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1.
Multimedia | Recursos Multimedia | ID: multimedia-13192

RESUMEN

Durante a Oficina do Projeto BVS Saúde Indígena (TA4/TC93), realizada pela BIREME/OPAS/OMS com SESAI/MS no Dia Nacional dos Povos Indígenas, Giovana Cruz Mandulão, Coordenadora-Geral de Gestão do Conhecimento, da Informação, da Avaliação e do Monitoramento da Secretaria de Saúde Indígena, realiza intervenção em homenagem e defesa dos povos indígenas do Brasil.


Asunto(s)
Brasil/etnología , Derechos Humanos , Indígenas Sudamericanos , Territorio Sociocultural , Pueblos Indígenas , Violencia Étnica , Discurso , Salud de Poblaciones Indígenas
2.
Womens Health (Lond) ; 20: 17455057241259173, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38847324

RESUMEN

BACKGROUND: There is an increasing emphasis on promoting women's autonomy in reproductive decision-making, particularly given global efforts to increase contraceptive access and uptake. Scales to quantify autonomy have inconsistently included the effect of external influences and focused primarily on influences of partners. OBJECTIVES: This study aimed to gain greater depth in understanding how influences including and beyond a woman's partner affect her contraceptive decision-making, as well as how external influences can overlap and further complicate contraceptive decision-making. DESIGN: A phenomenological, qualitative study in which in-depth interviews were conducted in three phases from May 2021 to February 2022 with women living in northwest Tanzania who had varying histories of contraceptive use or non-use. METHODS: One-on-one, in-depth interviews were conducted in Swahili, the national language of Tanzania, by trained female interviewers. Interviews were digitally recorded, transcribed, translated into English, and independently coded by three investigators. Analysis was conducted using NVivo. The codes developed from the transcripts were grouped into overarching themes with supporting illustrative quotes. RESULTS: A total of 72 women were interviewed. Partners were the most influential in women's family planning decision-making, followed by friends, relatives, community religious leaders, and healthcare providers. Out of the 52 women with a partner who had ever used family planning, 76.9% had discussed their desire to use family planning with their partner and nearly all reported strong pressures to use or not to use family planning from partners, family, and friends. Rarely, participants stated that they were devoid of any influence. CONCLUSION: In rural Tanzania, women's decision-making about family planning was highly impacted by external influences, including not only partners but also family, friends, and community. Indicators of women's reproductive autonomy and measurements of interventions to promote contraceptive use should incorporate measures of these external influences.


Asunto(s)
Conducta Anticonceptiva , Toma de Decisiones , Servicios de Planificación Familiar , Autonomía Personal , Investigación Cualitativa , Población Rural , Humanos , Femenino , Tanzanía , Adulto , Conducta Anticonceptiva/psicología , Conducta Anticonceptiva/estadística & datos numéricos , Adulto Joven , Anticoncepción/psicología , Anticoncepción/métodos , Entrevistas como Asunto , Persona de Mediana Edad , Parejas Sexuales/psicología , Adolescente
3.
PLoS One ; 19(6): e0302153, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38848414

RESUMEN

INTRODUCTION: Cervical cancer, a malignancy caused by infection with oncogenic human papillomavirus, disproportionally affects women from low resource settings. Persistence of human papillomavirus infection may mediate an association between tobacco use and cervical cancer. In limited resource settings, women from indigenous communities are often marginalized and do not benefit from evidence-based interventions to prevent tobacco use or cervical cancer due to the limited reach of mainstream healthcare services to these communities. This study determined the association between smoking and high-risk human papillomavirus infection among women from indigenous communities in western Botswana. METHODS: A cross-sectional study of women in indigenous communities was conducted between June and October 2022. Demographic, clinical and self-reported smoking data were collected. Cervical cytology and HPV DNA testing for high-risk human papillomavirus genotypes were performed. Multilevel multivariable logistic regression models were fit to evaluate the association between smoking and high-risk human papillomavirus infection while adjusting for potential confounders. RESULTS: A total of 171 participants with a median (interquartile range) age of 40 (31-50) years from three settlements and two villages were recruited for the study. Of these, 17% were current smokers, 32.8% were living with HIV and high-risk human papillomavirus DNA was detected in 32.8% of the cervical specimens. Women who were current smokers, were nearly twice as likely to have cervical high-risk human papillomavirus infection compared to non-smokers (Adjusted Odds Ratio (95% CI); 1.74(1.09, 2.79)) after controlling for confounders. CONCLUSION: These data underscore the need for effective tobacco control to help mitigate cervical cancer risk in this setting. These findings can help inform decisions about targeted cervical cancer prevention and tobacco cessation interventions for women from indigenous communities.


Asunto(s)
Infecciones por Papillomavirus , Fumar , Neoplasias del Cuello Uterino , Humanos , Femenino , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/virología , Botswana/epidemiología , Adulto , Persona de Mediana Edad , Estudios Transversales , Neoplasias del Cuello Uterino/virología , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/etiología , Neoplasias del Cuello Uterino/prevención & control , Pueblos Indígenas/estadística & datos numéricos , Papillomaviridae/aislamiento & purificación , Papillomaviridae/genética , Factores de Riesgo
4.
BMC Health Serv Res ; 24(1): 709, 2024 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-38849826

RESUMEN

BACKGROUND: Disparities in rates of contraceptive use are frequently attributed to unequal access to and affordability of care. There is a need to better understand whether common definitions of affordability that solely relate to cost or to insurance status capture the reality of individuals' lived experiences. We sought to better understand how individuals with low incomes and the capacity for pregnancy conceptualized one domain of contraceptive access-affordability --in terms of health system and individual access and how both shaped contraceptive care-seeking in the US South. METHOD: Between January 2019 to February 2020, we conducted twenty-five life-history interviews with low-income individuals who may become pregnant living in suburban counties in Georgia, USA. Interviews covered the ways individual and health system access factors influenced care-seeking for family planning over the life course. Interview transcripts were analyzed using a thematic analysis approach to identify experiences associated with individual and health system access. RESULTS: Affordability was identified as a major determinant of access, one tied to unique combinations of individual factors (e.g., financial status) and health system characteristics (e.g., cost of methods) that fluctuated over time. Navigating the process to attain affordable care was unpredictable and had important implications for care-seeking. A "poor fit" between individual and health system factors could lead to inequities in access and gaps in, or non-use of contraception. Participants also reported high levels of shame and stigma associated with being uninsured or on publicly funded insurance. CONCLUSIONS: Affordability is one domain of contraceptive access that is shaped by the interplay between individual factors and health system characteristics as well as by larger structural factors such as health and economic policies that influence both. Assessments of the affordability of contraceptive care must account for the dynamic interplay among multilevel influences. Despite the expansion of contraceptive coverage through the Affordable Care Act, low-income individuals still struggle with affordability and disparities persist.


Asunto(s)
Accesibilidad a los Servicios de Salud , Pobreza , Humanos , Femenino , Adulto , Georgia , Servicios de Planificación Familiar/economía , Adulto Joven , Adolescente , Entrevistas como Asunto , Anticoncepción/estadística & datos numéricos , Anticoncepción/economía , Anticoncepción/métodos
5.
BMJ Open ; 14(6): e083448, 2024 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-38839385

RESUMEN

INTRODUCTION: Indigenous people experience a unique set of health inequalities and social determinants that can negatively affect their physical health, mental health and wellness. This critical state of affairs is compounded by the limited availability of culturally appropriate care services and treatments for the different groups. In response, increasing numbers of studies are turning their focus to art-based interventions and how these might benefit Indigenous lives. The proposed scoping review aims to map this growing field of research. METHODS AND ANALYSIS: This scoping review is based on the Arksey and O'Malley methodological framework and the subsequent enhancements proposed by Levac et al. Academic databases and grey literature sources will be searched to identify appropriate studies for inclusion. The search strategies of all databases were tested on 25 April 2024. This will be followed by a two-step screening process to be conducted by two researchers and consisting of (1) a title and abstract review and (2) a full-text review. Data from the selected studies will be extracted, collated and charted to summarise all relevant interventions, their outcomes and key findings. An Indigenous research partner will be hired as a consultant, and the research will be further informed by other stakeholders. ETHICS AND DISSEMINATION: This study is the first step in a research programme involving working with Indigenous artists to codesign a pilot art-based intervention aimed at improving mental health and wellness among Indigenous people. The scoping review will identify the specific components in documented art-based interventions that have proven beneficial to this group. Since it will draw exclusively on data from published and public sources, no ethics approval is required. The results will be disseminated through knowledge translation activities with Indigenous organisations and art therapy groups; a summary of the results will also be distributed through Indigenous networks.


Asunto(s)
Arteterapia , Pueblos Indígenas , Humanos , Arteterapia/métodos , Servicios de Salud del Indígena , Proyectos de Investigación , Literatura de Revisión como Asunto
6.
Soc Sci Med ; 351 Suppl 1: 116291, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38825383

RESUMEN

The purpose of this article is to delineate the nature of the colonial mindset, which perpetuates gendered settler colonial structures of historical oppression in research and practice. By connecting a critical consciousness and living in alignment with agility (AWA), this work explicates pathways from gendered complicity to embodying praxis-or becoming gender AWAke. This article begins by describing the nature of the colonial mindset. Second, I critically examine the dominant discourse institutionalized by Western psychology. Third, I introduce the FHORT and critically analyze how the colonial mindset has affected and driven violence against Indigenous women. Examining how settler colonial structural sexism in its heteropatriarchal and heteropaternalistic forms has become imposed upon the lives of Indigenous women and gender-expansive peoples exposes subjugated knowledges; it provides an empirical scaffolding for people to become critically conscious of dominant gender norms that apply to people, institutions, and society more broadly. Finally, I propose living AWAke for personal and collective liberation.


Asunto(s)
Colonialismo , Humanos , Sexismo/psicología , Femenino , Identidad de Género , Pueblos Indígenas/psicología , Estado de Conciencia
7.
BMC Womens Health ; 24(1): 317, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38824536

RESUMEN

BACKGROUND: Inequalities in modern contraceptive use among women in low-income countries remain a major public health challenge. Eliminating or reducing the inequalities in modern contraceptive use among women could accelerate the achievement of Sustainable Development Goals, Targets 3.7 & 5.6. Thus, this study examined the inequality gaps in modern contraceptive use and associated factors among women of reproductive age in Nigeria between 2003 and 2018. METHODS: This study employed the World Health Organisation's Health Equity Assessment Toolkit to analyse the 2003 and 2018 Nigeria Demographic Health Surveys. Modern contraceptive use was aggregated using five equity stratifiers: age, economic status, educational level, place, and region of residence among women of reproductive aged 15 to 49, with a sample size of 5,336 and 29,090 for 2003 and 2018, respectively. Inequality was measured in this study using difference (D), ratio (R), population-attributable risk (PAR), and a population-attributable fraction (PAF). RESULTS: The study shows an increase in modern contraceptive use among women of reproductive age in Nigeria from 8.25% in 2003 to 12.01% in 2018, with the use being more prominent among women of reproductive age 20-49 and those in the richest economic quintile. In both surveys, women with primary education showed the most upward increase in modern contraceptive use. Women residing in the urban areas also show an upward use of modern contraceptives use. The study further highlights inequality gaps, with age being a substantial factor, while economic status and sub-national regions showed mild to marginal inequality gaps. Finally, the educational level of women of reproductive age in Nigeria significantly shows inequality in modern contraceptive use, with a PAF of 129.11 in 2003 and 65.39 in 2018. CONCLUSION: The inequality gap in modern contraceptive use among women of reproductive age in Nigeria between 2003 and 2018 reported in this study includes age, education, wealth quintile, residence, and region-related inequalities. The study highlights the need for policies and programmes that target the groups with low use of modern contraceptives to promote equity in family planning services.


Asunto(s)
Conducta Anticonceptiva , Factores Socioeconómicos , Humanos , Femenino , Nigeria , Adulto , Adolescente , Adulto Joven , Conducta Anticonceptiva/estadística & datos numéricos , Conducta Anticonceptiva/tendencias , Persona de Mediana Edad , Anticoncepción/estadística & datos numéricos , Anticoncepción/métodos , Servicios de Planificación Familiar/estadística & datos numéricos , Escolaridad
8.
J Midwifery Womens Health ; 69(3): 383-393, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38831486

RESUMEN

INTRODUCTION: Research on associations between knowledge and health beliefs for women at risk for gestational diabetes mellitus (GDM) has focused on adults at risk for or having GDM. Gaps also exist in examining interpersonal associations with family members or peers. We examined dyadic associations between knowledge and health beliefs about the risk for GDM between and within American Indian and Alaska Native (AIAN) female adolescents and young adults (FAYAs) at risk for GDM and their mothers or adult female caregivers (FCs). METHODS: Grounded in the Expanded Health Belief Model, we employed a cross-sectional design using baseline data from 147 dyads of AIAN FAYAs at risk for GDM and their FCs who participated in the Stopping GDM in Daughters and Mothers trial. FAYAs were 12.0 to 24.5 years of age, and 89.1% were students. FCs had a mean (SD) age of 44.0 (9.3) years, 87.0% were AIAN, 44.9% were college educated, 19.7% had ever had GDM, and 81.0% were the FAYA's mother. FAYAs and FCs completed surveys about knowledge and health beliefs (benefits, barriers, severity, susceptibility) regarding GDM risk and prevention. Bivariate correlational analyses were performed to examine associations between and within dyad members. Dyadic associations were investigated using actor-partner interdependence modeling (APIM) assuming distinguishable dyad members. RESULTS: Compared with their FCs, FAYAs had lower health-related knowledge and perceived benefits of GDM prevention and susceptibility regarding GDM risk. APIM revealed actor and partner effects of health-related knowledge on health beliefs for dyads. In particular, positive actor effects were found for FAYAs and FCs for GDM-related knowledge with perceived benefits (P < .001), and positive partner effects of GDM-related knowledge for FCs were related to perceived susceptibility and severity for FAYAs (P < .05). DISCUSSION: As shown in these AIAN dyads, FAYAs and their FCs, as members of one another's social network, may influence each other's health beliefs regarding GDM risk and prevention.


Asunto(s)
Nativos Alasqueños , Cuidadores , Diabetes Gestacional , Conocimientos, Actitudes y Práctica en Salud , Humanos , Femenino , Diabetes Gestacional/psicología , Embarazo , Estudios Transversales , Adolescente , Adulto Joven , Adulto , Nativos Alasqueños/psicología , Cuidadores/psicología , Madres/psicología , Indígenas Norteamericanos/psicología , Niño , Factores de Riesgo , Modelo de Creencias sobre la Salud
9.
Rural Remote Health ; 24(2): 8520, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38826130

RESUMEN

INTRODUCTION: Ninety-seven per cent of Indigenous Peoples live in low-and middle-income countries (LMICs). A previous systematic integrative review of articles published between 2000 and 2017 identified numerous barriers for Indigenous women in LMICs in accessing maternal healthcare services. It is timely given the aim of achieving Universal Health Coverage in six years' time, by 2030, to undertake another review. This article updates the previous review exploring the recent available literature on Indigenous women's access to maternal health services in LMICs identifying barriers to services. METHODS: An integrative review of literature published between 2018 and 2023 was undertaken. This review followed a systematic process using Whittemore and Knafl's five-step framework for integrative reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 944 articles were identified from six databases: Academic Search Premier, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycInfo, CINAHL Plus with Full Text and APA PsycArticles (through EBSCOhost). The search was undertaken on 16 January 2023. After screening of the title/abstract and the full text using inclusion and exclusion criteria 26 articles were identified. Critical appraisal resulted in 24 articles being included in the review. Data were extracted using a matrix informed by Penchansky and Thomas's taxonomy, extended by Saurman, which focused on six dimensions of access to health care: affordability, accessibility, availability, accommodation, acceptability and awareness. Ten studies took place in Asia, 10 studies were from the Americas and four studies took place in the African region. Seventeen articles were qualitative, two were quantitative and five were mixed methods. The methods for the integrative review were prespecified in a protocol, registered at Open Science Framework. RESULTS: Barriers identified included affordability; community awareness of services including poor communication between providers and women; the availability of services, with staff often missing from the facilities; poor quality services, which did not consider the cultural and spiritual needs of Indigenous Peoples; an overreliance on the biomedical model; a lack of facilities to enable appropriate maternal care; services that did not accommodate the everyday needs of women, including work and family responsibilities; lack of understanding of Indigenous cultures from health professionals; and evidence of obstetric violence and mistreatment of Indigenous women. CONCLUSION: Barriers to Indigenous women's access to maternal health services are underpinned by the social exclusion and marginalisation of Indigenous Peoples. Empowerment of Indigenous women and communities in LMICs is required as well as initiatives to challenge the stigmatisation and marginalisation that they face. The importance of community involvement in design and interventions that support the political and human rights of Indigenous Peoples are required. Limitations of this review include the possibility of missing articles as it was sometimes unclear from the articles whether a particular group was from an Indigenous community. More research on access to services in the postnatal period is still needed, as well as quality quantitative research. There is also a lack of research on Indigenous groups in North Africa, and in sub-Saharan Africa - especially hunter-gatherer groups - as well as the impact of COVID-19 on access to services.


Asunto(s)
Países en Desarrollo , Accesibilidad a los Servicios de Salud , Pueblos Indígenas , Servicios de Salud Materna , Humanos , Servicios de Salud Materna/organización & administración , Femenino , Servicios de Salud del Indígena/organización & administración , Embarazo
10.
JAMA Netw Open ; 7(6): e2414735, 2024 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-38833247

RESUMEN

Importance: Adolescent sleep problems are prevalent, particularly among racial and ethnic minority groups, and can increase morbidity. Despite the numerous strengths of their racial and ethnic group, urban American Indian and Alaska Native adolescents face significant health disparities but are rarely included in health research. Understanding how sleep problems are associated with health outcomes among American Indian and Alaska Native adolescents may elucidate novel targets for interventions to promote health equity. Objective: To assess whether baseline sleep problems are associated with changes in behavioral and cardiometabolic health outcomes among urban American Indian and Alaska Native adolescents 2 years later. Design, Setting, and Participants: American Indian and Alaska Native adolescents were recruited via flyers and community events for an observational cohort study in California. Baseline assessments were conducted among 142 adolescents from March 1, 2018, to March 31, 2020, and follow-ups were conducted among 114 adolescents from December 1, 2020, to June 30, 2022. Exposures: Baseline actigraphy-assessed sleep duration and efficiency and self-reported sleep disturbances and social jet lag (absolute value of the difference in sleep midpoint on weekends vs weekdays; indicator of circadian misalignment). Main Outcomes and Measures: Main outcome measures included self-reported depression (measured using the Patient Health Questionnaire), anxiety (measured using the Generalized Anxiety Disorder 7-item scale), past year alcohol and cannabis use, body mass index, systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist circumference, and glycosylated hemoglobin (HbA1c). Analyses examined whether baseline sleep was associated with health outcomes at follow-up, controlling for age, sex, and baseline outcome measures. Results: The baseline sample included 142 urban American Indian and Alaska Native adolescents (mean [SD] age, 14.0 [1.4] years; 84 girls [59%]), 80% of whom (n = 114; mean [SD] age, 14.1 [1.3] years; 71 girls [62%]) completed follow-ups. Linear or logistic regressions showed significant negative associations between shorter sleep duration and depression (ß = -1.21 [95% CI, -2.19 to -0.24]), anxiety (ß = -0.89 [95% CI, -1.76 to -0.03]), DBP (ß = -2.03 [95% CI, -3.79 to -0.28]), and HbA1c level (ß = -0.15 [95% CI, -0.26 to -0.04]) and likelihood of alcohol (odds ratio [OR], 0.57 [95% CI, 0.36-0.91]) and cannabis use (full week: OR, 0.59 [95% CI, 0.35-0.99]) at follow-up. Greater social jet lag was associated with significantly higher SBP (ß = 0.06 [95% CI, 0.01-0.11]) at follow-up. Conclusions and Relevance: This cohort study found significant associations between poor sleep and adverse changes in health outcomes. Findings highlight the importance of developing culturally responsive interventions that target sleep as a key modifiable risk factor to improve the health of American Indian and Alaska Native adolescents.


Asunto(s)
Nativos Alasqueños , Trastornos del Sueño-Vigilia , Humanos , Adolescente , Femenino , Masculino , Nativos Alasqueños/estadística & datos numéricos , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/etnología , Población Urbana/estadística & datos numéricos , Indígenas Norteamericanos/estadística & datos numéricos , California/epidemiología , Estudios de Cohortes
11.
BMC Womens Health ; 24(1): 335, 2024 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-38851734

RESUMEN

BACKGROUND: Teenage pregnancies are a global concern. Malawi is one of the countries with the highest teenage pregnancy rates despite government efforts to reverse the situation and yet studies on determinants of teenage pregnancy are rare with some factors remaining unexplored. Therefore, this study aimed to identify factors associated with teenage pregnancies in Malawi. METHODS: This was a community-based case-control study that used secondary data from the 2015-16 Malawi Demographic and Health Survey from all 28 districts of Malawi. The study population comprised women aged 20-24 who participated in the survey. The study ran from September 2021 to October 2022 and used a sample size of 3,435 participants who were all women aged 20-24 in the dataset who met the inclusion criteria. Data were analysed using Stata 16 software. Logistic regression analyses were used to determine factors. Variables with a P value of < 0.1 in the univariable analysis were included in the multivariable analyses, where statistical significance was obtained at a P value < 0. 05. RESULTS: Data on 3435 participants were analysed. In multivariable analyses: no teenage marriage (AOR 0.13); secondary education (AOR 0.26); higher education (AOR 0.39); richest category of wealth index (AOR 0.51), use of contraception (AOR 3.08), domestic violence by father or mother (AOR 0.37) were found to be significant factors. CONCLUSION: This study identified determinants of teenage pregnancy. The government has to sustain and expand initiatives that increase protection from teenage pregnancy, reinforce the implementation of amended marriage legislation, introduce policies to improve the socioeconomic status of vulnerable girls and increase contraceptive use among adolescent girls before their first pregnancy. Further research is also recommended to resolve inconclusive results.


Asunto(s)
Embarazo en Adolescencia , Humanos , Femenino , Embarazo en Adolescencia/estadística & datos numéricos , Malaui , Embarazo , Estudios de Casos y Controles , Adolescente , Adulto Joven , Conducta Anticonceptiva/estadística & datos numéricos , Matrimonio/estadística & datos numéricos , Factores Socioeconómicos , Factores de Riesgo , Escolaridad , Anticoncepción/estadística & datos numéricos , Modelos Logísticos
12.
Soc Sci Med ; 350: 116936, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38728976

RESUMEN

Indigenous Peoples are exposed to the impacts of the climatic, ecological and socioeconomic changes, yet there is a need for a better understanding of their health and higher involvement of Indigenous Peoples in health promotion design and implementation. Our study brings empirical data on the healthcare system of the Baka, forager-horticulturalists from Cameroon. Using a mixed methods approach, we explored the health issues they encounter, the emic determinants of health and healthcare system, and the different threats towards their healthcare system. We conducted focus group discussions, interviews with experts, and self-reported health recalls with 302 individuals living in two settlements from southeastern Cameroon during two fieldwork periods between June and November 2022. Our insights highlight the prevalence of respiratory and children's digestive issues, and the occurrence of illnesses implying a combination of symptoms that would deserve further Western biomedical attention. The Baka's healthcare relies on medicinal plants, knowledge experts, and on the social cohesion of the community, all largely affected by the local social-ecological impacts of global change. Exposure to the market and health facilities does not seem to relate to Baka's health state and practices but might affect their perception of health. Deforestation, poor water quality, and alcohol (ab)use were reported and observed threats to the Baka's health and healthcare system. Our work supplies empirical evidence for a better understanding of Baka's health and healthcare system, helpful in designing health prevention and policies adapted to their reality and culture. Further research and interventions on health should consider the current threats to Baka's local ecosystems and cultural knowledge. These insights contribute to a higher recognition of the Baka's, and most broadly, the Indigenous Peoples' emic perspective on health, and on culturally grounded indicators of the resilience of their healthcare system to current and future challenges.


Asunto(s)
Grupos Focales , Pueblos Indígenas , Humanos , Camerún , Pueblos Indígenas/psicología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Investigación Cualitativa , Adolescente , Anciano
13.
Health Res Policy Syst ; 22(1): 57, 2024 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-38741196

RESUMEN

BACKGROUND: Indigenous populations have increased risk of developing diabetes and experience poorer treatment outcomes than the general population. The FORGE AHEAD program partnered with First Nations communities across Canada to improve access to resources by developing community-driven primary healthcare models. METHODS: This was an economic assessment of FORGE AHEAD using a payer perspective. Costs of diabetes management and complications during the 18-month intervention were compared to the costs prior to intervention implementation. Cost-effectiveness of the program assessed incremental differences in cost and number of resources utilization events (pre and post). Primary outcome was all-cause hospitalizations. Secondary outcomes were specialist visits, clinic visits and community resource use. Data were obtained from a diabetes registry and published literature. Costs are expressed in 2023 Can$. RESULTS: Study population was ~ 60.5 years old; 57.2% female; median duration of diabetes of 8 years; 87.5% residing in non-isolated communities; 75% residing in communities < 5000 members. Total cost of implementation was $1,221,413.60 and cost/person $27.89. There was increase in the number and cost of hospitalizations visits from 8/$68,765.85 (pre period) to 243/$2,735,612.37. Specialist visits, clinic visits and community resource use followed this trend. CONCLUSION: Considering the low cost of intervention and increased care access, FORGE AHEAD represents a successful community-driven partnership resulting in improved access to resources.


Asunto(s)
Análisis Costo-Beneficio , Diabetes Mellitus , Servicios de Salud del Indígena , Hospitalización , Atención Primaria de Salud , Humanos , Atención Primaria de Salud/economía , Femenino , Masculino , Persona de Mediana Edad , Hospitalización/economía , Canadá , Servicios de Salud del Indígena/economía , Diabetes Mellitus/terapia , Atención a la Salud/economía , Anciano , Accesibilidad a los Servicios de Salud , Costos de la Atención en Salud , Indígenas Norteamericanos , Pueblos Indígenas , Adulto , Complicaciones de la Diabetes/terapia , Complicaciones de la Diabetes/economía
14.
Med Educ Online ; 29(1): 2350251, 2024 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-38720424

RESUMEN

BACKGROUND: Indigenous Peoples in Canada bear a disproportionate burden of disease and experience poorer health outcomes as compared to non-Indigenous populations within Canada; these conditions are said to be mediated and exacerbated by pervasive and uninterrupted anti-Indigenous racism. Third and fourth-year medical students at a Canadian medical school were asked to reflect on their experiences working with Indigenous patients in clinical settings, and how their preclinical Indigenous health curriculum impacted these experiences. METHOD: Phenomenology was used, guided by Goffman's theory of social stigma. Eleven undergraduate medical students were recruited using purposeful sampling. Semi-structured phone interviews were conducted to gain an in-depth understanding of the participants' experiences. Interviews were recorded and transcribed verbatim. Data were analyzed using the four main processes for phenomenological analysis. RESULTS: Four main themes emerged from students' descriptions of clinical experiences involving Indigenous patients: 1) students describe how their Indigenous patients encounter the health care system and their own lack of cultural sensitivity in this context; 2) racism was evident in students' clinical interactions with Indigenous patients, but students do not always perceive these biases nor the impact of this on patient care; 3) identifying the impact of racism on care is complicated by situational clinical encounters; and 4) practicality of preclinical Indigenous health education is desired by students to prepare them for working with Indigenous patients in the clinical setting. CONCLUSIONS: In their clinical experiences, students witness racism against Indigenous peoples yet are unprepared to stand up against it. Findings highlight the importance of enhancing undergraduate medical training to allow students to better understand the unique experiences and perspectives of Indigenous patients. The results support the need for ongoing Indigenous health education, to foster culturally sensitive experiences while learning about Indigenous patients.


Asunto(s)
Racismo , Estudiantes de Medicina , Humanos , Estudiantes de Medicina/psicología , Canadá , Racismo/psicología , Femenino , Masculino , Servicios de Salud del Indígena/organización & administración , Competencia Cultural , Entrevistas como Asunto , Educación de Pregrado en Medicina , Investigación Cualitativa , Pueblos Indígenas/psicología , Adulto , Actitud del Personal de Salud
15.
Rural Remote Health ; 24(2): 8674, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38697785

RESUMEN

INTRODUCTION: Māori (the Indigenous Peoples of Aotearoa New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD health care. Rural Māori experience additional barriers to treatment access, poorer health outcomes and a greater burden of CVD risk factors compared to Non-Māori and Māori living in urban areas. Importantly, these inequities are similarly experienced by Indigenous Peoples in other nations impacted by colonisation. Given the scarcity of available literature, a systematic scoping review was conducted on literature exploring barriers and facilitators in accessing CVD health care for rural Māori and other Indigenous Peoples in nations impacted by colonisation. METHODS: The review was underpinned by Kaupapa Māori Research methodology and was conducted utilising Arksey and O'Malley's (2005) methodological framework. A database search of MEDLINE (OVID), PubMed, Embase, SCOPUS, CINAHL Plus, Australia/New Zealand Reference Centre and NZResearch.org was used to explore empirical research literature. A grey literature search was also conducted. Literature based in any healthcare setting providing care to adults for CVD was included. Rural or remote Indigenous Peoples from New Zealand, Australia, Canada, and the US were included. Literature was included if it addressed cardiovascular conditions and reported barriers and facilitators to healthcare access in any care setting. RESULTS: A total of 363 articles were identified from the database search. An additional 19 reports were identified in the grey literature search. Following screening, 16 articles were included from the database search and 5 articles from the grey literature search. The literature was summarised using the Te Tiriti o Waitangi (Treaty of Waitangi) Framework principles: tino rangatiratanga (self-determination), partnership, active protection, equity and options. Themes elucidated from the literature were described as key drivers of CVD healthcare access for rural Indigenous Peoples. Key driver themes included input from rural Indigenous Peoples on healthcare service design and delivery, adequate resourcing and support of indigenous and rural healthcare services, addressing systemic racism and historical trauma, providing culturally appropriate health care, rural Indigenous Peoples' access to family and wellbeing support, rural Indigenous Peoples' differential access to the wider social determinants of health, effective interservice linkages and communication, and equity-driven and congruent data systems. CONCLUSION: The findings are consistent with other literature exploring access to health care for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the themes within the context of equity and rights for Indigenous Peoples. This review also highlighted the need for further research in this area to be conducted in the context of Aotearoa New Zealand.


Asunto(s)
Enfermedades Cardiovasculares , Accesibilidad a los Servicios de Salud , Población Rural , Humanos , Accesibilidad a los Servicios de Salud/organización & administración , Enfermedades Cardiovasculares/terapia , Enfermedades Cardiovasculares/etnología , Población Rural/estadística & datos numéricos , Nueva Zelanda/epidemiología , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Pueblos Indígenas , Servicios de Salud del Indígena/organización & administración , Servicios de Salud Rural/organización & administración
16.
Int J Circumpolar Health ; 83(1): 2343143, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38691019

RESUMEN

Pre-diabetes (pre-DM) is a strong predictor of diabetes (DM) over time. This study investigated how much of the recent increase in pre-DM identified among Alaska Native (AN) peoples living in urban southcentral Alaska may be due to changes in diagnostic methods. We used clinical and demographic data collected at baseline between 2004 and 2006 and at follow-up collected between 2015 and 2017 from the urban southcentral Alaska Education and Research Towards Health (EARTH) cohort. We used descriptive statistics and logistic regression to explore differences in demographic and clinical variables among the identified pre-DM groups. Of 388 participants in the follow-up study, 243 had A1c levels indicating pre-DM with only 20 demonstrating pre-DM also by fasting blood glucose (FBG). Current smoking was the sole predictor for pre-DM by A1c alone while abdominal obesity and elevated FBG-predicted pre-DM by A1c+FBG. No participants had an elevated FBG without an A1c elevation. A substantial portion of the rise in pre-DM found among urban southcentral AN peoples in the EARTH follow-up study was due to the addition of A1c testing. Pre-DM by A1c alone should be used to motivate behavioural changes that address modifiable risk factors, including smoking cessation, physical activity and weight management.


Asunto(s)
Nativos Alasqueños , Estado Prediabético , Humanos , Alaska/epidemiología , Masculino , Estado Prediabético/diagnóstico , Estado Prediabético/etnología , Femenino , Persona de Mediana Edad , Adulto , Estudios de Seguimiento , Educación en Salud/organización & administración , Hemoglobina Glucada/análisis , Glucemia/análisis , Tamizaje Masivo , Anciano , Fumar/epidemiología , Fumar/etnología , Factores de Riesgo
17.
BMC Public Health ; 24(1): 1210, 2024 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-38693512

RESUMEN

BACKGROUND: Available data show that the epidemiological profile of most indigenous Brazilian populations is characterized by the coexistence of long-standing health problems (high prevalence of infectious and parasitic diseases, malnutrition, and deficiency diseases, such as anemia in children and women of reproductive age), associated with new health problems, especially those related to obesity (hypertension, type 2 diabetes mellitus and dyslipidemia). Based on this scenario, this study analyzed the nutritional profile of the adult population of seven indigenous peoples from the Brazilian Amazon in the years 2007 and 2021. METHODS: A total of 598 adults individuals were analyzed in 2007 (319 women and 279 men) and 924 in 2021 (483 women and 441 men), from seven indigenous peoples located in the state of Pará, who were assisted during health actions carried out in 2007 and in 2021. Body mass index classification used the World Health Organization criteria for adults: low weight, < 18.5 kg/m2; normal weight, ≥ 18.5 and < 25 kg/m2); overweight, ≥ 25 and < 30 kg/m2, and obesity, ≥ 30 kg/m2. A waist circumference (WC) < 90 cm in men and < 80 cm in women was considered normal. RESULTS: The data revealed heterogeneous anthropometric profiles, with a low prevalence of nutritional changes in the Araweté, Arara and Parakanã peoples, and high proportions of excess weight and abdominal obesity in the Kararaô, Xikrin do Bacajá, Asurini do Xingu and Gavião peoples, similar to or even higher than the national averages. CONCLUSION: Different stages of nutritional transition were identified in the indigenous peoples analyzed, despite apparently having been subjected to the same environmental pressures that shaped their nutritional profile in recent decades, which may indicate different genetic susceptibilities to nutritional changes. The evidence shown in this study strongly suggests the need to investigate in greater depth the genetic and environmental factors associated with the nutritional profile of Brazilian indigenous peoples, with assessment of diet, physical activity and sociodemographic and socioeconomic variables that enable the development of appropriate prevention and monitoring measures.


Asunto(s)
Indígenas Sudamericanos , Obesidad Abdominal , Obesidad , Sobrepeso , Humanos , Brasil/epidemiología , Femenino , Masculino , Adulto , Obesidad Abdominal/epidemiología , Obesidad Abdominal/etnología , Indígenas Sudamericanos/estadística & datos numéricos , Sobrepeso/epidemiología , Sobrepeso/etnología , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad/etnología , Adulto Joven , Prevalencia , Pueblos Indígenas/estadística & datos numéricos , Adolescente
18.
BMC Health Serv Res ; 24(1): 553, 2024 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-38693527

RESUMEN

BACKGROUND: Indigenous adolescents access primary health care services at lower rates, despite their greater health needs and experience of disadvantage. This systematic review identifies the enablers and barriers to primary health care access for Indigenous adolescents to inform service and policy improvements. METHODS: We systematically searched databases for publications reporting enablers or barriers to primary health care access for Indigenous adolescents from the perspective of adolescents, their parents and health care providers, and included studies focused on Indigenous adolescents aged 10-24 years from Australia, Canada, New Zealand, and United States of America. Results were analyzed against the WHO Global standards for quality health-care services for adolescents. An additional ninth standard was added which focused on cultural safety. RESULTS: A total of 41 studies were included. More barriers were identified than enablers, and against the WHO Global standards most enablers and barriers related to supply factors - providers' competencies, appropriate package of services, and cultural safety. Providers who built trust, respect, and relationships; appropriate package of service; and culturally safe environments and care were enablers to care reported by adolescents, and health care providers and parents. Embarrassment, shame, or fear; a lack of culturally appropriate services; and privacy and confidentiality were common barriers identified by both adolescent and health care providers and parents. Cultural safety was identified as a key issue among Indigenous adolescents. Enablers and barriers related to cultural safety included culturally appropriate services, culturally safe environment and care, traditional and cultural practices, cultural protocols, Indigenous health care providers, cultural training for health care providers, and colonization, intergenerational trauma, and racism. Nine recommendations were identified which aim to address the enablers and barriers associated with primary health care access for Indigenous adolescents. CONCLUSION: This review provides important evidence to inform how services, organizations and governments can create accessible primary health care services that specifically meet the needs of Indigenous adolescents. We identify nine recommendations for improving the accessibility of primary health care services for Indigenous adolescents.


Asunto(s)
Accesibilidad a los Servicios de Salud , Servicios de Salud del Indígena , Pueblos Indígenas , Atención Primaria de Salud , Adolescente , Humanos , Australia , Canadá , Nueva Zelanda , Atención Primaria de Salud/normas , Estados Unidos
20.
Epidemiol Serv Saude ; 33: e20231075, 2024.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-38808804

RESUMEN

OBJECTIVE: To analyze the temporal trend of completeness and consistency of data on notifications of violence against indigenous women in the health macro-region of Dourados, state of Mato Grosso do Sul, Brazil, between 2009 and 2020. METHODS: An ecological time series study was conducted using data from the Notifiable Health Conditions Information System; Prais-Winsten regression was used to analyze the trend of data completeness and consistency, as well as the proportion of completed and coherent fields. RESULTS: A total of 2,630 cases were reported; completeness was found to be very poor in the variable "occupation" (48.9%) and poor in the variables "schooling" (68.3%) and "time of occurrence" (67.9%); in the analysis of temporal trends, only the variable "occupation" showed a decreasing trend (p = 0.045). CONCLUSION: The data analyzed demonstrated the need for improvement in the completeness of the variables "schooling", "occupation" and "time of occurrence" of the violent act. MAIN RESULTS: There was a progressive increase in notifications over the years. Most of the variables showed regular or excellent completeness and consistency. In the analysis of temporal trend, only the "occupation" variable showed a decreasing trend. IMPLICATIONS FOR SERVICES: Care for victims of violence is part of the daily routine of health services, and it is essential for health professionals to provide adequate compulsory notification for a comprehensive understanding of the victims' profile, thus assisting in addressing this issue. PERSPECTIVES: Further studies are needed to understand the factors associated with violence against indigenous women, which could help the development of health promotion actions and violence prevention strategies targeting these women.


Asunto(s)
Violencia , Humanos , Brasil , Femenino , Violencia/estadística & datos numéricos , Factores de Tiempo , Indígenas Sudamericanos/estadística & datos numéricos , Violencia de Género/estadística & datos numéricos , Pueblos Indígenas/estadística & datos numéricos , Escolaridad , Adulto , Sistemas de Información
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