COVID-19 vaccination in urban American Indian and Alaska Native children: Parental characteristics, beliefs and attitudes associated with vaccine acceptance.

Background: Little is known about vaccination rates for American Indian and Alaska Native (AI/AN) parents and their children, or parental decisions in this regard. Improving vaccination rates is a serious concern due to the disproportionate incidence and morbidity of COVID-19 in AI/AN people. Purpose: Our goal was to describe urban AI/AN parental attributes associated with COVID-19 vaccination of their children. Methods: Survey participants (n = 572) were ≥18 years of age, had children ≥5 years of age, AI/AN, and seen at one of six urban health organizations serving primarily AI/AN people within the prior year. They were asked about gender, age, education, marital status, perceived stress, trauma history, whether they had received the COVID-19 vaccine, tested positive for COVID-19 in the past, and if their child was vaccinated. They were also asked about 16 vaccine hesitancy reasons. Results: Parental vaccination rate was 82%, with 59% of their children vaccinated. Parents who vaccinated their children were older, had higher education, lower stress and trauma, and were more likely to be vaccinated compared to parents who did not vaccinate their children. Forty-two percent of parents indicated they would likely vaccinate their unvaccinated child in the future. Sixteen vaccine hesitancy reasons revealed four factors: distrust, inconvenience, lack of concern about the pandemic, and AI/AN concerns. Parents who had no plans to vaccinate their children had the highest vaccine distrust and lack of concern about the pandemic. Parents with greater vaccine distrust and AI/AN specific concern reported significantly greater trauma history and higher levels of education. Conclusion: Even though vaccination rates for AI/AN parents and children are high, the consequences of COVID-19 for AI/AN people are more severe than for other US populations. Providers should use trauma-informed, trust-building and culturally competent communication when discussing choices about vaccination with AI/AN parents.

Effectiveness of the COVID-19 vaccines on preventing symptomatic SARS-CoV-2 infections and hospitalizations in Southwestern Alaska, January-December 2021.

The population in rural southwest Alaska has been disproportionately affected by COVID-19. To assess the benefit of COVID-19 vaccines, we analyzed data from the regional health system. We estimated vaccine effectiveness (VE) during January 16-December 3, 2021, against symptomatic SARS-CoV-2 infection after a primary series or booster dose, and overall VE against hospitalization. VE of a primary series against symptomatic infection among adult residents was 91.3% (95% CI: 85.7, 95.2) during January 16-May 7, 2021, 50.3% (95% CI, 41.1%-58.8%) during July 17-September 24, and 37.0% (95% CI, 27.8-45.0) during September 25-December 3, 2021; VE of a booster dose during September 25-December 3, 2021, was 92.1% (95% CI: 87.2-95.2). During the overall study period, VE against hospitalization was 91.9% (95% CI: 85.4-95.5). COVID-19 vaccination offered strong protection against hospitalization and a booster dose restored protection against symptomatic infection.

Aniqsaaq (To Breathe): Study protocol to develop and evaluate an Alaska Native family-based financial incentive intervention for smoking cessation.

Background: Alaska Native and American Indian (ANAI) communities in Alaska are disproportionately affected by commercial tobacco use. Financial incentive interventions promote cigarette smoking cessation, but family-level incentives have not been evaluated. We describe the study protocol to adapt and evaluate the effectiveness and implementation of a remotely delivered, family-based financial incentive intervention for cigarette smoking among Alaskan ANAI people. Methods: The study has 3 phases: 1) qualitative interviews with ANAI adults who smoke, family members, and stakeholders to inform the intervention, 2) beta-test of the intervention, and 3) randomized controlled trial (RCT) evaluating intervention reach and effectiveness on verified, prolonged smoking abstinence at 6- and 12-months post-treatment. In the RCT, adult dyads (ANAI person who smokes [index participant] and family member) recruited throughout Alaska will be randomized to a no-incentives control condition (n = 328 dyads) or a 6-month incentive intervention (n = 328 dyads). All dyads will receive cessation support and family wellness materials. Smoking status will be assessed weekly for four weeks and at three and six months. Intervention index participants will receive escalating incentives for verified smoking abstinence at each time point (maximum $750 total); the family member will receive rewards of equal value. Results: A community advisory committee contributed input on the study design and methods for relevance to ANAI people, particularly emphasizing the involvement of families. Conclusion: Our study aligns with the strength and value AIAN people place on family. Findings, processes, and resources will inform how Indigenous family members can support smoking cessation within incentive interventions. Clinical Trials Registry: NCT05209451.

Tuberculosis remains a major burden in systemic lupus erythematosus patients in Durban, South Africa.

Objective: Infections are common in systemic lupus erythematosus (SLE), with tuberculosis (TB) being important in an endemic environment. We studied the prevalence and spectrum of TB in SLE in Durban, South Africa. Methods: A medical records review of SLE patients seen over 13-year period, and the demographic data, clinical manifestations, laboratory findings, treatment and outcome were noted. Results: There were 512 SLE patients and 72 (14.1%) had TB. Thirty (41.7%) had pulmonary TB (PTB) and 42 (58.3%) had extra-pulmonary TB (EPTB). The prevalence of TB among the different ethnic groups was 36/282 (12.8%) for Indian people, 29/184 (15.8%) Black African people, 7/26 (26.9%) admixed African people and none among the 18 White people. Comparison of the 72 SLE-TB patients with 72 SLE controls showed no difference in gender, age at SLE diagnosis and disease duration. The SLE-TB patients had a significant increase in the clinical and laboratory features of disease activity (arthritis, mucocutaneous lesions, renal involvement, vasculitis, low complement, raised ds-DNA antibodies), and cumulative prednisone use over the preceding 3 months.Compared to PTB, the EPTB patients were significantly younger, developed TB earlier after SLE diagnosis, and had higher disease activity. The EPTB patients also had increase in features of disease activity (renal, thrombocytopenia, ds-DNA antibodies), and increase in ever use of intravenous methylprednisolone (IV-MP) and mycophenolate mofetil (MMF). On multivariate analysis, the independent risk factors for EPTB were ever use of MMF (p = 0.003) and IV-MP (p = 0.027). Analysis of the cumulative SLE criteria showed renal involvement was an independent risk factor for EPTB. The outcome was similar in both groups. Conclusion: We show an increased prevalence of TB (14.1%) and EPTB (58.3%) in SLE in an endemic area and confirm that features of disease activity and use of immunosuppressive therapy are the major risk factors. Renal involvement (as a cumulative criterion) is an independent risk factor for EPTB.

Pesquisacaminhante: a pesquisa ação-participante (PAP) como método de pesquisa longitudinal / Walker research: the Action-Participant Research (PAP) as a longitudinal research method / Investigación walker: la Investigación Acción-Participante (PAP) como método de investigación longitudinal

Este artigo relata uma pesquisa ação-participante longitudinal realizada desde 2016 até 2021 com mulheres indígenas Xokleng/Laklãnõ que vivem no contexto urbano de Blumenau, SC. Analisa a trama afetiva que compôs esta caminhada de seis anos e traça a configuração do método que denominamos de pesquisacaminhante para demarcar a temporalidade e o lugar das pesquisadoras, das pesquisadoras-participantes e sua intencionalidade, de fortalecer a luta e a resistência dessas que vivem na cidade de Blumenau, uma cidade de origem germânica e marcadamente "branca". Como instrumento, foram utilizados entrevistas, fotografias, diversos encontros pela cidade e participação em eventos oficiais e, principalmente, encontros constantes entre as pesquisadoras, nos quais elas puderam se expressar como mulheres indígenas. O referencial teórico é a psicologia sócio-histórica, com base nas reflexões de Vigotski e Spinoza, utilizando o afeto como bússola das ações. O método revelou potência para contribuir com a práxis da psicologia social, destacando aquelas voltadas às comunidades tracionais. (AU)

This article reports a longitudinal participant-action research carried out from 2016 to 2021 with indigenous women Xokleng/Laklãnõ who live in the urban context of Blumenau, SC. Analyzes the affective plot that composed this walk of six years and outlines the configuration of the method we call walking research to demarcate the temporality and the place of researchers, researcher-participants and their intention to strengthen the struggle and resistance those who live in the city of Blumenau, a city of German origin and markedly "white". As instrument, interviews, photographs, various meetings around the city and participation in official events were used. and, mainly, constant meetings between the researchers, in which they could express themselves as women indigenous. The theoretical reference is socio-historical psychology, based on the reflections of Vigotski and Spinoza, using the affection as a compass of actions. The method revealed power to contribute to the practice of social psychology, highlighting those aimed at traditional communities. (AU)

Este artículo reporta una investigación longitudinal de acción participante realizada de 2016 a 2021 con mujeres indígenas Xokleng/Laklãnõ que viven en el contexto urbano de Blumenau, SC. Analiza la trama afectiva que compuso este paseo de seis años y esboza la configuración del método que llamamos walking research para demarcar la temporalidad y el lugar de los investigadores, los investigadores-participantes y su intención de fortalecer la lucha y la resistencia los que viven en a ciudad de Blumenau, ciudad de origen alemán y marcadamente "blanca". Como se utilizó el instrumento, entrevistas, fotografías, diversos encuentros por la ciudad y participación en actos oficiales, y, principalmente, encuentros constantes entre las investigadoras, en las que pudieran expresarse como mujeres indígena. El referente teórico es la psicología sociohistórica, a partir de las reflexiones de Vigotski y Spinoza, utilizando la el afecto como brújula de acciones. El método reveló poder contribuir a la práctica de la psicología social, destacando los destinados a las comunidades tradicionales. (AU)

Violência contra a mulher indígena e quilombola: uma perspectiva a partir de normativas de municípios do estado do Rio de Janeiro e de movimentos sociais do Brasil / Violence against indigenous and quilombola women: a perspective from legal regulations of municipalities in the state of Rio de Janeiro and Brazil's social movements

A violência contra a mulher está presente em todas as populações, inclusive as etnicamente diferenciadas. Por isso, enquanto cidadãs brasileiras, mulheres pertencentes a populações indígenas e quilombolas também carecem da proteção e defesa de seus direitos, inclusive o direito à saúde e segurança. O estado do Rio de Janeiro possui em seu território tais populações, estando algumas presentes em terras homologadas no caso de indígenas e tituladas, no caso de quilombolas. O trabalho busca identificar normativas que tratem sobre a violência contra a mulher em populações indígenas e quilombolas federais e no estado do Rio de Janeiro, bem como a ação por parte dos movimentos feministas. Estado e Sociedade Civil organizada elaboram formas de ação para abordar a violência contra a mulher indígena e quilombola, de maneiras distintas, o primeiro por atividades materializadas em normativas e a segunda por recomendações presentes em livros; em ambos os casos tornando essas formas de ação disponíveis para consulta em documentos. A pesquisa foi realizada por meio de busca eletrônica de normativas em repositórios de legislações federais, estaduais e municipais, de municípios com terras indígenas homologadas e terras quilombolas tituladas. Além disso, foi realizada a busca na literatura através de websites de busca de artigos científicos e de documentos provenientes da sociedade civil organizada por meio eletrônico. Dessa forma, foram analisados 4 municípios no estado do Rio de Janeiro e 5 websites de organizações não governamentais. As normativas encontradas sobre a violência contra a mulher indígena e quilombola incluem portarias, leis e resoluções, totalizando 12 federais, 6 estaduais e 27 municipais. Foi analisado o texto final de 6 conferências e encontros indígenas e 7 documentos de políticas oficiais a respeito da população quilombola. Nota-se uma escassez de documentos específicos sobre a violência contra a mulher indígena e quilombola, também perceptível na literatura, talvez pelo fato de que esse tipo de violência contra a mulher seja invisibilizado. Populações etnicamente diferenciadas pouco são especificadas nas normativas e materiais consultados. Entretanto, encontros e conferências revelam como as mulheres indígenas compreendem o fenômeno da violência nas suas aldeias, bem como uma carta do coletivo de mulheres quilombolas, que aponta para tal entendimento de maneira singular. Apenas um dos 4 municípios do estado do Rio de Janeiro com povos indígenas aldeados em terras homologadas e população quilombola em terras tituladas expressa com contundência uma forma de ação voltada para o enfrentamento da violência contra a mulher entre essas populações etnicamente diferenciadas.

Violence against women exists in all populations, including ethically different ones. Because of that, indigenous and quilombola women need protection and defense of their own rights, including health and safety. State of Rio de Janeiro has in its territory populations with these skills, some in approved lands, indigenous and titled lands, quilombolas. This paper tries to identify federal legal regulations about violence against indigenous and quilombola women and in the state of Rio de Janeiro just as the action of feminist movements. State and organized civil society elaborate different ways to approach violence against indigenous and quilombola women, the first one by actvities that are materialized into laws and the second ones by recomendations expressed in books, and in both cases making it available for consultation by documents. The research was carried out through na eletronic search of regulations in repositories of federal, state and municipal legislation, among these, only counties that have indigenous in approved lands and quilombolas in titled lands. In addition, a litterature search was carried out through websites to search for scientific articles and documents from organized civil society by electronic means. Thus, 4 municipalities in the state of Rio de Janeiro and 5 websites of non-governamental organizations were analyzed. Regulations found on violence against indigenous and quilombola women include ordinances, laws, resolutions, totalling 12 federal, 6 state and 27 municipal. The final text of 6 indigenous conferences and meetings and 7 official policy documents regarding the quilombola population were analyzed. There`s a scarcity of specific documents on violence against indigenous and quilombola women, also noticeable in the literature, perhaps due to the fact that this type of violence against women is made invisible. Ethnically differentiated populations are barely specified in the regulations and materials consulted. However, meetings and conferences reveal how indigenous women understand the phenomenon of violence in their villages, as well as a letter from a collective of quilombola women point to this understanding in a unique way. Only one of the 4 municipalities in the state of Rio de Janeiro with indigenous people living in approved lands and a quilombola population on titled lands strongly expresses a form of action aimed at combating violence against women among these ethnically differentiated populations.

New developments in India concerning the policy of passive euthanasia.

Euthanasia and assisted dying are illegal in India according to Sections 306 and 309 of the Indian Penal Code (IPC), and Article 21 of the Constitution of India. There have been a number of cases where the Indian High Courts and Indian Supreme Court issued differing verdicts concerning the right to life and the right to die. Nevertheless, on 7 March 2011, a paradigm shift happened as a result of the Indian Supreme Court's judgment on involuntary passive euthanasia in the case of Aruna Shanbaug. In its judgment, the Supreme Court requested the government to prepare a law on euthanasia. Accordingly, the 241st Report of the Law Commission of India proposed a bill to permit passive euthanasia. In May 2016 the Ministry of Health and Family Welfare (MOHFW) issued the draft bill for public comment in order to create an informed decision. The Indian people are divided on the issue of euthanasia. The majority of the scientific community welcome it, while some religious groups oppose it. Hindus, in general, express both supporting and opposing views on euthanasia, whereas, Christians and Muslims have hardened their opposition against it. The Supreme Court judgment and the Report of the Law Commission pave the way for the development of new policies pertaining to passive euthanasia by the central government of India. Once such legislation is passed, passive euthanasia may, and probably will, have an enormous impact on the cultural, political, public and medical spheres of India in the near future.

Guideline concordant detection and management of depression among Alaska Native and American Indian people in primary care.

BACKGROUND: A tribal health organization in Alaska implemented a primary care depression screening, detection and management initiative amongst 55,000 Alaska Native/American Indian people (AN/AIs). OBJECTIVES: (a) To describe the proportion of AN/AIs screening positive for depression with depression noted or diagnosed and proportion with guideline concordant management and (b) to assess whether management varied by patient and provider factors. RESEARCH DESIGN: Secondary analysis of electronic and paper medical record information of 400 AN/AIs. MEASURES: Provider variables, patient demographics and patient clinical factors were electronically queried. Manual chart audits assessed depression notation, diagnoses and management within 12 weeks of positive screening. Multilevel ordinal logistic modelling assessed management by patient and provider factors. RESULTS: A depression diagnosis was present in 141 (35%) charts and 151 (38%) had depressive symptoms noted. Detection was higher among AN/AIs with moderate and severe depression (p<0.001). In total, 258 patients (66%) received guideline concordant management, 32 (8%) had some management, and 110 (28%) received no management. Younger patient age and increased provider tenure increased odds of management. CONCLUSIONS: Most AN/AIs screening positive for depression received initial guideline concordant management. Additional outreach to older patients and additional support for providers newer to practices appears warranted.

A experiência de um serviço de saúde especializado no atendimento a pacientes indígenas / The experience of a specialized health service for the care of Indian patients

Estudo descritivo, de natureza qualitativa, na modalidade de relato de experiência. Trabalho desenvolvido em serviço de saúde especializado no atendimento a pacientes indígenas a partir de atividades de extensão universitária em acolhimento, promoção e educação em saúde. O Ambulatório do Índio e Hospital São Paulo da UNIFESP são referências no atendimento de média e alta complexidade aos povos indígenas de diversas regiões do Brasil. Os projetos de extensão tiveram por finalidade criar espaços de conversa, identificar percepções sobre processo saúde-doença e estabelecer projeto de cuidado a partir da identificação das necessidades do paciente indígena. Desafiou a equipe de saúde a proposta de formar vínculo com pacientes indígenas que ultrapasse o objetivo de resolução de um problema de saúde, mas adentre nas interfaces entre saúde, cultura e modo de vida. Conclui-se que o Ambulatório do Índio é um espaço permanente de reflexão para o atendimento diferenciado ao paciente indígena nos campos da assistência, ensino, pesquisa e extensão...

A descriptive study, of qualitative nature, in the modality of experience report. A paper developed in a specialized health service for the care of Indian patients, based on university extension activities of users’ reception, health promotion and education. The Indian outpatients clinic and São Paulo’s Hospital, of the Federal University of São Paulo, are references in medium and high complexity service to Indian populations in several regions in Brazil. The extension projects were intended to create conversation spaces, to identify perceptions about the health-disease process and to establish a health care project, from the identification of the indigenous patient needs. The proposal of forming bonds with Indian patients that go beyond the objective of solving a health problem to enter the interfaces among health, culture and life style was a challenge for the health staff. It can be concluded that the outpatient clinic of the Indian is a permanent space for reflection, for a differentiated service to these patients in the areas of health assistance, teaching, research and extension...

A saúde indigenista e os desafios da particip(ação) indígena / Indigenist health and the challenges of the indian particip(action)

Análise da participação indígena na saúde indigenista, tomando como referência empírica a atuação dos Tentehar-Guajajara (Amarante) na Casa de Apoio à Saúde do Índio (CASAI)/Pólo-Base Guajajara e no Distrito Sanitário Especial Indígena no Maranhão (DSEI-MA), no período de 2000 a 2007. A análise é realizada buscando apreender se ocorre e como se dá a participação dos índios no modelo Distrito Sanitário Especial Indígena (DSEI), de forma a identificar as possibilidades de respeito à diversidade étnica, através da participação indígena, prevista na Política Nacional de Atenção à Saúde dos Povos Indígenas. A pesquisa aponta que os Tentehar-Guajajara estão continuamente tentando participar de todas as questões relativas às políticas indigenistas, incluídas as de saúde. Além dos mecanismos oficiais de participação na saúde indigenista, eles têm criado estratégias próprias para serem sujeitos nesse processo. A necessidade de acionar tais estratégias sinaliza que a condução da saúde indigenista no DSEI-MA contradiz o que está posto nos documentos oficiais como uma de suas principais características: a criação de condições para a participação indígena.