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2.
Int J Equity Health ; 19(1): 63, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32381022

RESUMO

The coronavirus disease 2019 (COVID-2019) pandemic struck Latin America in late February and is now beginning to spread across the rural indigenous communities in the region, home to 42 million people. Eighty percent of this highly marginalized population is concentrated in Bolivia, Guatemala, Mexico and Peru. Health care services for these ethnic groups face distinct challenges in view of their high levels of marginalization and cultural differences from the majority. Drawing on 30 years of work on the responses of health systems in the indigenous communities of Latin America, our group of researchers believes that countries in the region must be prepared to combat the epidemic in indigenous settings marked by deprivation and social disparity. We discuss four main challenges that need to be addressed by governments to guarantee the health and lives of those at the bottom of the social structure: the indigenous peoples in the region. More than an analysis, our work provides a practical guide for designing and implementing a response to COVID-19 in indigenous communities.


Assuntos
Infecções por Coronavirus/epidemiologia , Coronavirus , Serviços de Saúde do Indígena/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Grupos Populacionais , População Rural , Betacoronavirus , Grupos Étnicos , Humanos , América Latina
3.
Artigo em Inglês | MEDLINE | ID: mdl-32423095

RESUMO

(1) Background: Combating viral disease outbreaks has doubtlessly been one of the major public health challenges for the 21st century. (2) Methods: The host entry machinery required for COVID-19 (SARS-CoV-2) infection was examined for the gene expression profiles and polymorphism. (3) Results: Lung, kidney, small intestine, and salivary glands were among the tissues which expressed the entry machinery coding genes Ace2, Tmprss2, CtsB, and CtsL. The genes had no significant expression changes between males and females. The four human population groups of Europeans, Africans, Asians, and Americans had specific and also a common pool of rare variants for the X-linked locus of ACE2 receptor. Several specific and common ACE2 variants including S19P, I21T/V, E23K, A25T, K26R, T27A, E35D/K, E37K, Y50F, N51D/S, M62V, N64K, K68E, F72V, E75G, M82I, T92I, Q102P, G220S, H239Q, G326E, E329G, G352V, D355N, H378R, Q388L, P389H, E467K, H505R, R514G/*, and Y515C were of the utmost importance to the viral entry and infection. The variants of S19P, I21T, K26R, T27A, E37K, N51D, N64K, K68E, F72V, M82I, G326E, H378R, Q388L, and P389H also had significant differences in frequencies among the population groups. Most interestingly, the analyses revealed that more than half of the variants can exist in males, i.e., as hemizygous. (4) Conclusions: The rare variants of human ACE2 seem to be one of the determinant factors associated with fitness in the battle against SARS viruses. The hemizygous viral-entry booster variants of ACE2 describe the higher SARS-CoV-2 mortality rate in males. This is also supported by the lack of gender bias for the gene expression profiles of entry machinery. A personalized medicine strategy is conceived for isolating high-risk individuals in epidemic circumstances.


Assuntos
Infecções por Coronavirus/mortalidade , Coronavirus , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/mortalidade , Polimorfismo Genético , Grupos Populacionais , Receptores Virais , Sexismo , Internalização do Vírus , Betacoronavirus , Coronavirus/isolamento & purificação , Coronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/genética , Feminino , Humanos , Pulmão/enzimologia , Pulmão/imunologia , Pulmão/metabolismo , Masculino , Peptidil Dipeptidase A/genética , Pneumonia Viral/diagnóstico , Pneumonia Viral/genética , Serina Endopeptidases , Síndrome Respiratória Aguda Grave/genética , Síndrome Respiratória Aguda Grave/metabolismo , Síndrome Respiratória Aguda Grave/virologia , Fatores Sexuais
4.
J Cross Cult Gerontol ; 35(2): 113-131, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32382881

RESUMO

Cross-cultural research has shown marked variation in health outcomes across the world's older adult populations. Indeed, older adults in the Circumpolar North experience a variety of health disparities. Because aging is a biological process rooted in sociocultural context, there exists great variation in the ways older adults define and experience healthy, or "successful," aging in their communities. The aim of this analysis was to synthesize qualitative research among older residents (aged 50+ years) in the Circumpolar North to identify a definition of healthy aging common in the region. A thorough review was conducted across a variety of academic search databases for peer-reviewed, qualitative studies conducted among community-dwelling older adults. The search strategy initially identified 194 articles; 23 articles met the inclusion criteria. Included studies were coded and analyzed using Grounded Theory to examine underlying themes of healthy aging in the Circumpolar North. The findings reveal the importance older adults place on respect, their relationship to the land, and psychosocial resilience into multidimensional models of healthy aging. This research also highlights the need for increased translational research with populations in the Circumpolar North that are under-represented in the literature.


Assuntos
Envelhecimento/psicologia , Envelhecimento Saudável/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Regiões Árticas , Feminino , Nível de Saúde , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Grupos Populacionais , Pesquisa Qualitativa
5.
PLoS One ; 15(5): e0229297, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32427995

RESUMO

OBJECTIVES: The objectives of the study were to estimate the prevalence of different clinical signs of trachoma and identify possible factors associated with TF. METHODOLOGY: Following the approval of the study protocol by the ethics committee, a cross-sectional study was conducted in Vaupés, a department of the Colombian Amazon, between the years 2012 and 2013 in two districts. Based on the records obtained from a standardized format for the clinical evaluation of the participants and the factors associated with follicular trachoma, an excel database was built and debugged, which was analyzed using IBM SPSS, Statistics Version 23 and Stata STATA (Version 14, 2015, StataCorp LLC, Texas, USA). RESULTS: The records of 13,091 individuals was collected from 216 rural indigenous communities, of which 12,080 were examined (92.3%); 7,274 in the Western and 4,806 in the Eastern districts. A prevalence of trachomatous inflammation-follicular (TF) of 21.7% (n = 599; 95% CI 20.2-23.3) in the Western and 24.9% (n = 483; 95% CI 23.1-26.9) in the Eastern district was found in children aged 1 to 9 years. Regarding trachomatous trichiasis (TT), 77 cases were found, of which 14 belonged to the Western district (prevalence 0.3%, CI 95% 0.2-0.5) and 63 to the Eastern district (1.8%, CI 95% 1.4-2.4). Children aged between 1 to 9 years were significantly more likely to have TF when there was the presence of secretions on the face (OR: 3.2; 95% CI: 2.6-3.9). CONCLUSIONS: Trachoma is a public health problem in Vaupés that requires the implementation of the SAFE strategy (S = Surgery, A = Antibiotics, F = Face Washing, E = Environment) in the Eastern and Western districts, for at least 3 consecutive years, in accordance with WHO recommendations.


Assuntos
Inquéritos Epidemiológicos , Grupos Populacionais , Saúde Pública , Tracoma/epidemiologia , Censos , Criança , Pré-Escolar , Chlamydia trachomatis/patogenicidade , Colômbia/epidemiologia , Feminino , Humanos , Lactente , Masculino , Fatores de Risco , População Rural , Tracoma/microbiologia , Tracoma/patologia
6.
Lancet ; 395(10238): 1727-1734, 2020 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-32422124

RESUMO

Indigenous communities worldwide share common features that make them especially vulnerable to the complications of and mortality from COVID-19. They also possess resilient attributes that can be leveraged to promote prevention efforts. How can indigenous communities best mitigate potential devastating effects of COVID-19? In Bolivia, where nearly half of all citizens claim indigenous origins, no specific guidelines have been outlined for indigenous communities inhabiting native communal territories. In this Public Health article, we describe collaborative efforts, as anthropologists, physicians, tribal leaders, and local officials, to develop and implement a multiphase COVID-19 prevention and containment plan focused on voluntary collective isolation and contact-tracing among Tsimane forager-horticulturalists in the Bolivian Amazon. Phase 1 involves education, outreach, and preparation, and phase 2 focuses on containment, patient management, and quarantine. Features of this plan might be exported and adapted to local circumstances elsewhere to prevent widespread mortality in indigenous communities.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Grupos Populacionais , Isolamento Social , Betacoronavirus , Bolívia , Busca de Comunicante , Humanos , Populações Vulneráveis
8.
PLoS One ; 15(4): e0231443, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32330143

RESUMO

BACKGROUND: The Health Resources and Services Administration (HRSA), an agency within the U.S. Department of Health and Human Services (HHS), works to ensure accessible, quality, health care for the nation's underserved populations, especially those who are medically, economically, or geographically vulnerable. HRSA-designated primary care Health Professional Shortage Areas (pcHPSAs) provide a vital measure by which to identify underserved populations and prioritize locations and populations lacking access to adequate primary and preventive health care-the foundation for advancing health equity and maintaining health and wellness for individuals and populations. However, access to care is a complex, multifactorial issue that involves more than just the number of health care providers available, and pcHPSAs alone cannot fully characterize the distribution of medically, economically, and geographically vulnerable populations. METHODS AND FINDINGS: In this county-level analysis, we used descriptive statistics and multiple correspondence analysis to assess how HRSA's pcHPSA designations align geographically with other established markers of medical, economic, and geographic vulnerability. Reflecting recognized social determinants of health (SDOH), markers included demographic characteristics, race and ethnicity, rates of low birth weight births, median household income, poverty, educational attainment, and rurality. Nationally, 96 percent of U.S. counties were either classified as whole county or partial county pcHPSAs or had one or more established markers of medical, economic, or geographic vulnerability in 2017, suggesting that at-risk populations were nearly ubiquitous throughout the nation. Primary care HPSA counties in HHS Regions 4 and 6 (largely lying within the southeastern and south central United States) had the most pervasive and complex patterns in population risk. CONCLUSION: HHS Regions displayed unique signatures with respect to SDOH markers. Descriptive and analytic findings from our work may help inform health workforce and health care planning at all levels, and, by illustrating both the complexity of and differences in county-level population characteristics in pcHPSA counties, our findings may have relevance for strengthening the delivery of primary care and addressing social determinants of health in areas beset by provider shortages.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Humanos , Área Carente de Assistência Médica , Grupos Populacionais/estatística & dados numéricos , Estados Unidos
9.
PLoS One ; 15(4): e0227083, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32251467

RESUMO

AIM: To determine the prevalence of pulmonary tuberculosis, socio-cultural practices and health seeking behaviour of tribal people in four districts of Odisha. METHODOLOGY: This was an action research study with qualitative and quantitative design following a sequential approach implemented in a 4-phased manner. It was carried out in the 6 selected villages from July,2015 to June,2017. The screening for active TB among chest symptomatics is followed as per the guidelines of the (RNTCP) Revised National Tuberculosis Control Program in India. RESULTS: In all, 1455 households were surveyed in the 6 tribal dominated villages of 4 districts, namely Balangir, Dhenkanal, Kandhamal and Mayurbhanj. Total population of the villages was 6681. Based on the eligibility, 5144 (97.7%) individuals were screened. About 139 (2.3%) could not be screened due to non-availability in their households during day time. Out of the screened individuals (5144), 126 chest symptomatics were identified. Sputum samples were collected from them and sent to the National Reference Laboratory, RMRC, Bhubaneswar using public transport and maintaining cold chain. Out of 126 chest symptomatics, 35 patients were found to be having active TB disease and 18 were culture positive. The prevalence of pulmonary TB is 0.68%. The risk factors seemed to be ignorance about TB symptoms, addiction to alcoholic drinks, difficulty reaching the health facilities owing to the long distances, lack of communication and transport. In addition, other morbidities like Malaria, diabetes, hypertension, malnutrition, etc. were observed in the tribes of the study sites. CONCLUSION: TB control programs need further strengthening in the tribal dominated regions. This study is the first of its kind in this State.


Assuntos
Comportamentos Relacionados com a Saúde , Mycobacterium tuberculosis/isolamento & purificação , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Grupos Populacionais/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Busca de Comunicante , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Grupos Populacionais/psicologia , Prevalência , Pesquisa Qualitativa , Fatores de Risco , Fatores Socioeconômicos , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/prevenção & controle , Adulto Jovem
10.
PLoS One ; 15(4): e0230809, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32315345

RESUMO

Riverine populations are typical of the Amazon region that depend on nature for subsistence. These people are considered an intermediate population between the urban and indigenous, the original Amazon habitants. The aim of this cross-sectional study was to evaluate the relationship between tooth wear and age in a remote riverine population from the Amazon, located by the Tucumanduba River (n = 94), and to compare them to previous findings obtained from semi-isolated indigenous (n = 223) and urban populations (n = 40) from the Amazon region, which were examined using the same methodology. Using linear regression, tooth wear explained 54.5% of the variation in the ages of the riverine subjects (p<0.001). This coefficient is mid-way between those obtained in semi-isolated indigenous populations (65-86%) and urban subjects (12%) living in the Amazon. Our findings suggest that tooth wear, a direct evidence of what an individual ate in the past, may be an indicator of the acculturation process in remote populations.


Assuntos
Desgaste dos Dentes/epidemiologia , Aculturação , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Populacionais , Rios , População Urbana , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-32235666

RESUMO

Recently, a very interesting article on solastalgia was published in the International Journal of Environmental Research and Public Health [...].


Assuntos
Grupos Populacionais , Saúde Pública , Humanos
12.
Biol Res ; 53(1): 15, 2020 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-32299502

RESUMO

BACKGROUND: Current South American populations trace their origins mainly to three continental ancestries, i.e. European, Amerindian and African. Individual variation in relative proportions of each of these ancestries may be confounded with socio-economic factors due to population stratification. Therefore, ancestry is a potential confounder variable that should be considered in epidemiologic studies and in public health plans. However, there are few studies that have assessed the ancestry of the current admixed Chilean population. This is partly due to the high cost of genome-scale technologies commonly used to estimate ancestry. In this study we have designed a small panel of SNPs to accurately assess ancestry in the largest sampling to date of the Chilean mestizo population (n = 3349) from eight cities. Our panel is also able to distinguish between the two main Amerindian components of Chileans: Aymara from the north and Mapuche from the south. RESULTS: A panel of 150 ancestry-informative markers (AIMs) of SNP type was selected to maximize ancestry informativeness and genome coverage. Of these, 147 were successfully genotyped by KASPar assays in 2843 samples, with an average missing rate of 0.012, and a 0.95 concordance with microarray data. The ancestries estimated with the panel of AIMs had relative high correlations (0.88 for European, 0.91 for Amerindian, 0.70 for Aymara, and 0.68 for Mapuche components) with those obtained with AXIOM LAT1 array. The country's average ancestry was 0.53 ± 0.14 European, 0.04 ± 0.04 African, and 0.42 ± 0.14 Amerindian, disaggregated into 0.18 ± 0.15 Aymara and 0.25 ± 0.13 Mapuche. However, Mapuche ancestry was highest in the south (40.03%) and Aymara in the north (35.61%) as expected from the historical location of these ethnic groups. We make our results available through an online app and demonstrate how it can be used to adjust for ancestry when testing association between incidence of a disease and nongenetic risk factors. CONCLUSIONS: We have conducted the most extensive sampling, across many different cities, of current Chilean population. Ancestry varied significantly by latitude and human development. The panel of AIMs is available to the community for estimating ancestry at low cost in Chileans and other populations with similar ancestry.


Assuntos
Grupos Étnicos/genética , Genética Populacional/organização & administração , Índios Sul-Americanos/genética , Polimorfismo de Nucleotídeo Único/genética , Grupos Populacionais/genética , Chile , Feminino , Frequência do Gene/genética , Marcadores Genéticos/genética , Genótipo , Técnicas de Genotipagem , Humanos , Masculino , Filogeografia , Saliva
14.
Epidemiol Infect ; 148: e18, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32019623

RESUMO

Q fever (caused by Coxiella burnetii) is thought to have an almost world-wide distribution, but few countries have conducted national serosurveys. We measured Q fever seroprevalence using residual sera from diagnostic laboratories across Australia. Individuals aged 1-79 years in 2012-2013 were sampled to be proportional to the population distribution by region, distance from metropolitan areas and gender. A 1/50 serum dilution was tested for the Phase II IgG antibody against C. burnetii by indirect immunofluorescence. We calculated crude seroprevalence estimates by age group and gender, as well as age standardised national and metropolitan/non-metropolitan seroprevalence estimates. Of 2785 sera, 99 tested positive. Age standardised seroprevalence was 5.6% (95% confidence interval (CI 4.5%-6.8%), and similar in metropolitan (5.5%; 95% CI 4.1%-6.9%) and non-metropolitan regions (6.0%; 95%CI 4.0%-8.0%). More males were seropositive (6.9%; 95% CI 5.2%-8.6%) than females (4.2%; 95% CI 2.9%-5.5%) with peak seroprevalence at 50-59 years (9.2%; 95% CI 5.2%-13.3%). Q fever seroprevalence for Australia was higher than expected (especially in metropolitan regions) and higher than estimates from the Netherlands (2.4%; pre-outbreak) and US (3.1%), but lower than for Northern Ireland (12.8%). Robust country-specific seroprevalence estimates, with detailed exposure data, are required to better understand who is at risk and the need for preventive measures.


Assuntos
Anticorpos Antibacterianos/sangue , Coxiella burnetii/imunologia , Febre Q/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Austrália/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Imunoglobulina G/sangue , Lactente , Masculino , Pessoa de Meia-Idade , Grupos Populacionais , Estudos Soroepidemiológicos , Inquéritos e Questionários , Adulto Jovem
15.
Int J Equity Health ; 19(1): 18, 2020 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005120

RESUMO

BACKGROUND: Equitable access to services that promote health and wellbeing is an important component of social justice. A community-engaged participatory qualitative study was conducted in Flint, Michigan, USA, to understand the needs of special populations (young women, perinatal women and new mothers, older women, women with disabilities, and LGBTQIA women) and elicit their ideas about solutions. METHODS: In-depth interviews (n = 100) were conducted. Participants were either women living in the Flint area, human service providers in the area, or both. A team of community and academic coders analyzed the data using an a priori framework. RESULTS: Participants identified needs of different groups of women and suggested ways to address them. Access to healthy food, reducing healthcare costs, and improving transportation, job opportunities and affordable quality housing were crosscutting themes across all groups of women. Mentoring support was said to protect vulnerable young women from the risk of human trafficking. Older women were said to gain a sense of purpose, build their social support and reduce their loneliness by engaging in mentoring younger women. Women with disabilities were reported to benefit from infrastructure accessibility and authentic inclusion in all areas of life. Providing help that considers their dignity, pride and self-worth were suggested. LGBTQIA women were reported to have housing needs due to discrimination; mostly turned down as renters and can be rejected from faith-based homeless shelters. LGBTQIA women would also benefit from increased sensitivity among healthcare providers. For all groups of women, streamlining access to social services and other resources, building social support networks and increasing awareness about existing resources were recommended. CONCLUSION: Efforts directed towards improving women's health and wellbeing should include perspectives and suggestions of diverse groups of women from the community. Acting on suggestions that emanate from the community's lived experiences may reduce inequalities in health and wellbeing.


Assuntos
Acesso aos Serviços de Saúde , Determinação de Necessidades de Cuidados de Saúde , Grupos Populacionais/estatística & dados numéricos , Saúde da Mulher , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Participação da Comunidade , Feminino , Humanos , Michigan , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Fatores Socioeconômicos , Adulto Jovem
16.
Gene ; 737: 144408, 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32007583

RESUMO

The pharmacogenomics has lately become a focal field of research that investigates the influence of genetic variations of drug-metabolizing enzymes and their receptors and downstream proteins on the interindividual variability in response to medications and adverse drug reactions. Therefore, it is significantly important to study and analyze the variations in drug response between different ethnic groups and populations. The current study aimed to detect the distribution of the genotype and allele frequencies in several very important pharmacogenetic (VIP) gene polymorphisms in the Jordanian population of Arab descent. This study involved 500 unrelated Jordanian individuals of Arab descent. A total of 65 VIP variants located within 33 candidate genes were randomly selected from the PharmGKB database and genotyped using the MassARRAY (iPLEX GOLD) system. The chi-square test was used to evaluate the significant differences of minor allele and genotype frequencies between the Jordanian and other populations including CHE, ASW, CEU, CHB, CDX, GIH, GBR, JPT, LWK, MXL, TSI, YRI, CAR, and ACB. This study revealed six variants were not in Hardy Weinberg equilibrium (HWE) (P-value > 0.05) and ten SNPs showed monomorphic features. Most of the remaining forty-nine variant frequencies were significantly different from the compared ethnic groups (P-value < 0.05). The results of this study may be helpful to develop safer treatment by applying the concept of personalized medicine based on the profile of VIP pharmacogene variants of the Jordanian population of Arab descent.


Assuntos
Árabes/genética , Variantes Farmacogenômicos , Polimorfismo de Nucleotídeo Único , Grupos Populacionais/genética , Frequência do Gene , Humanos , Jordânia
18.
BMC Public Health ; 20(1): 197, 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32028923

RESUMO

BACKGROUND: Traditionally, most Western models of health viewed sickness and disease as a product of individual factors such as personal behaviors and genetic predisposition; consequently, healthcare interventions were largely focused on fixing the individual, with little attention placed on contributing external factors. The WHO's "Social Determinants of Health" (SDH) framework, however, takes a broader ecological perspective that suggests that interventions must occur at multiple levels in order for good health to be achieved on an equitable basis. This model views health as a function of many circumstantial and environmental factors that are continuously and simultaneously interacting across multiple domains. These factors include structural mechanisms, such as laws and policies; socio-economic conditions, such as education and occupation; and intermediary circumstances, such as living and working conditions. Utilizing the SDH framework as a guide, this qualitative study sought to identify which specific determinants are most significant and present the greatest risk to the health and well-being of the Urak Lawoi' (UL), a "sea nomad" group indigenous to southern Thailand. METHODS: Interviews, household surveys, and focus group discussions were utilized to gather primary data from 71 subjects in three different UL communities in southern Thailand. In addition, a comprehensive literature review of relevant international mechanisms, national laws, and national policies was conducted. All data collected was analyzed and coded utilizing HyperRESEARCH. RESULTS: In all three communities, education and livelihoods were found to be the most critical determinants. Additionally, land grabbing and living conditions were identified as dire issues on Ko Lipe. The law and policy review revealed several deviations between international mechanisms and national laws and policies in both enshrinement and enforcement, with the Royal Thai Government (RTG) often overlooking the interests of the UL when formulating laws and policies. CONCLUSIONS: The above-mentioned determinants, along other structural and intermediary determinants, are synergizing, thereby placing the UL at increased risk of poorer health and health outcomes compared to other Thais living in the same vicinities. To rectify this, the RTG must reform national laws and policies that harm the UL, and civil society must hold them accountable. Several recommendations are offered to achieve a better future for the Urak Lawoi'.


Assuntos
Grupos Populacionais/estatística & dados numéricos , Determinantes Sociais da Saúde , Adolescente , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores Socioeconômicos , Inquéritos e Questionários , Tailândia , Adulto Jovem
19.
Am J Hum Genet ; 106(3): 303-314, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32059761

RESUMO

Disease risk varies significantly between ethnic groups, however, the clinical significance and implications of these observations are poorly understood. Investigating ethnic differences within the human proteome may shed light on the impact of ancestry on disease risk. We used admixture mapping to explore the impact of genetic ancestry on 237 cardiometabolic biomarkers in 2,216 Latin Americans within the Outcomes Reduction with an Initial Glargine Intervention (ORIGIN) study. We developed a variance component model in order to determine the proportion of variance explained by inter-ancestry differences, and we applied it to the biomarker panel. Multivariable linear regression was used to identify and localize genetic loci affecting biomarker variability between ethnicities. Variance component analysis revealed that 5% of biomarkers were significantly impacted by genetic admixture (p < 0.05/237), including C-peptide, apolipoprotein-E, and intercellular adhesion molecule 1. We also identified 46 regional associations across 40 different biomarkers (p < 1.13 × 10-6). An independent analysis revealed that 34 of these 46 regions were associated at genome-wide significance (p < 5 × 10-8) with their respective biomarker in either Europeans or Latin populations. Additional analyses revealed that an admixture mapping signal associated with increased C-peptide levels was also associated with an increase in diabetes risk (odds ratio [OR] = 6.07 per SD, 95% confidence interval [CI] 1.44 to 25.56, p = 0.01) and surrogate measures of insulin resistance. Our results demonstrate the impact of ancestry on biomarker levels, suggesting that some of the observed differences in disease prevalence have a biological basis, and that reference intervals for those biomarkers should be tailored to ancestry. Specifically, our results point to a strong role of ancestry in insulin resistance and diabetes risk.


Assuntos
Proteínas Sanguíneas/genética , Grupos Populacionais/genética , Proteoma , Biomarcadores/metabolismo , Humanos
20.
BMC Public Health ; 20(1): 139, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32000738

RESUMO

BACKGROUND: Indigenous people in the United States are at high risk for diabetes. Psychosocial stressors like historical trauma may impede success in diabetes prevention programs. METHODS: A comparative effectiveness trial compared a culturally tailored diabetes prevention program (standard group) with an enhanced one that addressed psychosocial stressors (enhanced group) in 2015 to 2017. Participants were 207 Indigenous adults with a body mass index (BMI) of ≥30 and one additional criterion of metabolic syndrome, and were randomized to the standard or enhanced group. Both groups received a culturally tailored behavioral diabetes prevention program. Strategies to address psychosocial stressors were provided to the enhanced group only. Change in BMI over 12 months was the primary outcome. Secondary outcomes included change in quality of life, and clinical, behavioral, and psychosocial measures at 6 and 12 months. RESULTS: The two groups did not significantly differ in BMI change at 12 months. The two groups also did not differ in any secondary outcomes at 6 or 12 months, with the exception of unhealthy food consumption; the standard group reported a larger mean decrease (95% CI) in consumption of unhealthy food compared with the enhanced group (- 4.6 [- 6.8, - 2.5] vs. -0.7 [- 2.9, 1.4], p = 0.01). At 6 months, significant improvements in weight and the physical component of the quality of life measure were observed for both groups compared with their baseline level. Compared with baseline, at 12 months, the standard group showed significant improvement in BMI (mean [95% CI], - 0.5 [- 1.0, - 0.1]) and the enhanced group showed significant improvement in the physical component of the quality of life (2.9 [0.7, 5.2]). CONCLUSIONS: Adding strategies to address psychosocial barriers to a culturally tailored diabetes prevention program was not successful for improving weight loss among urban Indigenous adults. TRIAL REGISTRATION: (if applicable): NCT02266576. Registered October 17, 2014 on clinicaltrials.gov. The trial was prospectively registered.


Assuntos
Diabetes Mellitus/prevenção & controle , Grupos Populacionais , População Urbana , Adulto , Idoso , Assistência à Saúde Culturalmente Competente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Populacionais/psicologia , Grupos Populacionais/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Psicologia , Estados Unidos , População Urbana/estatística & dados numéricos
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