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1.
Aust J Prim Health ; 302024 Apr.
Article in English | MEDLINE | ID: mdl-38621019

ABSTRACT

Background Many healthcare professionals and services strive to improve cultural safety of care for Australia's First Nations people. However, they work within established systems and structures that do not reliably meet diverse health care needs nor reflect culturally safe paradigms. Journey mapping approaches can improve understanding of patient/client healthcare priorities and care delivery challenges from healthcare professionals' perspectives leading to improved responses that address discriminatory practices and institutional racism. This project aimed to review accessibility and usability of the existing Managing Two Worlds Together (MTWT) patient journey mapping tools and resources, and develop new Health Journey Mapping (HJM) tools and resources. Method Four repeated cycles of collaborative participatory action research were undertaken using repeated cycles of look and listen, think and discuss, take action together. A literature search and survey were conducted to review accessibility and usability of MTWT tools and resources. First Nations patients and families, and First Nations and non-First Nations researchers, hospital and university educators and healthcare professionals (end users), reviewed and tested HJM prototypes, shaping design, format and focus. Results The MTWT tool and resources have been used across multiple health care, research and education settings. However, many users experienced initial difficulty engaging with the tool and offered suggested improvements in design and usability. End user feedback on HJM prototypes identified the need for three distinct mapping tools for three different purposes: clinical care, detailed care planning and strategic mapping, to be accompanied by comprehensive resource materials, instructional guides, videos and case study examples. These were linked to continuous quality improvement and accreditation standards to enhance uptake in healthcare settings. Conclusion The new HJM tools and resources effectively map diverse journeys and assist recognition and application of strengths-based, holistic and culturally safe approaches to health care.


Subject(s)
Delivery of Health Care , Indigenous Peoples , Humans , Hospitals , Patients , Quality Improvement
2.
JAMA Netw Open ; 7(4): e246805, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38625702

ABSTRACT

Importance: Genetic researchers must have access to databases populated with data from diverse ancestral groups to ensure research is generalizable or targeted for historically excluded communities. Objective: To determine genetic researchers' interest in doing research with diverse ancestral populations, which database stewards offer adequate samples, and additional facilitators for use of diverse ancestral data. Design, Setting, and Participants: This survey study was conducted from June to December 2022 and was part of an exploratory sequential mixed-methods project in which previous qualitative results informed survey design. Eligible participants included genetic researchers who held US academic affiliations and conducted research using human genetic databases. Exposure: Internet-administered survey to genetic research professionals. Main Outcomes and Measures: The survey assessed respondents' experience and interest in research with diverse ancestral data, perceptions of adequacy of diverse data across database stewards (ie, private, government, or consortia), and identified facilitators for encouraging use of diverse ancestral data. Descriptive statistics, χ2 tests, and z tests were used to describe respondents' perspectives and experiences. Results: A total of 294 researchers (171 men [58.5%]; 121 women [41.2%]) were included in the study, resulting in a response rate of 20.4%. Across seniority level, 109 respondents (37.1%) were senior researchers, 85 (28.9%) were mid-level researchers, 71 (24.1%) were junior researchers, and 27 (9.2%) were trainees. Significantly more respondents worked with data from European ancestral populations (261 respondents [88.8%]) compared with any other ancestral population. Respondents who had not done research with Indigenous ancestral groups (210 respondents [71.4%]) were significantly more likely to report interest in doing so than not (121 respondents [41.2%] vs 89 respondents [30.3%]; P < .001). Respondents reported discrepancies in the adequacy of ancestral populations with significantly more reporting European samples as adequate across consortium (203 respondents [90.6%]), government (200 respondents [89.7%]), and private (42 respondents [80.8%]) databases, compared with any other ancestral population. There were no significant differences in reported adequacy of ancestral populations across database stewards. A majority of respondents without access to adequate diverse samples reported that increasing the ancestral diversity of existing databases (201 respondents [68.4%]) and increasing access to databases that are already diverse (166 respondents [56.5%]) would increase the likelihood of them using a more diverse sample. Conclusions and Relevance: In this survey study of US genetic researchers, respondents reported existing databases only provide adequate ancestral samples for European populations, despite their interest in other ancestral populations. These findings suggest there are specific gaps in access to and composition of genetic databases, highlighting the urgent need to boost diversity in research samples to improve inclusivity in genetic research practices.


Subject(s)
Government , Indigenous Peoples , Male , Humans , Female , Databases, Factual , Internet , Probability
3.
Hawaii J Health Soc Welf ; 83(4): 108-112, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38585290

ABSTRACT

Purpose is an important construct across contexts and cultures, with evidence suggesting it is strongly related to health, health behaviors, discrimination, and experiences of trauma. In this narrative review of the research on purpose in Hawai'i, the authors identify, critically analyze, and synthesize the extant literature found through a comprehensive literature search. It then discusses important cultural considerations for engaging in purpose research in Hawai'i, broadly, and with the Indigenous people of Hawai'i (Kanaka Maoli). The review presents findings on how sense of purpose levels differ between Hawai'i and the continental United States and risk factors or strengths critical in shaping the development of purpose in Hawai'i. Potential future directions for this line of inquiry conclude this review, with a particular emphasis on the need for integration of Kanaka Maoli ontology and values.


Subject(s)
Health Behavior , Indigenous Peoples , Humans , United States , Hawaii , Risk Factors
4.
Nurs Leadersh (Tor Ont) ; 36(3): 70-77, 2024 Jan.
Article in English | MEDLINE | ID: mdl-38545749

ABSTRACT

Health inequity among Indigenous populations continues to widen despite advances in Indigenous health research. Under Canada's esteemed universal healthcare system, Indigenous populations continue to experience much poorer health outcomes due to the intersectional legacies of colonialism and racism. In this commentary, we reflect on structural, systemic and service delivery racism at all levels of care, which are deeply embedded in historical, political, institutional and socioeconomic policies and practices that continue to perpetuate harm and genocide of Indigenous Peoples. We call for immediate action to re-establishing epistemic justice and reframing Indigenous knowledge systems in nursing practices, policies, research and education as the starting point in counteracting systemic racism.


Subject(s)
Indigenous Peoples , Violence , Humans
5.
Scand J Pain ; 24(1)2024 Jan 01.
Article in English | MEDLINE | ID: mdl-38497253

ABSTRACT

BACKGROUND: Low back pain (LBP) represents a worldwide burden with rising disability, especially in low- and middle-income countries. Indigenous Peoples are exposed to many risk factors for LBP and seem to have overall worse health and higher mortality compared to non-Indigenous. This article aims to provide a topical overview of LBP in Indigenous Peoples. METHODS: A comprehensive search was done using the keywords "Indigenous" and "back pain." Secondly, a cross-reference search of the citations list of the included articles was conducted. RESULTS: LBP is a prevalent, disabling health condition among Indigenous Peoples that impacts activities of daily living, emotional well-being, and cultural identity. Indigenous Peoples face numerous and unique barriers to obtain Western health care. LBP in Indigenous Peoples is partly iatrogenic and available health care lacks a culturally secure setting. In combination with racism and discrimination by health care providers, this leads to miscommunication, frustration, and poor outcome in Indigenous patients around the world. CONCLUSION: Contextual considerations and interpretation of findings within the appropriate cultural context are needed in future research and treatment of LBP in Indigenous Peoples. However, our literature analysis exhibits disproportionate representation with the scarcity of studies of Indigenous Peoples of Asia and Africa. Addressing this gap in the literature could provide significant scientific value. Indigenous Peoples should not be forgotten in reducing the global burden for LBP.


Subject(s)
Low Back Pain , Humans , Low Back Pain/therapy , Activities of Daily Living , Risk Factors , Indigenous Peoples
6.
Glob Public Health ; 19(1): 2329210, 2024 Jan.
Article in English | MEDLINE | ID: mdl-38502923

ABSTRACT

Amazonian Indigenous Peoples are undergoing drastic changes in their ways of life including the quality and availability of food and its impact on their health and well-being. Indigenous populations have their own perspectives and interpretations of dietary changes unfolding in their communities. Based on in-depth interviews, observations and validation workshops we explored the way Awajún describe and problematise the concept of healthy and unhealthy food in the context of the nutrition transition. We learn that the characteristics of 'good food' are informed by their capacity to give strength, protect health and enable them to be hardworking people. On the contrary, food that comes from the city weakens the body and may result in health problems. For the Awajún, chicken with hormones, fish preserved in cans, and powdered milk negatively affect their health. We argue that the dichotomy 'healthy' and 'unhealthy' used to classify food provides information not only about Indigenous conceptualisations of health and die, but is also a critique of broader structural processes affecting their well-being. The terms, explanations and idioms used by the Awajún to talk about food, provide an insight into Indigenous perspectives and knowledge key to informing global health interventions in culturally appropriate ways.


Subject(s)
Food , Nutritional Status , Animals , Humans , Health Status , Indigenous Peoples , Food Supply
7.
Rev Bras Enferm ; 77Suppl 3(Suppl 3): e20230253, 2024.
Article in English, Portuguese | MEDLINE | ID: mdl-38477815

ABSTRACT

OBJECTIVE: To evaluate the need to develop an application with information about the measles vaccine for Warao indigenous people. METHODS: This was a quantitative study conducted at the Espaço de Acolhimento Tapanã refugee shelter in the city of Belém, Pará, Brazil. The study sample was selected for convenience. Data were analyzed descriptively using Bioestat 5.0 software. RESULTS: Twenty-one Warao indigenous individuals were interviewed. It was identified that 91% (n=20) had lost their vaccination card; 91% (n=20) stated they had lost their vaccination card more than three times, and 91% expressed interest in an application to store their vaccination information. CONCLUSIONS: The research provided important information for the development of a health application named WaraoMedI (Warao Measles Diversity Indigenous), as well as offered nursing professionals evidence about the challenges Warao indigenous refugees face in self-managing their vaccination information.


Subject(s)
Cardiology , Refugees , Humans , Measles Vaccine , Brazil , Indigenous Peoples
8.
Int J Qual Stud Health Well-being ; 19(1): 2321646, 2024 Dec.
Article in English | MEDLINE | ID: mdl-38437516

ABSTRACT

PURPOSE: Well-being is a complex, multi-dimensional, dynamic, and evolving concept, covering social, economic, health, cultural and spiritual dimensions of human living, and often used synonymously with happiness, life satisfaction, prosperity, and quality of life. We review the existing key wellbeing frameworks applied in Australia both for the wider public and Indigenous peoples. The aim is to provide a comprehensive overview of various applied frameworks, along with a critical analysis of domains or dimensions comprising those frameworks, and to analyse the role of nature in those frameworks. METHODOLOGY: We conducted a critical analysis of the main frameworks applied in Australia to date to measure the well-being of the mainstream (mainly non-Indigenous) and Indigenous populations. This study is particularly timely given the Australian Government's interest in revising the well-being frameworks as mentioned in the Government "Measuring What Matters" statement. RESULTS: The existing well-being frameworks in Australia either overlook or hardly consider the role of nature and its services which are important to support human well-being. Likewise, for Indigenous peoples "Country" (Indigenous clan land) is vital for their well-being as their living is imbued with "Country". The role of nature/"Country" needs to be considered in revising the well-being frameworks, indicators and measures to inform and develop appropriate policies and programs in Australia. CONCLUSION: To develop appropriate welfare policies and programs for achieving socio-economic and other wellbeing outcomes, it is essential to evolve and conceptualize wellbeing frameworks (and related indicators and measures) in line with people's contemporary values, particularly considering the role of nature and its services.


Subject(s)
Indigenous Peoples , Quality of Life , Humans , Australia , Happiness , Personal Satisfaction
9.
BMJ Open ; 14(3): e071504, 2024 Mar 05.
Article in English | MEDLINE | ID: mdl-38448060

ABSTRACT

OBJECTIVES: Self-medication with antibiotics (SMA) contributes significantly to the emergence of antimicrobial resistance (AMR), especially in low-income countries including Bangladesh. This study aimed to generate evidence on the self-reported prevalence of antibiotic self-medication and its determinants among indigenous people residing in Bangladesh's Chittagong Hill Tracts (CHT) districts. DESIGN: This study used a cross-sectional design with data collected through a survey using a semi-structured questionnaire. SETTING: This study was conducted from late January to early July 2021; among different indigenous group populations aged 18 years or more olders residing in the three districts of CHT. PARTICIPANTS: A total of 1336 indigenous people residing in Bangladesh's CHT districts were included. PRIMARY OUTCOME AND EXPLANATORY VARIABLES: The primary outcome measure was SMA while explanatory variables were socio-demographic characteristics, health status of participants, and knowledge of antibiotics usage and its side effects. RESULTS: Among the study participants, more males (60.54%) than females (51.57%) reported using antibiotics. The SMA rate was high among individuals with education levels below secondary (over 50%) and those in the low-income group (55.19%). The most common diseases reported were cough, cold and fever, with azithromycin being the most frequently used antibiotic. Levels of education, family income, having a chronic illness and place of residence were found to be the significant predictors of having good knowledge of antibiotic use as found in the ordered logit model. Findings from a logistic regression model revealed that men had 1.6 times higher odds (adjusted OR (AOR) 1.57; 95% CI 1.12 to 2.19) of SMA than women. Participants with ≥US$893 per month family income had lowest odds (AOR 0.14; 95% CI 0.03 to 0.64) of SMA than those who earned

Subject(s)
Anti-Bacterial Agents , Indigenous Peoples , Humans , Female , Male , Anti-Bacterial Agents/therapeutic use , Cross-Sectional Studies , Bangladesh , Prevalence
10.
Article in English | MEDLINE | ID: mdl-38541290

ABSTRACT

Indigenous peoples globally experience a high burden of type 2 diabetes in comparison to non-Indigenous peoples. While community-based exercise interventions designed for type 2 diabetes (T2D) management have garnered success in non-Indigenous populations, they likely require adjustments to meet the needs of Indigenous people. This systematic review aims to determine if health outcomes in Indigenous peoples with T2D could be improved by community-based exercise programmes and the features of those programmes that best meet their needs. The CINAHL, Embase, Informit Indigenous Collection, Medline, PubMed, Scopus, SportDiscus, and Web of Science databases have been searched to identify peer-reviewed literature with original outcome data that report on the health effects of community-based exercise interventions for the management of T2D among Indigenous peoples. The Mixed Methods Appraisal Tool and Indigenous Community Engagement Tool were implemented to assess methodological quality. Three moderate-to-high-quality studies were selected for review, including participants of Polynesian or Native American Zuni Indian descent. Results indicated positive effects of group exercise on glycated haemoglobin (HbA1c), body mass index, body weight, total cholesterol, blood pressure, quality of life, and patient activation levels in high-adhering participants. This review concludes that community-based exercise interventions may improve health outcomes for Indigenous adults with T2D when conducted with strong community engagement.


Subject(s)
Diabetes Mellitus, Type 2 , Indigenous Peoples , Humans , Diabetes Mellitus, Type 2/therapy , Outcome Assessment, Health Care , Quality of Life
11.
Article in English | MEDLINE | ID: mdl-38541310

ABSTRACT

Child sexual abuse is a form of violence that occurs across nations and cultures. Collective efforts are being made to address this issue within many Indigenous communities. In Australia, Aboriginal and Torres Strait Islander communities have expressed the need for cultural models of healing child sexual abuse. A preliminary exploration of the relevant literature shows a lack of synthesis with regard to the current evidence base. This protocol outlines the methods and background for a scoping review that aims to explore and collate the broad scope of literature related to healing from child sexual abuse within an Indigenous context. The proposed review utilises a 'population, concept, and context structure' from the Joanna Briggs Institute to explore the broad scope of the literature within a scoping review framework. The target population is Indigenous survivors of child sexual abuse, including Indigenous populations from six distinct regions: Aboriginal and Torres Strait Islander peoples from Australia; Maori peoples from Aotearoa (New Zealand); First Nations, Inuit and Métis peoples from Canada; Native American peoples from North America; Native peoples from Alaska; and the Sámi peoples of the Sápmi region in Northern Europe. The concept within the review is healing from an Indigenous perspective, which includes a broad range of processes related to both recovery and personal growth. The contexts explored within this review are any context in which healing from child sexual abuse can occur. This may include processes related to disclosure and accessing services, specific interventions or programs for survivors of child sexual abuse, as well as broader non-specific healing programs and personal experiences of healing without intervention. The scoping review will use search strings with broad inclusion and exclusion criteria to capture the potential breadth of perspectives. The search will be conducted across several academic databases and will also include an extensive search for grey literature. This protocol establishes the proposed benefits of this scoping review.


Subject(s)
Child Abuse, Sexual , Health Services, Indigenous , Indigenous Peoples , Child , Humans , Canada , Maori People , North America , Australian Aboriginal and Torres Strait Islander Peoples , Indigenous Canadians , American Indian or Alaska Native
12.
Article in English | MEDLINE | ID: mdl-38541344

ABSTRACT

BACKGROUND: There is increasing recognition of the importance of the preconception period for addressing reproductive and intergenerational health inequities and supporting improved maternal and child health outcomes. This study aimed to understand the extent and type of evidence that exists in relation to preconception health for Indigenous peoples living in high-income countries with similar experiences of colonisation, namely, Australia, New Zealand, Canada, and the United States. METHODS: This review was conducted as per the JBI methodology and PRISMA Extension for Scoping Reviews. A comprehensive search of PubMed, CINAHL [EBSCO], Ovid Embase, Scopus, and the Wiley Cochrane Library was conducted using keywords and index terms. We included research in English published between January 2010 and June 2023 on quantitative and qualitative primary studies. Data were extracted using a standardised tool, and the analysis included quantitative descriptions and qualitative content analysis. RESULTS: We identified 360 potential studies and included 57 articles in the review. Most studies were from the United States (n = 36, 63.2%) and Australia (n = 13, 22.8%), and they commonly reported associations between preconception health risk factors and maternal or child health outcomes (n = 27, 48.2%) or described the development, implementation, or evaluation of preconception health interventions (n = 26, 46.4%). Common preconception health areas were pre-pregnancy body mass index or weight (n = 34), alcohol (n = 16), diet (n = 14), physical activity (n = 12), and diabetes (n = 11). Most studies focused exclusively on women (n = 46, 80.7%), and very few included men (n = 3, 5.3%). The study populations were mostly urban and rural (n = 25, 43.9%) or rural only (n = 14, 24.6%); however, the geographical remoteness was often unclear (n = 14, 24.6%). CONCLUSIONS: While there was some research relating to the preconception health of Indigenous peoples, this review identified considerable research gaps. There is a need for dedicated research into preconception health risk factors and reproductive health outcomes, attitudes and awareness of preconception health, and preconception health interventions for Indigenous peoples.


Subject(s)
Indigenous Peoples , Preconception Care , Child , Pregnancy , Male , Humans , United States , Female , New Zealand/epidemiology , Australia , Canada/epidemiology
13.
Front Public Health ; 12: 1346753, 2024.
Article in English | MEDLINE | ID: mdl-38425465

ABSTRACT

Despite relatively higher rates of dementia among Indigenous populations internationally, research into drivers of disparities in brain health and cognitive function has tended to focus on modifiable risk factors over cultural understandings and contextual determinants. By seeking to characterize social and cultural factors that shape brain health and cognition in Indigenous populations, this mini scoping review expands prevailing schools of thought to include Indigenous knowledge systems. This reveals important gaps in culturally aligned care. It also reclaims horizons for research important to Indigenous Peoples that have garnered diminished attention in biomedical approaches. Twenty-three sources were included for data extraction. This synthesis of 23 sources includes health communication about dementia, health provider knowledge about Indigenous health, culturally relevant screening and assessment tools, and culturally grounded care models. Much of the focus is currently still on modifiable risk factors that reside at individual factors, whereas attention to wider social factors that impact populations is needed, as stressors through isolation, discrimination, and unequal care are widely reported. Going forward, identifying structural barriers to living well and recognizing the importance of connection to culture will benefit both Indigenous and non-Indigenous understandings of brain health.


Subject(s)
Dementia , Indigenous Peoples , Humans , Brain
14.
BMC Health Serv Res ; 24(1): 266, 2024 Mar 02.
Article in English | MEDLINE | ID: mdl-38429744

ABSTRACT

INTRODUCTION: Indigenous people who use unregulated drugs (IPWUD) face significant barriers to care, including sparse availability of culturally safe health services. Integrating Indigenous traditional and cultural treatments (TCT) into health service delivery is one way to enhance culturally safe care. In a Canadian setting that implemented cultural safety reforms, we sought to examine the prevalence and correlates of client perceptions of primary care provider awareness of TCT among IPWUD. METHODS: Data were derived from two prospective cohort studies of PWUD in Vancouver, Canada between December 2017 and March 2020. A generalized linear mixed model with logit-link function was used to identify longitudinal factors associated with perceived provider awareness of TCT. RESULTS: Among a sample of 507 IPWUD who provided 1200 survey responses, a majority (n = 285, 56%) reported their primary care provider was aware of TCT. In multiple regression analyses, involvement in treatment decisions always (Adjusted Odds Ratio [AOR] = 3.6; 95% confidence interval [CI]: 1.6-7.8), involvement in treatment decisions most or some of the time (AOR = 3.3; 95% CI: 1.4-7.7), comfort with provider or clinic (AOR = 2.7; 95% CI: 1.5-5.0), and receiving care from a social support worker (AOR = 1.5; 95% CI: 1.0-2.1) were positively associated with provider awareness of TCT. CONCLUSION: We found high levels of perceived provider awareness of TCT and other domains of culturally safe care within a cohort of urban IPWUD. However, targeted initiatives that advance culturally safe care are required to improve healthcare and health outcomes for IPWUD, who continue to bear a disproportionate burden of substance use harms.


Subject(s)
Delivery of Health Care , Indigenous Peoples , Humans , Canada/epidemiology , Prospective Studies , Surveys and Questionnaires
15.
Cien Saude Colet ; 29(3): e04702023, 2024 Mar.
Article in Portuguese, English | MEDLINE | ID: mdl-38451643

ABSTRACT

Mortality caused by the COVID-19 pandemic has impacted indicators of Years of Potential Life Lost (YPLL) worldwide. This study aimed to estimate the YPLL due to mortality caused by COVID-19, according to sex, age group, and race/color in Brazil, from March 2020 to December 2021. Deaths caused by COVID-19 were characterized, in which the rates and ratios of standardized YPLL rates, the average number of years of potential life lost (ANYPLL), and the average age at death (AAD) were estimated and compared. Overall, 13,776,969.50 potential years of life were lost, which resulted in an average loss of 22.5 potential years not lived. A greater loss of potential years of life was identified in men (58.12%) and in the age groups from 0 to 59 years in the black (58.92%) and indigenous (63.35%) populations, while in the age groups of 60 years and over, a greater loss of YPLL was observed in the white (45.89%) and yellow (53.22%) populations. Women recorded the highest ADD, with the exception of indigenous women. White men (1.63), brown men (1.59), and black men (1.61) had the highest rates when compared to white women. Although COVID-19 has a greater impact on the elderly, it was the black and indigenous populations under the age of 60 who had the greatest loss of potential years of life.


A mortalidade provocada pela pandemia da COVID-19 tem produzido impactos aos indicadores de Anos Potenciais de Vida Perdidos (APVP) em nível mundial. Objetiva-se estimar os APVP devido à mortalidade por COVID-19, segundo sexo, faixa etária e raça/cor, no período de março de 2020 a dezembro de 2021, no Brasil. Foram caracterizadas as mortes por COVID-19, estimadas e comparadas as taxas e razão de taxas padronizadas de APVP, a média de anos potenciais de vida não vividos (APVNV) e a idade média do óbito (IMO). No geral, foram perdidos 13.776.969,50 anos potenciais de vida, o que determinou uma perda média de 22,5 anos potenciais não vividos. Houve maior perda de anos potenciais de vida nos homens (58,12%) e nas faixas etárias de 0 a 59 anos nas populações negra (58,92%) e indígena (63,35%), enquanto nas faixas etárias de 60 anos e mais foi observada maior perda de APVP nas populações branca (45,89%) e amarela (53,22%). As mulheres registraram as maiores IMO, com exceção das mulheres indígenas. Homens brancos (1,63), pardos (1,59) e pretos (1,61) tiveram as maiores taxas em comparação às mulheres brancas. Apesar da COVID-19 ter tido maior impacto em idosos, foram as populações negra e indígena na faixa de menos de 60 anos quem teve maior perda de anos potenciais de vida.


Subject(s)
COVID-19 , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , Black People , Brazil/epidemiology , Life Expectancy , Pandemics , Indigenous Peoples , White
16.
Viruses ; 16(3)2024 Feb 26.
Article in English | MEDLINE | ID: mdl-38543725

ABSTRACT

Coronavirus disease 2019 (COVID-19) is an infection caused by SARS-CoV-2. Genome-wide association studies (GWASs) have suggested a strong association of genetic factors with the severity of the disease. However, many of these studies have been completed in European populations, and little is known about the genetic variability of indigenous peoples' underlying infection by SARS-CoV-2. The objective of the study is to investigate genetic variants present in the genes AQP3, ARHGAP27, ELF5L, IFNAR2, LIMD1, OAS1 and UPK1A, selected due to their association with the severity of COVID-19, in a sample of indigenous people from the Brazilian Amazon in order to describe potential new and already studied variants. We performed the complete sequencing of the exome of 64 healthy indigenous people from the Brazilian Amazon. The allele frequency data of the population were compared with data from other continental populations. A total of 66 variants present in the seven genes studied were identified, including a variant with a high impact on the ARHGAP27 gene (rs201721078) and three new variants located in the Amazon Indigenous populations (INDG) present in the AQP3, IFNAR2 and LIMD1 genes, with low, moderate and modifier impact, respectively.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , COVID-19/genetics , SARS-CoV-2/genetics , Genome-Wide Association Study , Gene Frequency , Indigenous Peoples/genetics , Intracellular Signaling Peptides and Proteins , LIM Domain Proteins
17.
JCO Glob Oncol ; 10: e2300258, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38301179

ABSTRACT

PURPOSE: Lung cancer is the biggest cancer killer of indigenous peoples worldwide, including Maori people in New Zealand. There is some evidence of disparities in access to lung cancer treatment between Maori and non-Maori patients, but an examination of the depth and breadth of these disparities is needed. Here, we use national-level data to examine disparities in access to surgery, radiation therapy and systemic therapy between Maori and European patients, as well as timing of treatment relative to diagnosis. METHODS: We included all lung cancer registrations across New Zealand from 2007 to 2019 (N = 27,869) and compared access with treatment and the timing of treatment using national-level inpatient, outpatient, and pharmaceutical records. RESULTS: Maori patients with lung cancer appeared less likely to access surgery than European patients (Maori, 14%; European, 20%; adjusted odds ratio [adj OR], 0.82 [95% CI, 0.73 to 0.92]), including curative surgery (Maori, 10%; European, 16%; adj OR, 0.72 [95% CI, 0.62 to 0.84]). These differences were only partially explained by stage and comorbidity. There were no differences in access to radiation therapy or systemic therapy once adjusted for confounding by age. Although it appeared that there was a longer time from diagnosis to radiation therapy for Maori patients compared with European patients, this difference was small and requires further investigation. CONCLUSION: Our observation of differences in surgery rates between Maori and European patients with lung cancer who were not explained by stage of disease, tumor type, or comorbidity suggests that Maori patients who may be good candidates for surgery are missing out on this treatment to a greater extent than their European counterparts.


Subject(s)
Health Services Accessibility , Healthcare Disparities , Lung Neoplasms , Humans , Indigenous Peoples , Lung Neoplasms/therapy , Maori People , New Zealand/epidemiology , Universal Health Care
18.
Int J Equity Health ; 23(1): 21, 2024 Feb 05.
Article in English | MEDLINE | ID: mdl-38317184

ABSTRACT

INTRODUCTION: In Brazil, a country of continental dimensions, the health needs of each region have an impact. In this context and the name of the principle of equity, the SUS organizes actions especially aimed at social groups such as the elderly, children, pregnant women, and indigenous peoples. The concept of justice proposed by John Rawls is one of equity, which is essential to this country. METHODS: This is an ecological, descriptive study, which analyzed hospital spending on cardiovascular diseases in the Unified Health System (SUS) among the indigenous elderly population and other ethnicities/colors in Brazil, between 2010 and 2019. RESULTS: Hospitalization costs and fatality rates for indigenous populations and other colors/ethnicities, between 2010 and 2019, were evaluated. A reduction in hospitalization costs for the indigenous population and an increase in other populations was observed throughout the historical series, while there was an increase in fatality rates for both groups. A comparison was made between hospitalization costs and the fatality rates of indigenous populations and other colors/ethnicities according to sex, between 2010 and 2019. It was observed that regardless of sex, there are significant differences (p<0.05) between hospitalization costs and fatality rates, with higher costs for patients of other colors/ethnicities and higher fatality rates for the indigenous population. CONCLUSIONS: Hospitalization costs due to cardiovascular diseases in elderly people from indigenous populations were lower compared to other ethnicities in most federative units, which may suggest an unequal allocation of resources or access for this indigenous population to the SUS. Although there is no strong correlation between spending on hospital admissions and fatality rates, it was found that these rates increased between 2010 and 2019, while spending was reduced.


Subject(s)
Cardiovascular Diseases , Aged , Child , Female , Humans , Pregnancy , Brazil/epidemiology , Cardiovascular Diseases/therapy , Hospitalization , Indigenous Peoples , Social Justice , Male
19.
Int Ophthalmol ; 44(1): 4, 2024 Feb 05.
Article in English | MEDLINE | ID: mdl-38315255

ABSTRACT

PURPOSE: Actinic conjunctivitis (AC), along with cheilitis (AChe), is part of the clinical spectrum of actinic prurigo (AP), a rare photo dermatosis that affects high-risk populations. We analyzed the clinical manifestations and onset of actinic conjunctivitis (AC), and its relationship with prurigo (AP) in a susceptible population. METHODS: This prospective observational cohort study was performed on Indigenous populations from the highlands of Chiapas, Mexico. Thorough dermatological and ophthalmological examinations were performed in patients attending a primary health care center. The clinical features, labor and environmental factors, onset timing, and clinical staging of AC and AP were analyzed. RESULTS: Of the 2913 patients studied, 54 patients (108 eyes) (1.8%) had AC, and 14 patients (25.9%) had AP. The mean age at diagnosis was 36.18 ± 18.52 years (6-70 years). The mean residential altitude was 1884 ± 434.2 m above sea level. Mean self-reported sun exposure was 5.14 ± 3.1 h a day (0.5-12 h). A total of 90.7% reported exposure to biomass fuels during cooking, and 50% to farm animals. AC was the sole manifestation in 70% of the cases. All patients had nasal and temporal photo-exposed conjunctiva. Among the eyes, 12.9% were classified as stage-1, 64.8% as stage-2, and 22.2% stage-3. A total of 83.3% of the patients had hyperpigmented lesions, and 35.1% had evaporative dry eye disease. CONCLUSIONS: AC may be the initial or sole manifestation of AP. Most AC cases (87%) were initially observed at the advanced stages of the disease. Although solar exposure was not associated with late AC stages, a positive association was found with farm animal exposure. Evaporative dry eye associated with meibomian gland dysfunction has not been previously reported in patients with AC.


Subject(s)
Conjunctivitis , Photosensitivity Disorders , Prurigo , Skin Diseases, Genetic , Animals , Humans , Adolescent , Young Adult , Adult , Middle Aged , Mexico/epidemiology , Prurigo/complications , Prurigo/epidemiology , Prurigo/pathology , Prospective Studies , Indigenous Peoples
20.
Neurology ; 102(5): e209138, 2024 Mar 12.
Article in English | MEDLINE | ID: mdl-38354325

ABSTRACT

BACKGROUND AND OBJECTIVES: Cardiovascular disease contributes significantly to disease burden among many Indigenous populations. However, data on stroke incidence in Indigenous populations are sparse. We aimed to investigate what is known of stroke incidence in Indigenous populations of countries with a very high Human Development Index (HDI), locating the research in the broader context of Indigenous health. METHODS: We identified population-based stroke incidence studies published between 1990 and 2022 among Indigenous adult populations of developed countries using PubMed, Embase, and Global Health databases, without language restriction. We excluded non-peer-reviewed sources, studies with fewer than 10 Indigenous people, or not covering a 35- to 64-year minimum age range. Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. We assessed quality using "gold standard" criteria for population-based stroke incidence studies, the Newcastle-Ottawa Scale for risk of bias, and CONSIDER criteria for reporting of Indigenous health research. An Indigenous Advisory Board provided oversight for the study. RESULTS: From 13,041 publications screened, 24 studies (19 full-text articles, 5 abstracts) from 7 countries met the inclusion criteria. Age-standardized stroke incidence rate ratios were greater in Aboriginal and Torres Strait Islander Australians (1.7-3.2), American Indians (1.2), Sámi of Sweden/Norway (1.08-2.14), and Singaporean Malay (1.7-1.9), compared with respective non-Indigenous populations. Studies had substantial heterogeneity in design and risk of bias. Attack rates, male-female rate ratios, and time trends are reported where available. Few investigators reported Indigenous stakeholder involvement, with few studies meeting any of the CONSIDER criteria for research among Indigenous populations. DISCUSSION: In countries with a very high HDI, there are notable, albeit varying, disparities in stroke incidence between Indigenous and non-Indigenous populations, although there are gaps in data availability and quality. A greater understanding of stroke incidence is imperative for informing effective societal responses to socioeconomic and health disparities in these populations. Future studies into stroke incidence in Indigenous populations should be designed and conducted with Indigenous oversight and governance to facilitate improved outcomes and capacity building. REGISTRATION INFORMATION: PROSPERO registration: CRD42021242367.


Subject(s)
Indigenous Peoples , Stroke , Adult , Female , Humans , Male , Incidence , Stroke/epidemiology , Stroke/ethnology , Middle Aged , Developed Countries
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