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1.
MMWR Morb Mortal Wkly Rep ; 69(37): 1283-1287, 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32941412

RESUMEN

Human papillomavirus (HPV) causes most cervical cancers and some cancers of the penis, vulva, vagina, oropharynx, and anus. Cervical precancers can be detected through screening. HPV vaccination with the 9-valent HPV vaccine (9vHPV) can prevent approximately 92% of HPV-attributable cancers (1).* Previous studies have shown lower incidence of HPV-associated cancers in non-Hispanic American Indian and Alaska Native (AI/AN) populations compared with other racial subgroups (2); however, these rates might have been underestimated as a result of racial misclassification. Previous studies have shown that cancer registry data corrected for racial misclassification resulted in more accurate cancer incidence estimates for AI/AN populations (3,4). In addition, regional variations in cancer incidence among AI/AN populations suggest that nationally aggregated data might not adequately describe cancer outcomes within these populations (5). These variations might, in part, result from geographic disparities in the use of health services, such as cancer screening or vaccination (6). CDC analyzed data for 2013-2017 from central cancer registries linked with the Indian Health Service (IHS) patient registration database to assess the incidence of HPV-associated cancers and to estimate the number of cancers caused by HPV among AI/AN populations overall and by region. During 2013-2017, an estimated 1,030 HPV-associated cancers were reported in AI/AN populations. Of these cancers, 740 (72%) were determined to be attributable to HPV types targeted by 9vHPV; the majority were cervical cancers in females and oropharyngeal cancers in males. These data can help identify regions where AI/AN populations have disproportionately high rates of HPV-associated cancers and inform targeted regional vaccination and screening programs in AI/AN communities.


Asunto(s)
Nativos de Alaska/estadística & datos numéricos , Indios Norteamericanos/estadística & datos numéricos , Neoplasias/etnología , Neoplasias/virología , Papillomaviridae/patogenicidad , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/etnología , Femenino , Humanos , Incidencia , Masculino , Sistema de Registros , Estados Unidos/epidemiología
2.
MMWR Morb Mortal Wkly Rep ; 69(34): 1166-1169, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-32853193

RESUMEN

Although non-Hispanic American Indian and Alaska Native (AI/AN) persons account for 0.7% of the U.S. population,* a recent analysis reported that 1.3% of coronavirus disease 2019 (COVID-19) cases reported to CDC with known race and ethnicity were among AI/AN persons (1). To assess the impact of COVID-19 among the AI/AN population, reports of laboratory-confirmed COVID-19 cases during January 22†-July 3, 2020 were analyzed. The analysis was limited to 23 states§ with >70% complete race/ethnicity information and five or more laboratory-confirmed COVID-19 cases among both AI/AN persons (alone or in combination with other races and ethnicities) and non-Hispanic white (white) persons. Among 424,899 COVID-19 cases reported by these states, 340,059 (80%) had complete race/ethnicity information; among these 340,059 cases, 9,072 (2.7%) occurred among AI/AN persons, and 138,960 (40.9%) among white persons. Among 340,059 cases with complete patient race/ethnicity data, the cumulative incidence among AI/AN persons in these 23 states was 594 per 100,000 AI/AN population (95% confidence interval [CI] = 203-1,740), compared with 169 per 100,000 white population (95% CI = 137-209) (rate ratio [RR] = 3.5; 95% CI = 1.2-10.1). AI/AN persons with COVID-19 were younger (median age = 40 years; interquartile range [IQR] = 26-56 years) than were white persons (median age = 51 years; IQR = 32-67 years). More complete case report data and timely, culturally responsive, and evidence-based public health efforts that leverage the strengths of AI/AN communities are needed to decrease COVID-19 transmission and improve patient outcomes.


Asunto(s)
Nativos de Alaska/estadística & datos numéricos , Infecciones por Coronavirus/etnología , Disparidades en el Estado de Salud , Indios Norteamericanos/estadística & datos numéricos , Neumonía Viral/etnología , Adolescente , Adulto , Anciano , Betacoronavirus/aislamiento & purificación , Niño , Preescolar , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Estados Unidos/epidemiología , Adulto Joven
3.
Front Health Serv Manage ; 37(1): 45-48, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32842089

RESUMEN

For populations experiencing the preexisting conditions of poverty and all its related social inequalities, the COVID-19 pandemic further complicates the delivery of healthcare. Two members of the American College of Healthcare Executives-Tim Egan, president and CEO of Roseland Community Hospital on the South Side of Chicago, Illinois, and Lynette Bonar, RN, FACHE, CEO of Tuba City Regional Health Care Corporation on the Navajo and Hopi reservations in Arizona-deal with those complications daily. Presented here together, their perspectives show resilience, cultural sensitivity, and commitment to protect the well-being of their diverse communities.


Asunto(s)
Adaptación Psicológica , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/psicología , Infecciones por Coronavirus/terapia , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/estadística & datos numéricos , Personal de Salud/psicología , Neumonía Viral/diagnóstico , Neumonía Viral/psicología , Neumonía Viral/terapia , Adulto , Arizona , Actitud del Personal de Salud , Betacoronavirus , Chicago , Ciudades/estadística & datos numéricos , Femenino , Humanos , Indios Norteamericanos , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Población Rural , Población Urbana
4.
J Ambul Care Manage ; 43(4): 301-305, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32858729

RESUMEN

Over 100 Community Health Representatives (CHRs) as part of the oldest and largest Community Health Worker (CHW) program in the United States serve the Dine People on the Navajo Nation. The CHRs work under a tribally determined scope of practice that embraces the importance of self-determination of tribal nations, a philosophy central to the CHW field nationally. Navajo CHRs are the epitome of frontline workers, as they extend their traditional role to encompass long-term emergency response during coronavirus disease-2019 (COVID-19). This article describes the Navajo CHR role in the pandemic through the lens of an interview with the program's director, Mae-Gilene Begay.


Asunto(s)
Agentes Comunitarios de Salud , Infecciones por Coronavirus/etnología , Infecciones por Coronavirus/epidemiología , Indios Norteamericanos , Neumonía Viral/etnología , Neumonía Viral/epidemiología , Rol Profesional , United States Indian Health Service/organización & administración , Betacoronavirus , Humanos , Pandemias , Estados Unidos/epidemiología
5.
Nature ; 583(7817): 524-525, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32641787
9.
Public Health Rep ; 135(4): 461-471, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32633599

RESUMEN

OBJECTIVES: Hepatitis C virus (HCV) and HIV transmission in the United States may increase as a result of increasing rates of opioid use disorder (OUD) and associated injection drug use (IDU). Epidemiologic trends among American Indian/Alaska Native (AI/AN) persons are not well known. METHODS: We analyzed 2010-2014 Indian Health Service data on health care encounters to assess regional and temporal trends in IDU indicators among adults aged ≥18 years. IDU indicators included acute or chronic HCV infection (only among adults aged 18-35 years), arm cellulitis and abscess, OUD, and opioid-related overdose. We calculated rates per 10 000 AI/AN adults for each IDU indicator overall and stratified by sex, age group, and region and evaluated rate ratios and trends by using Poisson regression analysis. RESULTS: Rates of HCV infection among adults aged 18-35 increased 9.4% per year, and rates of OUD among all adults increased 13.3% per year from 2010 to 2014. The rate of HCV infection among young women was approximately 1.3 times that among young men. Rates of opioid-related overdose among adults aged <50 years were approximately 1.4 times the rates among adults aged ≥50 years. Among young adults with HCV infection, 25.6% had concurrent OUD. Among all adults with arm cellulitis and abscess, 5.6% had concurrent OUD. CONCLUSIONS: Rates of HCV infection and OUD increased significantly in the AI/AN population. Strengthened public health efforts could ensure that AI/AN communities can address increasing needs for culturally appropriate interventions, including comprehensive syringe services programs, medication-assisted treatment, and opioid-related overdose prevention and can meet the growing need for treatment of HCV infection.


Asunto(s)
Nativos de Alaska/estadística & datos numéricos , Hepatitis C/epidemiología , Indios Norteamericanos/estadística & datos numéricos , Trastornos Relacionados con Opioides/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , United States Indian Health Service/estadística & datos numéricos , United States Indian Health Service/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto Joven
10.
J Med Microbiol ; 69(8): 1049-1061, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32602832

RESUMEN

Introduction. Metal exposure is an important factor for inducing antibiotic resistance in bacteria. Dandelion extracts have been used for centuries in traditional Chinese and Native American medicine.Aim. We assessed the effects of dandelion water extracts and taraxasterol on heavy metal-induced antibiotic resistance in Escherichia coli as well as the underlying mechanisms.Methodology. Dandelion extracts were obtained through 4 h of boiling in distilled water. Bacterial growth was monitored with a spectrophotometer. Biochemical assays were performed to assess the activities and gene transcriptions of ß-lactamase and acetyltransferase. Oxidative stress was determined using an oxidation-sensitive probe, H2DCFDA.Results. The present study demonstrated that higher concentrations of nickel (>5 µg ml-1), cadmium (>0.1 µg ml-1), arsenic (>0.1 µg ml-1) and copper (>5 µg ml-1) significantly inhibited the growth of E. coli. Lower concentrations of nickel (0.5 µg ml-1), cadmium (0.05 µg ml-1) and arsenic (0.05 µg ml-1) had no effect on bacterial growth, but helped the bacteria become resistant to two antibiotics, kanamycin and ampicillin. The addition of dandelion root extracts and taraxasterol significantly reversed the antibiotic resistance induced by these heavy metals. The supplements of antibiotics and cadmium generated synergistic effects on the activities of ß-lactamase and acetyltransferase (two antibiotic resistance-related proteins), which were significantly blocked by either dandelion root extract or taraxasterol. In contrast, oxidative stress was not involved in the preventative roles of dandelion root extracts and taraxasterol in heavy metal-induced antibiotic resistance.Conclusion. This study suggests that heavy metals induce bacterial antibiotic resistance and dandelion root extracts and taraxasterol could be used to help reverse bacterial resistance to antibiotics.


Asunto(s)
Farmacorresistencia Microbiana/efectos de los fármacos , Metales Pesados/efectos adversos , Extractos Vegetales/farmacología , Esteroles/farmacología , Taraxacum/química , Triterpenos/farmacología , Resistencia a la Ampicilina/efectos de los fármacos , Arsénico/efectos adversos , Cadmio/efectos adversos , Cobre/efectos adversos , Escherichia coli/efectos de los fármacos , Humanos , Indios Norteamericanos , Resistencia a la Kanamicina/efectos de los fármacos , Medicina China Tradicional , Medicina Tradicional , Níquel/efectos adversos , Raíces de Plantas/química
12.
South Med J ; 113(6): 311-319, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32483642

RESUMEN

OBJECTIVES: Prevalence and trends in all cardiovascular disease (CVD) risk factors among young adults (18-39 years) have not been evaluated on a large scale stratified by sex and race. The aim of this study was to establish the prevalence and temporal trend of CVD risk factors in US inpatients younger than 40 years of age from 2007 through 2014 with racial and sex-based distinctions. In addition, the impact of these risk factors on inpatient outcomes and healthcare resource utilization was explored. METHODS: A cross-sectional nationwide analysis of all hospitalizations, comorbidities, and complications among young adults from 2007 to 2014 was performed. The primary outcomes were frequency, trends, and race- and sex-based differences in coexisting CVD risk factors. Coprimary outcomes were trends in all-cause mortality, acute myocardial infarction, arrhythmia, stroke, and venous thromboembolism in young adults with CVD risk factors. Secondary outcomes were demographics and resource utilization in young adults with versus without CVD risk factors. RESULTS: Of 63 million hospitalizations (mean 30.5 [standard deviation 5.9] years), 27% had at least one coexisting CVD risk factor. From 2007 to 2014, admission frequency with CVD risk factors increased from 42.8% to 55.1% in males and from 16.2% to 24.6% in females. Admissions with CVD risk were higher in male (41.4% vs 15.9%) and white (58.4% vs 53.8%) or African American (22.6% vs 15.9%) patients compared with those without CVD risk. Young adults in the Midwest (23.9% vs 21.1%) and South (40.8% vs 37.9%) documented comparatively higher hospitalizations rates with CVD risk. Young adults with CVD risk had higher all-cause in-hospital mortality (0.4% vs. 0.3%) with a higher average length of stay (4.3 vs 3.2 days) and charges per admission ($30,074 vs $20,124). CONCLUSIONS: Despite modern advances in screening, management, and interventional measures for CVD, rising trends in CVD risk factors across all sex and race/ethnic groups call for attention by preventive cardiologists.


Asunto(s)
Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Hipertensión/epidemiología , Obesidad/epidemiología , Enfermedades Vasculares Periféricas/epidemiología , Fumar/epidemiología , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/etnología , Americanos Asiáticos/estadística & datos numéricos , Bases de Datos Factuales , Diabetes Mellitus/etnología , Dislipidemias/etnología , Grupos Étnicos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Mortalidad Hospitalaria , Hospitalización , Humanos , Hipertensión/etnología , Indios Norteamericanos/estadística & datos numéricos , Masculino , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etnología , Obesidad/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Enfermedades Vasculares Periféricas/etnología , Prevalencia , Factores de Riesgo , Factores Sexuales , Fumar/etnología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etnología , Estados Unidos/epidemiología , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etnología , Adulto Joven
14.
J Public Health Manag Pract ; 26(4): 371-377, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-325042

RESUMEN

OBJECTIVE: To determine the household and community characteristics most closely associated with variation in COVID-19 incidence on American Indian reservations in the lower 48 states. DESIGN: Multivariate analysis with population weights. SETTING: Two hundred eighty-seven American Indian Reservations and tribal homelands (in Oklahoma) and, as of April 10, 2020, 861 COVID-19 cases on these reservation lands. MAIN OUTCOME MEASURES: The relationship between rate per 1000 individuals of publicly reported COVID-19 cases at the tribal reservation and/or community level and average household characteristics from the 2018 5-Year American Community Survey records. RESULTS: By April 10, 2020, in regression analysis, COVID-19 cases were more likely by the proportion of homes lacking indoor plumbing (10.83, P = .001) and were less likely according to the percentage of reservation households that were English-only (-2.43, P = .03). Household overcrowding measures were not statistically significant in this analysis (-6.40, P = .326). CONCLUSIONS: Failure to account for the lack of complete indoor plumbing and access to potable water in a pandemic may be an important determinant of the increased incidence of COVID-19 cases. Access to relevant information that is communicated in the language spoken by many reservation residents may play a key role in the spread of COVID-19 in some tribal communities. Household overcrowding does not appear to be associated with COVID-19 infections in our data at the current time. Previous studies have identified household plumbing and overcrowding, and language, as potential pandemic and disease infection risk factors. These risk factors persist. Funding investments in tribal public health and household infrastructure, as delineated in treaties and other agreements, are necessary to protect American Indian communities.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Adulto , Femenino , Humanos , Indios Norteamericanos , Masculino , Pandemias , Estados Unidos/epidemiología
16.
J Relig Health ; 59(5): 2430-2441, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32424661

RESUMEN

Despite AI women's cancer disparities being a public health concern, a dearth of research on this populations' spiritual coping poses a barrier to redressing such disparities. The purpose of this article was to explore AI women cancer survivors' spiritual and religious coping. This qualitative descriptive study included a sample of 43 AI women cancer survivors. Qualitative content analysis revealed that 93% of AI women cancer survivors used a variety of AI spiritual coping, religious coping, and/or a mixture of the two. Results reveal the prevalence of AI spiritual coping, with traditional AI spiritual practices being particularly common.


Asunto(s)
Supervivientes de Cáncer , Indios Norteamericanos , Neoplasias , Adaptación Psicológica , Femenino , Humanos , Investigación Cualitativa , Espiritualidad
17.
Ann Epidemiol ; 45: 76-82.e1, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32371043

RESUMEN

PURPOSE: Examine (1) the distribution of experiencing the death of a parent or sibling (family death) by race/ethnicity and (2) how a family death affects attaining a college degree. METHODS: Participants (n = 8984) were from National Longitudinal Survey of Youth 1997 aged 13-17 at baseline in 1997 and 29-32 in 2013. We examined the prevalence of family deaths by age group and race/ethnicity and used covariate-adjusted logistic regression to assess the relationship between a family death and college degree attainment. RESULTS: A total of 4.2% of white youth experienced a family death, as did 5.0% of Hispanics, 8.3% of Blacks, 9.1% of Asians, and 13.8% of American Indians (group test P < .001). A family death from ages 13-22 was associated with lower odds of obtaining a bachelor's degree by ages 29-32 (OR = 0.65, 95% CI = 0.50, 0.84), compared with no family death. The effect of a death was largest during college years (age 19-22) (OR = 0.57, 95% CI = 0.39, 0.82). CONCLUSIONS: Young people of color are more likely to have a sibling or parent die; and family death during college years is associated with reduced odds of obtaining a college degree. Racial disparities in mortality might affect social determinants of health of surviving relatives, and college policies are a potential intervention point.


Asunto(s)
Éxito Académico , Escolaridad , Grupos Étnicos/estadística & datos numéricos , Muerte Parental/psicología , Hermanos/psicología , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Indios Norteamericanos/estadística & datos numéricos , Estudios Longitudinales , Masculino , Muerte Parental/etnología , Hermanos/etnología , Determinantes Sociales de la Salud , Factores Socioeconómicos , Estados Unidos , Adulto Joven
18.
Mol Genet Genomics ; 295(4): 1013-1026, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32363570

RESUMEN

Obesity, a risk factor for multiple diseases (e.g. diabetes, hypertension, cancers) originates through complex interactions between genes and prevailing environment (food habit and lifestyle) that varies across populations. Indians exhibit a unique obesity phenotype with high abdominal adiposity for a given body weight compared to matched white populations suggesting presence of population-specific genetic and environmental factors influencing obesity. However, Indian population-specific genetic contributors for obesity have not been explored yet. Therefore, to identify potential genetic contributors, we performed a two-staged genome-wide association study (GWAS) for body mass index (BMI), a common measure to evaluate obesity in 5973 Indian adults and the lead findings were further replicated in 1286 Indian adolescents. Our study revealed novel association of variants-rs6913677 in BAI3 gene (p = 1.08 × 10-8) and rs2078267 in SLC22A11 gene (p = 4.62 × 10-8) at GWAS significance, and of rs8100011 in ZNF45 gene (p = 1.04 × 10-7) with near GWAS significance. As genetic loci may dictate the phenotype through modulation of epigenetic processes, we overlapped genetic data of identified signals with their DNA methylation patterns in 236 Indian individuals and performed methylation quantitative trait loci (meth-QTL) analysis. Further, functional roles of discovered variants and underlying genes were speculated using publicly available gene regulatory databases (ENCODE, JASPAR, GeneHancer, GTEx). The identified variants in BAI3 and SLC22A11 genes were found to dictate methylation patterns at unique CpGs harboring critical cis-regulatory elements. Further, BAI3, SLC22A11 and ZNF45 variants were located in repressive chromatin, active enhancer, and active chromatin regions, respectively, in human subcutaneous adipose tissue in ENCODE database. Additionally, these genomic regions represented potential binding sites for key transcription factors implicated in obesity and/or metabolic disorders. Interestingly, GTEx portal identify rs8100011 as a robust cis-expression quantitative trait locus (cis-eQTL) in subcutaneous adipose tissue (p = 1.6 × 10-7), and ZNF45 gene expression in skeletal muscle of Indian subjects showed an inverse correlation with BMI indicating its possible role in obesity. In conclusion, our study discovered 3 novel population-specific functional genetic variants (rs6913677, rs2078267, rs8100011) in 2 novel (SLC22A11 and ZNF45) and 1 earlier reported gene (BAI3) for BMI in Indians. Our study decodes key genomic loci underlying obesity phenotype in Indians that may serve as prospective drug targets in future.


Asunto(s)
Estudio de Asociación del Genoma Completo , Factores de Transcripción de Tipo Kruppel/genética , Obesidad/genética , Transportadores de Anión Orgánico Sodio-Independiente/genética , Proteínas Represoras/genética , Adolescente , Adulto , Grupo de Ascendencia Continental Asiática/genética , Índice de Masa Corporal , Metilación de ADN , Femenino , Interacción Gen-Ambiente , Predisposición Genética a la Enfermedad , Humanos , Indios Norteamericanos/genética , Masculino , Obesidad/patología , Polimorfismo de Nucleótido Simple/genética , Sitios de Carácter Cuantitativo/genética , Secuencias Reguladoras de Ácidos Nucleicos/genética , Adulto Joven
20.
J Public Health Manag Pract ; 26(4): 371-377, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32433389

RESUMEN

OBJECTIVE: To determine the household and community characteristics most closely associated with variation in COVID-19 incidence on American Indian reservations in the lower 48 states. DESIGN: Multivariate analysis with population weights. SETTING: Two hundred eighty-seven American Indian Reservations and tribal homelands (in Oklahoma) and, as of April 10, 2020, 861 COVID-19 cases on these reservation lands. MAIN OUTCOME MEASURES: The relationship between rate per 1000 individuals of publicly reported COVID-19 cases at the tribal reservation and/or community level and average household characteristics from the 2018 5-Year American Community Survey records. RESULTS: By April 10, 2020, in regression analysis, COVID-19 cases were more likely by the proportion of homes lacking indoor plumbing (10.83, P = .001) and were less likely according to the percentage of reservation households that were English-only (-2.43, P = .03). Household overcrowding measures were not statistically significant in this analysis (-6.40, P = .326). CONCLUSIONS: Failure to account for the lack of complete indoor plumbing and access to potable water in a pandemic may be an important determinant of the increased incidence of COVID-19 cases. Access to relevant information that is communicated in the language spoken by many reservation residents may play a key role in the spread of COVID-19 in some tribal communities. Household overcrowding does not appear to be associated with COVID-19 infections in our data at the current time. Previous studies have identified household plumbing and overcrowding, and language, as potential pandemic and disease infection risk factors. These risk factors persist. Funding investments in tribal public health and household infrastructure, as delineated in treaties and other agreements, are necessary to protect American Indian communities.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Adulto , Femenino , Humanos , Indios Norteamericanos , Masculino , Pandemias , Estados Unidos/epidemiología
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