La interculturalidad vacía: derecho a la salud intercultural de los pueblos indígenas y personas migrantes en Chile / Empty interculturality: the right to intercultural health of indigenous peoples and migrants in Chile / A interculturalidade vazia: direito à saúde intercultural dos povos indígenas e pessoas migrantes no Chile

Resumen: Este trabajo analiza el desarrollo de la perspectiva intercultural en la protección y garantía del derecho a la salud en pueblos indígenas y población migrante en Chile desde el punto de vista jurídico. Revisa las prácticas y experiencias prevalentes en el ámbito de la salud pública en Chile, para establecer la forma y alcance de la interculturalidad en la protección del derecho a la salud y la manera en que tributa a la interculturalidad. La perspectiva intercultural en el acceso a la justicia en Chile es débil, formal, se trata de iniciativas incipientes en el caso de los pueblos indígenas, mientras en el caso de las personas migrantes apenas abordan barreras idiomáticas.

Abstract: This work analyzes the development of the intercultural perspective in the protection and guarantee of the right to health in indigenous peoples and migrant population in Chile from the legal point of view. It reviews the prevalent practices and experiences in the field of public health in Chile, to establish the shape and scope of interculturality in the protection of the right to health, and the way in which it contributes to interculturality. The intercultural perspective on access to justice in Chile is weak, formal, these are incipient initiatives in the case of indigenous peoples while in the case of migrants, they hardly address language barriers.

Resumo: Este trabalho analisa o desenvolvimento da perspectiva intercultural na proteção e garantia do direito à saúde nos povos indígenas e população migrante no Chile do ponto de vista jurídico. Revisa as práticas e experiências prevalentes no âmbito da saúde pública no Chile, para estabelecer a forma e alcance da interculturalidade na proteção do direito à saúde e à forma com que contribui à interculturalidade. A perspectiva intercultural no acesso à justiça no Chile é débil, formal, tratando-se de iniciativas incipientes no caso dos povos indígenas, enquanto que no caso das pessoas migrantes apenas abordam barreiras idiomáticas.

The COVID-19 era: the view from Nigeria.

If we were told that one day the entire world would take its guidance for managing a health crisis from empirical thought, nobody would have believed it. However, with the December 2019 arrival of COVID-19 in China, the world subsequently went into a frenzied state that resulted in the widespread adoption of untested strategies or potential cures; circumstantial evidence provided without randomized control trials (RCTs) was published rapidly and widely considered the gold standard in medical research and therapeutics. Nigeria and much of the rest of the world blindly adopted treatments like chloroquine or hydroxychloroquine and various prevention strategies, often without monitoring the efficacy of these treatment and social control strategies. COVID-19 provided Nigeria a critical opportunity to create or strengthen its national laboratory system by building up its Level 3 laboratories in all parts of the country with the capability to perform PCR tests and viral isolation. There was also an opportunity to establish hospitals in every region of a sufficient standard to reduce the numbers of Nigerians travelling abroad to seek medical treatment; to invest in building capacity to develop antiviral medications and vaccines in Nigeria, and to ensure better international health policies. Rather, Nigerian leaders, government and health managers decided (like most other nations of the world) to shut down the society using isolationist policies that were not necessarily tailored to local needs. Despite adopting these methods, COVID-19 cases continued to skyrocket in Nigeria. In the future, before adopting such broad sweeping policies, there should be local tailoring to assess their effectiveness in different communities. Given that the country has much experience in controlling Lassa and Marburg Fever outbreaks, Nigeria should lead by developing new strategies, new protocols and new local guidelines, based on validated and reproducible studies to ensure that the public health authorities are not caught unaware by any new outbreaks of emerging or remerging diseases.

Culturally competent healthcare - A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision.

BACKGROUND: Culturally and linguistically diverse patients access healthcare services less than the host populations and are confronted with different barriers such as language barriers, legal restrictions or differences in health beliefs. In order to reduce these disparities, the promotion of cultural competence in healthcare organizations has been a political goal. This scoping review aims to collect components and strategies from evaluated interventions that provide culturally competent healthcare for culturally and linguistically diverse patients within healthcare organizations and to examine their effects on selected outcome measures. Thereafter, we aim to organize identified components into a model of culturally competent healthcare provisions. METHODS AND FINDINGS: A systematic literature search was carried out using three databases (Pubmed, PsycINFO and Web of Science) to identify studies which have implemented and evaluated cultural competence interventions in healthcare facilities. PICO criteria were adapted to formulate the research question and to systematically choose relevant search terms. Sixty-seven studies implementing culturally competent healthcare interventions were included in the final synthesis. Identified strategies and components of culturally competent healthcare extracted from these studies were clustered into twenty categories, which were organized in four groups: Components of culturally competent healthcare-Individual level; Components of culturally competent healthcare-Organizational level; Strategies to implement culturally competent healthcare and Strategies to provide access to culturally competent healthcare. A model integrating the results is proposed. The overall effects on patient outcomes and utilization rates of identified components or strategies were positive but often small or not significant. Qualitative data suggest that components and strategies of culturally competent healthcare were appreciated by patients and providers. CONCLUSION: This scoping review used a bottom-up approach to identify components and strategies of culturally competent healthcare interventions and synthesized the results in a model of culturally competent healthcare provision. Reported effects of single components or strategies are limited because most studies implemented a combination of different components and strategies simultaneously.

Lesbian Pregnancy: Care and Considerations.

The constructs and the provision of preconception and obstetrical care have historically been based on the assumption of heterosexuality, and have often excluded lesbian women. However, due to significant strides in lesbian, gay, bisexual, transgender, and queer (LGBTQ) civil rights, more lesbian women desire to create and expand their families, and lesbian parented families are increasing. This places obstetrical care providers at the forefront of the movement to build inclusive health care environments. Therefore, it is incumbent upon those of us who work in obstetrics to understand, recognize, and respect the unique cultural considerations that pertain to lesbian women and couples seeking parenthood. This review seeks to provide culturally sensitive guidance on the specific concerns and challenges lesbians face, from preconception care to postpartum care, and briefly addresses legal issues and considerations for the nonbiologic mother. The recommendations outlined here are drawn from studies of the experiences of lesbian women with pregnancy. However, the scientific literature is very limited, and there is a clear need for additional obstetrical research focused on this patient group. As professionals committed to assuring optimal outcomes for all obstetrical patients, it is crucial that we promote the inclusion of sexual minority women in our clinical practices and research endeavors.

Is Aboriginal nutrition a priority for local government? A policy analysis.

OBJECTIVE: The present study aimed to explore how Australian local governments prioritise the health and well-being of Aboriginal populations and the extent to which nutrition is addressed by local government health policy. DESIGN: In the state of Victoria, Australia, all seventy-nine local governments' public health policy documents were retrieved. Inclusion of Aboriginal health and nutrition in policy documents was analysed using quantitative content analysis. Representation of Aboriginal nutrition 'problems' and 'solutions' was examined using qualitative framing analysis. The socio-ecological framework was used to classify the types of Aboriginal nutrition issues and strategies within policy documents. SETTING: Victoria, Australia. SUBJECTS: Local governments' public health policy documents (n 79). RESULTS: A small proportion (14 %, n 11) of local governments addressed Aboriginal health and well-being in terms of nutrition. Where strategies aimed at nutrition existed, they mostly focused on individual factors rather than the broader macroenvironment. CONCLUSIONS: A limited number of Victorian local governments address nutrition as a health issue for their Aboriginal populations in policy documents. Nutrition needs to be addressed as a community and social responsibility rather than merely an individual 'behaviour'. Partnerships are required to ensure Aboriginal people lead government policy development.

Advancing LGBT Elder Policy and Support Services: The Massachusetts Model.

The Massachusetts-based LGBT Aging Project has trained elder service providers in affirming and culturally competent care for LGBT older adults, supported development of LGBT-friendly meal programs, and advanced LGBT equality under aging policy. Working across sectors, this innovative model launched the country's first statewide Legislative Commission on Lesbian, Gay, Bisexual, and Transgender Aging. Advocates are working with policymakers to implement key recommendations, including cultural competency training and data collection in statewide networks of elder services. The LGBT Aging Project's success provides a template for improving services and policy for LGBT older adults throughout the country.

Improving maternity services for Indigenous women in Australia: moving from policy to practice.

The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life. Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia's National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory). We report on the actions targeting Indigenous women, and the progress that has been achieved in three priority areas: The Indigenous maternity workforce; Culturally competent maternity care; and; Developing dedicated programs for "Birthing on Country". The timeframe for the NMSP has expired without notable results in these priority areas. More urgent leadership is required from the Australian government. Funding needs to be allocated to the priority areas, including for scholarships and support to train and retain Indigenous midwives, greater commitment to culturally competent maternity care and the development and evaluation of Birthing on Country sites in urban, rural and particularly in remote and very remote communities. Tools such as the Australian Rural Birth Index and the National Maternity Services Capability Framework can help guide this work.

Lost in translation: impact of language barriers on children's healthcare.

PURPOSE OF REVIEW: As the cultural and linguistic diversity of the United States grows, a greater number of patients with limited English proficiency will enter the healthcare system. Best practices for the care of these individuals include identification of their language assistance needs and prompt provision of interpreter services. This review will summarize the legal basis for providing language access in the healthcare setting, discuss the impact of interpretation services on clinical care, and explore the effects of language barriers on health outcomes. RECENT FINDINGS: There has been greater awareness of language as an important and independent determinant in the racial and ethnic disparities that exist in healthcare. Studies have shown that there is suboptimal identification of patients who require linguistic assistance and, as such, there are missed opportunities to bridge language gaps with many of our patients. The lack of interpretation, or use of informal, untrained interpreters, has significant effects on patient safety, quality of care, and patient satisfaction. SUMMARY: Though federal and regulatory guidelines mandate meaningful access to language services, such processes are still a work in progress in many healthcare settings. Further research and quality improvement initiatives are needed to provide clinicians the knowledge and skills needed to effectively communicate with their limited English proficient patients.

ESPEN guideline on ethical aspects of artificial nutrition and hydration.

BACKGROUND: The worldwide debate over the use of artificial nutrition and hydration remains controversial although the scientific and medical facts are unequivocal. Artificial nutrition and hydration are a medical intervention, requiring an indication, a therapeutic goal and the will (consent) of the competent patient. METHODS: The guideline was developed by an international multidisciplinary working group based on the main aspects of the Guideline on "Ethical and Legal Aspects of Artificial Nutrition" published 2013 by the German Society for Nutritional Medicine (DGEM) after conducting a review of specific current literature. The text was extended and introduced a broader view in particular on the impact of culture and religion. The results were discussed at the ESPEN Congress in Lisbon 2015 and accepted in an online survey among ESPEN members. RESULTS: The ESPEN Guideline on Ethical Aspects of Artificial Nutrition and Hydration is focused on the adult patient and provides a critical summary for physicians and caregivers. Special consideration is given to end of life issues and palliative medicine; to dementia and to specific situations like nursing care or the intensive care unit. The respect for autonomy is an important focus of the guideline as well as the careful wording to be used in the communication with patients and families. The other principles of Bioethics like beneficence, non-maleficence and justice are presented in the context of artificial nutrition and hydration. In this respect the withholding and withdrawing of artificial nutrition and/or hydration is discussed. Due to increasingly multicultural societies and the need for awareness of different values and beliefs an elaborated chapter is dedicated to cultural and religious issues and nutrition. Last but not least topics like voluntary refusal of nutrition and fluids, and forced feeding of competent persons (persons on hunger strike) is included in the guideline.

Política nacional de comadronas de los cuatro pueblos de Guatemala: 2015-2025 / National policy of midwives of the four towns of Guatemala: 2015-2025

Fundamentada en la Ley para la Maternidad Saludable, considerada como prioridad nacional y amparada en el Acuerdo gubernativo: No. 102-105, esta Política Nacional quiere reconocer la labor de las comadronas, quienes por siglos han aportado a la salud de la comunidad a través de la atención materna neonatal y dado que la función de las comadronas está estrechamente vinculada a la promoción de la Maternidad Saludable. Según el INE, en el 2013 las 23,320 comadronas registradas por el MSPAS, atendieron 124,688 partos, que constituyen el 32,2 % de todos los partos atendidos en el país. Por todo ello, el MSPAS, implementará acciones para respetar, reconocer y revitalizar la labor de las comadronas en la población de Guatemala. La Política fue elaborada con base a los resultados de los 33 diálogos en los que participaron las comadronas representativas de las 29 áreas de salud de los 22 departamentos de Guatemala, en coordinación con instituciones gubernamentales, sociedad civil y agencias de cooperación internacional que trabajan en salud, lo que le da un respaldo social e institucional a la misma. Especialmente relevante es superar la incomprensión de algunos personeros de salud, debido a la desvalorización de dichas prácticas tradicionales. Por medio de esta Política no solo se quiere lograr el reconocimiento, sino establecer los ejes institucionales para el trabajo conjunto en pro del bienestar materno-infantil.

Reglamento Interno de la Unidad: Acuerdo Ministerial No. 8-2010 / Health Care Unit of Indigenous Peoples and Interculturality in Guatemala: Ministerial Agreement No. 1632-2009

El documento contiene dos acuerdos ministeriales: la Unidad de Atención de la Salud de los Pueblos Indígenas y su respectivo reglamento. Y lo que pretende lograr es propiciar la pertinencia cultural en salud a nivel nacional entre los cuatro pueblos Maya, Garífuna, Xinka y No Indígena. Los Acuerdos Ministeriales contenidos en este documento reflejan las aspiraciones de la Unidad de Atención de la Salud de los Pueblos Indígenas e Interculturalidad, en atender con una visión y misión inscritas en el marco legal, y estratégico en reconocer el valor de las prácticas terapéuticas de los pueblos, ­en particular los mayas­ ostentan los más graves problemas de salud pública. Contiene 11 Artículos el primer acuerdo y 13 el segundo.

Unidad de Atención de la Salud de los Pueblos Indígenas e Interculturalidad en Guatemala: Acuerdo Ministerial No. 1632-2009 / Reglamento Interno de la Unidad: Acuerdo Ministerial No. 8-2010 / Health Care Unit of Indigenous Peoples and Interculturality in Guatemala: Ministerial Agreement No. 1632-2009

**los dos documentos aparecen individualmente en la App y base de datos, pero con los mismos datos que verá aquí. El documento contiene dos acuerdos ministeriales: la Unidad de Atención de la Salud de los Pueblos Indígenas y su respectivo reglamento. Y lo que pretende lograr es propiciar la pertinencia cultural en salud a nivel nacional entre los cuatro pueblos Maya, Garífuna, Xinka y No Indígena. Los Acuerdos Ministeriales contenidos en este documento reflejan las aspiraciones de la Unidad de Atención de la Salud de los Pueblos Indígenas e Interculturalidad, en atender con una visión y misión inscritas en el marco legal, y estratégico en reconocer el valor de las prácticas terapéuticas de los pueblos, ­en particular los mayas­ ostentan los más graves problemas de salud pública. Contiene 11 Artículos el primer acuerdo y 13 el segundo.