Eligibility criteria and enrollment of a diverse racial and ethnic population in multiple myeloma clinical trials.

The narrow eligibility criteria may contribute to the underrepresentation of racial and ethnic subgroups in cancer clinical trials. We conducted a retrospective pooled analysis of multicenter global clinical trials submitted to the US Food and Drug Administration between 2006 and 2019 to support the approval of the use of multiple myeloma (MM) therapies that analyze the rates and reasons for trial ineligibility based on race and ethnicity in MM clinical trials. Race and ethnicity were coded per Office of Management and Budget standards. Patients flagged as having screen failures were identified as ineligible. Ineligibility rates were calculated as the percentage of patients who were ineligible compared with the screened population within the respective racial and ethnic subgroups. Trial eligibility criteria were grouped into specific categories to analyze the reasons for trial ineligibility. Black patients (24%) and other (23%) race subgroups had higher ineligibility rates than White patients (17%). The Asian race had the lowest ineligibility rate (12%) among all racial subgroups. Failure to meet the hematologic laboratory criteria (19%) and treatment-related criteria (17%) were the most common reasons for ineligibility among Black patients and were more common in Black patients than in other races. Failure to meet disease-related criteria was the most common reason for ineligibility among White (28%) and Asian (29%) participants. Our analysis indicates that specific eligibility criteria may contribute to enrollment disparities for racial and ethnic subgroups in MM clinical trials. However, the small number of screened patients in the underrepresented racial and ethnic subgroups limits definitive conclusions.

Cardiovascular risk factors: differences between ethnic groups.

OBJECTIVES: to compare the metabolic, anthropometric, tobacco and alcohol consumption indicators considered as risk factors for cardiovascular diseases, as well as the demographic and socioeconomic characteristics between indigenous from Rio Negro, Sateré-Mawé, mixed-race/black and white people living in the city of Manaus. METHODS: a cross-sectional observational study guided by the STROBE tool. There was a sample of 191 adults of both sexes. Anthropometric measurements, blood pressure and biochemical analyzes were performed. Statistical test was applied to cross color/race/ethnicity variable with the investigated variables. RESULTS: indigenous had better metabolic and anthropometric indicators related to cardiovascular diseases than mixed-race/black and white, as well as Sateré-Mawé in relation to Rionegrinos (from Rio Negro). CONCLUSIONS: the main differences were obesity, dyslipidemia, pre-systemic arterial hypertension/systemic arterial hypertension, and increased circumferences, with a worse situation for mixed-race/black people. The findings indicate differences in risk factors between race/color and ethnicity groups evaluated.

Colorectal cancer screening using faecal occult blood tests for Indigenous adults: A systematic literature review of barriers, enablers and implemented strategies.

OBJECTIVE: Colorectal cancer (CRC) screening using a Faecal Occult Blood Test (FOBT) is a well-established population intervention to reduce mortality and morbidity of CRC. As Indigenous people are not fully benefiting from the screening programs, a greater understanding of barriers and enablers affecting participation is needed. METHODS: Searches were carried out in PubMed, Embase, Sociological Abstracts, Scopus, CINAHL, and selected websites. Both qualitative and quantitative studies related to Indigenous populations of Canada, New Zealand, Australia and the United States of America were assessed for quality and data related to FOBT were extracted and synthetised. RESULTS: A total of 375 publications were identified and screened against the inclusion/exclusion criteria. Thirty-four studies were included in the review. The barriers for participation in CRC screening included the lack of culturally competent health service access, particularly access to Indigenous health service providers. Medical discrimination, long-standing distrust in Western medicine and/or health staff and screening tests were all identified as barriers for Indigenous people. There were a small number of promising interventions to improve participation, which could be considered on a broader scale to increase overall participation by Indigenous people in CRC screening. CONCLUSIONS: The review identified barriers and possible enablers for Indigenous participation in the CRC screening program, some which appear to be unique to Indigenous people. Further intervention studies conducted in partnership with Indigenous communities are needed to improve participation.

Cardiovascular risk factors: differences between ethnic groups / Factores de riesgo cardiovascular: diferencias entre grupos étnicos / Fatores de risco cardiovascular: diferenças entre grupos étnicos

ABSTRACT Objectives: to compare the metabolic, anthropometric, tobacco and alcohol consumption indicators considered as risk factors for cardiovascular diseases, as well as the demographic and socioeconomic characteristics between indigenous from Rio Negro, Sateré-Mawé, mixed-race/black and white people living in the city of Manaus. Methods: a cross-sectional observational study guided by the STROBE tool. There was a sample of 191 adults of both sexes. Anthropometric measurements, blood pressure and biochemical analyzes were performed. Statistical test was applied to cross color/race/ethnicity variable with the investigated variables. Results: indigenous had better metabolic and anthropometric indicators related to cardiovascular diseases than mixed-race/black and white, as well as Sateré-Mawé in relation to Rionegrinos (from Rio Negro). Conclusions: the main differences were obesity, dyslipidemia, pre-systemic arterial hypertension/systemic arterial hypertension, and increased circumferences, with a worse situation for mixed-race/black people. The findings indicate differences in risk factors between race/color and ethnicity groups evaluated.

RESUMEN Objetivos: comparar los indicadores metabólicos, antropométricos, de consumo de tabaco y alcohol considerados como factores de riesgo para enfermedades cardiovasculares, así como las características demográficas y socioeconómicas entre los indígenas del Rio Negro, Sateré-Mawé, población de raza mixta/negra y blanca que viven en la ciudad de Manaus. Métodos: estudio observacional transversal, guiado por la herramienta STROBE. La muestra consistió en 191 adultos de ambos sexos. Se realizaron mediciones antropométricas, presión sanguínea y análisis bioquímicos. La prueba estadística se aplicó a la variable de color/raza/etnia con las variables investigadas. Resultados: los indígenas tenían mejores indicadores metabólicos y antropométricos relacionados con las enfermedades cardiovasculares que los de raza mixta/negros y blancos, así como los Sateré-Mawé en relación con los rionegrinos (del Rio Negro). Conclusiones: las principales diferencias fueron: obesidad, dislipidemia, pre-hipertensión arterial sistémica/ hipertensión arterial sistémica y aumento de las circunferencias, con una situación peor para los raza mixta/negros. Los resultados indican diferencias en los factores de riesgo entre los grupos de raza/color y etnia evaluados.

RESUMO Objetivos: comparar os indicadores metabólicos, antropométricos, de consumo de tabaco e álcool, considerados como fatores de risco para doenças cardiovasculares, assim como as características demográficas e socioeconômicas entre indígenas do Rio Negro, Sateré-Mawé, Pardos/Negros e Brancos que residem na cidade de Manaus. Métodos: estudo observacional transversal, norteado pela ferramenta STROBE. Amostra de 191 adultos de ambos os sexos. Realizadas medidas antropométricas, pressão arterial e análises bioquímicas. Aplicado teste estatístico no cruzamento da variável cor/raça/etnia com as variáveis investigadas. Resultados: os indígenas apresentaram melhores indicadores metabólicos e antropométricos relacionados às doenças cardiovasculares que os pardos/negros e brancos, assim como os Sateré-Mawé em relação aos rionegrinos. Conclusões: as principais diferenças foram: obesidade, dislipidemia, pré-hipertensão arterial sistêmica/hipertensão arterial sistêmica e circunferências aumentadas, com destaque de pior situação para os pardos/negros. Os achados indicam haver diferenças nos fatores de risco entre os grupos de raça/cor e etnia avaliados.

Mapping a route to Indigenous engagement in cancer genomic research.

Precision oncology guided by genomic research has an increasingly important role in the care of people with cancer. However, substantial inequities remain in cancer outcomes of Indigenous peoples, including Indigenous Maori in Aotearoa New Zealand (New Zealand). These inequities will be perpetuated unless deliberate steps are taken to include Indigenous peoples in all parts of cancer research-as research participants, in research leadership, and in research governance. This approach is especially important when there have been historical breaches of trust that have discouraged their participation in health research. This Personal View describes a precision oncology research roadmap for neuroendocrine tumour research, which seeks to reflect the values of New Zealand's Indigenous Maori people. This roadmap includes facilitating ongoing dialogue, Maori leadership, reciprocity, agreed kawa (guiding principles), tikanga (cultural protocols), and honest monitoring of what is and what is not being achieved. We challenge cancer researchers worldwide to generate locally appropriate roadmaps that honestly assess their practices to benefit Indigenous people internationally.

Selected acculturation factors and birth defects in the National Birth Defects Prevention Study, 1997-2011.

BACKGROUND: Acculturation has been examined with respect to various pregnancy adverse outcomes, including birth defects. Given the mixed and limited findings on the association between nativity and birth defects, we sought to further explore parental nativity and years lived in the U.S. across a range of defects. METHODS: Data from the National Birth Defects Prevention Study were used for this analysis. Infants with one of 46 major isolated birth defects (30 noncardiac/16 cardiac conditions) and infants without birth defects (controls) born during 1997-2011 were included. We examined parental nativity (foreign-born mothers, fathers, and both parents combined compared to a referent of both U.S.-born parents) and the number of years lived in the U.S. (≤5/6+ years). Descriptive statistics and logistic regression analyses were performed to estimate crude/adjusted odds ratios and 95% confidence intervals. RESULTS: Compared to U.S.-born mothers, foreign-born mothers tended to be older (25+ years), of Hispanic or Other race/ethnicity and were less likely to have reported drinking, smoking, illicit drug use, or having taken folic acid. In the adjusted analysis, seven findings among both parents reporting a foreign-birth were significant, including an increased association with spina bifida, anotia/microtia, and diaphragmatic hernia (aORs range: 1.3-1.7), and a reduced association with craniosynostosis and gastroschisis (aORs = 0.7). A generally protective effect was observed among foreign-born subjects living in the U.S. ≤5 years. CONCLUSIONS: We found that nativity was associated with some selected isolated defects, although the direction of effect varied by phenotype and by a number of years residing in the U.S.

Cultural safety strategies for rural Indigenous palliative care: a scoping review.

BACKGROUND: There is little scholarship on culturally safe approaches to palliative care, especially for rural Indigenous clients. Thus, it is important to articulate how cultural safety can be enacted to support rural Indigenous Peoples and communities at end of life. We sought to identify strategies described in existing literature that have potential to deepen our understanding of culturally safe approaches to palliative care within rural and small-town settings in Canada. METHODS: We searched for peer-reviewed and grey literature about Indigenous palliative care in rural and small-town settings in Canada, United States, New Zealand, and Australia. Medline, CINAHL, and Embase were searched. We thematically analyzed 22 resulting articles to address our interest in culturally safe approaches to palliative care in rural/small-town and on-reserve contexts. RESULTS: The following themes were extracted from the literature: symbolic or small gestures; anticipating barriers to care; defer to client, family and community; shared decision-Making; active patient and family involvement; respectful, clear, and culturally appropriate communication; community ownership of services; empower cultural identity, knowledge, and traditions; and, policy. DISCUSSION: Culturally competent practices can improve Indigenous palliative care services; however, they do not result in decolonized care. Strategies include: symbolic or small gestures; anticipating barriers to access; deferring to the client, family, and community members; and, collective decision making and family involvement. Culturally safe approaches contribute to institutional or organizational change and decolonized care. Strategies include: involvement of patient and family in service planning; reflection about individual and systemic racism; community ownership of services and; recognizing distinct Worldviews that shape care. CONCLUSIONS: Culturally safe strategies invite decolonization of care through awareness of colonialism, racism, and discrimination. They invite commitment to building partnerships, power sharing, and decision-making in the delivery of care. Culturally competent activities may catalyze the adoption of a cultural safety framework; however, mislabeling of cultural competency as cultural safety may contribute to organizational inaction and a watering down of the spirit of cultural safety.

Social determinants of health associated with childhood accidents at home: An integrative review / Determinantes sociales de la salud asociados con accidentes domésticos en la infancia: una revisión integradora / Determinantes sociais da saúde associados a acidentes domésticos na infância: uma revisão integrativa

ABSTRACT Objective: to analyze the factors associated with childhood accidents at home according to the levels of the social determinants of health. Method: integrative review of the literature, with research in databases CINAHL, LILACS and PubMed, with the following main descriptors: child; social determinants of health; accidentes, home. We included 31 studies that related the social determinants of health and childhood accidents, in English, Portuguese and Spanish. Results: the proximal determinants identified were: age and sex of children, and ethnicity. Among the intermediate determinants of health, parental behavior, related to the supervision of an adult, prevailed. Parental employment and socioeconomic status were identified as distal determinants. Conclusion: the age and sex of the child, besides direct supervision, were the determinants most associated with accidents. The distal determinants should be better studied because their relation with the occurrence of domestic accidents has not been sufficiently clarified.

RESUMEN Objetivo: analizar los factores asociados a los accidentes domésticos en la infancia según los niveles de los determinantes sociales de la salud. Método: la revisión integradora de la literatura, con investigación en bases de datos CINAHL, LILACS y PubMed, con los siguientes descriptores principales: child; social determinants of health; accidentes, home. Se incluyeron 31 estudios relacionados con los determinantes sociales de la salud y accidentes domésticos en la infancia, en inglés, portugués y español. Resultados: los determinantes proximales identificados fueron: edad y sexo de los niños, y etnia. Entre los intermediarios, prevalecieron el comportamiento parental, relacionado a la supervisión de un adulto. El empleo de los padres y su situación socioeconómica fueron identificados como determinantes distales. Conclusión: la edad y el sexo de los niños, además de la supervisión directa, fueron los determinantes más asociados con los accidentes. Los determinantes distales deben ser más bien estudiados, pues su relación con la ocurrencia de los accidentes domésticos no se mostró suficientemente esclarecida.

RESUMO Objetivo: analisar os fatores associados aos acidentes domésticos na infância segundo os níveis dos determinantes sociais da saúde. Método: revisão integrativa da literatura, com pesquisa em bases de dados CINAHL, LILACS e PubMed, com os seguintes descritores principais: child; social determinants of health; accidentes, home. Foram incluídos 31 estudos que relacionaram os determinantes sociais da saúde e acidentes domésticos na infância, em inglês, português e espanhol. Resultados: os determinantes proximais identificados foram: idade e sexo das crianças, e etnia. Dentre os intermediários, prevaleceram o comportamento parental, relacionado à supervisão de um adulto. O emprego dos pais e a situação socioeconômica foram identificados como determinantes distais. Conclusão: a idade e o sexo da criança, além da supervisão direta, foram os determinantes mais associados aos acidentes. Os determinantes distais devem ser mais bem estudados, pois sua relação com a ocorrência dos acidentes domésticos não se mostrou suficientemente esclarecida.

Barriers, supports, and effective interventions for uptake of human papillomavirus- and other vaccines within global and Canadian Indigenous peoples: a systematic review protocol.

BACKGROUND: Despite the existence of human papilloma virus (HPV) vaccines with demonstrated safety and effectiveness and funded HPV vaccination programs, coverage rates are persistently lower and cervical cancer burden higher among Canadian Indigenous peoples. Barriers and supports to HPV vaccination in Indigenous peoples have not been systematically documented, nor have interventions to increase uptake in this population. This protocol aims to appraise the literature in Canadian and global Indigenous peoples, relating to documented barriers and supports to vaccination and interventions to increase acceptability/uptake or reduce hesitancy of vaccination. Although HPV vaccination is the primary focus, we anticipate only a small number of relevant studies to emerge from the search and will, therefore, employ a broad search strategy to capture literature related to both HPV vaccination and vaccination in general in global Indigenous peoples. METHODS: Eligible studies will include global Indigenous peoples and discuss barriers or supports and/or interventions to improve uptake or to reduce hesitancy, for the HPV vaccine and/or other vaccines. Primary outcomes are documented barriers or supports or interventions. All study designs meeting inclusion criteria will be considered, without restricting by language, location, or data type. We will use an a priori search strategy, comprised of key words and controlled vocabulary terms, developed in consultation with an academic librarian, and reviewed by a second academic librarian using the PRESS checklist. We will search several electronic databases from date of inception, without restrictions. A pre-defined group of global Indigenous websites will be reviewed for relevant gray literature. Bibliographic searches will be conducted for all included studies to identify relevant reviews. Data analysis will include an inductive, qualitative, thematic synthesis and a quantitative analysis of measured barriers and supports, as well as a descriptive synthesis and quantitative summary of measures for interventions. DISCUSSION: To our knowledge, this study will contribute the first systematic review of documented barriers, supports, and interventions for vaccination in general and for HPV vaccination. The results of this study are expected to inform future research, policies, programs, and community-driven initiatives to enhance acceptability and uptake of HPV vaccination among Indigenous peoples. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registration Number: CRD42017048844.

Ancestry indicative markers in HIV positive patients in the state of Mato Grosso, Brazil / Marcadores indicativos de ancestralidade em pacientes hiv positivos no estado de Mato Grosso, Brasil

OBJECTIVE: Ancestry Indicative Markers are used to define the allelic frequency of genes from different ethnic groups in populations of certain localities of interest, for analysis of population ancestry and estimation of ethnic mixture. This work aimed to evaluate the frequency of occurrence of the ancestry Indicative Markers SB-19.3, APO, AT3 / ID and PV-92 and to determine the existence of polymorphisms for these markers in the state of Mato Grosso. METHOD: The study aimed to estimate allelic and genotype frequencies, adherence to the Hardy-Weinberg equilibrium and genetic differentiation in the sample of 238 controls formed by HIV free individuals residing in twenty-six different municipalities in the state, collected at the Júlio Muller University Hospital and in a sample of 516 HIV-positive patients also residing in the state. RESULTS: The Hardy-Weinberg equilibrium test revealed an imbalance between the observed and expected proportions of Sb19.3 and APO loci in the control population. Applying the genetic differentiation test, control populations and HIV-positive patients differed for the four loci analyzed. CONCLUSION: The population of the state of Mato Grosso, Brazil proved to be very heterogeneous, confirming hypotheses about its history of colonization. Control populations and HIV-positive patients differed for the four loci analyzed.

OBJETIVO: Os Marcadores Indicativos de Ancestralidade (AIMs) são usados ​​para definir a frequência alélica de genes de diferentes grupos étnicos em populações de determinadas localidades de interesse, para análise de ascendência populacional e estimativa de mistura étnica. Este trabalho teve como objetivo avaliar a freqüência de AIMs (SB-19.3, APO, AT3 / ID e PV-92) e verificar a existência de polimorfismos para esses marcadores no estado de Mato Grosso. MÉTODO: O estudo teve como objetivo estimar as freqüências alélicas e genotípicas, a aderência ao equilíbrio de Hardy-Weinberg e a diferenciação genética na amostra de controles formada por indivíduos residentes em vinte e seis municípios do estado, coletados no Hospital Universitário Júlio Muller e em uma amostra de pacientes HIV positivos também residentes no estado. RESULTADOS: O teste de equilíbrio de Hardy-Weinberg revelou um desequilíbrio entre as proporções observadas e esperadas dos loci Sb19.3 e APO na população de controle. Aplicando o teste de diferenciação genética, a população controle e os pacientes HIV positivos diferenciaram-se para os quatro loci analisados. CONCLUSÃO: A população do estado de Mato Grosso mostrou-se heterogênea, confirmando hipóteses sobre sua história de colonização. A população controle e os pacientes HIV positivos diferenciaram-se para os quatro loci analisados.

Politica sobre etnicidad y salud (29. a Conferencia Sanitaria Panamericana) / Política sobre etnia e saúde (29a Conferência Sanitária Pan-Americana) / Politique en matière d'ethnicité et de santé (29e Conférence Sanitaire Panaméricaine) / Policy on Ethnicity and Health (29th Pan American Sanitary Conference)

En septiembre del 2017, los Estados Miembros de la OPS aprobaron por unanimidad la Política sobre etnicidad y salud en la 29.ª Conferencia Sanitaria Panamericana, 69.ª sesión del Comité Regional de la Organización Mundial de la Salud para las Américas. Con esta política, los Estados Miembros han acordado garantizar el enfoque intercultural en la salud y el tratamiento equitativo de los pueblos indígenas, los afrodescendientes, los romaníes y los miembros de otros grupos étnicos. Además, plantearon la necesidad de adoptar soluciones que sean inclusivas y promuevan la colaboración, a fin de cerrar las brechas en el acceso a los servicios de salud que afectan a estas poblaciones. Numerosos representantes de los pueblos indígenas, los afrodescendientes y los romaníes, los ministerios de salud y las organizaciones multilaterales participaron en la elaboración de esta política y se comprometieron a apoyar su aplicación. Con la aprobación de la Política sobre etnicidad y salud, la Región de las Américas se convierte en la primera región de la Organización Mundial de la Salud en reconocer la importancia de adoptar un enfoque intercultural para abordar las inequidades en la salud. Creo firmemente que esta política será una importante herramienta en los esfuerzos de toda la comunidad de la salud pública para avanzar hacia la cobertura universal de salud al reducir las desigualdades e inequidades en materia de salud de los distintos grupos étnicos.

Em setembro de 2017, na 29a Conferência Sanitária Pan-Americana (69a Sessão do Comitê Regional da Organização Mundial da Saúde para as Américas), os Estados Membros da OPAS aprovaram por unanimidade a Política sobre etnia e saúde. Com esta política, os Estados Membros concordaram em garantir o enfoque intercultural em saúde e a paridade de tratamento dos povos indígenas, dos afrodescendentes, dos roma e dos membros de outros grupos étnicos. Também abraçaram a busca por soluções colaborativas e inclusivas para contemplar as lacunas no acesso destas populações à saúde. Representantes dos povos indígenas, dos afrodescendentes, dos roma, dos ministérios da Saúde e de organizações multilaterais colaboraram na elaboração desta política e comprometeram-se a apoiar sua implementação. A Política sobre etnia e saúde torna a Região das Américas a primeira da Região da Organização Mundial da Saúde a reconhecer a importância de adotar o enfoque intercultural para enfrentar as iniquidades em saúde. Acredito firmemente que esta política servirá como uma importante ferramenta nos esforços de toda a comunidade da saúde pública de avançar rumo à saúde universal ao reduzir as desigualdades e iniquidades em saúde entre os grupos étnicos

En septembre 2017, à la 29e Conférence sanitaire panaméricaine (69e session du Comité régional de l'Organisation mondiale de la Santé pour les Amériques), les États Membres de l'OPS ont unanimement approuvé la Politique sur l'ethnicité et la santé. Par cette politique, les États Membres ont convenu de garantir une approche interculturelle de la santé et un traitement équitable des Autochtones, des Roms, des populations d'ascendance africaine, ainsi que des membres d'autres groupes ethniques. Ils ont également reconnu le besoin de solutions solidaires et collaboratives pour combler les lacunes d'accès à la santé de ces populations. Des représentants des Autochtones, des Roms et des populations d'ascendance africaine, des ministères de la Santé et des organisations multilatérales ont participé à l'élaboration de cette politique et se sont engagés à appuyer sa mise en œuvre. La Politique sur l'ethnicité et la santé fait de la Région des Amériques la première Région de l'Organisation mondiale de la Santé à reconnaître l'importance d'adopter une approche interculturelle pour répondre aux inégalités en matière de santé. Je crois profondément de cette politique constituera un outil essentiel dans les efforts déployés par l'ensemble de la communauté de la santé publique pour progresser vers la santé universelle en réduisant les inégalités et les iniquités de santé dans les groupes ethniques de la population.

In September 2017, at the 29th Pan American Sanitary Conference (69th Session of the Regional Committee of the World Health Organization for the Americas), PAHO Member States unanimously approved the Policy on Ethnicity and Health. With this policy, the Member States agreed to guarantee an intercultural approach to health and equitable treatment of indigenous peoples, Afro-descendants, Roma populations, and members of other ethnic groups. They also embraced the need for inclusive, collaborative solutions to address the gaps in access to health for these populations. Representatives from indigenous peoples, Afrodescendants, and Roma populations, ministries of health, and multilateral organizations participated in the development of this policy and committed to supporting its implementation. The Policy on Ethnicity and Health makes the Region of the Americas the first World Health Organization Region to acknowledge the importance of adopting an intercultural approach to address inequities in health.

Chronological narratives from smoking initiation through to pregnancy of Indigenous Australian women: A qualitative study.

OBJECTIVE: One in two Indigenous Australian pregnant women smoke, yet little is known about their trajectory of smoking. This study aimed to explore Aboriginal women's narratives from starting smoking through to pregnancy. METHODS: A female Aboriginal Researcher conducted individual face-to-face interviews with 20 Aboriginal women from New South Wales, Australia. Recruitment, through Aboriginal services and community networks, continued until saturation was reached. Audio-recorded transcripts were independently open coded by two researchers, inductively analysed and reported using a three-dimensional structure of looking backwards, forwards, inwards, outwards and a sense of place, to elucidate the chronology of events, life stages, characters, environments, and turning points of the stories. RESULTS: A chronology emerged from smoking initiation in childhood, coming of age, becoming pregnant, through to attempts at quitting, and relapse post-partum. Several new themes emerged: the role mothers play in women's smoking and quitting; the contribution of nausea to spontaneous quitting; depression as a barrier to quitting; and the hopes of women for their own and their children's future. The epiphany of pregnancy was a key turning point for many - including the interplay of successive pregnancies; and the intensity of expressed regret. CONCLUSIONS: Aboriginal women report multiple influences in the progression of early smoking to pregnancy and beyond. Potential opportunities to intervene include: a) childhood, coming of age, pregnancy, post-natal, in-between births; b) key influencers; c) environments, and d) targeting concurrent substance use. Morning sickness appears to be a natural deterrent to continued smoking. Depression, and its relationship to smoking and quitting in Australian Indigenous pregnant women, requires further research.

Smoking in Pregnancy Among Indigenous Women in High-Income Countries: A Narrative Review.

INTRODUCTION: Pregnant women in socioeconomically disadvantaged circumstances, such as Indigenous women, have a high prevalence of smoking. Tobacco smoking is the most significant reversible risk factor for the health of Indigenous pregnant women and their babies. METHODS: As researchers working in this specialized area, we conducted a narrative review of the literature on smoking among Indigenous pregnant women in the United States, Canada, New Zealand, and Australia. We summarize prevalence and factors influencing tobacco use, interventions, and evidence gaps for tobacco control and smoking cessation. Recommendations are made for future interventions, policy changes, and much-needed research. RESULTS: Common themes emerging across the four countries reveal opportunities for cross-cultural collaborative studies and trials. These include the social-normative use of tobacco as barriers to quitting in pregnancy and the need for evaluations of interventions at the family and community level. Socioeconomic disparities underscore the importance of enhancing the implementation and reach of strategies to prevent and reduce prenatal tobacco smoking among Indigenous women. Elders and community health care providers as role models for nontobacco use could be explored. Qualitative work is needed to understand the barriers and opportunities, such as cultural strengths supporting quitting tobacco to develop more effective approaches. CONCLUSIONS: Although a high-priority group, there remains a dearth of research on Indigenous women's smoking in pregnancy. Studies have assessed knowledge and attitudes to smoking in pregnancy, and small feasibility studies and a few empirical trials have been conducted. Recommendations for promising culturally appropriate cessation interventions have been made. Larger trials are warranted. IMPLICATIONS: Strategies to support quitting among pregnant Indigenous women need to be multifactorial and take account of the social determinants of smoking including historical antecedents, community norms, cultural strengths, and recognition of individual and community needs. Cross-country research collaborations have the potential to leverage funding, share expertise, and strengthen approaches to tackle an important and poorly attended health disparity that has a profound impact on the entire life course for Indigenous peoples.

Effective strategies to reduce commercial tobacco use in Indigenous communities globally: A systematic review.

BACKGROUND: All over the world, Indigenous populations have remarkably high rates of commercial tobacco use compared to non-Indigenous groups. The high rates of commercial tobacco use in Indigenous populations have led to a variety of health issues and lower life expectancy than the general population. The objectives of this systematic review were to investigate changes in the initiation, consumption and quit rates of commercial tobacco use as well as changes in knowledge, prevalence, community interest, and smoke-free environments in Indigenous populations. We also aimed to understand which interventions had broad reach, what the common elements that supported positive change were and how Aboriginal self-determination was reflected in program implementation. METHODS: We undertook a systematic review of peer-reviewed publications and grey literature selected from seven databases and 43 electronic sources. We included studies between 1994 and 2015 if they addressed an intervention (including provision of a health service or program, education or training programs) aimed to reduce the use of commercial tobacco use in Indigenous communities globally. Systematic cross-regional canvassing of informants in Canada and internationally with knowledge of Indigenous health and/or tobacco control provided further leads about commercial tobacco reduction interventions. We extracted data on program characteristics, study design and learnings including successes and challenges. RESULTS: In the process of this review, we investigated 73 commercial tobacco control interventions in Indigenous communities globally. These interventions incorporated a myriad of activities to reduce, cease or protect Indigenous peoples from the harms of commercial tobacco use. Interventions were successful in producing positive changes in initiation, consumption and quit rates. Interventions also facilitated increases in the number of smoke-free environments, greater understandings of the harms of commercial tobacco use and a growing community interest in addressing the high rates of commercial tobacco use. Interventions were unable to produce any measured change in prevalence rates. CONCLUSIONS: The extent of this research in Indigenous communities globally suggests a growing prioritization and readiness to address the high rates of commercial tobacco use through the use of both comprehensive and tailored interventions. A comprehensive approach that uses multiple activities, the centring of Aboriginal leadership, long term community investments, and the provision of culturally appropriate health materials and activities appear to have an important influence in producing desired change.

Cancer survivorship services for indigenous peoples: where we stand, where to improve? A systematic review.

OBJECTIVE: There are few support programs with evidence-based practices which address the needs of cancer survivors from indigenous populations. This systematic review analysed the experiences and current support services for cancer survivors from indigenous populations following the cessation of cancer treatment. METHODS: The data sourced for this article was identified from a systematic search of five databases (MEDLINE, MEDLINE In-Process, PyscINFO, CINAHL, and EMBASE). Studies were selected if they described the experiences of indigenous cancer survivors, their families, and/or clinicians primarily responsible for their care. In total 208 unique abstracts were screened, from which 17 studies were identified as having fulfilled all selection criteria. RESULTS: Of the 17 articles reviewed, 12 described qualitative data and 5 provided quantitative data. Common themes identified included the importance of family support throughout the survivorship period, the negative effect of community stigmatization, fatalistic attitudes towards cancer, and the importance of spirituality in coping with, and understanding, the cancer experience. Potential barriers to accessing care included distance and difficulties revisiting the survivor's cancer experience due to an associated fear of cancer recurrence. CONCLUSIONS: Indigenous cancer survivors would benefit from survivorship programs more specifically tailored to their individual circumstances, such as personalized spiritual care, facilitation of increased involvement of family members, and connection to other indigenous cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: The results from this review indicate that there is a need for survivorship care to be shaped specifically for the needs of indigenous cancer survivors.

Prevalence of self-reported myocardial infarction in Sami and non-Sami populations: the SAMINOR study.

OBJECTIVE: Measure the prevalence of self-reported myocardial infarction (SMI) in Sami and non-Sami populations in rural areas of Norway, and explore whether possible ethnic differences could be explained by established cardiovascular risk factors. DESIGN: Cross-sectional population-based study. METHODS: A health survey was conducted in 2003-2004 in areas with Sami and non-Sami populations (SAMINOR). The response rate was 60.9%. Information concerning lifestyle was collected by 2 self-administrated questionnaires, and clinical examinations provided anthropometric measurements, and data on blood pressure and lipid levels. RESULTS: The total number for the subsequent analysis was 15,206 men and women aged 36-79 years (born 1925-1968). Sex-specific analyses revealed no ethnic difference in SMI. In terms of the most important risk factors such as smoking, blood pressure, and lipid levels, no or only trivial ethnic differences were found in both women and men. CONCLUSION: In this study, we found no difference in SMI between Sami and non-Sami in rural areas in Norway. The similar risk profile is the most plausible explanation; similar living conditions and close interaction between the ethnic groups may explain this.

DESCRIPTION OF GASTROESOPHAGEAL REFLUX DISEASE IN DIFFERENT ETHNIC GROUPS, LIVING IN THE NORTH.

UNLABELLED: INTRODUCTIOD: Over the past 15 years, the relative frequency of detection of erosive form of GERD has increased from 3,1 to 16%. Manifestations of GERD in different ethnic populations of Yakutia are not well understood. AIM: Studying kliniko-endoscopic and the morfofunktsionalnykh of features of GERD in various ethnic groups living in conditions of Yakutia. MATERIALS AND METHODS: The study included 168 patients with GERD of different ethnic origins. Yakuts, Evens and Evenks, were considered as indigenous people and newcomers were all persons of other nationalities, who arrived at different times from other regions of Russia. The average age was 41.75 ± 24.73 years. RESULTS: Clinical manifestations of GERD in different ethnic groups living in Yakutia. Leukoplakia of the esophagus was detected in the indigenous population are four times more likely than newcomers. With GERD associated with thyroid disorders prevalent low level of contamination of Helicobacter pylori. Helicobacter pylori infection in patients with GERD in Yakutia was higher among immigrants than among the indigenous, with a high degree of contamination of Helicobacter pylori was detected more frequently in immigrants than among the indigenous. Pathological gastroesophageal reflux during the daily pH-metry of the esophagus was detected more frequently in patients visiting than among the indigenous. CONCLUSIONS: The found features of a current of GERD can be further the basis for the individualized and differentiated approaches to treatment of this disease.

Relationship between betel quid chewing and radiographic alveolar bone loss among Taiwanese aboriginals: a retrospective study.

BACKGROUND: Betel quid chewing is associated with the periodontal status; however, results of epidemiological studies are inconsistent. To the best of our knowledge, no study has reported radiographic alveolar bone loss (RABL) associated with betel quid chewing. METHODS: This survey was conducted in an aboriginal community in Taiwan because almost all betel quid chewers were city-dwelling cigarette smokers. In total, 114 subjects, aged 30-60 years, were included. Full-mouth intraoral RABL was retrospectively measured and adjusted for age, gender, and plaque index (PI). Multiple regression analysis was used to assess the relationship between RABL and potential risk factors. RESULTS: Age-, gender-, and PI-adjusted mean RABL was significantly higher in chewers with or without cigarette smoking than in controls. Multiple regression analysis showed that the RABL for consumption of 100,000 pieces betel quid for the chewer group was 0.40 mm. Full-mouth plotted curves for adjusted mean RABL in the maxilla were similar between the chewer and control groups, suggesting that chemical effects were not the main factors affecting the association between betel quid chewing and the periodontal status. CONCLUSION: Betel quid chewing significantly increases RABL. The main contributory factors are age and oral hygiene; however, the major mechanism underlying this process may not be a chemical mechanism. Regular dental visits, maintenance of good oral hygiene, and reduction in the consumption of betel quid, additives, and cigarettes are highly recommended to improve the periodontal status.

Receptor-defined subtypes of breast cancer in indigenous populations in Africa: a systematic review and meta-analysis.

BACKGROUND: Breast cancer is the most common female cancer in Africa. Receptor-defined subtypes are a major determinant of treatment options and disease outcomes but there is considerable uncertainty regarding the frequency of poor prognosis estrogen receptor (ER) negative subtypes in Africa. We systematically reviewed publications reporting on the frequency of breast cancer receptor-defined subtypes in indigenous populations in Africa. METHODS AND FINDINGS: Medline, Embase, and Global Health were searched for studies published between 1st January 1980 and 15th April 2014. Reported proportions of ER positive (ER+), progesterone receptor positive (PR+), and human epidermal growth factor receptor-2 positive (HER2+) disease were extracted and 95% CI calculated. Random effects meta-analyses were used to pool estimates. Fifty-four studies from North Africa (n=12,284 women with breast cancer) and 26 from sub-Saharan Africa (n=4,737) were eligible. There was marked between-study heterogeneity in the ER+ estimates in both regions (I2>90%), with the majority reporting proportions between 0.40 and 0.80 in North Africa and between 0.20 and 0.70 in sub-Saharan Africa. Similarly, large between-study heterogeneity was observed for PR+ and HER2+ estimates (I2>80%, in all instances). Meta-regression analyses showed that the proportion of ER+ disease was 10% (4%-17%) lower for studies based on archived tumor blocks rather than prospectively collected specimens, and 9% (2%-17%) lower for those with ≥ 40% versus those with <40% grade 3 tumors. For prospectively collected samples, the pooled proportions for ER+ and triple negative tumors were 0.59 (0.56-0.62) and 0.21 (0.17-0.25), respectively, regardless of region. Limitations of the study include the lack of standardized procedures across the various studies; the low methodological quality of many studies in terms of the representativeness of their case series and the quality of the procedures for collection, fixation, and receptor testing; and the possibility that women with breast cancer may have contributed to more than one study. CONCLUSIONS: The published data from the more appropriate prospectively measured specimens are consistent with the majority of breast cancers in Africa being ER+. As no single subtype dominates in the continent availability of receptor testing should be a priority, especially for young women with early stage disease where appropriate receptor-specific treatment modalities offer the greatest potential for reducing years of life lost. Please see later in the article for the Editors' Summary.