 74% (153) dos participantes. Entre garimpeiros, houve relatos de internações por malária grave, ataques prévios de malária e atrasos no tratamento após o início dos sintomas. Embora 73% (145) dos garimpeiros tenham relatado saber como a malária era transmitida, apenas 54% (107) usavam mosquiteiros ou repelentes. O uso de Artecom e cloroquina pelos garimpeiros não se destina ao tratamento completo, mas apenas ao alívio dos sintomas, permitindo o retorno às minas de ouro. Isso ressalta a importância da vigilância molecular para detectar a resistência antimalárica. Os indígenas são considerados uma população vulnerável à malária, e os garimpeiros promovem o aumento da malária nas Terras Indígenas de Roraima. Portanto, o acesso ao diagnóstico e tratamento em áreas indígenas invadidas por garimpeiros é imperativo para o enfrentamento dessa doença que assola as comunidades indígenas e ameaça a saúde pública em larga escala na meta de erradicar a malária no estado.

Resumen: La malaria es un problema de salud pública y los casos diagnosticados en la capital de Roraima, Brasil, tienen el potencial de caracterizar la carga de la enfermedad en todo el estado. El objetivo de este estudio fue describir los aspectos epidemiológicos, clínicos y de laboratorio de los casos de malaria diagnosticados en Boa Vista. Para ello, se realizó un estudio descriptivo y transversal en dos unidades de salud del municipio, con personas diagnosticadas con malaria y que aceptaron responder el cuestionario. De 206 participantes, caracterizados como hombres, pardos y jóvenes, el 96% (198) reportó actividad minera ilegal. Entre los mineros, el 66% (131) procedían de otros estados de Brasil o de otros países. Las minas estaban ubicadas principalmente en el territorio Yanomami, en Roraima. La infección por Plasmodium vivax se produjo en el 74% (153) de los participantes. Entre los mineros, hubo relatos de hospitalizaciones por malaria grave, ataques previos de malaria y retrasos en el tratamiento tras de la aparición de los síntomas. Aunque el 73% (145) de los mineros informó saber cómo se transmitía la malaria, solo el 54% (107) usaba mosquiteros o repelentes. El uso de Artecom y cloroquina por parte de los mineros no está destinado a un tratamiento completo, sino al alivio de los síntomas para permitir el regreso a las minas de oro. Esto resalta la importancia de la vigilancia molecular para detectar la resistencia a los antipalúdicos. Los indígenas son considerados una población vulnerable a la malaria, y los mineros promueven el aumento de la malaria en las Tierras Indígenas de Roraima. Por lo tanto, el acceso al diagnóstico y tratamiento en zonas indígenas invadidas por mineros es imperativo para combatir esta enfermedad que asola a las comunidades indígenas y amenaza la salud pública a gran escala en el objetivo de erradicar la malaria en el estado.

A saúde indígena na atenção especializada: perspectiva dos profissionais de saúde em um hospital de referência no Mato Grosso do Sul, Brasil / Indigenous health in specialized care: perspective of healthcare professionals in a reference hospital in Mato Grosso do Sul State, Brazil / La salud indígena en la atención especializada: la perspectiva de los profesionales de la salud en un hospital de referencia en Mato Grosso do Sul, Brasil

Resumo: Trata-se de estudo transversal com o objetivo de identificar a perspectiva dos profissionais de saúde e residentes acerca dos desafios enfrentados no atendimento aos usuários indígenas em um hospital referência no Mato Grosso do Sul, estado brasileiro que comporta a segunda maior população indígena do país. O estudo utilizou questionário semiestruturado online, enviado por e-mail a cada trabalhador(a) no período entre junho e agosto de 2020. As variáveis discretas foram sintetizadas em média e desvio padrão e mediana e intervalo interquartil (nível de significância de 5%). Participaram do estudo 230 profissionais de saúde e 29 residentes. Entre eles, apenas 14,7% conheciam as etnias atendidas, e 60,2% nunca havia presenciado práticas tradicionais no hospital, indicando baixa articulação entre as formas de cuidado biomédico e indígena. Ao confrontar respostas dos residentes e profissionais, observou-se que residentes têm uma visão mais positiva acerca da aproximação com o contexto indígena, sugerindo que consideram importante melhorar essa articulação. Na comparação entre categorias profissionais, destacam-se algumas divergências de opiniões da categoria médica em relação à assistência. Além disso, profissionais e residentes demonstraram sentir algum nível de dificuldade no atendimento à população indígena. Os resultados evidenciam a centralidade do modelo biomédico, o desconhecimento dos profissionais sobre o contexto das comunidades atendidas e a desvalorização de suas práticas. Além disso, contribuem para discussões sobre as políticas de saúde nos diversos níveis de atenção e gestão, bem como na qualificação da assistência hospitalar aos indígenas.

Abstract: This cross-sectional study aims to identify the perspective of healthcare professionals and residents regarding the challenges faced in providing care to Indigenous users in a reference hospital in Mato Grosso do Sul, a Brazilian state with the second-largest Indigenous population in the country. The study used a semi-structured online questionnaire emailed to each worker between June and August 2020. The discrete variables were summarized as mean and standard deviation and median and interquartile range (5% significance level). Two hundred thirty healthcare professionals and 29 residents participated in the study. Among the findings, only 14.7% of participants knew the ethnicities served, and 60.2% had never witnessed traditional practices in the hospital, indicating low articulation between biomedical and Indigenous forms of care. When comparing responses from residents and professionals, residents were noted to have a more positive view of approaching the Indigenous context, suggesting that they consider it essential to improve this articulation. When comparing professional categories, some differences of opinion among the medical category stand out concerning assistance. In addition, professionals and residents demonstrated some level of difficulty in caring for the Indigenous population. The results highlight the centrality of the biomedical model, the professionals' lack of knowledge about the context of the communities served, and the devaluation of their practices. The findings contribute to discussions about healthcare policies at different levels of care and management and the qualification of hospital care for Indigenous people.

Resumen: Se trata de un estudio transversal con el objetivo de identificar la perspectiva de los profesionales de la salud y los médicos residentes sobre los desafíos que enfrentan en la atención a los usuarios indígenas en un hospital de referencia en Mato Grosso del Sur, el estado brasileño que tiene la segunda población indígena más grande del país. El estudio utilizó un cuestionario semiestructurado en línea, enviado por correo electrónico para cada trabajador y trabajadora entre los meses de junio y agosto de 2020. Se sintetizaron las variables discretas en media y desviación estándar, y mediana y rango intercuartílico (nivel de significación del 5%). Participaron del estudio 230 profesionales de la salud y 29 médicos residentes. En los resultados, solo el 14,7% de los participantes conocían las etnias atendidas, y el 60,2% nunca había presenciado prácticas tradicionales en el hospital, lo que indica una baja articulación entre las formas de atención biomédica e indígena. Al confrontar respuestas de los médicos residentes y los profesionales, se constató que los médicos residentes tienen una perspectiva más positiva sobre el acercamiento al contexto indígena, lo que sugiere que ellos consideran importante mejorar esta articulación. Al comparar las categorías profesionales, se destacan algunas divergencias de opinión de la categoría médica en relación con la asistencia. Además, los profesionales y los médicos residentes demostraron un cierto nivel de dificultad en la atención a la población indígena. Los resultados demuestran la centralidad del modelo biomédico, la falta de conocimiento de los profesionales sobre el contexto de las comunidades atendidas y la desvalorización de sus prácticas. Los resultados contribuyen a las discusiones sobre las políticas de salud en varios niveles de atención y gestión, así como en la calificación de la atención hospitalaria a los indígenas.