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.

Traditional Indigenous-Amazonian Therapy Involving Ceremonial Tobacco Drinking as Medicine: A Transdisciplinary Multi-Epistemic Observational Study.

Although the tobacco plant has been employed as a medicinal and sacred herb by Indigenous cultures across the Americas, its usage drastically changed after the 15th-century colonial arrival; its large-scale commodification and global marketing once brought to Europe lead to hedonic and addictive uses harmful to health. As a consequence, tobacco smoking is now one of the largest public health problems worldwide. However, in the Peruvian Amazon, a region of origin of tobacco species, Indigenous healers still know how to use the plant for therapeutic purposes. Due to a general disregard of Indigenous knowledge and stigma, these uses have however not so far been clinically investigated. We hence conducted for the first time a clinical field study assessing a sample of patients treated by a traditional healer specialized in tobacco in the Peruvian Amazon (observational design, pilot study, N = 27). The study was conducted within a transdisciplinary and multi-epistemic medical frame, in close partnership with an Amazonian healer. We used validated self-report scales to quantitatively assess mental health variables before and after the weeklong treatment, and mixed-methods to report experienced effects. Paired-samples t-tests comparing pre- and post-treatment scores revealed significant reductions in anxiety, depression, perceived stress, and general symptom indicators. Experienced effects included initial physical discomfort, followed by psychologically or existentially/spiritually significant insights. Our findings point to a sophisticated therapeutic approach based on Indigenous knowledge of tobacco applications, which should be further investigated. The study also contributes to the burgeoning scientific field on therapeutic uses of contentious psychoactive plants.

Fostering collaboration: an exploration of knowledge exchange between Rongoa Maori practitioners and surgical clinicians.

BACKGROUND: This research investigates the potential for collaboration of Rongoa Maori, the Indigenous healing practices of Maori, with New Zealand's contemporary healthcare system. It aims to bridge the gap between Rongoa Maori and Western medicine by exploring the perspectives of practitioners from both fields, identifying barriers to integration, and highlighting potential areas for collaboration. METHODS: Qualitative interviews were conducted with both Rongoa practitioners and Western surgeons. The data collected were subjected to thematic analysis to extract key themes related to the integration process, challenges faced, and the potential for mutual recognition and respect between the two healing paradigms. RESULTS: The study reveals a deep respect for Rongoa Maori among Western surgeons but identifies significant systemic barriers that impede its integration. These include bureaucratic challenges and the absence of clear referral pathways. Rongoa practitioners express concerns over being overlooked within the healthcare system and highlight a lack of awareness among healthcare professionals about their practices. Despite these challenges, there is a shared interest in collaborative approaches to healthcare that respect and incorporate Rongoa Maori. CONCLUSIONS: The findings underscore the need for systemic changes to facilitate the integration of Rongoa Maori into mainstream healthcare, including the development of clear referral pathways and initiatives to raise awareness among healthcare professionals. The study highlights the need for a more collaborative healthcare approach that values the contributions of Rongoa Maori, aiming to improve patient care through holistic practices.

Randomized trial in rural Native American homes heated with wood stoves: results from the EldersAIR study.

Residential wood burning has both practical and traditional value among many indigenous communities of the United States Mountain West, although household biomass burning also results in emissions that are harmful to health. In a household-level three-arm placebo-controlled randomized trial we tested the efficacy of portable filtration units and education interventions on improving pulmonary function and blood pressure measures among elder participants that use wood stoves for residential heating. A total of 143 participants were assigned to the Education (n=49), Filter (n=47), and Control (n=47) arms. Blood pressure and spirometry measures were collected multiple times during a per-intervention winter period and during a follow-up post-intervention winter period. Despite strong PM2.5 exposure reduction results with the Filter arm (50% lower compared to Control arm), neither this intervention nor the Education intervention translated to improvements in the selected health measures among this population with a mixture of chronic conditions. Intention to treat analysis failed to demonstrate evidence that either of the intervention arms had beneficial effects on the blood pressure or the spirometry measures. Post-hoc evaluation of effect modification for blood pressure and spirometry outcomes did not reveal any interaction influence on the outcomes according to sex, residential smoking, chronic disease history and study area.

Prevalence and associated factors of chronic kidney disease among Truká Indigenous adults in Cabrobó, Brazil: a population-based study.

Background: The prevalence of chronic kidney disease (CKD) is increasing worldwide, especially in developing countries, due to factors such as lifestyle changes and the rise of non-communicable diseases. Populations living in socioeconomically disadvantaged areas are subject to a higher burden of CKD. However, the burden of CKD on Brazilian Indigenous people, especially those undergoing an advanced urbanisation process, has not yet been described. Methods: This cross-sectional study included 1715 Truká Indigenous adults from Cabrobó, Brazil. CKD was defined according to the Kidney Disease Improving Global Outcomes guidelines classification as a urinary albumin/creatinine ratio ≥30 mg/g and/or an estimated glomerular filtration rate <60 mL/min/1.73 m2. Univariate and multiple logistic regression models were used to evaluate factors associated with CKD. Odds ratio (OR) with a 95% confidence interval (CI) was used to measure association. Findings: Out of the 1654 participants analysed (61 excluded due to missing data), the prevalence of CKD was 10% (95% CI, 8.6%-11.5%), with a higher prevalence in women compared to men (12.4% versus 6.9%, p < 0.001). The mean age was 40.5 years, with 55.6% being women. In univariate analysis, female sex (OR, 1.9; 95% CI, 1.3-2.7), age ≥60 years (OR, 4.6; 95% CI, 3.2-6.6), cardiovascular disease (OR, 2.1; 95% CI, 1.1-4.1), and dyslipidemia (OR, 1.6; 95% CI, 1.1-2.4) were identified as associated factors with CKD. Multiple logistic regression analysis identified age ≥60 years, female sex, and dyslipidemia as independently associated factors with CKD. Interpretation: The prevalence of CKD among Truká Indigenous adults analysed is high and affects a higher proportion of women. Our study found no association between hypertension, diabetes, obesity, and CKD risk, despite their high prevalence. These findings assist in developing early CKD detection strategies in Brazilian Indigenous communities, supporting disease treatment and prevention. Funding: National Council for Scientific and Technological Development (CNPq)-Ministry of Science, Technology, and Innovation of Brazil, and the Maria Emília Foundation.

Assessment of antioxidant and antibacterial efficacy of some indigenous vegetables consumed by the Manipuri community in Sylhet, Bangladesh.

The rapid dietary changes experienced by indigenous people worldwide threaten the use of traditional foods, which are often undervalued. This study focused on evaluating the antioxidant and antibacterial efficacy of five vegetables typically consumed by the Manipuri ethnic groups in the Sylhet region of Bangladesh: Yongchak seed (Parkia speciosa), Telikadam seed (Leucaena leucocephala), Phakphai leaf (Persicaria odorata), Sheuli leaf (Nyctanthes arbor-tristis), and bamboo shoot (Bambusa spp.). The samples were dried and powdered to assess the antioxidant activity through total phenolic content (TPC), total flavonoid content (TFC), total tannin content (TTC), and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity. Antibacterial efficacy was determined by measuring the zone of inhibition (ZOI), minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC). Leafy vegetables exhibited higher TPC, TFC, and TTC than seeds and shoots, with N. arbor-tristis leaf showing the highest TPC (99.16 ± 2.07 mg GAE/g DW) and P. odorata leaf exhibiting the highest TFC (9.19 ± 0.7 mg QE/g) and TTC (3.59 ± 0.26 mg TAE/g). However, Bambusa spp. shoot extract showed the highest antioxidant potential (IC50: 1.66 ± 0.05 mg/mL). All samples exhibited higher ZOI against gram-positive bacteria (Bacillus spp. and Staphylococcus spp.), ranging from 10 ± 2.65 to 19.33 ± 2.08 mm. L. leucocephala seed extract showed the highest antibacterial activity against both the tested gram-positive bacteria with a MIC of 15.6 mg/mL. Conversely, the P. odorata leaf extract exerted the strongest antibacterial effect against gram-negative bacteria, with the lowest MIC values for Klebsiella spp. (31.25 mg/mL) and Escheria coli (62.5 mg/mL). The findings of this investigation suggest that the selected indigenous vegetables could be valuable sources of phytochemicals with potential antioxidant and antibacterial activities. Incorporating and promoting these traditional foods into the diet may improve food security, dietary diversity, and public health in Bangladesh.

Traditional ethnobotanical knowledge of important local plants in Sudhnoti, Azad Kashmir, Pakistan.

This research purpose was focused to document the traditional ethnobotanical knowledge (TEK) associated with important wild plants and indigenous communities residing in mountainous zone of District Sudhnoti of Azad Jammu and Kashmir, Pakistan and to determine their conservation status with suggestions and recommendations to protect and propagate the rare and endangered wild flora of the area for sustainable use. The data regarding traditional ethnomedicines (TEMs) and phytogeography with conservation analysis of wild plants were collected via structured and semi structured interviews of 150 participants belonging to various professions and of both genders. Prior consent and permission were obtained from family heads and from all the participants, and the data were shared with all the informants through the local female translator guide. To validate the collected data, various microstatistical tools, such as the informant consensus factor (ICF), fidelity level (FL) and data matrix ranking (DMR) were used. The relative frequency of citations (RFC) and rank order of popularity (ROP) were also calculated to determine and authenticate the relative importance of TEMs which may be further studied in future research and used for drug discovery. In the present study, 150 locally important plants belonging to 69 families were documented, and the Rosaceae was the most dominant and prevalent family. The results indicated that many locally important plants have multiple uses such as food, medicine, fodder, shelter, ornamental and fuel. The TEMs obtained from these plants have been known to be useful for curing various infirmities such as flu, renal disorders, fever, malaria, cough, migraine, whooping cough, influenza, skin rashes, allergies, stomach aches, wounds and bruises, diabetes, tumours and joint pains. The ICF analysis revealed that renal calculus, malaria, fever, whooping cough, rheumatoid arthritis and arthritis were prevalent infirmities of the mountainous area. The FL analysis indicated the popularity of these plants used in various TEMs and among these Artemisia maritima and Berberis lycium were the most common. The DMR indicated that Pinus roxburghii was the most common species being used for multipurpose by the indigenous communities. The highest use value index was found for Indigofera linifolia. The relative frequency of citations was calculated to determine the importance of plants in traditional ethnomedicine, highlighting Morus nigra, Pinus wallichiana, and Rosa indica as significant species. The Jaccard index indicated a high level of novelty in the research which can be exploited for neo-drug discovery and drug development. In conclusion, this study has successfully documented the ethnobotanically and ethnomedicinally important plants in District Sudhnoti, Azad Jammu and Kashmir, Pakistan. The findings of this research contribute to the preservation and documentation of cultural heritage, as well as provide a foundation for further studies in ethnobotany, ethnopharmacology and biodiversity conservation efforts for sustainable provision of wild flora to the indigenous communities which will also assist in combating drasting climatic changes.

Promoting women's wellbeing through the Niska (Goose) Harvesting Program in subarctic Ontario, Canada.

INTRODUCTION: Geese harvesting is a longstanding cultural tradition deeply ingrained among the Omushkego Cree in Fort Albany First Nation, embodying a holistic approach to health that integrates Indigenous knowledge, community wellbeing, and resilience. Despite historical disruptions stemming from colonization and assimilation policies, women have played a pivotal role in preserving and passing down traditional practices. The significance of goose harvesting extends beyond providing a nutrient-rich and cost-effective food source; it serves as a vehicle for cultural preservation and education, particularly fostering language acquisition among children. Nevertheless, concerns persist regarding the potential decline in the transmission of Indigenous knowledge. The interruption of intergenerational knowledge transfer not only poses implications for overall wellbeing but also worsens historical trauma within the community. In response to these challenges, the Niska (goose) harvesting program was developed with an aim to revitalize community harvesting practices, with a specific focus on incorporating the perspectives of women, especially in the preparatory and smoking phases of the geese. METHODS: Omushkego Cree women were approached to participate. The study was conducted during the spring of 2018, and employed photovoice and semi-structured interviews that explored the impact of geese preparatory activities on the health and wellbeing of Indigenous women. RESULTS: Major themes from the qualitative data included the importance of knowledge sharing, cultural continuity, healing, and the profound connection to the land. Women emphasized the value of sharing acquired knowledge, passing on traditions, and maintaining a connection to their cultural identity. Cultural continuity, depicted through intergenerational teachings and experiences, emerged as crucial for overall wellbeing. Participants spoke of the healing dynamics derived from engaging in traditional activities, highlighting the positive impact on physical, mental, emotional, and spiritual wellbeing. The land was identified as a central element in this healing process, representing more than just a physical space but an extension of home, contributing to a sense of peace and tranquility. The land became a medium for transmitting cultural teachings, shaping identity, and sustaining a subsistence lifestyle. CONCLUSION: The study emphasizes the importance of future research including more female youth participants to uncover specific challenges and strengths within this demographic. Overall, the Niska program demonstrates a comprehensive approach that intertwines cultural revitalization, community engagement, and holistic wellbeing, emphasizing the need for interventions that go beyond immediate challenges to create enduring positive impacts on Indigenous communities.

A randomized controlled trial evaluation of a smoking cessation and physical activity intervention delivered via telemedicine in the Norton Sound region of Alaska.

OBJECTIVES: Tobacco use disproportionately affects Alaska Native people. Physical activity may aid quitting smoking and provides health benefits. We tested telemedicine-delivered heart health interventions in Alaska's Norton Sound region. METHODS: Alaska Native adults (N = 299, 51.5 % male, 60.5 % Inupiaq) with hypertension and/or hypercholesterolemia who smoked daily were randomized to intervention on smoking and physical activity (group 1) or traditional diet and medication adherence (group 2). Intention to change was not required for participation. Stage-tailored mailed workbooks and personalized reports were supported by telehealth counseling at baseline, 3, 6, and 12 months. Study outcomes were assessed at baseline, 3-, 6-, 12-, and 18-months (i.e., 6-months after the final counseling session). Smoking outcomes were self-reported 7-day point prevalence abstinence (7d-PPA),1 bioconfirmed with urine anabasine; 24-hour quit attempts; and 50 % reduction in smoking. Self-reported physical activity outcomes were metabolic equivalent of task (MET) minutes and meeting moderate-to-vigorous physical activity (MVPA) guidelines. RESULTS: At baseline, participants averaged 12.4 (SD = 10.0) cigarettes/day, with 19.4 % prepared to quit smoking, and 81.6 % meeting MVPA guidelines. During the study, most (70.2 % group 1; 63.5 % group 2) reported a 24-hr quit attempt (p = 0.219), and Group 1 (53.6 %) was more likely than Group 2 (28.4 %) to use nicotine replacement therapy (NRT), OR = 2.92, p < 0.001. At 18-months, 40.5 % (group 1) and 32.5 % (group 2) had reduced their smoking by half or more (p = 0.343), and 10.8 % vs. 7.9 % (group 1 vs. 2) reported 7d-PPA with 4 % vs. 6 % (group 1 vs. 2) bioconfirmed. Time and baseline stage of change predicted 7d-PPA (p's≤.015), with no group effect (p = 0.325). Activity levels did not significantly differ by group or time. CONCLUSIONS: Telemedicine counseling supported NRT use but did not significantly affect behavioral outcomes.

Blood cancer incidence, mortality and survival for Maori in New Zealand.

BACKGROUND: Haematological ('blood') cancers are a diverse group of non-solid cancers with varying incidence, mortality and survival. While there is some evidence that Maori experience disparities in blood cancer outcomes relative to New Zealand's majority European population, there is a need for a comprehensive overview of the current state of evidence in this context. METHODS: Blood cancer registrations were derived from the NZ Cancer Registry for the 2007-2019 period (combined blood cancers: 2653 Maori, 20,458 Europeans), and linked to Mortality records. We calculated age-sex-standardised incidence and mortality rates, and conducted cancer-specific survival analysis, for four main categories of blood cancers (leukaemia, Hodgkin lymphoma, non-Hodgkin lymphoma and myeloma) as well as for sub-types of leukaemia non-Hodgkin lymphoma. RESULTS: We found that Maori are more likely to be diagnosed with (incidence) and to die from (mortality) both leukaemia and myeloma, and similarly likely to be diagnosed or die from Hodgkin and non-Hodgkin lymphoma, compared to Europeans. Maori had demonstrably poorer cancer-specific survival outcomes across most blood cancer types (age-sex-adjusted hazard ratios [HRs], Maori vs European: leukaemia 1.77, 95 % CI 1.57-2.00; Hodgkin lymphoma 1.18, 95 % CI 0.65-2.16; non-Hodgkin lymphoma 1.71, 95 % CI 1.50-1.95; myeloma 1.40, 95 % CI 1.19-1.64). CONCLUSION: Blood cancers are a common cancer type for Maori, and we found evidence of disparities in incidence, mortality and survival compared to Europeans. Further research is required to further pinpoint exactly where interventions should be aimed to reduce blood cancer incidence and address survival disparities for Maori.

A Cross-Sectional Survey Investigating Maori and Non-Maori Cancer Patients' Views on Psychedelic-Assisted Therapy in Aotearoa New Zealand.

People with cancer experience higher rates of psychological dysfunction than the general population, with extreme inequity among indigenous people. Psychedelic-assisted therapy (PAT) is a reemerging area with promising evidence as a treatment for mental health difficulties. The current study aimed to investigate the perceptions of PAT in indigenous (Maori) and non-indigenous cancer patients in Aotearoa, New Zealand. Eighty-five cancer patients (Maori n = 32, non-Maori n = 53) completed a brief anonymous survey assessing demographics, psychological factors, and awareness and perceptions of PAT. Participants were recruited online (via social media and cancer support e-mail lists) and in person at Auckland City Hospital. Maori had significantly poorer psychological well-being than non-Maori. All participants had low awareness of this novel treatment and held largely neutral attitudes. Regression analyses revealed that predictors of more favorable attitudes toward PAT included greater awareness of psychedelics, advanced cancer stage, younger age, poorer holistic well-being, greater demoralization, and prioritizing treatment effectiveness over possible risks and uncertainty. The current study provides a foundational step in exploring perceptions toward PAT in indigenous and non-indigenous groups. These results have the potential to shape future research trials investigating PAT and further highlight the importance of indigenous involvement in the psychedelic research space.

Characterization of Flavor Compounds in Chinese Indigenous Sheep Breeds Using Gas Chromatography-Ion Mobility Spectrometry and Chemometrics.

This study analyzed the flavor compounds in the meat of four indigenous breeds of Chinese sheep through the use of gas chromatography-ion mobility spectrometry (GC-IMS). GC-IMS provided information on the characteristics and strength of 71 volatile flavor compounds (monomers and dimers), with aldehydes, alcohols and ketones being the most abundant in all types of sheep meat. The compounds with higher intensity peaks in the sheep meat were aldehydes (n-nonanal, octanal, heptanal, 3-methylbutanal, and hexanal), alcohols (1-octen-3-ol, hexanol, and pentanol), ketones (3-hydroxy-2-butanon, 2-butanone, and 2-propanone), esters (methyl benzoate), and thiazole (trimethylthiazole). The volatile flavor components in the meat of the different breeds of sheep obtained via GC-IMS were further differentiated using principal component analysis. In addition, orthogonal partial least squares discriminant analysis (OPLS-DA) and variable importance on projection (VIP) were used to determine the characteristic flavor compounds in the meats of different breeds of sheep, and 21 differentially volatile components were screened out based on having a VIP above 1. These results indicate that GC-IMS combined with multivariate analysis is a convenient and powerful method for characterizing and discriminating sheep meat.

Physicochemical, Nutritional, and Antioxidant Properties of Traditionally Fermented Thai Vegetables: A Promising Functional Plant-Based Food.

Fermented plant-based products were gathered from various regions in Thailand and categorized into 10 types of traditional commercial vegetables. Different vegetable materials and natural fermentation methods influence the diverse physical, chemical, nutritional, and functional attributes of the products. All the traditionally fermented Thai vegetable samples collected showed physicochemical properties associated with the fermentation process, contributing to the nutritional and functional quality of the final products. Achieving consistent research results is challenging due to the intricate nature of food matrices and biochemical processes during fermentation. The roles of microorganisms, especially probiotics, are crucial in delivering health benefits through fermented foods. Traditionally fermented Thai vegetable foods contain high levels of total soluble solids, titratable acidity, and salinity in pickled shallot and ginger as a result of the natural fermentation process and the ingredients used. The research findings were confirmed using a hierarchical cluster analysis (HCA)-derived dendrogram pattern. The nutritional compositions, total phenolic contents, and antioxidant activities varied among the different types of vegetables. The correlations among lipid, protein, fiber, total soluble solid (TSSs), total titratable acidity (TTA), and salinity as potential biomarkers in fermented vegetable products were examined. The results suggest that traditionally fermented Thai vegetable products significantly impacted food research by enhancing the quality and preserving the authenticity of traditionally fermented Thai vegetables.

The Pantropical Genus Rhynchosia Lour. (Fabaceae: Cajaninae): Diversity of Medicinal Uses, Phytochemistry, Pharmacology, and Toxicology.

The pantropical genus Rhynchosia belongs to the family Fabaceae and consists of approximately 230 species distributed mainly in Africa, America, and Asia. Several species of the genus have been used ethnomedicinally since 300 - 400 AD. This review presents for the first time a global overview of the extent of ethnomedicinal uses of species in the genus in addition to their phytochemistry, pharmacological activities, and toxicology. Online databases such as NCBI, PubMed, Science Direct, Scopus, SpringerLink, Taylor and Francis Online, etc., were used to source for publications on Rhynchosia species. Based on this review, 30 species (19%) are traditionally used for treating an array of ailments around the globe, most especially in Africa and Asia. Flavonoids are the most detected/isolated phytochemicals from the Rhynchosia species. Pharmacological activities such as anticancer, antidiabetic, anti-hyperlipidemic, antifungal, antioxidant, anti-inflammatory, antinociceptive, butyrylcholinesterase, as well as eye-protective and melanogenic effects were elicited by the extracts and isolated compounds from Rhynchosia species. Toxicity tests have only been carried out on R. sublobata and R. elegans extracts. Future studies should focus on the toxicological evaluation and validation of ethnomedicinal claims on the traditional uses of Rhynchosia species that have not been pharmacologically tested.

E kaua e hoki i te waewae tutuki, a, apa ano hei te upoko pakaru - a systematic review of neurosurgical disease and care for Maori in New Zealand.

BACKGROUND: The Royal Australasian College of Surgeons (RACS) Te Rautaki Maori cites the need for more research dedicated to health equity in surgery for Maori. However, the gaps in research for Maori in surgery have not yet been highlighted. This review is the first in a series of reviews named Te Ara Pokanga that seeks to identify these gaps over all nine surgical specialties. The aim of this study was to assess neurosurgical disease incidence and perioperative outcomes for Maori at any point from referral through to the postoperative period. METHODS: A systematic review of Maori neurosurgical disease and care for Maori in NZ was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement assisted study selection and reporting. Kaupapa Maori (Maori-centred) research methodology and the Maori Framework were utilized to evaluate Maori research responsiveness. RESULTS: Nine studies were included in this review. All studies were retrospective cohort studies and only two studies had at least one Maori clinical or academic expert named on their research team. Therefore, only one study was deemed responsive to Maori. Studies assessing long-term outcomes from the management of neurosurgical disease for Maori and patient and whanau experiences of neurosurgical care are lacking. CONCLUSION: This study indicates the limited scope of research conducted for Maori in neurosurgery. The broader clinical implications of this review highlight the need for good quality research to investigate access to and long-term outcomes from the management of neurosurgical disease for Maori.

Experiences of a group of indigenous women from the Colombian Amazon with cervical cancer prevention screening. Qualitative study in the context of participatory research to reduce inequalities.

OBJECTIVES: Despite cervical cancer (CC) being a preventable disease, its incidence remains high in marginalized communities due to inequalities that restrict access to health services. This article investigates the experiences, perceptions, and attitudes regarding the screening of indigenous women in a region of the Colombian Amazon during a cervical cancer prevention initiative facilitated by community participation. DESIGN: Qualitative study based on interviews conducted with women and indigenous leaders from Paujil reserve. They participated in research focused on cervical cancer prevention, which employed a methodology of collaboration between academia and communities aimed at enhancing women's health and reducing inequalities in access to healthcare services. The analysis utilized a deductive and inductive approach. RESULTS: Five main themes were addressed: 'Barriers within health services'; 'Individual and cultural constraints'; 'Motivations and facilitators'; 'Positive experiences within the research framework'; and 'Suggestions for encouraging women's participation.' Challenges related to appointment scheduling and result delivery were frequently cited as obstacles to access. Misinformation, feelings of shame, fear, and distrust towards health services played significant roles in the reluctance to undergo screening. Factors such as support from family and community networks, respectful treatment, ease of scheduling appointments, the presence of female healthcare professionals, and involvement of leaders fluent in indigenous languages were identified as positive facilitators of screening acceptance. CONCLUSION: Understanding the factors that influence access to screening is crucial for reducing inequalities in service delivery for indigenous women. The involvement of trained leaders who can identify these factors and motivate women can have a positive impact on the acceptance and guidance of cervical cancer prevention programs.

Understanding Indigenous peoples experiences to inform recommendations for improving cultural safety and care in radiation therapy centres in Alberta, Canada.

INTRODUCTION: Rates of common cancers are continuously increasing among Indigenous peoples and are above the incidence rates of non-Indigenous Canadians. When considering the intersecting social determinants of health such as culture, geography, funding, and access to basic health services, these all contribute to the unique cancer burden faced by Indigenous people. Indigenous patients sometimes feel alienated by the word "cancer", intimidated in the oncology setting and often avoid or delay seeking care, bypass screening and preventative care, and cease prescribed treatment before it is finished. Providing culturally competent, safe care to improve Indigenous health outcomes have been suggested and prioritized in health care systems across Canada. METHODS: Using an Indigenous methodology, sharing circles were held in Northern Alberta, Canada. Five Indigenous survivors of cancer and two Indigenous caregivers shared their experiences with oncology treatment in the radiation therapy centre. Results were transcribed verbatim and thematic analysis was conducted. RESULTS: This resulted in four main themes (1) historical and cultural understandings (2) reduce systemic harm by having dedicated Indigenous staff, cultural competency, and Indigenous specific supports (3) meaningful time commitment and relationship building (4) importance of kinship and Indigenous-centred, family-and-patient-centred care. These themes fed into the development of nine recommendations for policy and decision makers to improve cultural safety in the Alberta radiation therapy centres. CONCLUSION: Support for Indigenous patients and caregivers is essential to improve care in the radiation therapy centres. The findings from this work will support recommendations for health decision and policy makers within radiation therapy centres, which may be transferable to other centres within oncology and health.

Sacred Sharing Circles: Urban Indigenous Experience with Bariatric Surgery in Manitoba.

INTRODUCTION: Obesity and type 2 diabetes (T2DM) are growing global health concerns. A disproportionate number of Indigenous Peoples live with obesity and its complications. Bariatric surgery offers superior weight loss and comorbidity resolution when compared to medical management. There is a paucity of literature regarding the experiences of Indigenous Peoples undergoing bariatric surgery. The aim of this study was to employ two-eyed seeing and a decolonizing approach to explore the experiences of urban Indigenous bariatric surgery patients. METHODS: An Indigenous Advisory Committee guided the conception and design of the study. Four urban Indigenous bariatric surgery patients with T2DM participated in two sequential sharing circles and individual interviews facilitated by an Elder. Audio transcripts were analyzed for emerging themes using inductive thematic analysis. RESULTS: Themes generated from shared participant experiences and knowledge included the following: (1) Experiencing hardship or challenges; (2) Reflecting on the importance of supports; (3) Understanding relationships with food; and (4) Healing and recovery. Overall, the participants described a generally positive experience with the bariatric pathway. Participants also described varied connectedness to their Indigenous identity but uniformly expressed interest in more culturally diverse supports such as sharing circles, access to an elder, and Indigenous peer mentorship. CONCLUSIONS: Indigenous Peoples have strong motivators for pursuing bariatric surgery and desire access to culturally relevant supports. Suggestions for program improvement included offering sharing circles, providing access to an elder, and Indigenous peer mentorship. This study is the first to qualitatively explore the bariatric surgery experiences of Indigenous Peoples in Canada.

Perception is reality: qualitative insights into how consumers perceive alcohol warning labels.

AIMS: This study explores perspectives of on-pack alcohol warning labels, and how they might influence alcohol purchase and/or consumption behavior to inform culturally appropriate label design for effective behavior change. METHODS: New Zealand participants ≥18 years, who reported having purchased and consumed alcoholic beverages in the last month were recruited via a market research panel and grouped into 10 focus groups (n = 53) by ethnicity (general population, Maori, and Pacific peoples), age group, and level of alcohol consumption. Participants were shown six potential alcohol health warning labels, with design informed by relevant literature, label framework, and stakeholder feedback. Interviews were transcribed and analyzed via qualitative (directed) content analysis. RESULTS: Effective alcohol labels should be prominent, featuring large red and/or black text with a red border, combining text with visuals, and words like "WARNING" in capitals. Labels should contrast with bottle color, be easily understood, and avoid excessive text and confusing imagery. Participants preferred specific health outcomes, such as heart disease and cancer, increasing message urgency and relevance. Anticipated behavior change included reduced drinking and increased awareness of harms, but some may attempt to mitigate warnings by covering or removing labels. Contextual factors, including consistent design and targeted labels for different beverages and populations, are crucial. There was a strong emphasis on collective health impacts, particularly among Maori and Pacific participants. CONCLUSIONS: Our findings indicate that implementing alcohol warning labels, combined with comprehensive strategies like retail and social marketing campaigns, could effectively inform and influence the behavior of New Zealand's varied drinkers.