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1.
Science ; 374(6564): 182-188, 2021 10 08.
Artículo en Inglés | MEDLINE | ID: mdl-34618559
2.
Washington, D.C.; OPS; 2021-10-18.
No convencional en Español | PAHO-IRIS | ID: phr-55047

RESUMEN

El presente informe regional sobre la situación de la tuberculosis en las Américas contiene la información correspondiente al 2019, provista por los países de la Región a través del sistema de recolección de datos de TB de la OMS. Esta información ha sido consolidada y analizada a nivel regional. Su objetivo, además de presentar la situación epidemiológica y programática de la TB en las Américas, es sensibilizar, motivar e incentivar a todas las partes involucradas en la prevención y el control de esta enfermedad, para acelerar los esfuerzos hacia su eliminación en la Región y alcanzar las metas de la Estrategia Fin de la TB. En el informe se consignan los logros, pero también las brechas en el trabajo que se realiza en aspectos de diagnóstico, tratamiento, comorbilidades, poblaciones vulnerables, factores de riesgo y financiación, entre otros asuntos. A partir de la información presentada, se brindan unas recomendaciones concretas para seguir avanzando.


Asunto(s)
Tuberculosis , Epidemiología , Mortalidad , VIH , Poblaciones Vulnerables , Factores de Riesgo , Salud de Poblaciones Indígenas , Pueblos Indígenas , Adolescente , Niño , Salud del Niño , Salud del Adolescente , Américas
3.
Washington, D.C.; PAHO; 2021-10-08.
en Inglés | PAHO-IRIS | ID: phr-54973

RESUMEN

Tuberculosis continues to represent a severe public health problem in the Region of the Americas, even more so in the case of indigenous peoples, whose TB incidence is much higher than that of the general population. To achieve tuberculosis control in these communities, it is necessary to respond to communities’ diverse needs from an intercultural perspective that allows the application of a holistic approach—from a standpoint of equality and mutual respect—and considers the value of their cultural practices. In the Region of the Americas, although there has been progress toward recognizing the need for an intercultural approach to health services, obstacles rooted in discrimination, racism, and the exclusion of indigenous peoples and other ethnic groups persist. To respond to this situation, the Pan American Health Organization (PAHO) prepared this guidance which––based on an intercultural approach in accordance with the priority lines of the current PAHO Policy on Ethnicity and Health and its practical development in the Region’s indigenous populations––represent a support tool for implementing the End TB Strategy. This publication integrates PAHO’s accumulated experience and best practices developed by its Member States in recent years, including discussions and experiences shared in regional meetings on the issue, and emphasizes innovation and social inclusion. This requires an urgent shift away from traditional paradigms, taking specific actions that gradually reduce TB incidence and moving toward effective multisectoral actions that have proven effective in quickly containing the epidemic.


Asunto(s)
Enfermedades Transmisibles , Tuberculosis , Pueblos Indígenas , Educación de la Población , Grupos Étnicos , Origen Étnico y Salud , Epidemias , Américas
4.
Sci Rep ; 11(1): 17534, 2021 09 02.
Artículo en Inglés | MEDLINE | ID: mdl-34475438

RESUMEN

The COVID-19 pandemic threatens indigenous peoples living in suburban areas of large Brazilian cities and has thus far intensified their pre-existing socio-economic inequalities. We evaluated the epidemiological situation of SARS-CoV-2 infection among residents of the biggest urban multiethnic indigenous community of the Amazonas state, Brazil. Blood samples of 280 indigenous people living in the surrounding area of Manaus were tested for the presence of anti-SARS-CoV-2 IgA or IgG antibodies. The risk factors and sociodemographic information were assessed through an epidemiological questionnaire. We found a total positivity rate of 64.64% (95% CI 59.01-70.28) for SARS-CoV-2 infection. IgA and IgG were detected in 55.71% (95% CI 49.89-61.54) and 60.71% (95% CI 54.98-66.45) of the individuals, respectively. Over 80% of positive individuals were positive for both IgA and IgG.No significant difference in positivity rates between genders or age groups was observed. Moreover, the age group ≥ 60 years old showed the highest antibody ratios (IgA mean ratio = 3.080 ± 1.623; IgG mean ratio = 4.221 ± 1.832), while the age groups 13-19 and 20-29 showed the lowest IgA (mean ratio = 2.268 ± 0.919) and IgG ratios (mean ratio = 2.207 ± 1.246), respectively. Individuals leaving the home more frequently were at higher risk of infection (Odds ratio (OD) 2.61; 95% CI 1.00-1.49; p = 0.048). Five or more individuals per household increased fivefold the risk of virus transmission (OR 2.56; 95% CI 1.09-6.01; p = 0.019). The disproportionate dissemination of SARS-CoV-2 infection observed among the study population might be driven by typical cultural behavior and socioeconomic inequalities. Despite the pandemic threat, this population is not being targeted by public policies and appears to be chronically invisible to the Brazilian authorities.


Asunto(s)
Prueba Serológica para COVID-19 , COVID-19 , Pueblos Indígenas , Pandemias , SARS-CoV-2/metabolismo , Adolescente , Adulto , Anticuerpos Antivirales/sangre , Brasil/epidemiología , Brasil/etnología , COVID-19/sangre , COVID-19/epidemiología , COVID-19/etnología , Femenino , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad
5.
J Anim Ecol ; 2021 Sep 24.
Artículo en Inglés | MEDLINE | ID: mdl-34558076

RESUMEN

It is not uncommon for one or a few species, and their interactions, to have disproportionate effects on other species in ecological communities. Such keystone interactions might affect how communities respond to the invasion of non-native species by preventing or inhibiting the establishment, spread or impact of non-native species. We explore whether a keystone mutualism among a hummingbird-mistletoe-marsupial promotes ecological resistance to an invasive pollinator, the bumblebee Bombus terrestris, by comparing data collected at sites prior to bumblebee invasion to data collected 11 years after the invasion in sites with and without the keystone mutualism. We built pollination networks and focused on network motifs, regarded as building blocks of networks, to identify the central pollinators and estimate the change in their interactions after invasion of B. terrestris. We also estimated the interaction rewiring across the season in post-invasion networks and tested it as a possible mechanism explaining how the keystone mutualism increased ecological resistance to invasion. We found two times more species in post-invasion sites with the keystone mutualism than in post-invasion sites without the keystone mutualism. Moreover, we found that invasive bumblebee reduced the strength and interaction niche of the five central pollinator species while increasing its own strength and interaction niche, suggesting a replacement of interactions. Also, we found that the keystone mutualism promoted resistance to B. terrestris invasion by reducing its negative impacts on central species. In the presence of the keystone mutualism, central species had three times more direct interactions than in sites without this keystone mutualism. The higher interaction rewiring, after invasion of B. terrestris, in sites with the keystone mutualism indicates greater chances of central pollinators to form new interactions and reduces their competence for resources with the non-native bumblebee. Our results demonstrate that a keystone mutualism can enhance community resistance against the impacts of a non-native invasive pollinator by increasing species diversity and promoting interaction rewiring in the community. This study suggests that the conservation of mutualisms, especially those considered keystone, could be essential for long-term preservation of natural communities under current and future impacts of global change.

6.
BMJ Open ; 11(9): e047404, 2021 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-34551941

RESUMEN

INTRODUCTION: Chronic conditions impact indigenous peoples of Australia at a much higher rate than non-indigenous Australians. Attendance at the Medicare Benefits Scheme (MBS) supported indigenous health checks are crucial to improve prevention and management of chronic health conditions. However, in conjunction with lifestyle and environmental factors, attendance rates at primary healthcare services for screening and treatment have fallen in Australia during the COVID-19 pandemic. This study aims to explore the influence of the COVID-19 pandemic on preventive health behaviours of indigenous Australians and the associated barriers to, and enablers of, engagement with health services to formulate a targeted intervention strategy. METHODS AND ANALYSIS: A concurrent mixed-methods study (comprising quantitative and qualitative data collection methods) will be employed. Descriptive analysis of MBS data about the characteristics of indigenous peoples of Australia claiming health assessment services will be performed. Generalised estimating equation regression models will be used to examine the use of health assessment services over time. Qualitative interviews informed by indigenous research methods will be conducted. Interviews will investigate barriers to, and enablers of, engagement with health services. Thematic approach guided by the principles of indigenist praxis, storytelling and collaborative research will be used to analyse the interview data. The project commenced in July 2020 and will be completed by July 2022. ETHICS AND DISSEMINATION: The project received ethics approval from the Aboriginal Health and Medical Research Council of New South Wales and the University of New England Human Research Ethics Committee. Findings will be disseminated via peer-reviewed journal articles, conferences, government and relevant stakeholder reports, and infographics.


Asunto(s)
COVID-19 , Servicios de Salud del Indígena , Programas Nacionales de Salud , Anciano , Australia , Conductas Relacionadas con la Salud , Humanos , Pueblos Indígenas , Nueva Gales del Sur , Grupo de Ascendencia Oceánica , Pandemias , SARS-CoV-2
7.
Washington, D.C.; OPS; 2021-09-21.
No convencional en Español | PAHO-IRIS | ID: phr-54864

RESUMEN

El propósito de estas herramientas es ayudar a determinar y aplicar las prioridades en la prevención del suicidio. En ellas se proporciona orientación para establecer redes de apoyo que ayuden a las comunidades en las actividades de prevención o en la mejora de actividades que ya estén en curso. En cada sección se ofrece orientación sobre cómo avanzar en la participación de la comunidad y se indican las herramientas que pueden usarse para poner en marcha el proceso de elaborar un plan de acción que sea pertinente para la comunidad. Además, cada comunidad puede adaptar este material para asegurarse de que las actividades sean aceptables y adecuadas para el contexto local.


Asunto(s)
Enfermedades no Transmisibles , Salud Mental , Suicidio , Participación de la Comunidad , Emigrantes e Inmigrantes , Pueblos Indígenas , Adulto Joven , Anciano
9.
Rev Lat Am Enfermagem ; 29: e3477, 2021.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-34495189

RESUMEN

OBJECTIVE: to identify the risk factors associated with prehypertension and arterial hypertension among Munduruku indigenous people in the Brazilian Amazon. METHOD: a cross-sectional study carried out with 459 Munduruku indigenous people selected by means of stratified random sampling. Sociodemographic variables, habits and lifestyles, anthropometric data, fasting glucose and lipid profiles were evaluated. An automatic device calibrated and validated to measure blood pressure was used. The analyses of the data collected were carried out in the R software, version 3.5.1. For continuous variables, the Kruskall-Wallis test was used; for the categorical ones, Fischer's Exact. The significance level was set at 5% and p-value≤0.05. RESULTS: the prevalence of altered blood pressure levels was 10.2% for values suggestive of hypertension and 4.1% for pre-hypertension. The risk of prehypertension among indigenous people was associated with being male (OR=1.65; 95% CI=0.65-4.21) and having a substantially increased waist circumference (OR=7.82; 95% CI=1.80-34.04). Regarding the risk for arterial hypertension, it was associated with age (OR=1.09; 95% CI=1.06-1.12), with increased waist circumference (OR=3.89; 95% CI=1.43-10, 54) and with substantially increased waist circumference (OR=5.46; 95% CI=1.78-16.75). CONCLUSION: among Munduruku indigenous people, men were more vulnerable to developing hypertension; age and increased waist circumference proved to be strong cardiovascular risk factors.


Asunto(s)
Enfermedades Cardiovasculares , Hipertensión , Presión Sanguínea , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Estudios Transversales , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Hipertensión/epidemiología , Pueblos Indígenas , Masculino , Prevalencia , Factores de Riesgo
11.
Transl Behav Med ; 11(9): 1655-1664, 2021 09 15.
Artículo en Inglés | MEDLINE | ID: mdl-34347863

RESUMEN

American Indian (AI) older adults experience pronounced health disparities and demonstrate one of the lowest levels of physical activity (PA) among racial and ethnic groups. Nearly half of AI older adults live in rural areas, indicating distinct challenges to participation in PA. Research to identify factors influencing PA in this population is missing from the literature, yet is critical to informing culturally relevant PA intervention development and implementation. The purpose was to identify barriers to and facilitators of PA among rural AI older adults using the ecological model and qualitative methods. A community-based approach was used to conduct semi-structured interviews with rural AI older adults. Interview questions were based on a multi-level ecological model. Content analysis was performed, using an iterative coding process to identify findings. The mean age of participants (n = 21) was 66 years. Barriers to and facilitators of PA were identified across ecological model levels. Barriers included factors such as caregiving and community responsibilities, lack of acceptable areas for walking, and overall lack of community-level support for older adult health. Facilitators included a personal connection to the land and ancestors through PA, multigenerational participation, and supportive tribal policies. This study addressed a gap in the literature by identifying barriers to and facilitators of PA among rural AI older adults, which can inform PA intervention development. With barriers and facilitators identified by AI older adults themselves, the voices of those directly affected are uplifted to shape efforts toward addressing longstanding health disparities through relevant public health interventions.


Asunto(s)
Nativos Estadounidenses , Actividad Motora , Anciano , Ejercicio Físico , Humanos , Población Rural , Caminata
15.
Pan Afr Med J ; 38: 352, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34367431

RESUMEN

Introduction: despite increasing research interest on Indigenous peoples´ health worldwide, the nutritional status of Indigenous children in Cameroon remains unknown. This study was conducted to assess the prevalence of stunting, wasting, and underweight among under-five Indigenous Mbororo children in the Foumban and Galim health districts of the West Region. Methods: a cross-sectional study was conducted involving 472 child-caregiver pairs from 16 Mbororo Communities in the Foumban and Galim health districts. Interviewer-administered questionnaires were used for data collection. Anthropometric measurements were collected using standard procedures. Socio-demographic data were analyzed using descriptive statistics. Anthropometric indices: height-for-age, weight-for-height, and weight-for-age - z-scores were analyzed using z-score 06 Stata version 11 and compared with World Health Organization growth reference standards. Ethical approval was obtained from the Faculty of Health Sciences Institutional Review Board of the University of Buea. Results: overall prevalence of stunting, wasting and underweight were 55.08% (95% CI: 50.5-59.58), 13.77% (95% CI: 10.65-16.89), and 31.99% (95% CI: 27.76-36.21), respectively. Severe stunting, wasting and underweight were 34.53% (95% CI: 30.22-38.83), 3.18% (95% CI: 1.58-4.76), and 10.59% (95% CI: 7.80-13.37), respectively. Rates of stunting, wasting and underweight for female and male were: 56.88% and 52.71%; 12.38% and 14.72%; and 30.73% and 32.55%, respectively. Stunting, wasting and underweight rates varied with child age. Conclusion: the prevalence of undernutrition was high, indicating a serious public health problem and the necessity for strategies to ensure the optimal health of the target population.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Trastornos del Crecimiento/epidemiología , Delgadez/epidemiología , Síndrome Debilitante/epidemiología , Adolescente , Adulto , Camerún/epidemiología , Trastornos de la Nutrición del Niño/etnología , Preescolar , Estudios Transversales , Femenino , Trastornos del Crecimiento/etnología , Humanos , Pueblos Indígenas , Lactante , Recién Nacido , Masculino , Estado Nutricional , Prevalencia , Distribución por Sexo , Delgadez/etnología , Síndrome Debilitante/etnología , Adulto Joven
16.
Artículo en Inglés | MEDLINE | ID: mdl-34360089

RESUMEN

Indigenous peoples' environments can be easily disrupted by foreign investments, and disputes have occasionally occurred over the past few years. The objective of this research article is to examine if current international investment law, especially its investor-state dispute settlement (ISDS) mechanism, could provide necessary protection to Indigenous rights. We searched all publicly available ISDS cases from 2000 to 2020, and selected 10 typical ones for comprehensive case study by using various research methods such as doctrinal legal research and comparative analysis. Our research revealed that Indigenous peoples' participation in the ISDS proceedings is legally restrained, time-consuming, and rarely favorably decided by the arbitral tribunals. Responsibility for such undesirable outcomes rests with all stakeholders involved in the process, while the consequences of post-arbitration tend to be "triple losing". These findings highlight the quest for a more sustainable international investment regime that promotes Indigenous peoples' wellbeing and environment protection. We argue that future reform could be promoted not only over ISDS procedural matters, but also by upgrading substantive rules in international investment agreements (IIAs), emphasizing free, prior, and informed consent (FPIC), and strengthening foreign investors' corporate social responsibilities (CSR).


Asunto(s)
Disentimientos y Disputas , Pueblos Indígenas , Humanos , Inversiones en Salud , Grupos de Población , Responsabilidad Social
17.
Front Public Health ; 9: 667926, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34368048

RESUMEN

In 2018, the Community Health Representative (CHR) workforce celebrated their 50th year and serve as the oldest and only federally funded Community Health Worker (CHW) workforce in the United States. CHRs are a highly trained, well-established standardized workforce serving the medical and social needs of American Indian communities. Nationally, the CHR workforce consists of ~1,700 CHRs, representing 264 Tribes. Of the 22 Tribes of Arizona, 19 Tribes operate a CHR Program and employ ~250 CHRs, equivalent to ~30% of the total CHW workforce in the state. Since 2015, Tribal CHR Programs of Arizona have come together for annual CHR Policy Summits to dialogue and plan for the unique issues and opportunities facing CHR workforce sustainability and advancement. Overtime, the Policy Summits have resulted in the Arizona CHR Workforce Movement, which advocates for inclusion of CHRs in state and national level dialogue regarding workforce standardization, certification, training, supervision, and financing. This community case study describes the impetus, collaborative process, and selected results of a 2019-2020 multi-phase CHR workforce assessment. Specifically, we highlight CHR core roles and competencies, contributions to the social determinant of health and well-being and the level to which CHRs are integrated within systems and teams. We offer recommendations for strengthening the workforce, increasing awareness of CHR roles and competencies, integrating CHRs within teams and systems, and mechanism for sustainability.


Asunto(s)
Equidad en Salud , Indios Norteamericanos , Nativos Estadounidenses , Agentes Comunitarios de Salud , Humanos , Salud Pública , Estados Unidos , Recursos Humanos
18.
Int J Equity Health ; 20(1): 164, 2021 07 14.
Artículo en Inglés | MEDLINE | ID: mdl-34261500

RESUMEN

In this paper we explore some of the ways systemic racism operates and is maintained within our health and social services. We look at a very specific context, that of Nunavik Quebec, land and home to 13,000 Nunavimmiut, citizens of Quebec and Canada, signatories of the James Bay and Northern Quebec Agreement. We operationalize some of the ways in which policies and practices create and support social hierarchies of knowledges, also called epistemic racism, and how it impacts our ability to offer quality care that Indigenous peoples can trust and use.


Asunto(s)
Política de Salud , Servicios de Salud del Indígena , Disparidades en Atención de Salud , Racismo , Canadá/etnología , Disparidades en Atención de Salud/etnología , Humanos , Pueblos Indígenas , Conocimiento , Grupo de Ascendencia Oceánica , Política Organizacional , Grupos de Población
19.
BMC Palliat Care ; 20(1): 120, 2021 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-34320961

RESUMEN

BACKGROUND: Moving palliative care from a solely clinical focus to a more population based and community orientated approach is the hallmark of a much advocated public health approach to palliative care. Young adults are a vital cohort of the public, yet their understanding of palliative care has not been investigated. This study aimed to explore young adults' understanding of palliative care and identify factors that influence their engagement. METHODS: A purposive sample of young adults (n = 24) aged 18-29 years were recruited from one UK University. Semi-structured interviews were undertaken face to face or via telephone or Skype between November 2017 and February 2018. Thematic analysis using a framework approach and underpinned by a socioecological perspective was used to analyse the interviews. RESULTS: Three thematic categories were identified relating to intrapersonal and interpersonal influences, cultural and social influences and organisational and public policy influences. Palliative care was understood as supportive comfort care, delivered in the absence of cure, associated with the end of life and specifically focused on death and dying. Negative attitudes related to the context of care, which represented a static and hopeless situation. Whilst some reported positive attitudes, potential engagement was seen to be governed by a lack of knowledge and protective cultural norms. In terms of demonstrating readiness to engage with palliative care, participants requested clear information and suggested a normalising of palliative care through the education system. CONCLUSION: Young adults in this study were ready to find out more about palliative care and identified social media as a platform upon which to engage this population. However, their perception of a society that views palliative care as a subject for those directly affected, creates a barrier to engagement. This study identified the ingredients of a public health message and mediums for disseminating the message. However, findings also suggest that a cultural shift is required to recognise the potential of engaging young adults in health issues that cross the life span, empowering them not only as individuals but as vital members of community and society.


Asunto(s)
Enfermería de Cuidados Paliativos al Final de la Vida , Cuidados Paliativos , Humanos , Grupos de Población , Salud Pública , Investigación Cualitativa , Adulto Joven
20.
Aust Occup Ther J ; 68(5): 444-453, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34296445

RESUMEN

INTRODUCTION: The COVID-19 pandemic, which has disrupted occupations and lives of people around the world, has simultaneously exposed deeply rooted social inequities and structural injustices that have negated the facile claim that "we're all in this together." But the pandemic has also opened up opportunities to imagine other ways of living and doing in the future. This paper imagines some possibilities for shaping occupational therapy's future practices and seeks to illustrate why it is both timely and necessary to re-imagine occupational therapy in 2021. METHODS: Drawing from epidemiological research, the paper explores the inequitable impacts of COVID-19, environmental degradation, and multiple social determinants on people's real opportunities for health, wellbeing, and occupational engagement. FINDINGS: Evidence presented in this paper challenges occupational therapy's individualised approach towards wellbeing and contests the limited parameters of occupations "that matter" that are prioritised and promoted within the profession. In response, the paper seeks to expose the specific, political, economic, and ableist ideology that has effectively shaped the occupational therapy profession's assumptions, models, theories, and the practices these inform. CONCLUSION: Drawing from the "Build back better" approach to post-disaster recovery-with its dual attentions to wellbeing, equity, and inclusivity and to physical, social, cultural, economic, and environmental vulnerabilities-this paper imagines an occupational therapy for a post-COVID-19 world; an occupational therapy that takes seriously the premise that occupations and people are inseparable from their environments; a profession that no longer colludes in individualising problems that are inherently social or in depoliticising the systemic social and economic inequalities that create stress and illness; an occupational therapy that no longer promotes the values of neoliberal ableism; and an occupational therapy dedicated to expanding people's just and equitable opportunities to engage in meaningful occupations that contribute positively to their own wellbeing and the wellbeing of their communities.


Asunto(s)
Terapia Ocupacional/tendencias , COVID-19 , Humanos , Pueblos Indígenas , Pandemias , Determinantes Sociales de la Salud , Justicia Social
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