Participatory action research to develop and implement multicomponent, multilevel strategies for implementing colorectal cancer screening interventions in American Indian communities in New Mexico.

BACKGROUND: Despite the effectiveness of colorectal cancer (CRC) screening, American Indians (AIs) have low screening rates in the US. Many AIs receive care at Indian Health Services, Tribal, and Urban Indian (I/T/U) healthcare facilities, where published evidence regarding the implementation of CRC screening interventions is lacking. To address this gap, the University of New Mexico Comprehensive Cancer Center and the Albuquerque Area Southwest Tribal Epidemiology Center collaborated with two tribally-operated healthcare facilities in New Mexico with the goal of improving CRC screening rates among New Mexico's AI communities. METHODS: Guided by the principles of Community Based Participatory Research, we engaged providers from the two tribal healthcare facilities and tribal community members through focus group (two focus groups with providers (n = 15) and four focus group and listening sessions with community members (n = 65)), to elicit perspectives on the feasibility and appropriateness of implementing The Guide to Community Preventive Services (The Community Guide) recommended evidence-based interventions (EBIs) and strategies for increasing CRC screening. Within each tribal healthcare facility, we engaged a Multisector Action Team (MAT) that participated in an implementation survey to document the extent to which their healthcare facilities were implementing EBIs and strategies, and an organizational readiness survey that queried whether their healthcare facilities could implement additional strategies to improve uptake of CRC screening. RESULTS: The Community Guide recommended EBIs and strategies that received the most support as feasible and appropriate from community members included: one-on-one education from providers, reminders, small media, and interventions that reduced structural barriers. From the providers' perspective, feasible and acceptable strategies included one-on-one education, patient and provider reminders, and provider assessment and feedback. Universally, providers mentioned the need for patient navigators who could provide culturally appropriate education about CRC and assist with transportation, and improved support for coordinating clinical follow-up after screening. The readiness survey highlighted overall readiness of the tribal facility, while the implementation survey highlighted that few strategies were being implemented. CONCLUSIONS: Findings from this study contribute to the limited literature around implementation research at tribal healthcare facilities and informed the selection of specific implementation strategies to promote the uptake of CRC screening in AI communities.

Ethnic differences in hepatitis A and E virus seroprevalence in patients attending the Emergency Department, Paramaribo, Suriname.

BACKGROUND: Hepatitis A virus (HAV) and hepatitis E virus (HEV) have enteric modes of transmission and are common causes of acute hepatitis in low- and middle-income countries. HEV is also characterised as a zoonotic infection and is prevalent in high-income countries. Data on HAV and HEV prevalence in Suriname, a middle-income country in South America, are scarce. METHODS: Serum samples of 944 and 949 randomly selected patients attending the Emergency Department at the Academic Hospital of Paramaribo, the capital of Suriname, were analysed for anti-HAV antibodies (anti-HAV) and anti-HEV antibodies (anti-HEV), respectively. Determinants of anti-HAV and anti-HEV positive serology were evaluated using multivariable logistic regression. RESULTS: Anti-HAV prevalence was 58.3% (95% CI 55.4 to 61.4%) and higher prevalence was independently associated with belonging to the Tribal or Indigenous population and older age. Anti-HEV prevalence was 3.7% (95% CI 2.6 to 5.0%) and higher prevalence was associated with Tribal and Creole ethnicity and older age. CONCLUSIONS: In Suriname, exposure to HAV is consistent with a very low endemic country and exposure to HEV was rare. Both viruses were more prevalent in specific ethnic groups. As anti-HAVantibodies were less frequently found in younger individuals, they could be susceptible to potential HAV outbreaks and might require HAV vaccination.

Escuela multinivel en contexto indígena: fortalezas, limitaciones y desafíos desde la perspectiva de los profesores en La Araucanía

El artículo expone las principales fortalezas, limitaciones y desafíos de la escuela multinivel en contexto indígena, desde las voces de los profesores en La Araucanía (Chile). La metodología es cualitativa, se aplicaron seis entrevistas semiestructuradas a profesores; la técnica de análisis de la información es el análisis de contenido en complementariedad con la teoría fundamentada. Los resultados revelan la persistencia de prejuicios hacia la familia indígena, el desconocimiento de los profesores sobre los saberes locales y la carencia de competencias para desarrollar una educación en perspectiva intercultural. Se concluye la necesidad de vinculación y diálogo entre escuela-familia-comunidad, lo que permita la revitalización de la identidad sociocultural en los procesos de enseñanza y aprendizaje.

O artigo expõe as principais fortalezas, limitações e desafios da escola multinível em um contexto indígena, a partir das vozes de professores em La Araucanía, Chile. A metodologia é qualitativa, foram aplicadas seis entrevistas semiestruturadas, a técnica de análise da informação é a análise de conteúdo em complementaridade com a teoria fundamentada. Os resultados revelam a persistência de preconceitos em relação à família indígena, o desconhecimento dos professores sobre os saberes locais e a carência de competências para desenvolver uma educação com perspectiva intercultural. Concluímos sobre a necessidade de articulação e diálogo entre escola-família-comunidade, que permita a revitalização da identidade sociocultural nos processos de ensino e aprendizagem.

The article presents the main strengths, limitations and challenges of multilevel schools in an indigenous context, from the voices of teachers in La Araucanía, Chile. The methodology is qualitative and involved six semi-structured interviews with teachers. The technique for analyzing the information is content analysis in conjunction with grounded theory. The results reveal the persistence of prejudices towards indigenous families, the teachers' lack of knowledge about local ways of knowing and the lack of competencies to develop education in an intercultural perspective. We conclude that there is a need for engagement and dialogue between the school, family and community, which would enable a revitalization of the socio-cultural identity in the teaching and learning processes.

Insight into the antioxidant activities of ten Fabaceae plant species that are medicinally used by the Aucan Tribal Peoples from the Republic of Suriname (South America).

Fabaceae are associated with a high antioxidant activity (AA) and a high total phenolic (TPC), total flavonoid (TFC), and selenium content (SeC). In this study, the aqueous extracts from ten Fabaceae species that are medicinally used by the Aucan Tribal Peoples from Suriname (South America), were evaluated for AA using a DPPH and a FRAP assay, and for TPC, TFC, and SeC using Folin-Ciocalteu's, an AlCl3 colorimetric, and an azure B-based method. Associations between pairs of these variables were determined by Pearson correlation coefficient. One-way ANOVA with post-hoc Tukey's test was used to evaluate the data for statistically significant differences (p < 0.05). The I. stipularis (bark), C. guyanensis (bark), A. jupunba (twigs), and M. urens (fruit) extracts had the highest DPPH IC50 values (36 - 70 µg/mL) and FRAP values (346 - 573 µM FeE/100 µg) and the highest TPC (25 - 41 GAEq/100 µg), TFC (21 - 39 REq/100 µg), and SeC (4 -17 µg/g). The values for the T. indica (leaf), P. macroloba (bark), M. pigra (whole plant), S. quinquangulata (leaf), A. sensitiva (whole plant), and L. leucocephala (leaf) extracts were > 10-fold lower. AA, TPC, TFC, and SeC correlated well with each other (correlation coefficient ≥ 0.83, p ≤ 0.0030). Thus, AA, TPC, TFC, and SeC may represent important determinants of the health benefits of the former four samples but not of the others. Future studies should focus on the precise contribution of AA, TPC, TFC, and SeC to the therapeutic value of medicinal Fabaceae.

Toward Inclusive Landscape Governance in Contested Landscapes: Exploring the Contribution of Participatory Tools in the Upper Suriname River Basin.

Nowadays, tropical forest landscapes are commonly characterized by a multitude of interacting institutions and actors with competing land-use interests. In these settings, indigenous and tribal communities are often marginalized in landscape-level decision making. Inclusive landscape governance inherently integrates diverse knowledge systems, including those of indigenous and tribal communities. Increasingly, geo-information tools are recognized as appropriate tools to integrate diverse interests and legitimize the voices, values, and knowledge of indigenous and tribal communities in landscape governance. In this paper, we present the contribution of the integrated application of three participatory geo-information tools to inclusive landscape governance in the Upper Suriname River Basin in Suriname: (i) Participatory 3-Dimensional Modelling, (ii) the Trade-off! game, and (iii) participatory scenario planning. The participatory 3-dimensional modelling enabled easy participation of community members, documentation of traditional, tacit knowledge and social learning. The Trade-off! game stimulated capacity building and understanding of land-use trade-offs. The participatory scenario planning exercise helped landscape actors to reflect on their own and others' desired futures while building consensus. Our results emphasize the importance of systematically considering tool attributes and key factors, such as facilitation, for participatory geo-information tools to be optimally used and fit with local contexts. The results also show how combining the tools helped to build momentum and led to diverse yet complementary insights, thereby demonstrating the benefits of integrating multiple tools to address inclusive landscape governance issues.

Association of Mercury Exposure and Maternal Sociodemographics on Birth Outcomes of Indigenous and Tribal Women in Suriname.

Information regarding adverse birth outcomes (ABO) of Indigenous and Tribal women living in the remote tropical rainforest of Suriname, where mercury (Hg) use is abundant in artisanal gold mining, is not available. In the context of a health system analysis, we examined the association between Hg exposure, maternal sociodemographics on the ABO of Indigenous and Tribal women living in Suriname's interior and its capital, Paramaribo. ABO were determined in pregnant women enrolled from December 2016 to July 2019 in the Caribbean Consortium for Environmental and Occupational Health prospective environmental epidemiologic cohort study. Associations were explored using Pearson's χ2-test and the Mann-Whitney U-test. Among 351 singleton participants, 32% were Indigenous, residing mainly in the interior (86.8%), and 23.1% had ABO. Indigenous participants had higher rates of ABO (29.8% vs. 19.8%) and preterm birth (PTB) (21.2% vs. 12.4%), higher Hg levels, delivered at a younger age, were less educated, and had lower household income compared to Tribal participants. Multivariate logistic regression models revealed that Indigenous participants had higher odds of ABO (OR = 3.60; 95% CI 1.70-7.63) and PTB (OR = 3.43; 95% CI 1.48-7.96) compared with Tribal participants, independent of Hg exposure and age at delivery. These results highlight the importance of effective risk reduction measures in support of Indigenous mothers, families, and communities.

Adequate antenatal care and ethnicity affect preterm birth in pregnant women living in the tropical rainforest of Suriname.

BACKGROUND: Adequate antenatal care (ANC) services are key for early identification of pregnancy related risk factors and maintaining women's health during pregnancy. This study aimed to assess the influence of ANC provided by the Medical Mission Primary Health Care Suriname (MMPHCS) and of ethnicity on adverse birth outcomes in Tribal and Indigenous women living in Suriname's remote tropical rainforest interior. METHOD: From April 2017 to December 2018 eligible Tribal and Indigenous women with a singleton pregnancy that received ANC from MMPHCS were included in the study. Data on low birth weight (LBW < 2500 g), preterm birth (PTB < 37 weeks), low Apgar score (< 7 at 5 min), parity (≤1 vs. > 1) and antenatal visits utilization (≥8 vs. < 8) in 15 interior communities were retrospectively analyzed using descriptive statistics, crosstabs and Fisher's exact tests. RESULTS: A total of 204 women were included, 100 (49%) were Tribal, mean age was 26 ± 7.2 years and 126 women (62%) had 8 or more ANC visits. One participant had a miscarriage; 22% had adverse birth outcomes: 16 (7.9%) LBW and 30 (14.8%) PTB; 7 women had a child with both PTB and LBW; 5 women had stillbirths. None of the newborns had low Apgar scores. Maternal age, ethnicity, ANC and parity were associated with PTB (χ2 = 8,75, p = 0.003, χ2 = 4,97, p = 0.025, χ2 = 17,45, p < 0.001, χ2 = 11,93, p < 0.001 respectively). CONCLUSION: Despite an almost 100% study adherence over one fifth of women that received ANC in the interior of Suriname had adverse birth outcomes, in particular PTB and LBW. Younger nulliparous Indigenous women with less than the recommended 8 ANC visits had a higher risk for PTB. The rate of adverse birth outcomes highlights the need for further research to better assess factors influencing perinatal outcomes and to put strategies in place to improve perinatal outcomes. Exposure assessment of this sub-cohort and neurodevelopment testing of their children is ongoing and will further inform on potential adverse health effects associated with environmental exposures including heavy metals such as mercury and lead.

Prenatal Mercury Exposure in Pregnant Women from Suriname's Interior and Its Effects on Birth Outcomes.

Prenatal mercury (Hg) exposure was determined in a sub-cohort of the Caribbean Consortium for Environmental and Occupational Health's environmental epidemiologic prospective cohort study of pregnant women living in Suriname's interior. The associations between Hg exposure, low birth weight (LBW, <2500 g) and preterm birth (PTB, <37 weeks) were explored. Correlation analysis, Fisher's exact test and logistic regression analyses were conducted to evaluate the associations between maternal hair Hg levels and birth weight, LBW and PTB, and between potential confounders, LBW and PTB, respectively. Among 204 singleton births were 198 live births, five stillbirths and one miscarriage. The mean participant age was 26 years; 15.7% of participants had PTBs and 8.1% delivered a child with a LBW. The median hair Hg level was 3.48 µg/g hair. Low hair Hg exposure, based on lowest tertile < 2.34 µg/g, was associated with LBW (OR = 7.2; 95% CI 1.5-35.6; p = 0.015); this association was independent of maternal age, ethnic background, household income and village location, and no correlation was found between hair Hg and PTB. Young maternal age was associated with PTB (RR = 5.09, 95% CI: 1.92-13.85; p = 0.0004) while maternal age was not associated with hair Hg or LBW. The impact of prenatal Hg exposure on pediatric neurodevelopment is currently being evaluated in the infant sub-cohort.

COVID-19 in New Mexico Tribal Lands: Understanding the Role of Social Vulnerabilities and Historical Racisms.

The Coronavirus 2019 (COVID-19) pandemic has disproportionally affected Indigenous Peoples. Unfortunately, there is no accurate understanding of COVID-19's impacts on Indigenous Peoples and communities due to systematic erasure of Indigenous representation in data. Early evidence suggests that COVID-19 has been able to spread through pre-pandemic mechanisms ranging from disproportionate chronic health conditions, inadequate access to healthcare, and poor living conditions stemming from structural inequalities. Using innovative data, we comprehensively investigate the impacts of COVID-19 on Indigenous Peoples in New Mexico at the zip code level. Specifically, we expand the U.S. Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) to include the measures of structural vulnerabilities from historical racisms against Indigenous Peoples. We found that historically-embedded structural vulnerabilities (e.g., Tribal land status and higher percentages of house units without telephone and complete plumbing) are critical in understanding the disproportionate burden of COVID-19 that American Indian and Alaska Native populations are experiencing. We found that historically-embedded vulnerability variables that emerged epistemologically from Indigenous knowledge had the largest explanatory power compared to other social vulnerability factors from SVI and COVID-19, especially Tribal land status. The findings demonstrate the critical need in public health to center Indigenous knowledge and methodologies in mitigating the deleterious impacts of COVID-19 on Indigenous Peoples and communities, specifically designing place-based mitigating strategies.

Sandfly species diversity in association with human activities in the Kani tribe settlements of the Western Ghats, Thiruvananthapuram, Kerala, India

Sandfly prevalence in the Kani tribe settlements of Western Ghats in India was investigated. A total of 1,279 sandflies comprising 17 species was obtained. Sandfly abundance showed a negative correlation (r = -0.97, p = 0.003) with increase in altitudinal ranges from 0-1,000 m. When sandfly samples were grouped according to landscape characteristics of the location, the estimated Shannon-Weiner index (H) and species richness index (S) were high and species evenness index (J) was low in settlements located at 0-300 m altitudinal range. On the contrary, the values of H and J were high, while S was low at 301-600 m altitudinal range. With further increase in altitude, species diversity, S and J were low. Though the relative abundance of sandflies decreased with increase in altitude, the influence of altitudinal variation could not be attributed to determine sandfly diversity, since the number of sampling units were not uniform at all the altitudinal gradients due to nonavailability of suitable resting shelters. Sandfly species showed great aggregation at 0-300 m altitude interval, where not only the number of settlements were maximum (n = 19), but also the environmental conditions favoured sandfly abundance due to the concentration of tribal settlements, human dwellings and his activities.

Anotações sobre a aplicação da Convenção 169 da OIT sobre povos indígenas por tribunais da América Latina / Notes on the implementation by Latin American countries of the ILO Convention 169 in indigenous peoples / Apuentes sobre la aplicación del Convenio 169 de la OIT sobre pueblos indígenas por los tribunales de América Latina

O artigo apresenta alguns casos emblemáticos da aplicação da Convenção 169 da Organização Internacional do Trabalho sobre Povos Indígenas e Tribais em Países Independentes por tribunais da América Latina. O trabalho discute um número reduzido de casos sobre temas diversos e que representam diferentes países da região; bem como o tribunal regional de direitos humanos - a Corte Interamericana de Direitos Humanos. Os casos selecionados foram aqueles que apresentaram perspectivas particularmente interessantes com relação à temática abordada, inovação em sua interpretação ou relevância de suas consequências. Antes de apresentar os casos, entretanto, exponho alguns esclarecimentos que podem ser úteis para a compreensão do material selecionado e o contexto no qual estes casos estão inseridos.

This article presents some cases that are emblematic of the application of the International Labour Organisation's Convention 169 concerning Indigenous and Tribal Peoples in Independent Countries, by courts of Latin America. It discusses: a limited number of cases that cover various topics and represent the distinct countries of the region; and the regional court of human rights - the Inter-American Court of Human Rights. These cases are highlighted either according to their subject, by the innovative insight they offer, or by the relevance of their consequences. Before outlining these cases, however, some clarifications are presented which might be useful in explaining the material set forth below and the context in which the material should be situated.

Este trabajo presenta algunos casos emblemáticos de aplicación del Convenio 169 de la Organización Internacional del Trabajo sobre Pueblos Indígenas y Tribales en Países Independientes por Tribunales de América Latina. Discute un número reducido de casos que cubren temas diversos, y representan a distintos países de la región, y al tribunal regional de derechos humanos -la Corte Interamericana de Derechos Humanos y se destacan por su temática, por lo novedoso de la interpretación que ofrecen o por la relevancia de sus consecuencias. Antes de reseñar los casos, se efectúan algunas aclaraciones previas que pueden ser útiles para explicar el material que aquí se expone, y el contexto en el que debe situarse.