Safe birth in cultural safety in southern Mexico: a pragmatic non-inferiority cluster-randomised controlled trial.

BACKGROUND: Available research on the contribution of traditional midwifery to safe motherhood focuses on retraining and redefining traditional midwives, assuming cultural prominence of Western ways. Our objective was to test if supporting traditional midwives on their own terms increases cultural safety (respect of Indigenous traditions) without worsening maternal health outcomes. METHODS: Pragmatic parallel-group cluster-randomised controlled non-inferiority trial in four municipalities in Guerrero State, southern Mexico, with Nahua, Na savi, Me'phaa and Nancue ñomndaa Indigenous groups. The study included all pregnant women in 80 communities and 30 traditional midwives in 40 intervention communities. Between July 2015 and April 2017, traditional midwives and their apprentices received a monthly stipend and support from a trained intercultural broker, and local official health personnel attended a workshop for improving attitudes towards traditional midwifery. Forty communities in two control municipalities continued with usual health services. Trained Indigenous female interviewers administered a baseline and follow-up household survey, interviewing all women who reported pregnancy or childbirth in all involved municipalities since January 2016. Primary outcomes included childbirth and neonatal complications, perinatal deaths, and postnatal complications, and secondary outcomes were traditional childbirth (at home, in vertical position, with traditional midwife and family), access and experience in Western healthcare, food intake, reduction of heavy work, and cost of health care. RESULTS: Among 872 completed pregnancies, women in intervention communities had lower rates of primary outcomes (perinatal deaths or childbirth or neonatal complications) (RD -0.06 95%CI - 0.09 to - 0.02) and reported more traditional childbirths (RD 0.10 95%CI 0.02 to 0.18). Among institutional childbirths, women from intervention communities reported more traditional management of placenta (RD 0.34 95%CI 0.21 to 0.48) but also more non-traditional cold-water baths (RD 0.10 95%CI 0.02 to 0.19). Among home-based childbirths, women from intervention communities had fewer postpartum complications (RD -0.12 95%CI - 0.27 to 0.01). CONCLUSIONS: Supporting traditional midwifery increased culturally safe childbirth without worsening health outcomes. The fixed population size restricted our confidence for inference of non-inferiority for mortality outcomes. Traditional midwifery could contribute to safer birth among Indigenous communities if, instead of attempting to replace traditional practices, health authorities promoted intercultural dialogue. TRIAL REGISTRATION: Retrospectively registered ISRCTN12397283 . Trial status: concluded.

In many Indigenous communities, traditional midwives support mothers during pregnancy, childbirth, and some days afterwards. Research involving traditional midwives has focused on training them in Western techniques and redefining their role to support Western care. In Guerrero state, Mexico, Indigenous mothers continue to trust traditional midwives. Almost half of these mothers still prefer traditional childbirths, at home, in the company of their families and following traditional practices. We worked with 30 traditional midwives to see if supporting their practice allowed traditional childbirth without worsening mothers' health. Each traditional midwife received an inexpensive stipend, a scholarship for an apprentice and support from an intercultural broker. The official health personnel participated in a workshop to improve their attitudes towards traditional midwives. We compared 40 communities in two municipalities that received support for traditional midwifery with 40 communities in two municipalities that continued to receive usual services. We interviewed 872 women with childbirth between 2016 and 2017. Mothers in intervention communities suffered fewer complications during childbirth and had fewer complications or deaths of their babies. They had more traditional childbirths and fewer perineal tears or infections across home-based childbirths. Among those who went to Western care, mothers in intervention communities had more traditional management of the placenta but more non-traditional cold-water baths. Supporting traditional midwifery increased traditional childbirth without worsening health outcomes. The small size of participating populations limited our confidence about the size of this difference. Health authorities could promote better health outcomes if they worked with traditional midwives instead of replacing them.

Initiation and duration of breastfeeding of Aboriginal infants in South Australia.

BACKGROUND: Benefits of breastfeeding are well-established. Few studies have examined initiation and duration of breastfeeding of Aboriginal infants. METHODS: Population-based study of women giving birth to an Aboriginal infant in South Australia, July 2011-June 2013. FINDINGS: 344 women took part. Participants were representative in relation to maternal age, infant birthweight and gestation. Eighty-six percent initiated breastfeeding, declining to 54% at 12 weeks postpartum. Women living in remote areas were more likely to be breastfeeding at 12 weeks than women living in Adelaide (Odds Ratio=2.6, 95% Confidence Interval 1.5-4.7). Two-thirds of women (67%) attending standard public antenatal care in regional areas and 61% attending regional Aboriginal Family Birthing Program Services were breastfeeding at 12 weeks, compared to one third of women (36%) attending standard metropolitan public antenatal care and 49% of women attending metropolitan Aboriginal Family Birthing Program Services. Less than half of women (45%) described their postnatal care as 'very good', and 40% were not always able to access support with infant feeding when needed. The most common reasons for switching to formula before 6 weeks were: low milk supply/baby not gaining weight, mastitis/sore breasts or other feeding problems. Mothers also identified their own health as a factor. CONCLUSION: While the findings must be treated with caution due to small numbers, they suggest benefits for women attending Aboriginal Family Birthing Program services in the urban environment where rates of initiation and continued breastfeeding are lowest. Provision of culturally appropriate support to Aboriginal women during and after pregnancy is key to improving outcomes.

Safe Birth and Cultural Safety in southern Mexico: study protocol for a randomised controlled trial.

BACKGROUND: Indigenous women in the southern Mexican state of Guerrero face poor maternal health outcomes. Living as they do at the very periphery of the Western health system, they often receive low-quality care from health services that lack human and financial resources. Traditional health systems remain active in indigenous communities where traditional midwives accompany women through motherhood. Several interventions have explored training birth attendants in Western birthing skills, but little research has focussed on supporting traditional midwives by recognising their knowledge. This trial supports traditional midwifery in four indigenous groups and measures its impact on maternal health outcomes. METHODS: The study includes four indigenous populations in the State of Guerrero (Nahua, Na savi/Mixteco, Me'phaa/Tlapaneco and Nancue ñomndaa/Amuzgo), covering approximately 8000 households. A parallel-group cluster-randomised controlled trial will compare communities receiving usual care with communities where traditional midwives received support in addition to the usual care. The intervention was defined in collaboration with participants in a 2012 pilot study. Supported midwives will receive a small stipend, a scholarship to train one apprentice, and support from an intercultural broker to deal with Western health personnel; additionally, the health staff in the intervention municipalities will participate in workshops to improve understanding and attitudes towards authentic traditional midwives. A baseline and a final survey will measure changes in birth and pregnancy complications (primary outcomes), and changes in gender violence, access to healthcare, and engagement with traditional cultural activities (secondary outcomes). The project has ethical approval from the participating communities and the Universidad Autónoma de Guerrero. DISCUSSION: Indigenous women at the periphery of Western health services do not benefit fully from the attenuated services which erode their own healthcare traditions. Western health service providers in indigenous communities often ignore traditional knowledge and resources, inadvertently or in ignorance, disrespecting indigenous cultures. Improved understanding between midwives and the official healthcare system can contribute to more appropriate referral of high-risk cases, improving the use of scarce resources while lowering costs of healthcare for indigenous families. TRIAL REGISTRATION: ISRCTN12397283 . Retrospectively registered on 6 December 2016.

O desafio do atendimento à criança rural no canadá / The challenge of rural childcare in canada

RESUMO: No Canadá, o atendimento à infância é pouco desenvolvido, apesar de o país ser uma federação rica. Ao contrário de muitas políticas sociais bem desenvolvidas, os serviços de atendimento à infância são principalmente ofertados por meio de mercados voluntários, comerciais ou sem fins lucrativos, em vez de iniciativas governamentais. Essa estrutura política desfavorece todas as crianças e famílias e tem consequências severas, particularmente para canadenses de áreas rurais, remotas e do norte do país. Este artigo fornece uma visão geral dos servidos de atenção à infância fora das cidades, considerando (a) como o sistema político canadense de federalismo e (b) sua arquitetura política liberal de bem-estar social trabalham contra a alta qualidade e equidade dos serviços.

ABSTRACT: Childcare is underdeveloped in Canada even though the country is a rich federation. Unlike many better-developed social policies, childcare services are delivered primarily through voluntary, non-profit or commercial markets rather than by governments. This policy framework is disadvantageous for all children and families, and has particularly severe consequences for rural, remote and northern Canadians. This article provides an overview of childcare services outside of towns and cities, considering how Canada's political system of federalism and its liberal social welfare policy architecture work against high quality and equitable childcare services.

Risk of Mortality into Adulthood According to Gestational Age at Birth.

OBJECTIVES: To quantify the independent risks of neonatal (0-28 days), postneonatal (29-364 days), 1- to 5- and 6- to 30-year mortality by gestational age and investigate changes in survival over time in an Australian birth cohort. STUDY DESIGN: Maternal and birth related Western Australian population data (1980-2010) were linked to the state mortality data using a retrospective cohort study design involving 722 399 live-born singletons infants. RESULTS: When compared with 39- to 41-week born infants, the adjusted risk ratio for neonatal mortality was 124.8 (95% CI 102.9-151.3) for 24-31 weeks of gestation, 3.4 (95% CI 2.4-4.7) for 35-36 weeks of gestation, and 1.4 (95% CI 1.1-1.8) for 37-38 weeks of gestation. For 24-31 weeks of gestation infants, the adjusted hazard ratio for postneonatal mortality (29-364 days) was 13.9 (95% CI 10.9-17.6), for 1- to 5-year mortality 1.4 (95% CI 0.7-3.0) and for 6- to 30-year mortality 1.3 (95% CI 0.8-2.3). The risk of neonatal and postneonatal mortality for those born preterm decreased over time. CONCLUSIONS: In Western Australia, late preterm and early term infants experienced higher risk of neonatal and postneonatal mortality when compared with their full-term peers. There was insufficient evidence to show that gestational length was independently associated with mortality beyond 1 year of age. Neonatal and postneonatal mortality improved with each decade of the study period.

A psicologia brasileira e os povos indígenas: atualização do estado da arte / A brazilian psychology and the indigenous peoples: updating the state of art / a psicología brasileña y los pueblos indígenas: actualización del estadio del arte

Resumo De acordo com o último censo do IBGE (2010a), 0,4% da população brasileira é composta por indígenas, população que vem aumentando nos últimos anos e cresceu 39% em relação ao censo de 2000, embora ainda continue sendo uma população invisibilizada e só recentemente tenha começado a ser estudada pela Psicologia. Como marcos da recente aproximação da Psicologia com a temática indígena, destacamos: o relatório do seminário “Subjetividade e Povos Indígenas” (2004) e o livro “Psicologia e Povo Indígenas” (2010). O objetivo deste estudo é atualizar o estado da arte sobre os povos indígenas na Psicologia no Brasil, considerando duas bases de dados o PePSIC e a SciELO. Utilizando como palavras-chave “indígena” ou “índio” em toda coleção na primeira base e somente nas revistas de Psicologia na segunda, encontramos um total de 25 artigos, os quais foram lidos na íntegra e agrupados de acordo com os temas estudados. Concluímos que os artigos encontrados se caracterizam, por um lado, pela interdisciplinaridade, e por outro, pela falta de um referencial teórico bem-definido específico da área da Psicologia. Entendemos que a complexidade da temática demanda um olhar interdisciplinar, no entanto, a escassez de referências específicas da Psicologia nos indica que ainda temos muito a avançar, possivelmente pela aproximação recente da Psicologia com o estudo da temática e também pela própria constituição da Psicologia enquanto ciência pautada principalmente por tradições individualistas, que destoam das tradições indígenas que se baseiam principalmente no coletivismo.(AU)

Abstract According to the last census of IBGE (2010a) 0,4% of Brazilian population is composed of indigenous, this population has increased in recent years and grew 39% compared to the 2000 census, although they continue being a invisibly population and just recently has begun to be studied by Psychology. The landmarks of the recent approach of Psychology to indigenous issues, detached: the seminar report “Subjetividade e Povos Indígenas” (2004) and the book “Psicologia e Povos Indígenas” (2010). The goal of this study is to update the state of the art on indigenous peoples in Psychology in Brazil, considering PePSIC and SciELO databases. Using as keywords “indigenous” or “Indian” throughout all the collection in the first databases and only in psychological journals in the second, we found 25 papers that have been read in full and grouped according to the subjects studied. We concludes that the articles found are characterized, first, by interdisciplinary, and secondly, the lack of specific well-defined theoretical framework in the area of psychology. We understand the complexity of the subject demands an interdisciplinary approach, however the lack of specific references Psychology tells us that we still have much to learn, possibly by the recent approach of psychology to the subject and also by the very constitution of psychology as science guided mainly individualistic traditions that are different of indigenous traditions, which are based on collectivism.(AU)

Resumen Según el ultimo censo del IBGE (2010a) el 0,4% de la población brasileña esta compuesta por indígenas, población esta que es cada vez mayor y creció 39% en relación al censo llevado a cabo en 2000, aunque continua a ser una población que no es visible y que solamente ahora empezó a ser estudiada por la Psicología. Como hitos de la reciente enfoque de la Psicología acerca de las cuestiones indígenas, destacamos: el informe del seminário “Subjetividade e Povos Indígenas” (2004) y el libro “Psicologia e Povo indígenas” (2010). El objetivo de este estudio es actualizar el estado del arte acerda de los pueblos indígenas en la Psicología brasileña, teniendo en cuenta dos bases de datos: PePSIC y SciELO. Las palabras clave utilizadas eran “indígenas” o “indios” a lo largo de la colección en la primera base y sólo en revistas de psicología en la segunda y se encontraron un total de 25 artículos que fueron leídos íntegramente y agrupados conforme el tema. Se concluí que los artículos encontrados son caracterizados por su interdisciplinariedad y por la escasez de referencias a las teorías bien definidas y específicas de la Psicología. Entendemos que la complexidad del tema necesita una mirada interdisciplinaria, sin embargo la escasez de referencias especificas de la Psicología, nos muestra que todavía hay mucho a avanzar, posiblemente por el aproximación recente de la Psicología a los estudios del tema y también por la propia constitución de la Psicología como ciencia basada principalmente en tradiciones individualistas que es diferente de las tradiciones indígenas, que son basadas en el colectivismo.(AU)

A Psicologia Brasileira e os Povos Indígenas: Atualização do Estado da Arte / A Brazilian Psychology and the Indigenous Peoples: Updating the State of Art / La Psicología Brasileña y los Pueblos Indígenas: Actualización del Estadio del Arte

Resumo De acordo com o último censo do IBGE (2010a), 0,4% da população brasileira é composta por indígenas, população que vem aumentando nos últimos anos e cresceu 39% em relação ao censo de 2000, embora ainda continue sendo uma população invisibilizada e só recentemente tenha começado a ser estudada pela Psicologia. Como marcos da recente aproximação da Psicologia com a temática indígena, destacamos: o relatório do seminário “Subjetividade e Povos Indígenas” (2004) e o livro “Psicologia e Povo Indígenas” (2010). O objetivo deste estudo é atualizar o estado da arte sobre os povos indígenas na Psicologia no Brasil, considerando duas bases de dados o PePSIC e a SciELO. Utilizando como palavras-chave “indígena” ou “índio” em toda coleção na primeira base e somente nas revistas de Psicologia na segunda, encontramos um total de 25 artigos, os quais foram lidos na íntegra e agrupados de acordo com os temas estudados. Concluímos que os artigos encontrados se caracterizam, por um lado, pela interdisciplinaridade, e por outro, pela falta de um referencial teórico bem-definido específico da área da Psicologia. Entendemos que a complexidade da temática demanda um olhar interdisciplinar, no entanto, a escassez de referências específicas da Psicologia nos indica que ainda temos muito a avançar, possivelmente pela aproximação recente da Psicologia com o estudo da temática e também pela própria constituição da Psicologia enquanto ciência pautada principalmente por tradições individualistas, que destoam das tradições indígenas que se baseiam principalmente no coletivismo....(AU)

Abstract According to the last census of IBGE (2010a) 0,4% of Brazilian population is composed of indigenous, this population has increased in recent years and grew 39% compared to the 2000 census, although they continue being a invisibly population and just recently has begun to be studied by Psychology. The landmarks of the recent approach of Psychology to indigenous issues, detached: the seminar report “Subjetividade e Povos Indígenas” (2004) and the book “Psicologia e Povos Indígenas” (2010). The goal of this study is to update the state of the art on indigenous peoples in Psychology in Brazil, considering PePSIC and SciELO databases. Using as keywords “indigenous” or “Indian” throughout all the collection in the first databases and only in psychological journals in the second, we found 25 papers that have been read in full and grouped according to the subjects studied. We concludes that the articles found are characterized, first, by interdisciplinary, and secondly, the lack of specific well-defined theoretical framework in the area of psychology. We understand the complexity of the subject demands an interdisciplinary approach, however the lack of specific references Psychology tells us that we still have much to learn, possibly by the recent approach of psychology to the subject and also by the very constitution of psychology as science guided mainly individualistic traditions that are different of indigenous traditions, which are based on collectivism....(AU)

Resumen Según el ultimo censo del IBGE (2010a) el 0,4% de la población brasileña esta compuesta por indígenas, población esta que es cada vez mayor y creció 39% en relación al censo llevado a cabo en 2000, aunque continua a ser una población que no es visible y que solamente ahora empezó a ser estudiada por la Psicología. Como hitos de la reciente enfoque de la Psicología acerca de las cuestiones indígenas, destacamos: el informe del seminário “Subjetividade e Povos Indígenas” (2004) y el libro “Psicologia e Povo indígenas” (2010). El objetivo de este estudio es actualizar el estado del arte acerda de los pueblos indígenas en la Psicología brasileña, teniendo en cuenta dos bases de datos: PePSIC y SciELO. Las palabras clave utilizadas eran “indígenas” o “indios” a lo largo de la colección en la primera base y sólo en revistas de psicología en la segunda y se encontraron un total de 25 artículos que fueron leídos íntegramente y agrupados conforme el tema. Se concluí que los artículos encontrados son caracterizados por su interdisciplinariedad y por la escasez de referencias a las teorías bien definidas y específicas de la Psicología. Entendemos que la complexidad del tema necesita una mirada interdisciplinaria, sin embargo la escasez de referencias especificas de la Psicología, nos muestra que todavía hay mucho a avanzar, posiblemente por el aproximación recente de la Psicología a los estudios del tema y también por la propia constitución de la Psicología como ciencia basada principalmente en tradiciones individualistas que es diferente de las tradiciones indígenas, que son basadas en el colectivismo....(AU)

Chagas' disease in Aboriginal and Creole communities from the Gran Chaco Region of Argentina: Seroprevalence and molecular parasitological characterization.

Most indigenous ethnias from Northern Argentina live in rural areas of "the Gran Chaco" region, where Trypanosoma cruzi is endemic. Serological and parasitological features have been poorly characterized in Aboriginal populations and scarce information exist regarding relevant T. cruzi discrete typing units (DTU) and parasitic loads. This study was focused to characterize T. cruzi infection in Qom, Mocoit, Pit'laxá and Wichi ethnias (N=604) and Creole communities (N=257) inhabiting rural villages from two highly endemic provinces of the Argentinean Gran Chaco. DNA extracted using Hexadecyltrimethyl Ammonium Bromide reagent from peripheral blood samples was used for conventional PCR targeted to parasite kinetoplastid DNA (kDNA) and identification of DTUs using nuclear genomic markers. In kDNA-PCR positive samples from three rural Aboriginal communities of "Monte Impenetrable Chaqueño", minicircle signatures were characterized by Low stringency single primer-PCR and parasitic loads calculated using Real-Time PCR. Seroprevalence was higher in Aboriginal (47.98%) than in Creole (27.23%) rural communities (Chi square, p=4.e(-8)). A low seroprevalence (4.3%) was detected in a Qom settlement at the suburbs of Resistencia city (Fisher Exact test, p=2.e(-21)).The kDNA-PCR positivity was 42.15% in Aboriginal communities and 65.71% in Creole populations (Chi square, p=5.e(-4)). Among Aboriginal communities kDNA-PCR positivity was heterogeneous (Chi square, p=1.e(-4)). Highest kDNA-PCR positivity (79%) was detected in the Qom community of Colonia Aborigen and the lowest PCR positivity in two different surveys at the Wichi community of Misión Nueva Pompeya (33.3% in 2010 and 20.8% in 2014). TcV (or TcII/V/VI) was predominant in both Aboriginal and Creole communities, in agreement with DTU distribution reported for the region. Besides, two subjects were infected with TcVI, one with TcI and four presented mixed infections of TcV plus TcII/VI. Most minicircle signatures clustered according to their original localities, but in a few cases, signatures from one locality clustered with signatures from other village, suggesting circulation of the same strains in the area. Parasitic loads ranged from undetectable to around 50 parasite equivalents/mL, showing higher values than those generally observed in chronic Chagas disease patients living in urban centers of Argentina. Our findings reveal the persistence of high levels of infection in these neglected populations.

La solidaridad y las declaraciones internacionales de derechos humanos y bioética: el caso del derecho a la salud de los pueblos indígenas colombianos / A solidariedade e as declarações internacionais de direitos humanos e bioética: o caso do direito à saúde dos povos indígenas colombianos / Solidarity, international human rights declarations and bioethics: the case of the right to health of aboriginal Colombian peoples

Este artículo muestra el papel del principio de solidaridad en relación con el derecho a la salud de los pueblos indígenas colombianos, a partir del análisis de la Declaración Universal de los Derechos de los Pueblos Indígenas y de la Declaración de Bioética y Derechos Humanos. Se presenta la situación actual de estos grupos étnicos en términos de acceso a los más altos niveles de salud, teniendo como base los informes de Naciones Unidas, los documentos oficiales de política pública colombiana, los lineamientos de Naciones Unidas y los postulados de los pueblos indígenas respecto del derecho a la salud. La revisión evidencia que el papel de la solidaridad en este campo debe servir como elemento de promoción de las prácticas tradicionales indígenas para integrarlas a los sistemas de salud occidentales. Esto garantizaría el acceso en equidad y el fortalecimiento de sus instituciones médicas, sin generar practicas de asimilación o exclusión en el acceso al derecho a la salud.

This paper shows the role of the solidarity principle in relation to right to health of Colombian aboriginal peoples, analyzing the Universal declaration of the rights of aboriginal peoples and the Declaration on Bioethics and Human Rights. Current situation of these ethnic groups is presented as it relates to access to the highest levels of health, based on reports from United Nations and postulates of aboriginal peoples regarding the tight to health. The analysis evidences that the role of solidarity in this field should serve as an element for promoting traditional indigenous practices in order to integrate them to Western health systems. This would guarantee the access in equity and the strengthening of medical institutions without generating assimilation or exclusion in the access to the right to health.

Este artigo mostra o papel do princípio da solidariedade em relação ao direito à saúde dos povos indígenas colombianos, a partir da análise da Declaração Universal dos Direitos dos Povos Indígenas e da Declaração de Bioética e Direitos Humanos. Apresenta-se a situação atual destes grupos étnicos em termos de acesso aos mais altos níveis de saúde, tendo como base os informes das Nações Unidas, os documentos oficiais de política pública colombiana, as orientações das Nações Unidas e os postulados dos povos indígenas em relação ao direito à saúde. A revisão evidencia que o papel da solidariedade neste campo deve servir como elemento de promoção das práticas tradicionais indígenas para integrá-las aos sistemas de saúde ocidentais. Isto garantiria o acesso em equidade e o fortalecimento de suas instituições médicas, sem gerar práticas de assimilação ou exclusão no acesso ao direito à saúde.

Oral health status and treatment needs of iruligas at ramanagara District, Karnataka, India / Estado de la salud oral y necesidades de tratamiento de los iruligas, en el Distrito de Ramanagara, Karnataka, India

OBJECTIVES: To assess the oral health status and treatment needs of Iruliga tribal community residing at Ramanagara District, Karnataka, India. METHODS: The total population of 2605 Iruligas residing at 26 villages of Ramanagara District was included for the study. Data were collected using World Health Organization (WHO) 1997 'Oral Health Assessment Form'. Examination was done under good natural light using a mouth mirror and community periodontal index (CPI) probe. RESULTS: The total study population was 2605, comprising 1545 males and 1060 females in the age group of 1-80 years with the mean age of 30.56 ± 19.51. The majority of Iruligas (79.8%) used chew sticks as an oral hygiene aid. Subjects with leukoplakia were found to be 3 (0.12). The most commonly seen enamel opacity/hypoplasia was diffuse opacity affecting 930 (35.7%) subjects. A mild form of dental fluorosis affected 1658 (63.65%) subjects. Subjects with bleeding were only 4.22%; subjects with calculus were 57.9%; those with shallow pockets (4-5 mm) were 22.0% and subjects with deep pockets (> 6 mm) were 3.67%. The prevalence of dental caries among Iruligas was found to be 7.52%. The mean number of decayed, missing, filled (DMF) permanent teeth per person was 0.55 ± 0.1. Definite malocclusion, which required elective treatment, was noted in 14.1%. Iruligas with need for referral were found to be 29.94% (n = 780) according to the various treatment needs required for different oral diseases. CONCLUSION: This study revealed less prevalence of oral diseases among Iruligas, highlighting the role of good oral health practices prevalent among this isolated population.

OBJETIVOS: Evaluar el estado de salud oral y las necesidades de tratamiento en la comunidad tribal Iruliga, que reside en el Distrito de Ramanagara, Karnataka, India. MÉTODOS: La población total de 2605 Iruligas que residen en 26 aldeas del Distrito de Ramanagara, fue incluida en el estudio. Los datos fueron recogidos usando el Formulario de evaluación de la salud oral (OMS) de 1997. El examen se hizo bajo buena luz natural, usando un espejo bucal, y la sonda Índice Periodontal Comunitario (IPC). RESULTADOS: La población total del estudio fue 2605, y abarcó 1545 varones y 1060 hembras en el grupo etario de 1-80 años, con una edad media de 30.56 ± 19.51. La mayoría de los Iruligas (79.8%) usaban palillos de masticar como medio para la higiene oral. Se halló que los sujetos con leucoplasia oral eran 3 (0.12). La hipoplasia u opacidad del esmalte más común fue la opacidad difusa que afectaba a 930 (35.7%) sujetos. Una forma leve de fluorosis dental afectaba a 1658 (63.65%) de los sujetos. Los sujetos con sangramiento fueron sólo el 4.22%. Los sujetos con cálculo fueron el 57.9%; los que presentaban bolsas poco profundas (4-5 mm) fueron el 22.0% y los sujetos con bolsas profundas (> 6 mm) fueron el 3.67%. Se halló que la prevalencia de las caries dentales entre los Iruligas fue de 7.52%. El número promedio de dientes permanentes con caries, faltantes y obturados (DMF) fue 0.55 ± 0.1. La maloclusión definida, que requirió tratamiento electivo, se hizo evidente en 14.1%. Se halló que los Iruligas con necesidad de ser remitidos fue un 29.94% (n = 780) de acuerdo con las diferentes necesidades de tratamiento requeridas para las diferentes enfermedades orales. CONCLUSIÓN: Este estudio reveló menos prevalencia de enfermedades orales entre los Iruligas, destacando el papel de las buenas prácticas de la salud oral prevalentes entre esta población aislada.

Human papillomavirus risk factors for infection and genotype distribution in aboriginal women from Northern Argentina / Virus papiloma humano (hpv) en mujeres de la etnia Pilagá del nordeste argentino: Factores de riesgo de infección y distribución de tipos virales

The mortality rate for cervical cancer (CC) in Northern Argentina is three times higher than the average for the country (7.8 deaths/100 000 women). We determined the prevalence and genotype distribution of human papillomavirus (HPV) in 227 sexually active women of the native Pilagá community in Formosa, Argentina. We also conducted an HPV-16 variant analysis and studied several community factors that might play a role in viral entry and infection. Endo- and exocervical samples were tested for HPV DNA with MY09/11-PCR or with GP5+/6+-PCR. HPV was detected in 46.7% of the samples and 21 different types were found; the most frequent being HPV-16 (19.4%), -6 and -18 (5.3%), -58 (3.5%) and -31 and -33 (3.1%). In relation to HPV-16 variants, 68.2% were European and 31.8% Asian-American. Among the cofactors analyzed only disposal of human excreta to the open air (P=0.01) was significantly associated with HPV infection. Our prevalence estimates clearly show that Pilagá women are highly exposed to or infected with high risk HPV types and therefore are at a high risk of developing precancerous lesions and eventually CC at the population level.(AU)

La tasa de mortalidad por cáncer cervical (CC) en la región norte de la Argentina es tres veces más alta que la media del país (7.8 muertes/100 000 mujeres). En el presente trabajo se determinó la prevalencia de infección por virus papiloma humano (VPH) y la distribución y frecuencia de los genotipos en 227 mujeres sexualmente activas de la etnia aborigen Pilagá (Formosa, Argentina). También se realizó un análisis de las variantes intratípicas de VPH-16 presentes en la comunidad y se analizaron diversos factores socioculturales que podrían tener algún rol destacado en la transmisión de la infección viral. Se estudiaron muestras de células endo-exocervicales mediante PCR basadas en los cebadores MY09/11 y GP5+/6+ con posterior restricción enzimática y/o hibridación dot-blot. La infección por VPH fue detectada en el 46.7% de las mujeres analizadas. Fueron identificados 21 genotipos, de los cuales los más frecuentes fueron HPV-16 (19.4%), -6 y -18 (5.3%), -58 (3.5%) y -31 y -33 (3.1%). Respecto al HPV-16, se encontraron 68.2% de variantes europeas y 31.8% de asiático-americanas. Entre los cofactores analizados, solo la disposición de excretas al aire libre estuvo significativamente asociada con la infección por VPH (P = 0.01). Los datos obtenidos reflejan que la comunidad Pilagá está altamente expuesta a las infecciones por genotipos de alto riesgo de VPH, lo cual puede estar asociado a una alta incidencia de lesiones cervicales preneoplásicas y neoplásicas.(AU)

Human papillomavirus risk factors for infection and genotype distribution in aboriginal women from Northern Argentina / Virus papiloma humano (hpv) en mujeres de la etnia Pilagá del nordeste argentino: Factores de riesgo de infección y distribución de tipos virales

The mortality rate for cervical cancer (CC) in Northern Argentina is three times higher than the average for the country (7.8 deaths/100 000 women). We determined the prevalence and genotype distribution of human papillomavirus (HPV) in 227 sexually active women of the native Pilagá community in Formosa, Argentina. We also conducted an HPV-16 variant analysis and studied several community factors that might play a role in viral entry and infection. Endo- and exocervical samples were tested for HPV DNA with MY09/11-PCR or with GP5+/6+-PCR. HPV was detected in 46.7% of the samples and 21 different types were found; the most frequent being HPV-16 (19.4%), -6 and -18 (5.3%), -58 (3.5%) and -31 and -33 (3.1%). In relation to HPV-16 variants, 68.2% were European and 31.8% Asian-American. Among the cofactors analyzed only disposal of human excreta to the open air (P=0.01) was significantly associated with HPV infection. Our prevalence estimates clearly show that Pilagá women are highly exposed to or infected with high risk HPV types and therefore are at a high risk of developing precancerous lesions and eventually CC at the population level.

La tasa de mortalidad por cáncer cervical (CC) en la región norte de la Argentina es tres veces más alta que la media del país (7.8 muertes/100 000 mujeres). En el presente trabajo se determinó la prevalencia de infección por virus papiloma humano (VPH) y la distribución y frecuencia de los genotipos en 227 mujeres sexualmente activas de la etnia aborigen Pilagá (Formosa, Argentina). También se realizó un análisis de las variantes intratípicas de VPH-16 presentes en la comunidad y se analizaron diversos factores socioculturales que podrían tener algún rol destacado en la transmisión de la infección viral. Se estudiaron muestras de células endo-exocervicales mediante PCR basadas en los cebadores MY09/11 y GP5+/6+ con posterior restricción enzimática y/o hibridación dot-blot. La infección por VPH fue detectada en el 46.7% de las mujeres analizadas. Fueron identificados 21 genotipos, de los cuales los más frecuentes fueron HPV-16 (19.4%), -6 y -18 (5.3%), -58 (3.5%) y -31 y -33 (3.1%). Respecto al HPV-16, se encontraron 68.2% de variantes europeas y 31.8% de asiático-americanas. Entre los cofactores analizados, solo la disposición de excretas al aire libre estuvo significativamente asociada con la infección por VPH (P = 0.01). Los datos obtenidos reflejan que la comunidad Pilagá está altamente expuesta a las infecciones por genotipos de alto riesgo de VPH, lo cual puede estar asociado a una alta incidencia de lesiones cervicales preneoplásicas y neoplásicas.

Acceso a la vivienda, derechos de territorio / Housing access and territorial rights

El presente trabajo se propone estudiar las condiciones actuales del acceso a la vivienda en sectores sociales marginalizados y algunos de los efectos psicosociales sobre la población afectada, a través del análisis de dos casos específicos que los autores han investigado en profundidad: una cooperativa autogestiva de vivienda en la ciudad de Buenos Aires, y una comunidad aborigen en la provincia de Chubut. Se introduce la problemática a partir de la consideración de dos casos que cobraron notoriedad mediática durante el año 2010, y se discuten algunos aportes conceptuales en torno a las nociones de territorio y de organización en la comunidad. A partir del análisis de estos casos, se desprende por un lado la gravedad de los atropellos cometidos contra el derecho a la vivienda de las clases bajas y de las comunidades indígenas, así como también la capacidad de resistencia que las mismas poseen mediante su incipiente organización.

This paper aims to studying the current conditions of access to housing in marginalized social sectors and some of the psychosocial effects on the affected population, through the analysis of two specific cases that the authors have investigated in depth: a self-managed housing cooperative in the city of Buenos Aires, and an aboriginal community in the province of Chubut. The problem is introduced through the consideration of two cases that gained mediatic notoriety in 2010, and some conceptual contributions around the notions of territory and community organization are discussed. From the analysis of these cases, it is concluded on the one hand the severity of the abuses committed against the housing rights of the lower classes and indigenous communities, as well as the resilience potential that they possess through their growing organization.

Asma bronquial en poblaciones aborígenes chilenas: una realidad desconocida / Bronchial asthma in Chilean aboriginal populations: an unknown reality

According to the 2002 census living ion chile 692.192 persons belonging to ethnic groups. Largest groups correspond to the mapuche ethnic group with 604.349 people. Not know the prevalence and caractheristics ofasthma in Chilean aboriginal groups. Worlwide while the number of publications is limited research shows that asthma prevalence is important in adult indigenous population of the Australia and United States. So well havedeveloped some interesting projects in Chile of interaction in health with the mapuche and huilliche communitiesnational studies are needed to enable the development of appropriate health policies for the management of asthma aboriginal populations.

Según el censo 2002 en Chile viven 692.102 personas pertenecientes a grupos étnicos. El grupo más grande corresponde a la etnia mapuche con 604.349 personas. Se desconoce la prevalencia y características del asma bronquial en grupos aborígenes chilenos. A nivel mundial si bien el número de publicaciones es reducido los estudios revelan que el asma presenta una prevalencia importante en población indígena adulta de Australia y Estados Unidos. Si bien en Chile se han desarrollado algunos proyectos interesantes de interacción en salud en comunidades mapuches y huilliches es necesario realizar estudios nacionales que permitan el desarrollo de políticas de salud adecuadas para el manejo del asma en poblaciones indígenas.

As histórias e culturas indígenas e as afro-brasileiras nas aulas de matemática / Indians and afro-brazilians histories and culture in mathematics lessons

Inicialmente, é evidenciada a necessidade de implementação da Lei 11.645/08, que torna obrigatória a abordagem escolar das histórias e das culturas negras e indígenas. Em seguida, defende-se que: ressaltar tais culturas e histórias não implica vê-las fechadas em si mesmas; não é necessário estabelecer oposição frontal entre brancos, negros e índios; importa evidenciar o silenciado, os mecanismos de dominação e de exploração entre os grupos humanos e dissolver nossas certezas para que, ao descobrirmos outros significados, desconstruamos nossas percepções e categorizações, tornando-nos mais capazes de abordar tais histórias e culturas. Restringindo a discussão para a área de Educação Matemática, esses tópicos são, então, discutidos a partir dos referenciais da Etnomatemática, da História Cultural e dos Estudos do Imaginário. Finalmente, nesse contexto, é apresentado um breve estudo do maracatu para sugerir aos professores algumas possibilidades de ação.

Initially the necessity of implementation of the Law 11,645/08 is evidenced, which determines the approach of histories and the black and Indians cultures in the basic schools. After that, the arguments are presented: these histories and cultures are not close in itself; it is not necessary to establish a frontal opposition among white, black and Indians ; it matters to evidence the silenced one, the mechanisms of domination and exploration in human groups and, when discovering other meanings, we are becoming capable for approaching such histories and cultures. Shortening the discussion on the mathematical area, these arguments are discussed based on the use of Ethnomatematics, Cultural History and the Imaginary Studies. Finally, in this context, is presented a short study of Maracatu in order to suggest some possibilities of action to the teachers.

Investigación de parásitos intestinales en una comunidad aborigen de la provincia de Salta / Survey of intestinal parasites among an aboriginal community in Salta

Se investigó la presencia de protozoarios y helmintos intestinales en una comunidad aborigen ubicada a 6 km de Tartagal, provincia de Salta, Argentina. La edad de los individuos estudiados estaba comprendida entre 1 y 49 años. Ciento doce muestras de materia fecal se recogieron en solución acética formolada (SAF). Cada muestra se recolectó en tres días, en forma alternada. Todas las muestras se procesaron por el método de concentración bifásico de Ritchie y la técnica de flotación de Faust. Para la investigación de Enterobius vermicularis, se recolectaron 68 muestras seriadas de 6 días en formol al 5% por escobillado anal. Para la búsqueda de Dientamoeba fragilis se utilizó la coloración tricrómica modificada de Gomori-Wheatley. Ciento seis individuos (94.6%) fueron positivos para parásitos entéricos. Cuarenta y cuatro sujetos (41.5%) estaban poliparasitados, con más de cuatro especies. Los parásitos más frecuentes entre los protozoarios fueron Blastocystis hominis (58.9%), Entamoeba coli (51.8%), Giardia lamblia (27.7%) y Entamoeba histolytica/E. dispar (24.1%). Entre los helmintos, los hallados con mayor frecuencia fueron uncinarias (58.0%), Hymenolepis nana (31.2%) y Strongyloides stercoralis (24.1%). Por primera vez se informa Entamoeba histolytica/E. dispar (24.1%) y Dientamoeba fragilis (2.7%) en una comunidad aborigen de los alrededores de Tartagal. Este estudio revela el problema de salud pública que constituyen las parasitosis intestinales en la comunidad indígena estudiada, en la que coexisten la falta de saneamiento y de abastecimiento de agua potable.

The prevalence of intestinal parasitoses by protozoans and helminths was determined in an aboriginal community located 6 km from Tartagal, province of Salta, Argentina. The age of the inhabitants studied ranged from 1 to 49 years old. A total of 112 stool samples were collected in sodium acetate-acetic acid- formalin solution (SAF). Each sample was obtained in three different days, alternatively. Ritchie biphasic concentration method and Faust flotation technique were applied. For survey of Enterobius vermicularis, 68 samples were collected during six consecutive days using anal swabs. For the diagnosis of Dientamoeba fragilis, the modified trichrome Gomori-Wheatley staining technique was used. One hundred and six (94.6%) subjects resulted positive for enteric parasites. Forty-four (41.5%) individuals were positive for four or more parasites. The parasites more frequently found were, among the protozoans Blastocystis hominis (58.9%), Entamoeba coli (51.8%), Giardia lamblia (27.7%) and Entamoeba histolytica/E. dispar (24.1%). Among the helminths, the most frequent were hookworms (58.0%), Hymenolepis nana (31.2%) and Strongyloides stercoralis (24.1%). This is the first time that Entamoeba histolytica/E. dispar (24.1%) and Dientamoeba fragilis (2.7%) have been registered in the suburbs of Tartagal. This study reveals how intestinal parasitoses constitute a critical problem of public health in aboriginal communities like the one examined, where the lack of adequate sanitation conditions and unsuitable supply of water coexist.