Social media and postsecondary student adoption of mental health labels: protocol for a scoping review.

INTRODUCTION: Many postsecondary students use social media at an age when mental health issues often arise for the first time. On social media, students describe their mental states or social interactions using psychiatric language. This is a process of mental health labelling as opposed to receiving a formal diagnosis from a psychiatrist. Despite substantial literature on psychiatric labelling effects such as stigma, little research has addressed the mechanisms and effects of labelling through social media. Our objective is to summarise the existing evidence to address this gap. METHODS AND ANALYSIS: This review includes articles in English published since 1995 on how postsecondary students interact with mental health labels in their use of social media. We will consider empirical studies and theses. The search strategy includes SCOPUS, PubMed, OVID MEDLINE (to access APA PsycINFO), Web of Science and ProQuest Global Dissertations and Theses. This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extensions for protocols and Scoping Reviews guidelines. The artificial intelligence application, Connected Papers, will assist in identifying additional references. The outcomes of interest are labelling by self or others and changes in self-concept and presentation associated with these labels. Two researchers will independently identify the included studies and extract data, solving disagreements with a third opinion. We will produce tables and narrative descriptions of the operationalisation and measurement methods of labelling and social media use, reported effects and uses of labelling, and explanatory mechanisms for the adoption of labels. ETHICS AND DISSEMINATION: This literature review does not require ethics approval. The researchers will present their findings for publication in an open-access peer-reviewed journal and at student/scientific conferences. Potential knowledge users include university students, social media users, researchers, mental health professionals and on-campus mental health services.

Experimental studies testing interventions to promote cultural safety, interculturality or antiracism in healthcare: protocol for a systematic review.

INTRODUCTION: Cultural safety, interculturality and antiracism are crucial concepts in addressing health disparities of minority and diverse groups. Measuring them is challenging, however, due to overlapping meanings and their highly contextual nature. Community engagement is essential for evaluating these concepts, yet the methods for social inclusion and protocols for participation remain unclear. This review identifies experimental studies that measure changes resulting from culturally safe, intercultural or antiracist healthcare. The review will describe outcomes and additional factors addressed in these studies. METHODS AND ANALYSIS: The study focuses on epidemiological experiments with counterfactual comparisons and explicit interventions involving culturally safe, intercultural or antiracist healthcare. The search strategy covers PubMed, CINAHL, Scopus, Web of Science, ProQuest, LILACS and WHO IRIS databases. We will use critical appraisal tools from the Joanna Briggs Institute to assess the quality of randomised and non-randomised experimental studies. Two researchers will screen references, select studies and extract data to summarise the main characteristics of the studies, their approach to the three concepts under study and the reported effect measures. We will use fuzzy cognitive mapping models based on the causal relationships reported in the literature. We will consider the strength of the relationships depicted in the maps as a function of the effect measure reported in the study. Measures of centrality will identify factors with higher contributions to the outcomes of interest. Illustrative intervention modelling will use what-if scenarios based on the maps. ETHICS AND DISSEMINATION: This review of published literature does not require ethical approval. We will publish the results in a peer-reviewed journal and present them at conferences. The maps emerging from the process will serve as evidence-based models to facilitate discussions with Indigenous communities to further the dialogue on the contributing factors and assessment of cultural safety, interculturality and antiracism. PROSPERO REGISTRATION NUMBER: CRD42023418459.

Isquemia mesentérica aguda: un desafío de la medicina. Reporte de un caso

La isquemia intestinal aguda es una emergencia vascular provocada por fenómenos oclusivos y no oclusivos de la circulación mesentérica arterial y venosa, de difícil diagnóstico y pronóstico ominoso. Su incidencia va en aumento paulatino con el decurso de los años, asociada fundamentalmente al envejecimiento de la población. La tasa de mortalidad es elevada a pesar de los avances en el campo de la imagenología. Suele diagnosticarse de forma tardía, cuando está establecido el daño isquémico intestinal de carácter irreversible. El elemento imprescindible e indispensable lo constituye el tiempo que trascurre hasta la cirugía, por lo que su diagnóstico sigue siendo un reto clínico. El tratamiento exige medidas médicas intensivas, al igual que cirugía de revascularización y resección del intestino necrosado. Por desdicha, el examen físico y los hallazgos de laboratorio no son sensibles ni específicos para su diagnóstico. Teniendo en cuenta estos elementos, se presenta el caso de una paciente de 38 años con clínica difusa de vómitos, diarrea y dolor abdominal progresivo, que requirió intervención quirúrgica de urgencia con diagnóstico transoperatorio de isquemia mesentérica aguda. Durante su estancia hospitalaria se relaparotomizó en dos ocasiones, mantuvo soporte ventilatorio e inotrópico por fallo multiorgánico en la Unidad de Cuidados Intensivos, mostrando una adecuada evolución posquirúrgica. El objetivo de esta presentación es enfatizar en la clínica como elemento fundamental para abordar de forma correcta esta entidad en un medio hospitalario de limitados recursos diagnósticos imagenológicos, al abordar conceptos teóricos recientes y facilitar una adecuada actuación en la toma de decisiones.

Acute intestinal ischemia is a vascular emergency caused by occlusive and non-occlusive phenomena of the mesenteric arterial and venous circulation of difficult diagnosis and ominous prognosis. Its incidence is gradually increasing over the years, mainly associated with the ageing of the population. The mortality rate is high despite advances in the field of imaging. It is usually diagnosed late, when irreversible ischemic intestinal damage is established. The essential and indispensable element is the time that elapses until surgery, so its diagnosis continues to be a clinical challenge. Treatment requires intensive medical measures, as well as revascularization surgery and resection of the necrotic intestine. Unfortunately, physical examination and laboratory findings are neither sensitive nor specific for its diagnosis. Taking these elements into account, the authors present the case of a 38-year-old female patient with diffuse symptoms of vomiting, diarrhea and progressive abdominal pain that required emergency surgery with intraoperative diagnosis of acute mesenteric ischemia. During her hospital stay, she underwent re-laparotomy twice, maintained ventilatory and inotropic support due to multi-organ failure in the Intensive Care Unit, showing an adequate post-surgical evolution. The objective of this presentation is to emphasize in the clinic as a fundamental element to correctly address this entity in a hospital environment with limited imaging diagnostic resources by addressing recent theoretical concepts and facilitating adequate action in decision-making.

How does participatory research work: protocol for a realist synthesis.

INTRODUCTION: Participatory research science deals with partnerships underlying research, governance and ownership of research products. It is concerned with relationships behind research objectives and methods. Participatory research has gained significant traction in design of health interventions, contextualising these to local settings and stakeholder groups. Despite a massive increase in participatory research exercises, the field remains undertheorised, and the mechanisms for improving health outcomes remain unclear. This realist review seeks to understand how and under what circumstances participatory research impacts health and social outcomes. METHODS AND ANALYSIS: The review will follow four steps: (1) searching for and selecting evidence, (2) assessing the quality of evidence, (3) extracting and categorising data and (4) synthesising the data in the form of context-mechanism-outcomes configurations. The review will follow the Realist And Meta Narrative Evidence Syntheses: Evolving Standards (RAMESES) II guidelines for reporting realist evaluations. We categorise and synthesise data in four steps: (1) identifying outcomes, (2) identifying contextual components of outcomes, (3) theoretical redescription (abduction) and (4) identifying mechanisms. A retroductive analysis will identify mechanisms by moving between empirical data and theories, using inductive and deductive reasoning to explain the outcomes-context matches. The output will generate middle-range theories on how participatory research works, for whom and under what circumstances. ETHICS AND DISSEMINATION: This study is a review of a published literature. It does not involve human participants. We will convene a workshop to share and discuss the preliminary results with partners and key stakeholders involved in participatory health research. We will publish the review results in peer-reviewed journals and academic conferences.

What facilitates or prevents academic fraud in a Colombian faculty of medicine-Protocol of a study using fuzzy cognitive mapping.

INTRODUCTION: Academic fraud is any behavior that gives a student an undeserved advantage over another student. Few studies have explored the causes of and possible solutions to academic fraud in Latin America. We aim to map the knowledge of stakeholders in a Colombian faculty of medicine about the factors that facilitate and prevent academic fraud. METHODS: Fuzzy cognitive mapping. We will use the approach proposed by Andersson and Silver to generate fuzzy cognitive maps representing stakeholder knowledge. This process consists of ten steps: (1) definition of the research question; (2) identification of participants; (3) generation of ideas; (4) rationalization of ideas; (5) organization and connection of ideas; (6) weighing; (7) pattern grouping; (8) list of links and digitization; (9) combination of maps and network analysis; and (10) deliberative dialogue. To draw the maps, we will invite medical students, interns, resident physicians, master's students, and professors in the faculty of medicine. Four medical students will receive training to facilitate the sessions. Participants will identify the factors contributing to academic fraud and their causal relationships. We will use a combination of network analysis and graph theory to identify the chains of factors with greatest influence on academic fraud. CONCLUSION: The maps will serve to discuss strategies to reduce academic fraud in the Faculty of Medicine and to identify factors that could be addressed in other contexts with similar problems. This research will allow the students who facilitate mapping sessions to learn about research techniques, fuzzy cognitive mapping and academic fraud. Study registration: Registered in OSF Registries on August 2nd, 2022. Registration number: osf.io/v4amz.

Why urban communities from low-income and middle-income countries participate in public and global health research: protocol for a scoping review.

INTRODUCTION: As the number of people living in cities increases worldwide, particularly in low-income and middle-income countries (LMICs), urban health is a growing priority of public and global health. Rapid unplanned urbanisation in LMICs has exacerbated inequalities, putting the urban poor at increased risk of ill health due to difficult living conditions in cities. Collaboration with communities in research is a key strategy for addressing the challenges they face. The objective of this scoping review is, therefore, to identify factors that influence the participation of urban communities from LMICs in public and global health research. METHODS AND ANALYSIS: We will develop a search strategy with a health librarian to explore the following databases: MEDLINE, Embase, Web of Science, Cochrane, Global Health and CINAHL. We will use MeSH terms and keywords exploring the concepts of 'low-income and middle-income countries', 'community participation in research' and 'urban settings' to look at empirical research conducted in English or French. There will be no restriction in terms of dates of publication. Two independent reviewers will screen and select studies, first based on titles and abstracts, and then on full text. Two reviewers will extract data. We will summarise the results using tables and fuzzy cognitive mapping. ETHICS AND DISSEMINATION: This scoping review is part of a larger project to be approved by the University of Montréal's Research Ethics Committee for Science and Health in Montréal (Canada), and the Institutional Review Board of the James P Grant School of Public Health at BRAC University in Dhaka (Bangladesh). Results from the review will contribute to a participatory process seeking to combine scientific evidence with experiential knowledge of stakeholders in Dhaka to understand how to better collaborate with communities for research. The review could contribute to a shift toward research that is more inclusive and beneficial for communities.

Giving birth in a good way when it must take place away from home: Participatory research into visions of Inuit families and their Montreal-based medical providers.

BACKGROUND: Transferring pregnant women out of their communities for childbirth continues to affect Inuit women living in Nunavik-Inuit territory in Northern Quebec. With estimates of maternal evacuation rates in the region between 14% and 33%, we examine how to support culturally safe birth for Inuit families when birth must take place away from home. METHODS: A participatory research approach explored perceptions of Inuit families and their perinatal healthcare providers in Montreal for culturally safe birth, or "birth in a good way" in the context of evacuation, using fuzzy cognitive mapping. We used thematic analysis, fuzzy transitive closure, and an application of Harris' discourse analysis to analyze the maps and synthesize the findings into policy and practice recommendations. RESULTS: Eighteen maps authored by 8 Inuit and 24 service providers in Montreal generated 17 recommendations related to culturally safe birth in the context of evacuation. Family presence, financial assistance, patient and family engagement, and staff training featured prominently in participant visions. Participants also highlighted the need for culturally adapted services, with provision of traditional foods and the presence of Inuit perinatal care providers. Stakeholder engagement in the research resulted in dissemination of the findings to Inuit national organizations and implementation of several immediate improvements in the cultural safety of flyout births to Montreal. CONCLUSIONS: The findings point toward the need for culturally adapted, family-centered, and Inuit-led services to support birth that is as culturally safe as possible when evacuation is indicated. Application of these recommendations has the potential to benefit Inuit maternal, infant, and family wellness.

Traditional Midwifery Contribution to Safe Birth in Cultural Safety: Narrative Evaluation of an Intervention in Guerrero, Mexico.

A 2017 randomised controlled trial in Guerrero State, Mexico, showed supporting Indigenous traditional midwives on their own terms improved traditional childbirths without inferior maternal health outcomes. This narrative evaluation complements the trial to document participant experience of safer birth in cultural safety, transformative dynamics and implementation issues of the intervention. Stories came from 26 traditional midwives, 28 apprentices, 12 intercultural brokers and 20 Indigenous women who experienced the intervention. Their accounts indicate the intervention revitalised traditional midwifery and consolidated local skills through traditional midwife apprentices and intercultural brokers to support safe birth. According to the stories, communities reintroduced traditional perinatal care and reported positive health impacts for mothers, children, and other adults, which contributed to early collaboration with official health services. Challenges included remuneration and disinterest of younger apprentices and brokers. The intervention seems to have improved interaction between traditional and Western services, setting the stage for further intercultural dialogue.

Factors and Priorities Influencing Satisfaction with Care among Women Living with HIV in Canada: A Fuzzy Cognitive Mapping Study.

Engagement along the HIV care cascade in Canada is lower among women compared to men. We used Fuzzy Cognitive Mapping (FCM), a participatory research method, to identify factors influencing satisfaction with HIV care, their causal pathways, and relative importance from the perspective of women living with HIV. Building from a map of factors derived from a mixed-studies review of the literature, 23 women living with HIV in Canada elaborated ten categories influencing their satisfaction with HIV care. The most central and influential category was "feeling safe and supported by clinics and healthcare providers", followed by "accessible and coordinated services" and "healthcare provider expertise". Participants identified factors that captured gendered social and health considerations not previously specified in the literature. These categories included "healthcare that considers women's unique care needs and social contexts", "gynecologic and pregnancy care", and "family and partners included in care." The findings contribute to our understanding of how gender shapes care needs and priorities among women living with HIV.

Community Participation in Primary Healthcare in the South Sudan Boma Health Initiative: A Document Analysis.

BACKGROUND: Community participation is central to primary healthcare, yet there is little evidence of how this works in conflict settings. In 2016, South Sudan's Ministry of Health launched the Boma Health Initiative (BHI) to improve primary care services through community participation. METHODS: We conducted a document analysis to examine how well the BHI policy addressed community participation in its policy formulation. We reviewed other policy documents and published literature to provide background context and supplementary data. We used a deductive thematic analysis that followed Rifkin and colleagues' community participation framework to assess the BHI policy. RESULTS: The BHI planners included inputs from communities without details on how the needs assessment was conducted at the community level, what needs were considered, and from which community. The intended role of communities was to implement the policy under local leadership. There was no information on how the Initiative might strengthen or expand local women's leadership. Official documents did not contemplate local power relations or address gender imbalance. The policy approached households as consumers of health services. CONCLUSION: Although the BHI advocated community participation to generate awareness, increase acceptability, access to services and ownership, the policy document did not include community participation during policy cycle.

Overview of traditional medicine in the Muisca Reserve of Cota, Colombia: A cross-sectional study. / Panorama de la medicina tradicional en el Resguardo Muisca de Cota, Colombia: estudio transversal.

Introduction: The Muisca Indigenous people in Cota, Colombia, has committed to reviving and strengthening their traditional culture, including the ancestral knowledge associated with their traditional medicine. Objective: To explore the occurrence of traditional medicine and factors associated with its use among the Muisca people in Cota, Colombia. Methods: A participatory cross-sectional study applied a questionnaire to 471 Muisca mothers who had at least one child over 10 in April 2019. The 44 questions inquired demographic, social, and cultural factors of participants and their knowledge, use and practice of traditional medicine. We used the Mantel-Haenszel procedure to measure the associations using Odds Ratio and 95% confidence intervals. Results: 66.2% (312/471) of the mothers knew at least three cases of traditional diseases; 56.8% (267/470) had and used medicinal plants; 15.8% (73/462) had practiced traditional self-care for flu, menstruation and postpartum; and 11.8% (54/458) reported that they had gone to midwives, bonesetters and healers. Four factors had a significant association (p < 0.05) with traditional medicine: consumption of three traditional foods; having traditional gardens and plants; living within the reservation; and parents born in a municipality of indigenous influence. Conclusions: The study showed that the permanence of traditional medicine is strongly associated with traditional food, agricultural vocation and the possession and use of medicinal plants. The results suggest that the strategy for the recovery of traditional medicine could focus on promoting a stronger link between indigenous identity, territory, food and health.

Introducción: La población del Resguardo Indígena Muisca de Cota, Colombia, se encuentra en un proceso de fortalecimiento cultural. Ahora busca la recuperación de sus saberes ancestrales relacionados con la medicina tradicional. Objetivo: Explorar la ocurrencia de la medicina tradicional y factores asociados con su vigencia en el resguardo indígena Muisca de Cota, Colombia. Métodos: Estudio transversal participativo con los miembros del resguardo. Para este estudio se aplicó en abril de 2019 un instrumento de 44 preguntas a 471 madres de familia que tenían por lo menos un hijo mayor de diez años. A través de él se indagaron algunos factores demográficos, sociales y culturales. Además, se plantearon preguntas relacionadas con conocimiento, uso y práctica de medicina tradicional. Usamos el procedimiento de Mantel-Haenszel para establecer las asociaciones mediante el Odds ratio e intervalos de confianza del 95%. Resultados: El 66,2% (312/471) de las madres conocía al menos tres casos de enfermedades tradicionales, el 56,8% (267/470) tenía y usaba plantas medicinales, el 15,8% (73/462) practicaba cuidados tradicionales de la gripa, la menstruación y el puerperio, y el 11,8% (54/458) reportó que han acudido a parteras, sobanderos y curanderos. El consumo de tres alimentos tradicionales, la tenencia de huertos y plantas tradicionales, tener la vivienda dentro del resguardo y padres nacidos en un municipio de influencia indígena, fueron los principales factores asociados con la prevalencia de la medicina tradicional (p < 0,05). Conclusiones: El estudio mostró que la permanencia de la medicina tradicional está fuertemente asociada a la alimentación tradicional, a la vocación agrícola y a la tenencia y uso de plantas medicinales. Los resultados sugieren que la estrategia de recuperación de la medicina tradicional podría enfocarse en promover un mayor vínculo entre identidad indígena, territorio, alimentación y salud.

Panorama de la medicina tradicional en el Resguardo Muisca de Cota, Colombia: estudio transversal / Overview of traditional medicine in the Muisca Reserve of Cota, Colombia: a cross-sectional study

INTRODUCCIÓN: La población del Resguardo Indígena Muisca de Cota, Colombia, se encuentra en un proceso de fortalecimiento cultural. Ahora busca la recuperación de sus saberes ancestrales relacionados con la medicina tradicional. OBJETIVO: Explorar la ocurrencia de la medicina tradicional y factores asociados con su vigencia en el resguardo indígena Muisca de Cota, Colombia. MÉTODOS: Estudio transversal participativo con los miembros del resguardo. Para este estudio se aplicó en abril de 2019 un instrumento de 44 preguntas a 471 madres de familia que tenían por lo menos un hijo mayor de diez años. A través de él se indagaron algunos factores demográficos, sociales y culturales. Además, se plantearon preguntas relacionadas con conocimiento, uso y práctica de medicina tradicional. Usamos el procedimiento de Mantel-Haenszel para establecer las asociaciones mediante el Odds ratio e intervalos de confianza del 95%. RESULTADOS: El 66,2% (312/471) de las madres conocía al menos tres casos de enfermedades tradicionales, el 56,8% (267/470) tenía y usaba plantas medicinales, el 15,8% (73/462) practicaba cuidados tradicionales de la gripa, la menstruación y el puerperio, y el 11,8% (54/458) reportó que han acudido a parteras, sobanderos y curanderos. El consumo de tres alimentos tradicionales, la tenencia de huertos y plantas tradicionales, tener la vivienda dentro del resguardo y padres nacidos en un municipio de influencia indígena, fueron los principales factores asociados con la prevalencia de la medicina tradicional (p < 0,05). CONCLUSIONES: El estudio mostró que la permanencia de la medicina tradicional está fuertemente asociada a la alimentación tradicional, a la vocación agrícola y a la tenencia y uso de plantas medicinales. Los resultados sugieren que la estrategia de recuperación de la medicina tradicional podría enfocarse en promover un mayor vínculo entre identidad indígena, territorio, alimentación y salud.

INTRODUCTION: The Muisca Indigenous people in Cota, Colombia, has committed to reviving and strengthening their traditional culture, including the ancestral knowledge associated with their traditional medicine. OBJECTIVE: To explore the occurrence of traditional medicine and factors associated with its use among the Muisca people in Cota, Colombia. METHODS: A participatory cross-sectional study applied a questionnaire to 471 Muisca mothers who had at least one child over 10 in April 2019. The 44 questions inquired demographic, social, and cultural factors of participants and their knowledge, use and practice of traditional medicine. We used the Mantel-Haenszel procedure to measure the associations using Odds Ratio and 95% confidence intervals. RESULTS: 66.2% (312/471) of the mothers knew at least three cases of traditional diseases; 56.8% (267/470) had and used medicinal plants; 15.8% (73/462) had practiced traditional self-care for flu, menstruation and postpartum; and 11.8% (54/458) reported that they had gone to midwives, bonesetters and healers. Four factors had a significant association (p < 0.05) with traditional medicine: consumption of three traditional foods; having traditional gardens and plants; living within the reservation; and parents born in a municipality of indigenous influence. CONCLUSIONS: The study showed that the permanence of traditional medicine is strongly associated with traditional food, agricultural vocation and the possession and use of medicinal plants. The results suggest that the strategy for the recovery of traditional medicine could focus on promoting a stronger link between indigenous identity, territory, food and health.

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.

Childbirth evacuation among rural and remote Indigenous communities in Canada: A scoping review.

PROBLEM: Routine evacuation of pregnant Indigenous women from remote regions to urban centres for childbirth is a central strategy for addressing maternal health disparities in Canada. Maternal evacuation continues despite mounting evidence of its negative impacts on Indigenous women and families. BACKGROUND: Since the 1960s, pregnant Indigenous women living in remote regions in Canada have been transferred to urban hospitals for childbirth. In the following decades, evidence emerged linking maternal evacuation with negative impacts on Indigenous women, their families, and communities. In some communities, resistance to evacuation and the creation of local birthing facilities has resulted in highly diverse experiences of childbirth and evacuation. AIM: A scoping review mapped the evidence on maternal evacuation of Indigenous women in Canada and its associated factors and outcomes from 1978 to 2019. METHODS: We searched MEDLINE, Embase, and CINAHL, and grey literature from governmental and Indigenous organizations. We collated the evidence on maternal evacuation into 12 themes. RESULTS: Factors related to evacuation include (a) evacuation policies (b) institutional coercion (c) remoteness and (d) maternal-fetal health status. Evacuation-related outcomes include (e) maternal-child health impacts (f) women's experience of evacuation (g) financial hardships (h) family disruption (i) cultural continuity and community wellness (ij) engagement with health services (k) self-determination, and (l) quality of health services. DISCUSSION: Numerous emotional, social and cultural harms are associated with evacuation of Indigenous women in Canada. Little is known about the long-term impacts of evacuation on Indigenous maternal-infant health. Evidence on evacuation from remote Métis communities remains a critical knowledge gap.

Maternal health and Indigenous traditional midwives in southern Mexico: contextualisation of a scoping review.

OBJECTIVES: Collate published evidence of factors that affect maternal health in Indigenous communities and contextualise the findings with stakeholder perspectives in the Mexican State of Guerrero. DESIGN: Scoping review and stakeholder fuzzy cognitive mapping. INCLUSION AND EXCLUSION: The scoping review included empirical studies (quantitative, qualitative or mixed methods) that addressed maternal health issues among Indigenous communities in the Americas and reported on the role or influence of traditional midwives before June 2020. The contextualisation drew on two previous studies of traditional midwife and researcher perspectives in southern Mexico. RESULTS: The initial search identified 4461 references. Of 87 selected studies, 63 came from Guatemala and Mexico. Three small randomised trials involved traditional midwives. One addressed the practice of traditional midwifery. With diverse approaches to cultural differences, the studies used contrasting definitions of traditional midwives. A fuzzy cognitive map graphically summarised the influences identified in the scoping review. When we compared the literature's map with those from 29 traditional midwives in Guerrero and eight international researchers, the three sources coincided in the importance of self-care practices, rituals and traditional midwifery. The primary concern reflected in the scoping review was access to Western healthcare, followed by maternal health outcomes. For traditional midwives, the availability of hospital or health centre in the community was less relevant and had negative effects on other protective influences, while researchers conditioned its importance to its levels of cultural safety. Traditional midwives highlighted the role of violence against women, male involvement and traditional diseases. CONCLUSIONS: The literature and stakeholder maps showed maternal health resulting from complex interacting factors in which promotion of cultural practices was compatible with a protective effect on Indigenous maternal health. Future research challenges include traditional concepts of diseases and the impact on maternal health of gender norms, self-care practices and authentic traditional midwifery.

Efecto y seguridad de un tratamiento ambulatorio de medicina tradicional para el asma en 26 pacientes de Cota, Colombia: una serie de casos / Effect and safety of an outpatient traditional medicine treatment for asthma in 26 patients from Cota, Colombia: a case series

The prevalence, morbidity and costs of asthma care have increased worldwide. This study describes the effect and safety of an outpatient medical treatment with traditional medicine for asthma, through a retrospective case series with patients admitted to outpatient consultation from 1995 to 2015 in Cota, Colombia. Analyzing 26 cases with a clinical diagnosis of asthma, during the treatment 34.6% (9/26) did not present episodes of uncontrolled asthma and 61.5% (16/26) were classified as controlled asthma in their last consultation of control. 88.4% (23/26) of the patients reported no adverse reactions and the three reported were mild. The results allow to generate hypotheses about the effectiveness and safety of an outpatient treatment based on the incorporation of resources from traditional medicine. These observations could beexplored with experimental studies to determine their long-term effectiveness, safety and low cost.

La prevalencia, morbilidad y costos de atención del asma se ha incrementado en el mundo. Este estudio describe el efecto y la seguridad de un tratamiento médico ambulatorio con recursos de la medicina tradicional para el asma, mediante una serie de casos retrospectiva con pacientes admitidos a consulta externa de 1995 a 2015 en Cota, Colombia. Analizando 26 casos con diagnóstico clínico de asma, durante el tratamiento el 34,6% (9/26) no presentó episodios de asma no controlada y el 61,5% (16/26) fueron clasificados como asma controlada en su última consulta de control. El 88,4% (23/26) de los pacientes no reportó reacciones adversas y las tres reportadas fueron leves. Los resultados permiten generar hipótesis acerca de la efectividad y seguridad de un tratamiento ambulatorio basado en la incorporación de recursos de la medicina tradicional. Estas observaciones podrían ser exploradas con estudios experimentales, para determinar su efectividad, seguridad y bajo costo a largo plazo.

[Cultivation and use of medicinal plants and association with reporting of childhood asthma: A case-control study in the Bogotá savanna]. / Cultivo y uso de plantas medicinales y su asociación con el reporte de asma infantil: estudio de casos y controles en la Sabana de Bogotá.

INTRODUCTION: The prevalence of childhood asthma has increased in recent years. The World Health Organization has called for conducting research exploring the role of traditional medicine and medicinal plants in respiratory disease control. OBJECTIVE: To identify the relationship between the prevalence of childhood asthma and traditional care of the respiratory system, including cultivation and use of medicinal plants. METHODS: We conducted an observational, analytic, case-control study that included children 2 to 14 years old who used official health services in eight municipalities near Bogota between 2014 and 2015. Cases were children diagnosed with asthma. We randomly selected the controls among the remaining patients of the same healthcare facilities. We applied an 18-question survey. The Mantel-Haenszel procedure identified significant associations using 95% confidence intervals. RESULTS: We surveyed the caretakers of 97 cases and 279 controls in eight municipalities. Some 23.4% (88/376) and 37.9% (142/375) reported using traditional remedies for fever control and common cold management, respectively. 8.8% (33/376) reported following traditional care during a common cold, 30.4% (114/375) reported growing medicinal plants at home, and 45% (166/369) reported using medicinal plants for health purposes in their household. Multivariate analysis showed that having and using medicinal plants at home is associated with a lower reporting of asthma (odds ratio 0.49; 95% confidence interval: 0.25 to 0.99). CONCLUSIONS: Cultivating and using medicinal plants at home is associated with a lower reporting of childhood asthma. Researchers should consider the therapeutic, environmental, and cultural properties of medicinal plants to prevent respiratory diseases.

INTRODUCCIÓN: La prevalencia de asma infantil ha aumentado en los últimos años. La Organización Mundial de la Salud invita a buscar evidencia científica en las medicinas tradicionales y el uso de plantas medicinales, como contribución al control de las enfermedades respiratorias. OBJETIVOS: Identificar la relación entre prevalencia de asma infantil y cuidados respiratorios tradicionales, incluyendo el cultivo y uso de plantas medicinales. MÉTODOS: Estudio observacional, analítico con diseño de casos y controles en niños (de 2 a 14 años) atendidos por servicios estatales de salud en ocho municipios vecinos a Bogotá durante 2014 y 2015. Fueron casos quienes recibieron diagnóstico de asma y se seleccionaron los controles aleatoriamente entre los demás usuarios de las mismas instituciones. Aplicamos un cuestionario con 18 preguntas. La prueba de Mantel-Haenszel identificó asociaciones significativas usando el Odds ratio e intervalos de confianza del 95%. RESULTADOS: Encuestamos a los acudientes de 97 casos y 279 controles en ocho municipios. El 23,4% (88/376) reportó el uso de remedios caseros para controlar la fiebre y el 37,9% (142/375) para manejar la gripe. El 8,8% (33/376) reportó cumplir con todos los cuidados del frío durante la gripe; 30,4% (114/375) tiene plantas medicinales sembradas en su vivienda y 45% (166/369) reportó uso de plantas medicinales para el cuidado de la salud en el hogar. El análisis multivariado mostró que la tenencia y uso de plantas medicinales en la vivienda se asoció con menor reporte de asma (Odds ratio: 0,49; intervalo de confianza 95%: 0,25 a 0,99). CONCLUSIONES: Cultivar y usar plantas medicinales en los hogares está asociado con menor reporte de asma infantil. Conviene considerar las propiedades terapéutica, ambiental y cultural de las plantas medicinales para la prevención de enfermedades respiratorias.

Community views on short birth interval in Northern Uganda: a participatory grounded theory.

BACKGROUND: Short birth interval is associated with adverse perinatal, maternal, and infant outcomes, although evidence on actionable factors underlying short birth interval remains limited. We explored women and community views on short birth intervals to inform potential solutions to promote a culturally safe child spacing in Northern Uganda. METHODS: Gendered fuzzy cognitive mapping sessions (n = 21), focus group discussions (n = 12), and an administered survey questionnaire (n = 255) generated evidence on short birth intervals. Deliberative dialogues with women, their communities, and service providers suggested locally relevant actions promote culturally safe child spacing. RESULTS: Women, men, and youth have clear understandings of the benefits of adequate child spacing. This knowledge is difficult to translate into practice as women are disempowered to exercise child spacing. Women who use contraceptives without their husbands' consent risk losing financial and social assets and are likely to be subject to intra-partner violence. Women were not comfortable with available contraceptive methods and reported experiencing well-recognized side effects. They reported anxiety about the impact of contraception on the health of their future children. This fear was fed by rumors in their communities about the effects of contraceptives on congenital diseases. The women and their communities suggested a home-based sensitization program focused on improving marital relationships (spousal communication, mutual understanding, male support, intra-partner violence) and knowledge and side-effects management of contraceptives. CONCLUSIONS: The economic context, gender power dynamics, inequality, gender bias in land tenure and ownership regulations, and the limited contraceptive supply reduce women's capacity to practice child spacing.

The evidence on what increases birth spacing remains limited. This study explored community views on influences on short birth interval to promote a culturally safe child spacing in Northern Uganda. A participatory research process began by collating perspectives of causes of short birth intervals through fuzzy cognitive mapping. Focus group discussions clarified concepts emerging from the fuzzy cognitive mapping exercise. Fieldworkers administered a household survey to quantify reproductive health outcomes. In deliberative dialogue sessions involving women and their communities, shared and discussed these results and suggested potential actions to promote culturally safe child spacing. Women, men, and youth showed clear understandings of the benefits of adequate child spacing. This knowledge is difficult to translate into practice, however, as women feel they are unable to exercise child spacing. Women who use contraceptives without their husbands' consent risk losing financial and social resources and are likely to face intra-partner violence. Women were not comfortable with contraceptive methods and reported experiencing side effects. The deliberative dialogues suggested a home-based sensitization program focused on improving marital relationships (spousal communication, mutual understanding, male support, intra-partner violence) and knowledge and side-effects management of contraceptives.

Causes of short birth interval (kunika) in Bauchi State, Nigeria: systematizing local knowledge with fuzzy cognitive mapping.

BACKGROUND: Short birth intervals, defined by the World Health Organization as less than 33 months, may damage the health and wellbeing of children, mothers, and their families. People in northern Nigeria recognise many adverse effects of short birth interval (kunika in the Hausa language) but it remains common. We used fuzzy cognitive mapping to systematize local knowledge of causes of kunika to inform the co-design of culturally safe strategies to address it. METHODS: Male and female groups in twelve communities built 48 maps of causes and protective factors for kunika, and government officers from the Local Government Area (LGA) and State made four maps. Each map showed causes of kunika or no-kunika, with arrows showing relationships with the outcome and between causes. Participants assigned weights for the perceived strength of relationships between 5 (strongest) and 1 (weakest). We combined maps for each group: men, women, and government officers. Fuzzy transitive closure calculated the maximum influence of each factor on the outcome, taking account of all relationships in the map. To condense the maps, we grouped individual factors into broader categories and calculated the cumulative net influence of each category. We made further summarised maps and presented these to the community mapping groups to review. RESULTS: The community maps identified frequent sex, not using modern or traditional contraception, and family dynamics (such as competition between wives) as the most influential causes of kunika. Women identified forced sex and men highlighted lack of awareness about contraception and fear of side effects as important causes of kunika. Lack of male involvement featured in women's maps of causes and in the maps from LGA and State levels. Maps of protective factors largely mirrored those of the causes. Community groups readily appreciated and approved the summary maps resulting from the analysis. CONCLUSIONS: The maps showed how kunika results from a complex network of interacting factors, with culture-specific dynamics. Simply promoting contraception alone is unlikely to be enough to reduce kunika. Outputs from transitive closure analysis can be made accessible to ordinary stakeholders, allowing their meaningful participation in interpretation and use of the findings. For people in Bauchi State, northern Nigeria, kunika describes a short interval between successive births, understood as becoming pregnant again before the previous child is weaned. They recognise it is bad for children, mothers and households. We worked with 12 communities in Bauchi to map their knowledge of the causes and protective factors for kunika. Separate groups of men and women built 48 maps, and government officers at local and state level built four maps. Each group drew two maps showing causes of kunika or of no-kunika with arrows showing the links between causes and the outcome. Participants marked the strength of each link with a number (between 5 for the strongest and 1 for the weakest). We combined maps for women, men and government officers. We grouped similar causes together into broader categories. We calculated the overall influence of each category on kunika or no-kunika and produced summary maps to communicate findings. The maps identified the strongest causes of kunika as frequent sex, not using modern or traditional contraception, and family dynamics. Women indicated forced sex as an important cause, but men focused on lack of awareness about contraception and fear of side effects. The maps of protective factors mirrored those of the causes. The groups who created the maps approved the summary maps. The maps showed the complex causes of kunika in Bauchi. Promoting contraception is unlikely to be enough on its own to reduce kunika. The summary maps will help local stakeholders to co-design culturally safe ways of reducing kunika.

ANTECEDENTES: Los intervalos intergenésicos cortos (menores de 33 meses, según la OMS) afectan la salud y el bienestar de la madre, el niño y la familia. Aunque los habitantes del norte de Nigeria reconocen muchos efectos adversos de un intervalo intergenésico corto (kunika en lengua hausa), éstos aún son frecuentes. Nosotros usamos cartografía cognitiva para sintetizar el conocimiento local sobre causas de kunika y guiar el codiseño de estrategias culturalmente seguras que permitan su disminución. MéTODO: Grupos de hombres y mujeres en doce comunidades hicieron 48 mapas, mientras funcionarios del Estado de Bauchi y del Área Local de Gobierno (LGA) hicieron otros cuatro. Cada mapa mostraba causas de kunika o de no-kunika con flechas indicando la influencia entre ellas. Los participantes ponderaron la influencia entre 1 (la más débil) y 5 (la más fuerte). Nosotros combinamos los mapas por grupos de mujeres, hombres y funcionarios. Con fuzzy transitive closure calculamos la máxima influencia entre factores cuando todas las relaciones en el mapa son consideraras. Condensamos los mapas agrupando factores individuales en categorías y calculamos la influencia neta acumulativa para cada una. Estos mapas los sintetizamos aún más para revisarlos con sus autores. RESULTADOS: Los mapas de los grupos comunitarios identificaron el sexo frecuente y factores relacionados, no usar anticonceptivos modernos o tradicionales y las dinámicas familiares (como el deseo de tener más hijos o la competencia entre esposas) como las causas más importantes de kunika. Los mapas de las mujeres identificaron el sexo forzado como causa importante y los mapas de los hombres destacaron la falta de conocimiento sobre anticoncepción y el temor a los efectos secundarios. La falta de participación masculina apareció en los mapas de las mujeres, del LGA y del Estado. Los mapas de los factores protectores reflejaron en gran medida los de las causas. Los grupos comunitarios aprobaron y apreciaron los mapas que sintetizaban el análisis. CONCLUSIONES: Los mapas comunitarios mostraron que kunika es el resultado de una compleja red de factores con dinámicas culturales específicas. Es poco probable que enfocarse solo en promover anticoncepción reduzca kunika. Los resultados del transitive closure pueden comunicarse al público en general para una mayor participación en la interpretación y uso de los resultados.

Communities and service providers address access to perinatal care in postconflict Northern Uganda: socialising evidence for participatory action.

OBJECTIVES: Describe participatory codesign of interventions to improve access to perinatal care services in Northern Uganda. STUDY DESIGN: Mixed-methods participatory research to codesign increased access to perinatal care. Fuzzy cognitive mapping, focus groups and a household survey identified and documented the extent of obstructions to access. Deliberative dialogue focused stakeholder discussions of this evidence to address the obstacles to access. Most significant change stories explored the participant experience of this process. SETTING: Three parishes in Nwoya district in the Gulu region, Northern Uganda. PARTICIPANTS: Purposively sampled groups of women, men, female youth, male youth, community health workers, traditional midwives and service providers. Each of seven stakeholder categories included 5-8 participants in each of three parishes. RESULTS: Stakeholders identified several obstructions to accessing perinatal care: lack of savings in preparation for childbirth in facility costs, lack of male support and poor service provider attitudes. They suggested joining saving groups, practising saving money and income generation to address the short-term financial shortfall.They recommended increasing spousal awareness of perinatal care and they proposed improving service provider attitudes. Participants described their own improved care-seeking behaviour and patient-provider relationships as short-term gains of the codesign. CONCLUSION: Participatory service improvement is feasible and acceptable in postconflict settings like Northern Uganda. Engaging communities in identifying perinatal service delivery issues and reflecting on local evidence about these issues generate workable community-led solutions and increases trust between community members and service providers.