Participatory Methods to Identify Perceived Healthy and Sustainable Traditional Culinary Preparations across Three Generations of Adults: Results from Chile's Metropolitan Region and Region of La Araucanía

Traditional diets reflect different cultures and geographical locations, and may provide healthy diet options. In Chile, it is unknown whether traditional culinary preparations are still remembered, let alone consumed. Therefore, we adapted methods to identify traditional culinary preparations for healthy and sustainable dietary interventions. In Chile's Metropolitan Region and the Region of La Araucanía, we collected data on the variety of traditional diets through cultural domain analyses: direct participant observation (n = 5); free listing in community workshops (n = 10); and pile sort activities within semi-structured individual interviews (n = 40). Each method was stratified by age (25-45 year, 46-65 year and ≥ 65 year) and ethnic group (first nations or not). About 600 preparations and single-ingredient foods were identified that differed both in frequency and variety by region. The foods most consumed and liked (n = 24-27) were ranked in terms of sustainability for public nutrition purposes. Methods originally designed to collect information about plants of indigenous peoples can be extended to collect data on the variety of existing traditional culinary preparations, globally. Context, both geographical and cultural, matters for understanding food variety, and its subsequent use in the design of healthy and sustainable diet interventions.

Antibiotic use among twelve Canadian First Nations communities: a retrospective chart review of skin and soft tissue infections

BACKGROUND

Previous publications indicated an emerging issue with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), particularly skin and soft tissue infections (SSTIs), in Indigenous communities in Canada. The objectives of this analysis were to explore the prevalence of SSTIs due to CA-MRSA and patterns of antimicrobial use in the community setting.

METHODS

A retrospective chart review was conducted as part of an environmental scan to assess antibiotic prescriptions in 12 First Nations communities across five provinces in Canada including Alberta, Saskatchewan, Manitoba, Ontario, and Québec. Charts were randomly selected from nursing stations and patients who had accessed care in the previous 12 months and were ≥ 18 years were included in the review. Data was collected from September to December, 2013 on antibiotic prescriptions, including SSTIs, clinical symptoms, diagnostic information including presence of CA-MRSA infection, and treatment.

RESULTS

A total of 372 charts were reviewed, 60 from Alberta, 70 from Saskatchewan, 120 from Manitoba, 100 from Ontario, and 22 from Québec. Among 372 patients, 224 (60.2%) patients had at least one antibiotic prescription in the previous 12 months and 569 prescriptions were written in total. The prevalence of SSTIs was estimated at 36.8% (137 cases of SSTIs in 372 charts reviewed). In 137 cases of SSTIs, 34 (24.8%) were purulent infections, and 55 (40.2%) were due to CA-MRSA.

CONCLUSIONS

This study has identified a high prevalence of antibiotic use and SSTIs due to CA-MRSA in remote and isolated Indigenous communities across Canada. This population is currently hard to reach and under-represented in standard surveillance system and randomized retrospective chart reviews can offer complimentary methodology for monitoring disease burden, treatment and prevention.

Recent population genomic insights into the genetic basis of arsenic tolerance in humans: the difficulties of identifying positively selected loci in strongly bottlenecked populations

Recent advances in genomics have enabled researchers to shed light on the evolutionary processes driving human adaptation, by revealing the genetic architectures underlying traits ranging from lactase persistence, to skin pigmentation, to hypoxic response, to arsenic tolerance. Complicating the identification of targets of positive selection in modern human populations is their complex demographic history, characterized by population bottlenecks and expansions, population structure, migration, and admixture. In particular, founder effects and recent strong population size reductions, such as those experienced by the indigenous peoples of the Americas, have severe impacts on genetic variation that can lead to the accumulation of large allele frequency differences between populations due to genetic drift rather than natural selection. While distinguishing the effects of demographic history from selection remains challenging, neglecting neutral processes can lead to the incorrect identification of candidate loci. We here review the recent population genomic insights into the genetic basis of arsenic tolerance in Andean populations, and utilize this example to highlight both the difficulties pertaining to the identification of local adaptations in strongly bottlenecked populations, as well as the importance of controlling for demographic history in selection scans.

The use of jarilla native plants in a Diaguita-Calchaquí indigenous community from northwestern Argentina: An ethnobotanical, phytochemical and biological approach

ETHNOPHARMACOLOGICAL RELEVANCE

In northwestern Argentina inhabit several ancient indigenous communities with diverse cultural and historical background. Geographical isolation has contributed to the prevalence of a native plant-based folk medicine; "jarilla" species are medicinal plants widely used in local communities for the treatment of mycosis, respiratory, gastrointestinal and rheumatic disorders.

THE AIM OF THE STUDY

To assemble the traditional knowledge acquired through years with scientific data concerning to phytochemistry, antioxidant and anti-inflammatory potential of three "jarillas" species.

MATERIAL AND METHODS

Ethnobotanical data of three "jarillas", Zuccagnia punctata (Zp), Larrea cuneifolia (Lc), and Larrea divaricata (Ld), were explored by interviewing native people from Indigenous Community of Amaicha del Valle, Tucumán. Phenolic profiles from each infusion were analyzed by HPLC-ESI-MS/MS. Antioxidant activity was determined by superoxide anion and hydrogen peroxide scavenging capacity, lipoperoxidation inhibition, and ferrous iron chelating activity. It was also assessed their ability to inhibit pro-inflammatory enzymes, such as xanthine oxidase, lipoxygenase, and hyaluronidase.

RESULTS

Ethnobotanical interviews showed that local people use "jarillas" mainly as infusions and baths. It was reported different categories of uses, such as medicinal (10 curative applications), to religious purposes, tinctorial, as construction material and as fuel. From infusions prepared, the MS and MS/MS data allowed the identification of 27 compounds from Z. punctata, and 11 from both Larrea sp. The infusions showed an important antioxidant activity through different mechanisms, highlighting Zp and Lc in free radical scavenging capacity and Ld on lipid peroxidation inhibition and iron binding. They were also capable of inhibit xanthine oxidase and lipoxygenase enzymes, being Lc the most active one.

CONCLUSIONS

This research work provides novel information concerning to several categories of traditional uses of "jarilla" species in a Diaguita-Calchaquí community and focus attention to infusions from a phytochemical and biological approach.

Non-random medicinal plants selection in the Kichwa community of the Ecuadorian Amazon

The non-random selection of medicinal plants theory, which predicts taxonomical biases in ethnopharmacopeias, indirectly demonstrates that traditional medicinal systems are rational and based in part on the therapeutic efficacy of plants. This theory suggests that because members of a taxonomical group share similar characteristics, some groups will be over-utilized in pharmacopeias, while other groups bereft of therapeutic potential will be under-utilized medicinally. Empirical evidence fo this theory comes from studies that used data collected at the national level which may lead to the overestimation of medicinal plant list given that some parts of the country (e.g., protected areas) can be unavailable for medicinal plant collection. Similarly, because medicinal plant importance and knowledge can be gender-specific and depends on the degree of exposure of a community, failure to account for gender and community experience can limit our understanding of non-random selection of medicinal plants. In this study, we used the negative binomial model and an examination of studentized residuals to demonstrate that a Kichwa community in the Ecuadorian Amazon over-utilized different sets of medicinal plant families depending on the gender of the informants or the experience of the community. We showed that utilizing local data instead of nationwide data reveals new over-utilized families. Seven of the nine most over-utilized medicinal plant families we found were previously reported in different biogeographical regions. The other two families are novel reports. Overall, our study proposes a novel method to uncover the intracultural heterogeneity of traditional knowledge and people non-random selection of medicinal plants at the local level.

Family as the Conduit to Promote Indigenous Women and Men's Enculturation and Wellness: "I wish I had learned earlier"

The purpose of this article is to explore how food and other cultural traditions promote wellness, cultural continuity, enculturation, and family resilience within tribal communities in the U.S. Using the Framework of Historical Oppression, Resilience, and Transcendence (FHORT), this critical ethnography examines Indigenous peoples' perspectives on and experiences with food and cultural traditions. Thematic analysis of data from 436 participants (approximately 2/3rds of which were women) across two Southeastern tribes revealed a theme of "fostering the transmission of tribal knowledge and intergenerational family bonding." Traditions such as dancing, food, sewing, beadwork, basket-weaving, music, and tribal sports were some important facets of tribal culture that participants described. Food and cultural practices promoted wellness, pro-social values, and health by fostering physical activity, traditional food practices, enculturation, and social support. Cultural practices offset historical oppression and health disparities. Programs that utilize the strengths of experiential learning through family and cultural practices are highly recommended.

Indigenous Peoples: A Holistic and Sex-Specific Systematic Review

PURPOSE

The purpose of this systematic review is to examine mental, sociocultural, behavioral, and physical risk and protective factors related to cardiovascular disease (CVD) and related outcomes among U.S. Indigenous peoples.

METHODS

A total of 51 articles met the inclusion criteria of research focusing factors for CVD among U.S. Indigenous peoples (Mental n= 15; Sociocultural, n =17; Behavioral/Physical, n =19).

RESULTS

This review reveals clear risks for CVD, which tended to be elevated for females. Mental health problems (depression, anxiety, PTSD/trauma, alcohol and other drug (AOD) abuse) were clearly associated with CVD, along with enculturation, social support, and the social environment-including discrimination and trauma. Poor diet and obesity, diabetes, hypertension, cholesterol were behavioral or physical factors.

DISCUSSION

Overall, identified research was limited and in beginning stages, lacking more information on etiology of the interconnections across sex and the mental, sociocultural, and behavioral determinants of CVD.

CUTICULAR DRUSEN IN AN INDIGENOUS AUSTRALIAN

BACKGROUND/PURPOSE

To report a case of cuticular drusen in an indigenous Australian.

METHODS

A 37-year-old indigenous (aboriginal) Australian woman from a remote Western Australian town presented with a 2-month history of vision loss. Clinical history, examination, and multimodal retinal imaging data from spectral domain optical coherence tomography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography were analyzed.

RESULTS

Multimodal imaging confirmed cuticular drusen complicated by a right choroidal neovascularization with pigment epithelial detachment and a left foveal vitelliform lesion. An unusual "negative-staining" pattern was noted on late phase indocyanine green angiography and this spared the regions affected by cuticular drusen.

CONCLUSION

To the best of our knowledge, this is the first published report of cuticular drusen in an indigenous Australian. We hypothesize that this may be secondary to ancestral mixing of the gene pool. An unusual staining pattern witnessed on indocyanine green angiography suggests widespread disturbance of lipoprotein deposition in the Bruch membrane.

Prevalence, incidence and outcomes of diabetes in Ontario First Nations children: a longitudinal population-based cohort study

BACKGROUND

First Nations people are known to have a higher risk of childhood-onset type 2 diabetes, yet population-level data about diabetes in First Nations children are unavailable. In a partnership between Chiefs of Ontario and academic researchers, we describe the epidemiologic features and outcomes of diabetes in First Nations children in Ontario.

METHODS

We created annual cohorts from 1995/96 to 2014/15 using data from the Registered Persons Database linked with the federal Indian Register. We used the Ontario Diabetes Database to identify children with all types of diabetes and calculated the prevalence and incidence for First Nations children and other children in Ontario. We describe glycemic control in First Nations children and other children in 2014.

RESULTS

In 2014/15, there were 254 First Nations children and 10 144 other children with diagnosed diabetes in Ontario. From 1995/96 to 2014/15, the prevalence increased from 0.17 to 0.57 per 100 children, and the annual incidence increased from 37 to 94 per 100 000 per year among First Nations children. In 2014/15, the prevalence of diabetes was 0.62/100 among First Nations girls and 0.36/100 among other girls. The mean glycosylated hemoglobin level among First Nations children was 9.1% (standard deviation 2.7%) and for other children, 8.5% (standard deviation 2.1%).

INTERPRETATION

First Nations children have substantially higher rates of diabetes than non-Aboriginal children in Ontario; this is likely driven by an increased incidence of type 2 diabetes and increased risk for diabetes among First Nations girls. There is an urgent need for strategies to address modifiable factors associated with the risk of diabetes, improve access to culturally sensitive diabetes care and improve outcomes for First Nations children.

Comparative Analysis of Classification Methods with PCA and LDA for Diabetes

BACKGROUND

The modern society is extremely prone to many life-threatening diseases, which can be easily controlled as well as cured if diagnosed at an early stage. The development and implementation of a disease diagnostic system have gained huge popularity over the years. In the current scenario, there are certain factors such as environment, sedentary lifestyle, genetic (hereditary) are the major factors behind the life threatening diseases such as 'diabetes.' Moreover, diabetes has achieved the status of the modern man's leading chronic disease. So one of the prime needs of this generation is to develop a state-of-the-art expert system which can predict diabetes at a very early stage with a minimum of complexity and in an expedited manner. The primary objective of this work is to develop an indigenous and efficient diagnostic technique for detection of diabetes. Method & Discussion: The proposed methodology comprises of two phases: In the first phase The Pima Indian Diabetes Dataset (PIDD) has been collected from the UCI machine learning repository databases and Localized Diabetes Dataset (LDD) has been gathered from Bombay Medical Hall, Upper Bazar Ranchi, Jharkhand, India. In the second phase, the dataset has been processed through two different approaches. The first approach entails classification through Adaboost, Classification via Regression (CVR), Radial Basis Function Network (RBFN), K-Nearest Neighbor (KNN) on Pima Indian Diabetes Dataset and Localized Diabetes Dataset. In the second approach, Principal Component Analysis (PCA) and Linear Discriminant Analysis (LDA) have been applied as a feature reduction method followed by using the same set of classification methods used in the first approach. Among all of the implemented classification methods, PCA_CVR achieves the maximum performance for both the above mentioned datasets.

CONCLUSION

In this article, comparative analysis of outcomes obtained by with and without the use of PCA and LDA for the same set of classification method has been done w.r.t performance assessment. Finally, it has been concluded that PCA & LDA both are useful to remove the insignificant features, decreasing the expense and computation time while improving the ROC and accuracy. The used methodology may similarly be applied to other medical diseases.

Hospital admission for stroke or transient ischemic attack among First Nations people with diabetes in Ontario: a population-based cohort study

BACKGROUND

First Nations people have high rates of diabetes mellitus, which is a risk factor for stroke. We studied the rates of hospital admission, processes of care and outcomes of stroke and transient ischemic attack (TIA) in First Nations people in Ontario.

METHODS

Using linked administrative databases, we identified annual cohorts of people aged 20-105 years in Ontario with prevalent diabetes between Apr. 1, 1995, and Mar. 31, 2015. We identified Status First Nations people in Ontario from the Indian Register. We compared age- and sex-standardized rates of hospital admission for stroke or TIA, processes of care and case fatality among First Nations versus other people in Ontario with diabetes.

RESULTS

Overall, 28 874 people with diabetes (of whom 536 were First Nations people) were admitted to hospital with a stroke or TIA between Apr. 1, 2011, and Mar. 31, 2016. Admission rates for stroke or TIA declined over the study period but were higher among First Nations people than other Ontarians in most years after 2005/06. First Nations people admitted with stroke or TIA were as likely as other Ontarians to undergo neuroimaging within 24 hours (94.6% v. 96.0%), be discharged to inpatient rehabilitation (31.8% v. 34.8%) and receive carotid revascularization (1.4% v. 2.7%), but were less likely to receive thrombolysis (6.3% v. 11.0%). Age- and sex-standardized stroke case fatality was similar in First Nations people and other Ontarians at 7 days (12.0% v. 8.5%), 30 days (19.2% v. 16.0%) and 1 year (33.8% v. 28.1%).

INTERPRETATION

Rates of hospital admission for stroke or TIA were higher among First Nations people than other people with diabetes in Ontario. Future work should focus on determining Indigenous-specific determinants of health related to this disparity and implementing appropriate interventions to mitigate the risks and sequelae of stroke in First Nations people.

Characterizing risk of type 2 diabetes in First Nations people living in First Nations communities in Ontario: a population-based analysis using cross-sectional survey data

BACKGROUND

Population-based planning tools are important for informing diabetes-prevention efforts in First Nations communities. We used the Diabetes Population Risk Tool (DPoRT) to predict 10-year diabetes risk and describe the factors that contribute to diabetes risk in First Nations adults living in Ontario First Nations communities.

METHODS

We examined population data from adult (≥ 20 yr) respondents to the First Nations Regional Health Survey (RHS) phase 3, a representative cohort of First Nations people living in Ontario First Nations communities. We applied the DPoRT to risk factor information in the survey to predict the distribution of 10-year type 2 diabetes incidence and number of new diabetes cases from 2015/16 to 2025/26.

RESULTS

There were 993 respondents to the RHS phase 3 adult survey, of whom 936 (708 without diabetes and 228 with a diagnosis of type 2 diabetes) were eligible for inclusion. The DPoRT predicted a type 2 diabetes risk of 9.6% (confidence interval [CI] 8.3-10.8) between 2015/16 and 2025/26, corresponding to 3501 (95% CI 2653-4348) new diabetes cases. Diabetes cases were predicted to occur disproportionately among those experiencing food insecurity, low income, overweight, obesity and physical inactivity. Reduced diabetes risk was predicted among those who reported connections to Indigenous culture, as measured by eating traditional vegetative foods a few times or often in the previous 12 months.

INTERPRETATION

Socioeconomic conditions and known risk factors for type 2 diabetes are important determinants of diabetes risk in First Nations communities. Culturally appropriate policies, programming and services that address socioeconomic disadvantage and other diabetes risk factors in First Nations communities likely have an important role for diabetes prevention in First Nations adults.

Best practices for EHR implementation: A BC First Nations community's experience

First Nations and other health leaders are looking to Electronic Health Records (EHRs) to improve the quality of health information, efficiency of health services, and health outcomes for Indigenous people in Canada. This study used qualitative and quantitative methods to identify the success factors in an EHR implementation at a First Nations health centre in British Columbia, Canada. The Best Practices EHR Implementation Framework (EHRIF) was used to analyze the success factor data and found that all of the success factors from the planning and implementation phases in the framework were important. Provincial and federal government commitment and collaboration with key stakeholders including a local physician champion were also critically important for the electronic medical record implementation to proceed. This study suggests the EHRIF can be used to promote successful EHR implementations in Aboriginal communities and can contribute to building health informatics expertise and capacity in First Nations communities.

Water spirits within the fishers' worldview: implications for fishing management in Northeast Brazil

BACKGROUND

Historically, aquatic environments are linked to the worldview of many local people, where there is an interconnection between the natural world, the supernatural, and the social organization. In this study, we provided a discussion on how the supernatural beings that inhabit the freshwater systems interact with artisanal fishers and fishing resources in the riverine community of Parnaíba River middle course, in Mid North of Northeast Brazil. We also provided the implications of these interactions on the fisher's behaviors and how the acculturation process (e.g., introduction of new religions) can affect the fishers' worldview.

METHOD

The selection of participants was done through intentional sampling. The content qualitative analysis was carried out to interpret the data from semi-structured interviews with 29 artisanal fishers.

RESULTS

The mythical representations that inhabit the aquatic environments in the surveyed area were as follows: Mãe d' água, Cabeça de cuia, Muleque d'água, Visage, Piratinga, Sucuiuiu, and Luz e Arco-íris. These beings have distinctions regarding the form and attributions and can be associated with seasonality (temporal markers) and specific habitats (spatial markers). The respect and fear feeling of the mythical beings were striking among the fishers interviewed. For instance, we have record offering practices in order to obtain protection and success during the fisheries. These practices suggest that there may be local conservationist habits in fisheries management. However, the advancement of urbanization and the introduction of new religions that deny the existence of mythical entities are factors that can generate the acculturation process among the fishers.

CONCLUSIONS

It is therefore necessary to carry out more studies in the surveyed area in order to evaluate the existence of possible patterns in the relationship between fisher and mythical beings. This information could confirm the role of mythical beings as environmental regulators. Consequently, it could be considered in the conservationist policies of fishery resources, reinforcing the importance of local knowledge and cultural factors for fishing management approaches.

Health Risk Modifiers of Exposure to Persistent Pollutants among Indigenous Peoples of Chukotka

The aim of the study was to assess temporal trends in health risks related to most common persistent contaminants, including polychlorinated biphenyls (PCBs), dichloro-diphenyl-trichloroethanes (DDTs), lead (Pb), as well as mercury (Hg) among indigenous peoples living in coastal areas of Chukotka in Arctic Russia. This is examined in relation to exposure pathways and a range of social and behavioral factors capable of modifying the exposure to these contaminants, including place of residence, income, traditional subsistence, alcohol consumption, and awareness of risk prevention. The primary exposure pathway for PCBs is shown to be the intake of traditional foods, which explained as much as 90% of the total health risk calculated employing established risk guidelines. Nearly 50% of past DDT-related health risks also appear to have been contributed by contaminated indoor surfaces involving commonly used DDT-containing insecticides. Individuals who practiced traditional activities are shown to have experienced a 4.4-fold higher risk of exposure to PCBs and a 1.3-fold higher risk for DDTs, Pb, and Hg. Low income, high consumption of marine mammal fat, alcohol consumption, and lack of awareness of health risk prevention are attributed to a further 2- to 6-fold increase in the risk of PCBs exposure. Low socioeconomic status enhances the health risks associated with exposure to the persistent contaminants examined.

Traditional knowledge of invertebrates used for medicine and magical-religious purposes by traditional healers and indigenous populations in the Plateau Department, Republic of Benin

BACKGROUND

Since ancient times, invertebrates have played an important role in the traditional medicine in many parts of the world. In south-eastern Benin, more specifically in the Plateau Department, invertebrates are widely used in folk medicine. However, studies on their therapeutic use has been neglected and their magical-religious purposes are poorly understood. The present study aims to document traditional knowledge related to the use of invertebrates for medicinal and magical-religious purposes by traditional healers and indigenous people of Plateau Department.

METHODS

An ethno-sociological survey was conducted with 145 informants (80 traditional healers, 12 merchants of medicinal animals and 53 households) belonging to six ethnic groups, in 20 villages located in Plateau of Benin. Data were collected through the participatory rural appraisal method involving individual interviews and direct observations with semi-structured questionnaires. The collected data regarding various medicinal and magical-religious uses of invertebrates were analysed through informant consensus factor (ICF), use value (UV) and, fidelity level (FL).

RESULTS

A total of 20 families and 38 species of invertebrates, distributed among 6 taxonomic categories, were found to be used to treat 50 different ailments. Insects occupied 64.7% of the total invertebrates listed. The African earthworm Eudrilus eugeniae K. and African giant snail Achatina achatina L. had the highest use values. The highest ICF value (1.0) was cited for diseases of the blood or blood-forming organs. A principal component analysis (PCA) revealed the influence of ethnic groups in the diseases treated with invertebrates. The highest FL (100%) was recorded for 12 invertebrate species treating various ailments. Most of invertebrate-based remedies were associated with plant species. The mode of administration was mainly oral and topical. Most of the invertebrate drugs were traditionally collected in nature or imported, mainly from Nigeria. In addition, 7 magical-religious practices are documented.

CONCLUSIONS

Our results reveal that several invertebrate species play an important role in healing practices and magical-religious rituals in the Plateau Department. We suggest further studies to confirm the presence of any bioactive compounds on invertebrate species use in traditional medicine. In addition, this study highlights the need for ecological investigations of these species, in order to develop strategies for their conservation and sustainable use.

Mercury exposure assessment in indigenous communities from Tarapaca village, Cotuhe and Putumayo Rivers, Colombian Amazon

Mercury (Hg) is a complex and multifaceted global pollutant. Artisanal and small-scale gold mining activities are largely responsible for Hg contamination in developing countries, in many cases impacting areas of high biodiversity such as the Amazon. The aim of the study was to establish Hg exposure in indigenous citizens from the Tarapaca village, Cotuhe and Putumayo Rivers, at the Colombian Amazon. Total Hg (T-Hg) concentrations were measured employing a DMA-80 Hg analyzer. For that purpose, 190 hair samples were taken from volunteers living in different communities of Tarapaca. The overall mean T-Hg level for all samples was 10.6 ± 0.4 μg/g, with values ranging from 0.61 to 31.1 μg/g. The mean T-Hg level decreased in the order Puerto Huila > Puerto Ticuna > Ventura > Nueva Union > Buenos Aires > Santa Lucia > Puerto Nuevo > Caña Brava > Pupuña. Based on recommendations from the United States Environmental Protection Agency (US EPA), 99.5% of the samples exceeded the maximum level of 1.0 μg/g. Hg content in human hair was significantly associated with fish consumption (ρ = 0.253; p < 0.001). According to the health survey, at least 24.7% of the volunteers manifested some signs and symptoms of Hg poisoning. In short, these data support the extensive Hg exposure in the environment of the Colombian Amazon, a process that could be impacting the quality of life of its vulnerable indigenous groups. Immediate actions must be taken by competent authorities to protect these communities from Hg poisoning.

Knee osteoarthritis risk in non-industrial societies undergoing an energy balance transition: evidence from the indigenous Tarahumara of Mexico

Non-industrial societies with low energy balance levels are expected to be less vulnerable than industrial societies to diseases associated with obesity including knee osteoarthritis. However, as non-industrial societies undergo rapid lifestyle changes that promote positive energy balance, individuals whose metabolisms are adapted to energetic scarcity are encountering greater energy abundance, increasing their propensity to accumulate abdominal adipose tissue and thus potentially their sensitivity to obesity-related diseases.

OBJECTIVES

Here, we propose that knee osteoarthritis is one such disease for which susceptibility is amplified by this energy balance transition.

METHODS

Support for our hypothesis comes from comparisons of knee radiographs, knee pain and anthropometry among men aged ≥40 years in two populations: Tarahumara subsistence farmers in Mexico undergoing the energy balance transition and urban Americans from Framingham, Massachusetts.

RESULTS

We show that despite having markedly lower obesity levels than the Americans, the Tarahumara appear predisposed to accrue greater abdominal adiposity (ie, larger abdomens) for a given body weight, and are more vulnerable to radiographic and symptomatic knee osteoarthritis at lower levels of body mass index. Also, proportionate increases in abdomen size in the two groups are associated with greater increases in radiographic knee osteoarthritis risk among the Tarahumara than the Americans, implying that the abdominal adipose tissue of the Tarahumara is a more potent stimulus for knee degeneration.

CONCLUSIONS

Heightened vulnerability to knee osteoarthritis among non-industrial societies experiencing rapid lifestyle changes is a concern that warrants further investigation since such groups represent a large but understudied fraction of the global population.

Adaptation of potentially preventable medication-related hospitalisation indicators for Indigenous populations in Australia using a modified Delphi technique

OBJECTIVES

One of the outcomes of a medication review service is to identify and manage medication-related problems (MRPs). The most serious MRPs may result in hospitalisation, which could be preventable if appropriate processes of care were adopted. The aim of this study was to update and adapt a previously published set of clinical indicators for use in assessing the effectiveness of a medication review service tailored to meet the needs of Indigenous people, who experience some of the worst health outcomes of all Australians.

DESIGN

A modified Delphi technique was used to: (i) identify additional indicators for consideration, (ii) assess whether the original indicators were relevant in the context of Indigenous health and (iii) reach consensus on a final set of indicators. Three rounds of rating were used via an anonymous online survey, with 70% agreement required for indicator inclusion.

SETTING

The indicators were designed for use in Indigenous primary care in Australia.

PARTICIPANTS

Thirteen panellists participated including medical specialists, general practice doctors, pharmacists and epidemiologists experienced in working with Indigenous patients.

RESULTS

Panellists rated 101 indicators (45 from the original set and 57 newly identified). Of these, 41 were accepted unchanged, seven were rejected and the remainder were either modified before acceptance or merged with other indicators. A final set of 81 indicators was agreed. Conclusions This study provides a set of clinical indicators to be used as a primary outcome measure for medication review services for Indigenous people in Australia and as a prompt for pharmacists and doctors conducting medication reviews.

TRIAL REGISTRATION NUMBER

The trial registration for the Indigenous Medication Review Service feasibility study is ACTRN12618000188235.

From plant selection by elephants to human and veterinary pharmacopeia of mahouts in Laos

ETHNOPHARMACOLOGICAL RELEVANCE

To what extent has animal observation contributed to the development of human pharmacopeias? We approach this question here through the study of mahouts' knowledge regarding the responses by elephants to their health problems, and the human medicinal uses of plants and the care of domestic animals that result from their observations.

MATERIALS AND METHODS

32 mahouts were interviewed in Thongmyxay district and 28 at the Elephant Conservation Center in the province of Xayabury. Interviews focused on the elephants' diet, health problems, plant items they consume in particular physiological or pathological contexts and the treatments that mahouts provide them. For each plant mentioned, the part of the plant consumed and mode of preparation and administration if used by mahouts were recorded. Species samples were then collected and later identified by specialists.

RESULTS

114 species were recorded as being consumed by elephants during interviews with mahouts and forest outings with them to collect samples. Twenty species were identified as used by elephants in particular pathological conditions or physiological states. According to interviewed mahouts, the consumption of certain plants improves the health of the elephant. We observed clear convergences between the observations interpreted by the mahouts as self-medication behaviour from elephants and their own medicinal practices (for human and veterinary purposes).

CONCLUSION

Beyond a mere reproduction of elephant self-medication behaviours observed, the human or veterinary medicinal cares derived from these observations are the result of complex arrangements integrating all available medicinal and conceptual resources into elaborate preparations. We recommend that mahouts' knowledge about traditional medicinal care given to elephants be further compiled, as it could have a beneficial impact on veterinary health care provided in elephant resorts and elephants' well-being.

Prevalence of e-cigarette use from a nationally representative sample in New Zealand

OBJECTIVE

To explore the prevalence of e-cigarette use in New Zealand in a nationally representative sample aged 15 years and over.

METHODS

The Health and Lifestyles Survey (HLS) is a biennial face-to-face in-house survey of New Zealand adults aged 15 years or over. The HLS was completed by 3854 participants in 2016.

RESULTS

17% of adults have tried e-cigarettes, while only 2% reported current use. The prevalence of ever use of e-cigarettes was greater in young and middle-aged adults, compared with older adults, Māori compared with NZ European, and current and former smokers, compared to never smokers. Current smokers and recent quitters displayed the highest levels of e-cigarette use, with never smokers reporting low ever use (2.8%) and no regular use. Following adjusted analyses only current smokers and recent quitters were more likely to report current or daily e-cigarette use.

CONCLUSION

Although 17% of adults report having tried e-cigarettes, very few report current use. It is possible that difficulty of use, compounded by lack of support, is preventing conversion to regular use or successful use as a quitting aid. Public health initiatives should inform individuals how to correctly use e-cigarettes optimally for smoking cessation, ideally targeting this messaging toward younger and middle-aged adults, Māori, current smokers, and recent quitters.

HPV self-sampling acceptability in rural and indigenous communities in Guatemala: a cross-sectional study

INTRODUCTION

Cervical cancer disproportionately burdens low-income and middle-income countries (LMICs) such as Guatemala. Self-collection testing for human papillomavirus (HPV) has been suggested as a form of cervical cancer screening to facilitate access in LMICs. This study assessed and compared the acceptability of self-collection HPV testing in two rural, indigenous and ethnically distinct communities in Guatemala: Santiago Atitlán, Sololá and Livingston, Izabal.

METHODS

All participants, women between the ages of 18 and 60, completed a questionnaire. Eligible participants were also asked to self-collect a vaginal sample and complete a questionnaire regarding comfort and acceptability. Self-collected samples were tested for high-risk HPV using the real-time PCR Hybribio kit.

RESULTS

In the indigenous community of Santiago Atitlán, of 438 age-eligible participants, 94% completed self-collection. Of those, 81% found it comfortable and 98% were willing to use it as a form of screening. In the multiethnic (Afro-Caribbean, indigenous) community of Livingston, of 322 age-eligible participants, 53% chose to self-collect. Among those who took the test, 83% found it comfortable and 95% were willing to use it as a form of screening. In Livingston, literacy (can read and/or write vs cannot read or write) was higher in women who chose to self-collect (prevalence ratio 2.25; 95% CI 1.38 to 3.68). Ethnicity, history of screening and reproductive history were not associated with willingness to self-collect in Livingston. Women in Santiago reported less prior use of healthcare than women in Livingston. Overall, 19% (106/549) of samples tested positive for high-risk HPV.

CONCLUSION

Among women willing to self-collect in rural and indigenous communities in Guatemala, self-collection for HPV testing is highly acceptable. However, willingness to try self-collection might vary across communities and settings. Women from a community that used less healthcare were more likely to choose self-collection. Further research is necessary to determine what factors influence a woman's choice to self-collect.

Investigation of the temporal roaming behaviour of free-roaming domestic dogs in Indigenous communities in northern Australia to inform rabies incursion preparedness

Australia is canine rabies free but free-roaming, domestic dog populations in remote northern communities are at risk of an incursion due to proximity to rabies-endemic south-east Asia. Unrestricted contact between dogs could facilitate rabies spread following an incursion, and increase the impact on both dogs and people. Whilst dog vaccination is the foundation of rabies prevention, control strategies could be enhanced by understanding the temporal pattern of roaming and associated risk factors, so that movement restrictions can be targeted. Global positioning system datasets from 132 dogs in eight Indigenous communities in the Torres Strait and Northern Peninsula Area (NPA) of Australia were analysed using regression methods. The influence of risk factors (including age, sex, location, season and hour of day) on dogs' distance from their residences were assessed. Dogs roamed furthest in the NPA and during the dry season. Daily peaks in mean roaming distance were observed at 1000-1100 hrs and 1700-1800 hrs in the Torres Strait, and 1700-1800 hrs in the NPA. These findings demonstrate that understanding community-specific temporal roaming patterns can inform targeted movement restrictions during an outbreak of rabies in remote communities in northern Australia.

"Another thing to live for": Supporting HCV treatment and cure among Indigenous people impacted by substance use in Canadian cities

BACKGROUND

Colonization and colonial systems have led to the overrepresentation of Indigenous people impacted by substance use and HCV infection in Canada. It is critical to ensure Indigenous people's equitable access to new direct acting antiviral HCV treatments (DAAs). Identifying culturally-safe, healing-centered approaches that support the wellbeing of Indigenous people living with HCV is an essential step toward this goal. We listened to the stories and perspectives of HCV-affected Indigenous people and HCV treatment providers with the aim of providing pragmatic recommendations for decolonizing HCV care.

METHODS

Forty-five semi-structured interviews were carried out with Indigenous participants affected by HCV from the Cedar Project (n = 20, British Columbia (BC)) and the Canadian Coinfection Cohort (n = 25, BC; Ontario (ON); Saskatchewan (SK)). In addition, 10 HCV treatment providers were interviewed (n = 4 BC, n = 4 ON, n = 2 SK). Interpretive description identified themes to inform clinical approaches and public health HCV care. Themes and related recommendations were validated by Indigenous health experts and Indigenous participants prior to coding and re-contextualization.

RESULTS

Taken together, participants' stories and perceptions were interpreted to coalesce into three overarching and interdependent themes representing their recommendations. First: treatment providers must understand and accept colonization as a determinant of health and wellness among HCV-affected Indigenous people, including ongoing cycles of child apprehension and discrimination within the healthcare system. Second: consistently safe attitudes and actions create trust within HCV treatment provider-patient relationships and open opportunities for engagement into care. Third: treatment providers who identify, build, and strengthen circles of care will have greater success engaging HCV-affected Indigenous people who have used drugs into care.

CONCLUSION

There are several pragmatic ways to integrate Truth and Reconciliation as well as Indigenous concepts of whole-person wellness into the HCV cascade of care. By doing so, HCV treatment providers have an opportunity to create greater equity and support long-term wellness of Indigenous patients.

Cumulative Effects of Bullying and Racial Discrimination on Adolescent Health in Australia

This study examined how cumulative exposure to racial discrimination and bullying victimization influences the health of Australian adolescents (n = 2802) aged 10 to 11 years (19.3% visible ethnic minorities [nonwhite, non-Indigenous]; 2.6% Indigenous) using data from three waves (2010-2014) of the nationally representative Longitudinal Study of Australian Children (LSAC). Cumulative exposure to racial discrimination and bullying victimization had incremental negative effects on socioemotional difficulties. Higher accumulated exposure to both stressors across time was associated with increased body mass index z-scores and risk of overweight/obesity. Studies that examine exposure to single risk factors such as bullying victimization or racial discrimination at one time point only are likely to miss key determinants of health for adolescents from stigmatized racial-ethnic backgrounds and underestimate their stressor burden.

Culturally Responsive Services as a Path to Equity in Mental Healthcare

Indigenous peoples, immigrants and refugees and racialized groups, as well as some long-established ethnic, linguistic, cultural and religious communities, experience inequities in mental health in Canadian society. These inequities result from social structural determinants of health that are embedded in the cultural knowledge, values and attitudes of the specific group as well as those of the larger society. Culture shapes the experience and expression of mental health problems, modes of coping, pathways to care and the effectiveness of treatment and prevention, as well as the processes of resilience and recovery. Systematic attention to culture in the provision of mental health services can improve access, utilization and health outcomes. We review models to address diversity in mental healthcare and identify key areas in which we believe policy innovation is urgently needed: 1. Cultural competence, safety and anti-racism training and accreditation standards for practitioners and for healthcare education, service systems and institutions; 2. National regulations and quality assurance standards to ensure use of language interpreters; 3. Development of a cadre of culture brokers to improve clinical communication; and 4. Integration of attention to culture in service systems design, as well as clinical practice.

Genetics, adaptation to environmental changes and archaic admixture in the pathogenesis of diabetes mellitus in Indigenous Australians

Indigenous Australians are particularly affected by type 2 diabetes mellitus (T2D) due to both their genetic susceptibility and a range of environmental and lifestyle risk factors. Recent genetic studies link predisposition to some diseases, including T2D, to alleles acquired from archaic hominins, such as Neanderthals and Denisovans, which persist in the genomes of modern humans today. Indo-Pacific human populations, including Indigenous Australians, remain extremely underrepresented in genomic research with a paucity of data examining the impact of Denisovan or Neanderthal lineages on human phenotypes in Oceania. The few genetic studies undertaken emphasize the uniqueness and antiquity of Indigenous Australian genomes, with possibly the largest proportion of Denisovan ancestry of any population in the world. In this review, we focus on the potential contributions of ancient genes/pathways to modern human phenotypes, while also highlighting the evolutionary roles of genetic adaptation to dietary and environmental changes associated with an adopted Western lifestyle. We discuss the role of genetic and epigenetic factors in the pathogenesis of T2D in understudied Indigenous Australians, including the potential impact of archaic gene lineages on this disease. Finally, we propose that greater understanding of the underlying genetic predisposition may contribute to the clinical efficacy of diabetes management in Indigenous Australians. We suggest that improved identification of T2D risk variants in Oceania is needed. Such studies promise to clarify how genetic and phenotypic differences vary between populations and, crucially, provide novel targets for personalised medical therapies in currently marginalized groups.

Waimānalo Pono Research Hui: A Community-Academic Partnership to Promote Native Hawaiian Wellness through Culturally Grounded and Community-Driven Research and Programming

Although Hawai'i is often portrayed as an idyllic paradise and is recognized as one of the healthiest States in the United States, pervasive health disparities exist among Native Hawaiians. Similar to other indigenous populations across the globe, these disparities are linked to unjust social and economic policies rooted in colonization and historical trauma. Western-centric efforts to address these disparities have yielded limited results. Consequently, indigenous frameworks to decolonize western-centric research processes have emerged. The Waimānalo Pono Research Hui is an example of a community-academic partnership that uses indigenous methodologies and principles of community-based participatory research as the foundation to engage Native Hawaiian community members in research. Monthly gatherings are held where community members and academic researchers share a meal and discuss community priorities with the goal of shaping research and programming that are rooted in Native Hawaiian values. A mission for the group has been created as well as protocols for community engagement to ensure all projects that work with the Waimānalo Pono Research Hui are ethically sound and grounded in the community's preferences, cultural knowledge, and lived experiences. Our community members continually report that the Waimānalo Pono Research Hui has positively transformed their perception of and willingness to engage in research. Similarly, university students and academic researchers express how much their knowledge about working with communities has grown and inspired them. Creating spaces for communities and researchers to build authentic relationships and engage in ongoing conversations can promote culturally grounded and community-driven research and programming.

Inter and intra cultural variations of millet (Pennisetum glaucum (L.) R. Br) uses in Niger (West Africa)

BACKGROUND

An ethnobotanical study was conducted in the eight regions of Niger to identify local knowledge variation of millet (Pennisetum glaucum (L.) R. Br) uses. In fact, the level of individual knowledge can be affected by many factors such as gender, age, ethnicity, occupation, religious and cultural beliefs, etc. This study documented indigenous knowledge of millet uses in Niger and aimed specifically to (i) identify the different types of millet organ uses and (ii) assess the variation of local knowledge of millet uses along with ethnicity, occupation, and age.

METHODS

The data were collected in 32 major millet-producing villages in Niger through individual semi-structured interviews and focus group discussions. About 508 individuals from 5 ethnic groups were interviewed. The assessment of the knowledge was performed by calculating five ethnobotanical indices such as the number of reported uses by parts of the plant (RU), the use-value of the parts of the plant (PPV), the specific use-value (SU), the intraspecific use-value (IUV), and the relative frequency of citations (FRC). Data were analyzed using descriptive, univariate, and multivariate statistical analyses.

RESULTS

The results indicated a significant variation in uses across ethnic groups (H = 38.14, P = 0.000) and socio-occupational categories (H = 6.80, P = 0.033). The Hausa, Kanuri, and Zarma-Sonhrai ethnic groups, farmers were the largest users of the species. Dietary (51.40%) and forage (40.35%) were the most reported uses. The most commonly used parts of the plant were the stubble (74.92%) and grains (73.68%).

CONCLUSIONS

The study showed the importance of P. glaucum in the daily life of local people. It also confirmed the uneven distribution of indigenous knowledge of millet uses in Niger due to social factors. Now, the challenge is how to incorporate these social differences in knowledge of millet uses in view to sustainable management and conservation of local genetic resources of millet. Finally, this work could be an important decision-making tool for future millet valuing.

Hepatitis B virus infection: Epidemiology and seroprevalence rate amongst Negrito tribe in Malaysia

INTRODUCTION

Prevalence of Hepatitis B virus (HBV) infection among the non-indigenous people in Malaysia has been well established and range between 3% and 5%. However, data from the indigenous (Orang Asli) people is still lacking. The Negrito population is the most remotely located Orang Asli tribe with limited access to health care facilities. This study was undertaken to determine the epidemiology and seroprevalence of HBV infection among the Negrito.

METHODS

Surveys were conducted in five Negrito settlements in Kelantan and Perak states in Malaysia. A total of 150 participants were recruited. Clinical history was taken and physical examination was performed. Five millilitres of whole blood were collected and tested for hepatitis B surface antigen (HBsAg) using electrochemiluminescence immunoassay.

RESULTS

Participants were mainly from the Bateq (49.3%) and Mendriq (29.4%) sub-tribes. Overall, 13 subjects (8.7 %); nine males and four females were HBsAg positive. Nine of the HBsAg positive subjects were ≥35 years old. All of them had history of home deliver without evidence of antenatal record. Six (46%) of the HBsAg positive subjects had tattoo and body piercing in the past.

CONCLUSION

The prevalence of HBV infection rate amongst the Negrito tribe is almost three-fold compared to the national rates. The reason for this finding remains unclear. Tattooing, body piercing and vertical transmission could be the main possible routes of transmission of HBV among the Negrito population in Malaysia.

Ethnomycological knowledge among Kaqchikel, indigenous Maya people of Guatemalan Highlands

BACKGROUND

The Guatemalan Highlands is a region of great but so far poorly known mycological diversity. People living in this area have long used wild fungi as a source of food and income. However, our knowledge of the ethnomycological practices of the Mayan peoples of Guatemala is still rudimental, especially if compared with information reported for the neighboring region of Mexico. Among the main indigenous groups of the Maya people inhabiting the highlands of Central Guatemala, stand the Kaqchikel, accounting for nearly 8% of the entire Guatemalan population. The main aim of this study was to record the traditional knowledge and use of edible wild mushrooms by inhabitants of the municipality of San Juan Sacatepéquez that lies at the heart of the Kaqchikel area in the central highlands of Guatemala, also describing the relevant selling practices and dynamics. A secondary aim was to compare the diversity and composition of the mushroom assemblage offered at the market with the macrofungal diversity of woods in the area.

METHODOLOGY

This study is the result of 4 years of ethnomycological research, conducted through continuous visits to the municipal market and focused interviews with collectors and vendors. Field sampling in pine-oak forested areas surrounding San Juan Sacatepéquez, from where the mushrooms sold at the market are foraged, were also conducted, in the presence of local collectors.

RESULTS

The results show a significant richness of species sold in the market, a network of commerce of purchase, sale, and resale of several species, with relatively stable prices, and knowledge about edible and inedible species that is transmitted mainly within the family nucleus. The business of selling mushrooms in the market is an exclusive activity of women, who are supplied by collectors or by other vendors. Fungi are sold and bought only as food, while no consumption of hallucinogenic mushrooms or medicinal mushrooms was recorded. Several species of Amanita, Cantharellus, Boletus, Lactarius, and Russula were those most commercialized in the 4 years of the study, but we also spotted fungi never reported before as consumed in the country, including Gastropila aff. fumosa (= Calvatia fumosa) and several species of Cortinarius. Field sampling in nearby pine-oak forests confirmed an elevated local macrofungal diversity.

CONCLUSION

Our study unveiled the contemporary wealth of Kaqchikel culture for what concerns mushrooms, demonstrating that mushrooms continue to be culturally and economically important for these communities despite the erosion of traditional knowledge. Our results also confirmed the need to investigate in greater detail the Guatemalan mycodiversity that is vast and poorly known.

Hidden Suicides of the Indigenous People of the Brazilian Amazon: Gender, Alcohol and Familial Clustering

OBJECTIVE

To evaluate the coverage, characteristics and the risk of suicide in the indigenous people of Tabatinga in the Brazilian Amazon.

METHODS

An active surveillance strategy for suicide cases was used: records of the Ministry of Health, the Municipal Health Secretariat, the Special Indigenous Health District of the Upper River Solimões (Distrito Sanitario Especial Indígena Alto Río Solimões), the Military Hospital of Tabatinga, the National Indian Foundation (Fundación Nacional del Indio) and the civil registry offices were examined from 2007 to 2011 for individuals over 9 years of age. Adjusted rates were estimated using the direct method and according to age. A descriptive analysis was performed and the hypothesis tests were considered significant if p-values were <0.05.

RESULTS

The coverage of indigenous suicide was 82.8%, since 11 (17.2%) were classified as hidden suicides. For men between 15 and 29 years of age, and for women aged from 12 to 20 years, the probability of suicide was around 70.0%. In 17.2% of the sample there was a record of alcohol consumption before death and relationship between victims. The corrected adjusted mortality rate was 111.7/100,000 (95% CI, 84.6-148.6).

CONCLUSIONS

The risk of suicide in the indigenous people of the Tabatinga is very high. Coping strategies should consider the complex relationship between suicide and alcohol consumption, gender differences and the existence of vulnerable groups, such as young people, especially those with close relatives who have committed suicide.

Association between participation in the Families First Home Visiting programme and First Nations families' public health outcomes in Manitoba, Canada: a retrospective cohort study using linked administrative data

OBJECTIVE

To determine whether the Families First Home Visiting (FFHV) programme, which provides home visiting services to families across Manitoba, is associated with improved public health outcomes among First Nations families facing multiple parenting challenges.

DESIGN

Retrospective cohort study using population-based administrative data.

SETTING

Manitoba, Canada.

PARTICIPANTS

First Nations children born in Manitoba in 2003-2009 (n=4010) and their parents enrolled in FFHV compared with non-enrolled families with a similar risk profile.

INTERVENTION

FFHV supports public health in Manitoba by providing home visiting services to First Nations and non-First Nations families with preschool children and connecting them with resources in their communities.

OUTCOMES

Predicted probability (PP) and relative risk (RR) of childhood vaccination, parental involvement in community support programmes and children's development at school entry.

RESULTS

FFHV participation was associated with higher rates of complete childhood vaccination at age 1 (PP: FFHV 0.715, no FFHV 0.661, RR 1.08, 95% CI 1.03 to 1.14) and age 2 (PP: FFHV 0.465, no FFHV 0.401, RR 1.16, 95% CI 1.08 to 1.25), and with parental involvement in community support groups (PP: FFHV 0.149, no FFHV 0.097, RR 1.54, 95% CI 1.27 to 1.86). However, there was no difference between FFHV participants and non-participants in rates of children being vulnerable in at least one developmental domain at age 5 (PP: FFHV 0.551, no FFHV 0.557, RR 1.00, 95% CI 0.91 to 1.11).

CONCLUSIONS

FFHV supports First Nations families in Manitoba by promoting childhood vaccination and connecting families to parenting resources in their communities, thus playing an important role in fulfilling the mandate of public health practice.

Therapeutic tattooing in the Arctic: Ethnographic, archaeological, and ontological frameworks of analysis

This essay describes the potential for using ethnographic evidence and mummified tattooed skin to reflect on past therapeutic tattoo practice in the Arctic. It also considers the ways in which circumpolar concepts of disease emerged in relation to the agency of nonhuman entities. I argue that specific forms of curative tattooing offer interpretive models for the paleopathological and bioarchaeological study of care through an ontological framework of analysis.

Obstacles and opportunities for monitoring ethnicity-based inequalities in maternal health care: Lessons from Mexico

BACKGROUND

Monitoring and reducing inequalities in health care has become more relevant since the adoption of the Sustainable Development Goals (SDGs). The SDGs bring an opportunity to put the assessment of inequalities by ethnicity on the agenda of decision-makers. The objective of this qualitative study is to know how current monitoring is carried out and to identify what factors influence the process in order to incorporate indicators that allow the evaluation of inequalities by ethnicity.

METHODS

We conducted 17 semi-structured interviews with key informants from the health ministry, monitoring observatories, research centers, and international organizations, involved in maternal health care monitoring in Mexico. Our analysis was interpretative-phenomenological and focused on examining experiences about monitoring maternal health care in order to achieve a full picture of the current context in which it takes place and the factors that influence it.

RESULTS

The obstacles and opportunities pointed out from the participants emerge from the limitations or advantages associated with the accuracy of evaluation, availability of information and resources, and effective management and decision-making. Technicians, coordinators, researchers or decision-makers are not only aware of the inequalities but also of its importance. However, this does not lead to political decisions permitting an indicator to be developed for monitoring it. As for opportunities, the role of international organizations and their links with the countries is crucial to carry out monitoring, due to political and technical support.

CONCLUSIONS

The success of a monitoring system to help decision-makers reduce inequalities in health care depends not only on accurate evaluations but also on the context in which it is implemented. Understanding the operation, obstacles and opportunities for monitoring could be a key issue if the countries want to advance towards assessing inequalities and reducing health inequities with the aid of concrete policies and initiatives.

Indigenous knowledge networks in the face of global change

Indigenous communities rely extensively on plants for food, shelter, and medicine. It is still unknown, however, to what degree their survival is jeopardized by the loss of either plant species or knowledge about their services. To fill this gap, here we introduce indigenous knowledge networks describing the wisdom of indigenous people on plant species and the services they provide. Our results across 57 Neotropical communities show that cultural heritage is as important as plants for preserving indigenous knowledge both locally and regionally. Indeed, knowledge networks collapse as fast when plant species are driven extinct as when cultural diffusion, either within or among communities, is lost. But it is the joint loss of plant species and knowledge that erodes these networks at a much higher rate. Our findings pave the road toward integrative policies that recognize more explicitly the inseparable links between cultural and biological heritage.

Association of Modifiable Risk Factors With Dental Caries Among Indigenous and Nonindigenous Children in Australia

Importance

Although the prevalence of untreated dental caries among Indigenous Australian children greatly exceeds the prevalence observed among non-Indigenous children, the associations of dental caries with risk factors is considered to be the same.

Objective

To estimate the association of modifiable risk factors with area-based inequalities in untreated dental caries among Indigenous and non-Indigenous Australian children using decomposition analysis.

Design, Setting, Participants

Cross-sectional study using data from Australia's National Child Oral Health Study 2012-2014, a nationally representative sample of both Indigenous and non-Indigenous children aged 5 to 14 years. Data analyses were completed in November 2018.

Main Outcomes and Measures

Outcomes were the mean number of decayed tooth surfaces in the primary dentition for children aged 5 to 10 years and mean number of decayed tooth surfaces in the permanent dentition for children aged 8 to 14 years. The area-based measure was the school-based Index of Community Socio-Educational Advantage, with individual-level variables including sex, equivalized household income, tooth-brushing frequency, sugar-sweetened beverage (SSB) consumption, time from last dental visit, and residing in an area with water fluoridation.

Results

There were 720 Indigenous children aged 5 to 10 years, 14 769 non-Indigenous children aged 5 to 10 years, 738 Indigenous children aged 8 to 14 years, and 15 631 non-Indigenous children aged 8 to 14 years. For area-based inequalities in primary dentition among Indigenous children, two-thirds of the contribution was associated with SSB consumption (65.9%; 95% CI, 65.5%-66.3%), followed by irregular tooth brushing (15.0%; 95% CI, 14.6%-15.5%) and low household income (14.5%; 95% CI, 14.1%-14.8%). Among non-Indigenous children, almost half the contribution was associated with low household income (47.6%; 95% CI, 47.6%-47.7%), followed by SSB consumption (31.0%; 95% CI, 30.9%-31.0%) and residing in an area with nonfluoridated water (9.5%; 95% CI, 9.5%-9.6%). For area-based inequalities in permanent dentition among Indigenous children, 40.0% (95% CI, 39.9%-40.1%) of the contribution was associated with residing in an area with nonfluoridated water, followed by low household income (20.0%; 95% CI, 19.7%-20.0%) and consumption of SSBs (20.0%; 95% CI, 19.9%-20.1%). Among non-Indigenous children, the contribution associated with low household income, SSB consumption, and last dental visit more than a year ago were each 28.6%.

Conclusions and Relevance

The association of modifiable risk factors with area-based inequalities in untreated dental caries among Indigenous and non-Indigenous Australian children differed substantially. Targets to reduce SSB consumption may reduce oral health inequalities for both groups; however, Indigenous children require additional focus on oral hygiene.

Indigenous and non-Indigenous people experiencing homelessness and mental illness in two Canadian cities: A retrospective analysis and implications for culturally informed action

OBJECTIVES

Indigenous people in Canada are not only over-represented among the homeless population but their pathways to homelessness may differ from those of non-Indigenous people. This study investigated the history and current status of Indigenous and non-Indigenous people experiencing homelessness and mental illness. We hypothesised that compared with non-Indigenous people, those who are Indigenous would demonstrate histories of displacement earlier in life, higher rates of trauma and self-medication with alcohol and other substances.

DESIGN AND SETTING

Retrospective data were collected from a sample recruited through referral from diverse social and health agencies in Winnipeg and Vancouver.

PARTICIPANTS

Eligibility included being 19 years or older, current mental disorder and homelessness.

MEASURES

Data were collected via interviews, using questionnaires, on sociodemographics (eg, age, ethnicity, education), mental illness, substance use, physical health, service use and quality of life. Univariate and multivariable models were used to model the association between Indigenous ethnicity and dependent variables.

RESULTS

A total of 1010 people met the inclusion criteria, of whom 439 self-identified as Indigenous. In adjusted models, Indigenous ethnicity was independently associated with being homeless at a younger age, having a lifetime duration of homelessness longer than 3 years, post-traumatic stress disorder, less severe mental disorder, alcohol dependence, more severe substance use in the past month and infectious disease. Indigenous participants were also nearly twice as likely as others (47% vs 25%) to have children younger than 18 years.

CONCLUSIONS

Among Canadians who are homeless and mentally ill, those who are Indigenous have distinct histories and current needs that are consistent with the legacy of colonisation. Responses to Indigenous homelessness must be developed within the context of reconciliation between Indigenous and non-Indigenous Canadians, addressing trauma, substance use and family separations.

TRIAL REGISTRATION NUMBER

ISRCTN42520374, ISRCTN57595077, ISRCTN66721740.

Traditional knowledge-based lifestyle interventions in the prevention of obesity and type 2 diabetes in Indigenous children in Canada: a systematic review protocol

BACKGROUND

Approximately 50% of all youth-onset type 2 diabetes mellitus (T2DM) in Canada occurs in Indigenous children. In adults, cardiovascular disease is one of the leading causes of mortality in First Nations communities, and diabetes is a significant contributor to the risk of developing this disorder. The early onset of diabetes may predispose these children to premature cardiovascular disease and influence their longevity and quality of life. As a result, the implementation of culturally tailored obesity and T2DM primary prevention programs is vital. This systematic review aims to assess the effectiveness of existing traditional knowledge-based lifestyle intervention programs on preventing obesity and T2DM in Indigenous children in Canada.

METHODS

We will conduct database searches in MEDLINE, Embase, PsycINFO, SPORTDiscus, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, and the Cochrane Controlled Register of Trials. We will also conduct grey literature searches of central repository of trials ( ClinicalTrials.gov ), ProQuest Dissertations, Theses A&I, and Indigenous studies portal research tools. Reviewers will independently review titles, abstracts, and full-text articles retrieved from databases to assess potentially eligible studies, and relevant articles will be assessed for risk of bias and quality. The primary outcomes include the change in body mass index z-scores or a diagnosis of diabetes. The secondary outcomes include the change in measures of adiposity as well as lifestyle and metabolic profiles. A meta-analysis will be performed if two or more studies have used similar study designs, comparable intervention techniques , similar populations and measured similar outcomes.

DISCUSSION

This review will provide a summary of current interventions to prevent obesity and T2DM in Indigenous children in Canada and help determine the gaps in the literature so that interventions can be developed to control the surge in pediatric T2DM in Indigenous communities.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017072781.

Examining the relationship between body mass index and adverse cardio-metabolic profiles among Australian Indigenous and non-Indigenous young adults

Australian Indigenous young people have a 10-fold excess of deaths from ischaemic heart disease compared with non-Indigenous Australians, yet the reasons behind this remain understudied. This paper aims to describe cardio-metabolic profiles among Australian Indigenous (n = 459) and non-Indigenous (n = 117) young adults (21-27 years). The association between body size and an adverse cardio-metabolic profile (≥3 abnormal cardio-metabolic markers) is assessed by gender and urban/rural residence, employing regression analyses. The prevalence of obesity was highest among urban Indigenous participants, both males and females (22% and 23%, respectively). Overall, BMI showed a significant positive association with an adverse cardio-metabolic profile. Moreover, adverse cardio-metabolic profile was present in a substantial proportion of Indigenous participants even in overweight and normal BMI categories. Among females, this could reflect elevated waist circumference, which was present in half of those of normal weight. Remote Indigenous females had the highest predicted probability of having an adverse cardio-metabolic profile across all BMI categories (13% for underweight, 54% for normal BMI, 93% for overweight, and 99% for obese). Our findings highlight the associations between obesity and adverse cardio-metabolic profiles among Indigenous and non-Indigenous youth. Culturally-relevant strategies that address lifestyle risks, including access to healthy food, are urgently needed in this age group.

Health and saliva microbiomes of a semi-urbanized indigenous tribe in Peninsular Malaysia

Background: The indigenous people of Peninsular Malaysia, also known as Orang Asli, have gradually been urbanized. A shift towards non-communicable diseases commonly associated with sedentary lifestyles have been reported in many tribes. This study engaged with a semi-urbanized Temiar tribe from Kampong Pos Piah, Perak, who are experiencing an epidemiological transition. Methods:  Weight, height, waist circumference, blood pressure, HbA1C and lipid levels were measured as indicators of cardio-metabolic health. DNA was extracted from saliva using salting-out method followed by PCR amplification of the V3-V4 region of the 16S rRNA gene and sequencing on Illumina MiSeq. Microbiome analysis was conducted on Qiime v1.9. Statistical analysis was conducted using Qiime v1.9 and R.   Results: The study revealed that 60.4% of the Temiar community were overweight/obese, with a higher prevalence among women. HbA1C levels showed that 45% of Temiar had pre-diabetes. Insulin resistance was identified in 21% of Temiar by using a surrogate marker, TG/HDL. In total, 56.5% of Temiar were pre-hypertensive, and the condition was prevalent across all age-groups. The saliva microbiome profiles of Temiar revealed significant differences by gender, BMI, abdominal obesity as well as smoking status. The relative abundance of the genus Bifidobacterium was increased in men whereas the genera  Prevotella, Capnocytophaga, Leptotrichia, Neisseria and Streptococcus were increased in women. Proteobacteria was significantly depleted in smokers. Conclusions: Temiar from Pos Piah had a high prevalence of cardio-metabolic risks, including general and abdominal obesity, pre-diabetes, prehypertension and hypertension. This phenomenon has not been previously reported in this tribe. The saliva microbiome profiles were significantly different for individuals of different gender, BMI, abdominal obesity and smoking status.

Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: prevalence and inequalities in 23 countries

BACKGROUND

The rise in contraceptive use has largely been driven by short-acting methods of contraception, despite the high effectiveness of long-acting reversible contraceptives. Several countries in Latin America and the Caribbean have made important progress increasing the use of modern contraceptives, but important inequalities remain. We assessed the prevalence and demand for modern contraceptive use in Latin America and the Caribbean with data from national health surveys.

METHODS

Our data sources included demographic and health surveys, multiple indicator cluster surveys, and reproductive health surveys carried out since 2004 in 23 countries of Latin America and the Caribbean. Analyses were based on sexually active women aged 15-49 years irrespective of marital status, except in Argentina and Brazil, where analyses were restricted to women who were married or in a union. We calculated contraceptive prevalence and demand for family planning satisfied. Contraceptive prevalence was defined as the percentage of sexually active women aged 15-49 years who (or whose partners) were using a contraceptive method at the time of the survey. Demand for family planning satisfied was defined as the proportion of women in need of contraception who were using a contraceptive method at the time of the survey. We separated survey data for modern contraceptive use by type of contraception used (long-acting, short-acting, or permanent). We also stratified survey data by wealth, area of residence, education, ethnicity, age, and a combination of wealth and area of residence. Wealth-related absolute and relative inequalities were estimated both for contraceptive prevalence and demand for family planning satisfied.

FINDINGS

We report on surveys from 23 countries in Latin America and the Caribbean, analysing a sample of 212 573 women. The lowest modern contraceptive prevalence was observed in Haiti (31·3%) and Bolivia (34·6%); inequalities were wide in Bolivia, but almost non-existent in Haiti. Brazil, Colombia, Costa Rica, Cuba, and Paraguay had over 70% of modern contraceptive prevalence with low absolute inequalities. Use of long-acting reversible contraceptives was below 10% in 17 of the 23 countries. Only Cuba, Colombia, Mexico, Ecuador, Paraguay, and Trinidad and Tobago had more than 10% of women adopting long-acting contraceptive methods. Mexico was the only country in which long-acting contraceptive methods were more frequently used than short-acting methods. Young women aged 15-17 years, indigenous women, those in lower wealth quintiles, those living in rural areas, and those without education showed particularly low use of long-acting reversible contraceptives.

INTERPRETATION

Long-acting reversible contraceptives are seldom used in Latin America and the Caribbean. Because of their high effectiveness, convenience, and ease of continuation, availability of long-acting reversible contraceptives should be expanded and their use promoted, including among young and nulliparous women. In addition to suitable family planning services, information and counselling should be provided to women on a personal basis.

FUNDING

Wellcome Trust, Pan American Health Organization.

Hepatitis C Virus Infection in Indigenous Populations in the United States and Canada

American Indian/Alaska Native (AI/AN) and Canadian Indigenous people are disproportionally affected by hepatitis C virus (HCV) infection yet are frequently underrepresented in epidemiologic studies and surveys often used to inform public health efforts. We performed a systematic review of published and unpublished literature and summarized our findings on HCV prevalence in these Indigenous populations. We found a disparity of epidemiologic literature of HCV prevalence among AI/AN in the United States and Indigenous people in Canada. The limited data available, which date from 1995, demonstrate a wide range of HCV prevalence in AI/AN (1.49%-67.60%) and Indigenous populations (2.28%-90.24%). The highest HCV prevalence in both countries was reported in studies that either included or specifically targeted people who inject drugs. Lower prevalence was reported in studies of general Indigenous populations, although in Canada, the lowest prevalence was up to 3-fold higher in Aboriginal people compared with general population estimates. The disparity of available data on HCV prevalence and need for consistent and enhanced HCV surveillance and reporting among Indigenous people are highlighted. HCV affects Indigenous peoples to a greater degree than the general population; thus we recommend tribal and community leaders be engaged in enhanced surveillance efforts and that funds benefitting all Indigenous persons be expanded to help prevent and cover health care expenses to help stop this epidemic.

A Scoping Review of Obesity among Indigenous Peoples in Canada

Indigenous populations in Canada are heavily affected by the burden of obesity, and certain communities, such as First Nations on reserve, are not included in the sampling framework of large national health surveys. A scoping review of ever published original research reporting obesity rates (body mass index ≥ 30), among adult Indigenous peoples in Canada, was conducted to identify studies that help close the Canadian Community Health Survey (CCHS) data gap for obesity prevalence in Indigenous populations in Canada and to make comparisons based on ethnicity, sex, time, and geography. First Nations on reserve with self-reported height and weight had higher rates of obesity (30%-51%) than First Nations off reserve (21%-42%) and non-Indigenous populations (12%-31%) in their respective province or territory, with the exception of Alberta, where rates in First Nations on reserve (30% and 36%) were lower or similar to those reported in First Nations off reserve (38%). First Nations on reserve with predominantly measured height and weight (42%-66%) had higher rates of obesity compared to Inuit in Quebec (28%), Nunavut (33%), and Newfoundland and Labrador (41%), while the rates were similar to those in Inuit in Northwest Territories (49%). Obesity in these large studies conducted among Inuit was based solely on measured height and weight. Studies in First Nations and Inuit alike showed higher prevalence of obesity in women, as well as an increase with time. No recent studies measured the obesity rates for First Nations in Yukon and Northwest Territories and for Métis living in settlements of Northern Alberta. Researchers are encouraged to conduct total diet studies in these regions, and to use existing data to analyze the associations between obesity, road access, latitude, food environment, and traditional food intake, to further inform community planning and development.