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Objectives: Indigenous peoples in Canada endure health inequalities and cultural erosion due to colonial legacies. This study examines the relationship between ethnic belonging and chronic disease patterns among three Indigenous groups: First Nations, Inuit, and Métis., Methods: We analyzed data from the 2017 Indigenous Peoples Survey of Canada, performing latent class analysis to identify distinct classes among 12 chronic disease indicators. We used multinomial logistic regression to examine the relationship between ethnic belonging and subtypes of chronic diseases, also employing average marginal effects to interpret heterogeneity. All analyses incorporated complex survey weights to ensure national representativeness., Results: The final sample comprised 19,621 individuals. Four distinct subgroups were identified: Relatively Healthy, Physical Illness, Mental Illness, and Severe Illness groups. Descriptive statistics revealed that up to 35.0 % of the Indigenous population is in a suboptimal health state. Regression outcomes demonstrated that a strong sense of cultural belonging significantly reduces the odds of both Mental Illness (OR = 0.82, 95 % CI [0.76,0.88]) and Severe Illness (OR = 0.92, 95 % CI [0.84,0.99]). Heterogeneity analyses revealed that the positive association between belonging and health outcomes was stronger in the adult age group, among men, and within First Nations and Inuit groups., Conclusion: This study underscores the critical role of ethnic belonging in enhancing health among Indigenous populations, particularly in reducing odds associated with mental and severe health conditions. Policies and community practices should focus on strengthening Indigenous peoples' community belonging and cultural connections., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.)

From the beginning of the COVID-19 pandemic, the potential impact on Indigenous (First Nations, Métis and Inuit) communities in Canada was a major concern. Evidence from previous pandemics, particularly H1N1, suggested that more cases and poorer outcomes among Indigenous Peoples was likely and that there might be barriers to Indigenous Peoples' vaccination. In this short report we consider the non-vaccination decisions of a sample of unvaccinated Métis Nation of Ontario citizens. A small sample of six Métis individuals who had chosen not to receive the COVID-19 vaccine was recruited using referral and interviewed online. Participants expressed low confidence in COVID-19 vaccines, and cited safety concerns as the primary reason. Low confidence was in government and media was a major concern, and respondents referred to historical treatment of Indigenous peoples as reasons for suspicion. We discuss this continuing mistrust and its implications for future pandemic response., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Cooke, Martin reports financial support was provided by Canadian Institutes of Health Research. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Multimorbidity is associated with negative effects on the health of individuals, increasing the complexity of health care. This study aimed to determine the prevalence of multimorbidity and associated factors in the adult Indigenous population living in villages in Aracruz, Espírito Santo State, Brazil. This is a cross-sectional study using data from the project called Assessment of the Prevalence and Severity of Chronic Diseases in the Indigenous Population of Espírito Santo State. Data were collected from 2020 to 2022. Multimorbidity was defined as the presence of two or more chronic morbidities in a group of eight morbidities. As a measure of association, the prevalence ratio (PR) and its 95% confidence interval (95%CI), calculated by Poisson regression with robust variance, in crude models and models adjusted for covariates were used. The prevalence of multimorbidity was 52.1% (95%CI: 49.1-55.2), being significantly higher among women (PR = 1.47; 95%CI: 1.29-1.67), those aged ≥ 40 years (40-59 years: PR = 1.49; 95%CI: 1.28-1.73; ≥ 60 years: PR = 1.85; 95%CI: 1.55-2.20) and lower for individuals with higher education (PR = 0.65; 95%CI: 0.47-0.89). The prevalence of multimorbidity in the Indigenous population living in villages in Espírito Santo State was higher than that found in other studies in the general Brazilian population. There was association between the presence of multimorbidity and sex, age and education level.

Many Indigenous Peoples are at risk of poor eye health outcomes due to the various financial, social, geographic, and cultural barriers faced when accessing care. Available literature indicates Indigenous populations across Canada suffer greater rates of eye diseases, including diabetic retinopathy, uveitis, and untreated refractive error, as well as their associated complications. However, many gaps within the current state of knowledge exist. Here, we review the available literature regarding the prevalence of eye disease among Indigenous populations in Canada, as well as previously trialed models of eye care delivery. Various models have been attempted to increase access to eye care for Indigenous communities, although several are focused on screening for diabetic retinopathy in northern populations, with many Indigenous Peoples remaining at risk for poor eye health and permanent vision loss. Failing to address the eye care needs of Indigenous communities will hinder the development of adequate solutions, leading to profound inequities, poor eye health outcomes, and greater vision loss among this population. Future research should seek to understand the root causes of why Indigenous communities have high rates of diabetes and associated ocular complications, including the roles of discrimination, colonialism, and mistrust toward the health care system., (Copyright © 2024 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Indigenous populations have experienced inequality of accessing mental health services compared with their non-Indigenous counterparts, although the way of measuring mental health service accessibility for Indigenous populations is unclear. This systematic review examines measures of mental health service accessibility for Indigenous people, including the diversity of mental health services that are available to them and the barriers to accessing mental healthcare. Using a systematic search procedure, we identified 27 studies that explored Indigenous populations' mental health service access. Our review shows that 18 studies used interview-based methods to explore how Indigenous people use mental health services, and only nine studies used quantitative methods to measure the uptake of mental health services. While advanced methods for quantifying geographical access to healthcare services are widely available, these methods have not been applied in the current literature to explore the potential access to mental health services by Indigenous populations. This is partially due to limited understanding of how Indigenous populations seek mental healthcare, barriers that prevent Indigenous people from accessing diverse types of mental health services, and scarcity of data that are available to researchers. Future research could focus on developing methods to support spatially explicit measuring of accessibility to mental health services for Indigenous populations., Competing Interests: Declarations. Competing Interests: The authors declare no competing interests., (© 2024. The Author(s).)

Indigenous communities are reportedly among the most vulnerable populations exposed to rabies worldwide. Accordingly, this study aimed to assess rabies serum titers from healthy Indigenous individuals, their dogs, and healthcare professionals of four Indigenous communities from São Paulo state, southeastern Brazil. Blood samples were collected, and an epidemiological questionnaire applied. The samples were processed by Fluorescent Antibody Virus Neutralization (FAVN) method. Overall, 35/299 (11.7%) individuals and 22/166 (13.2%) dogs without prior vaccination were seropositive. Furthermore, 4/18 (16.7%) healthcare professionals were seropositive, with only one reporting prior rabies vaccination. The lack of rabies titers in the remaining 14/18 (77.8%) healthcare professionals indicates no immune protection. Seropositivity was associated with being from the Kopenoty community (p = 0.026) and with owners reporting seeing their dogs in contact with bats (p = 0.022). In summary, these results should be considered as a warning for the risk of human-dog rabies exposure and infection, mainly due to bat contact., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Ribeiro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Tooth loss among indigenous people in the Amazon emphasizes the need for culturally appropriate oral health interventions. The objective of this study was to analyze the incidence of tooth loss in two remote Amazon indigenous populations. This prospective cohort evaluated a total of 47 indigenous in the permanent dentition at T0 and thirteen years later (T1) from two villages, Arara-Laranjal (n = 28, mean age 16.1 and 29.9 years) and Assurini do Xingu (n = 19, mean age 15.9 and 29.5 years), of different ethnic groups. A multilevel Poisson regression model assessed the influence of village, sex, and age on tooth loss. At T0, the indigenous people had all their permanent teeth. Forty-two lost at least one tooth (89%), and a total of 172 teeth were lost at T1 at an incidence of 97% among females and 76% in males. There was no influence of ethnicity on tooth loss ( p = 1.000). A lower risk of tooth loss was associated with male subjects (β = -0.50, p < 0.05) but not with age. In females (22/46.8%) and males (11/23.4%), the highest incidence of tooth loss was the lower second molars. The risk was higher among females, and there was no influence on age, village, or ethnicity. The second and first molars were the most affected teeth. These findings suggest an increase in tooth loss caused by close contact between indigenous and urban populations.

Background: Human activities, such as urbanization and climate change, have facilitated the spread of arbovirus-carrying vectors, disproportionately affecting vulnerable traditional Indigenous communities., Objective: To explore the relationships between subclinical myocardial dysfunction, assessed by global longitudinal strain (GLS), and comprehensive arbovirus serology in an Indigenous population, while also describing the serological and epidemiological profile of dengue, chikungunya, and Zika viruses., Methods: This ancillary study is part of the first phase (2016-2017) of the Project of Atherosclerosis among Indigenous Populations (PAI), a cross-sectional study involving participants from two Indigenous communities with different degrees of urbanization and a highly urbanized city in Northeast Brazil. We assessed the seroprevalence of dengue, chikungunya, and Zika viruses in the Fulni-ô Indigenous community, the less urbanized and most traditional group. Additionally, we explored the relationship between these viruses and subclinical heart disease, assessed by speckle-tracking echocardiography-derived GLS., Results: One hundred seventy-four participants were included, with a median age of 45.0 years (interquartile range 38.0-55.0). The majority were female (58.6%; n = 102). The prevalence of anti-ZIKV IgG was 95.3%; anti-DENV IgG was 85.8%, and anti-CHIKV IgG was 70.9%. GLS abnormalities were detected in nearly half (48.3%) of the cohort. However, no significant association was found between arbovirus serology and GLS., Conclusions: The findings reveal a high prevalence of positive serology for arboviruses and a significant rate of subclinical cardiac dysfunction. There was no significant association between reduced left ventricular longitudinal strain and positive arbovirus serology, likely due to the limited number of participants with indications of acute contact with the viruses studied. However, the unprecedented and relevant results of this study are noteworthy, as they address critical public health issues, particularly in vulnerable populations. Further research is needed to explore these findings in more depth., Competing Interests: Declarations. Ethical approval: The research was approved by the National Council on Research Ethics (CONEP number 1.488.268), the National Indigenous Foundation (Fundação Nacional do Indio [FUNAI]; procedure number 08620.028965/2015-66) and the Indigenous leaders of the participating groups approved. All participants provided written informed consent before participating in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Recent advancements in Artificial Intelligence (AI) and data center infrastructure have brought the global cloud computing market to the forefront of conversations about sustainability and energy use. Current policy and infrastructure for data centers prioritize economic gain and resource extraction, inherently unsustainable models which generate massive amounts of energy and heat waste. Our team proposes the formation of policy around earth-friendly computation practices rooted in Indigenous models of circular systems of sustainability. By looking to alternative systems of sustainability rooted in Indigenous values of aloha 'āina, or love for the land, we find examples of traditional ecological knowledge (TEK) that can be imagined alongside Solarpunk visions for a more sustainable future. One in which technology works with the environment, reusing electronic waste (e-waste) and improving data life cycles.

Background: In India, indigenous populations, known as Tribes, are among the poorest and most marginalized groups. We estimated the prevalence of smoking, alcohol use, and betel quid chewing and examined the association between gender and smoking, alcohol use, and betel quid chewing among Kattunayakan primitive Tribes who are categorized as a Particularly Vulnerable Tribal Group (PVTG) in the Kerala State of India. Methods: A secondary analysis of a sample of the Wayanad District Tribal Household survey comprising 388 Kattunayakan PVTG households selected through multistage cluster random sampling was undertaken. Binary logistic regression models were used to estimate an association between gender and smoking, alcohol use, and betel quid chewing in these Tribal households. Results: Mean age was 39.2 years (±15.1), more than three-fourths of the respondents were female (75.3%), and approximately 24% of the respondents reported smoking tobacco in past 12 months. A fivefold increased odds of smoking among males compared to smoking among females was observed (OR = 4.92; p < .01). More than 64% reported betel quid chewing. Prevalence of alcohol use was 16%, which significantly varied between males (49%) and females (5.1%; OR = 17.71; p < .01). Among tobacco smokers, 64.1% were involved in betel quid use. Among alcohol users, 62.9% were involved in betel quid use and more than 58% were smoking tobacco. Betel quid chewing was the most prevalent substance use. Conclusion: Single and dual substance use of the three commonest types were disproportionately high among this hard-to-reach Tribal population in the southern state of India, with some gender variations. Alcohol consumption was relatively low. However, the complex nature of substance use, compounded by inaccessible health services, poses a significant challenge to rethink and to reimagine innovative methods of providing mental health care services, for instance, mobile health clinics.

The aim is to identify the epidemiological profile of mortality among Brazilian indigenous children under five years of age, through an integrative review. Articles that evaluated the mortality of indigenous Brazilian children under one and/or five years of age, from 2000 to 2020, in Portuguese, English, and/or Spanish, in the LILACS, SciELO, and MEDLINE databases were included. Of the 3,229 publications found, 22 were included in the review. Infant mortality ranged from 15.2/1,000 live births (LB) (1995-1999) for the Kayabí ethnic group to 307.7/1,000 LB (2000) for the Hupdäh ethnic group. Among the studies that evaluated infant mortality by age components, the post-neonatal period stands out, with proportions that varied from 15.2% (1990-1994), for indigenous children from Paraná, to 83.3% (2007- 2008) for the Guarani ethnic group. The main cause of mortality was respiratory diseases, ranging from 17.1% (2010) to 75% (2007-2008) among the Guarani ethnic group. Brazilian indigenous children under one year of age experienced high mortality rates, when compared to non-indigenous children, for all ethnicities and regions of the country. Among the IMT components, a high number of deaths were observed in the post-neonatal period, with respiratory system diseases representing the main causes of death.

The following sections are included: Overview, Background & key terms, Earth Friendly Computation 574: Indigenous Data Sovereignty, Circular Systems, and Solarpunk Solutions for a Sustainable Future, AI in Point-of-Care: A Sustainable Healthcare Revolution at the Edge, Conclusion: The Future of Earth Friendly Computation, Acknowledgments, References.

Background: COVID-19 vaccination of minors is crucial for global pandemic control, especially among indigenous populations, who are often more vulnerable due to limited healthcare resources and communal living settings., Objectives: To assess the immunogenicity responses of the BNT162b2 vaccine in immunized Brazilian indigenous adolescents., Methods: A cohort study was conducted with indigenous adolescents aged 12 to 18 years residing in the largest peri-urban indigenous region in Brazil. SARS-CoV-2-specific immune responses were analyzed before (D1) and after (D2) completion of the vaccination schedule. Demographic data were collected using a questionnaire., Results: Of the 129 adolescents invited, 98 (75.96 %) participated in the study. Most were of Guarani ethnicity, single, had lower incomes, and were educated only to the elementary level. Post-vaccination, a statistically significant increase was noted in IgG concentration (24.03 % to 37.02 %). Increases were observed in B lymphocytes (11.88 to 13.92 cells/mm 3 ), memory B cells (13.58 to 15.96 cells/mm 3 ), NK cells (20.23 to 24.08 cells/mm 3 ), and non-classical monocytes (9.23 to 11.34 cells/mm 3 ), while CD8+ T cells decreased (24.41 to 21.69 cells/mm 3 ). Adolescents with prior exposure to the virus showed increased levels of B lymphocytes and CD8+ T cells. No significant changes were observed in other cell subpopulations from exposure to the virus., Conclusion: Elevated levels of antibodies and certain cell subpopulations were observed in vaccinated adolescents, confirming the effectiveness of the BNT162b2 vaccine in maintaining humoral and cellular responses. This study is the first to describe data from indigenous minors vaccinated against COVID-19 with the BNT162b2 vaccine, highlighting the importance of vaccination efforts and the potential need for booster doses., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Vaccination rates in Canada tend to be lower among Indigenous peoples than the rest of the population. The COVID-19 pandemic provided an unprecedented opportunity to better understand Indigenous perceptions about vaccination. The aim of this study was to explore perceptions of COVID-19 vaccine and other factors influencing COVID-19 vaccine acceptance as evidenced by public posts and comments on Facebook by Indigenous peoples in Quebec, Canada. We collected data on 95 Facebook pages or groups used by Indigenous peoples in Quebec between November 1, 2020, to June 15, 2021. To identify posts relating to COVID-19 vaccination, a keyword search ("vaccination," "vaccine," "shot," "does," "Moderna," "Pfizer") was carried out in English and French in the search bar of each Facebook page/group. Results show that First Nations peoples and Inuit in Quebec had important concerns about the usefulness, safety and effectiveness of COVID-19 vaccine. They also expressed fear of being used as test subjects for the rest of the population. Motivations mentioned by First Nations peoples and Inuit to get vaccinated against COVID-19 included to travel again and return to normal life with their loved ones, and the desire to protect the most vulnerable in their communities, especially Elders. Results show that Indigenous health care professionals were considered as reliable and trustful source of information regarding COVID-19, and that seeing role models being vaccinated build confidence and foster acceptance of the vaccine. Culturally adapted messages and vaccination campaigns by and for Indigenous peoples appear to be key to building trust toward COVID-19 vaccination.

Despite years of a national deworming campaign, the incidence of intestinal parasitic infections (IPIs) remains relatively high among certain ethnic groups, with lifestyle factors distinct from those of the general population. Despite existing studies on the prevalence of IPIs, there is limited research exploring the contextual associated factors within the Badi Indigenous community. Our objective in this study was to assess the prevalence of IPIs in the indigenous Badi community of Gurbhakot Municipality, Surkhet, Nepal, considering socioeconomic, lifestyle, and behavioral factors. A total of 205 stool samples were obtained from individuals aged 18-70 years through purposive sampling and preserved in a 2.5% potassium dichromate solution. A structured questionnaire was administered to the selected participants. Three diagnostic methods were used: direct wet mount, saturated salt flotation, and formal ether sedimentation. The study revealed an overall parasite prevalence of 27% (n = 55) in the indigenous Badi communities. Protozoan infections were found in 19% (n = 39) of the studied community, whereas helminthic infections were present in only 7.8% (n = 16). The highest prevalence was observed for Giardia lamblia at 16.1% (n = 33), followed by Ascaris lumbricoides at 5.9% (n = 12), Entamoeba histolytica at 2.9% (n = 6), and both Enterobius vermicularis and Hymenolepis nana at 1% (n = 2). The female population had a higher exposure to E. histolytica (5.8%, n = 6) than did the male population (0%, n = 0). The multivariate logistic regression analysis revealed increased odds of IPIs among participants involved in agriculture [aOR: 5.37, 95% CI: (2.31 to 12.47)], those who kept free-ranging pigs and poultry [aOR: 5.22, 95% CI: (1.87 to 14.53)], those who did not use soap before eating [aOR: 9.96, 95% CI: (2.11 to 46.99)], and those who consumed raw or undercooked meat [aOR: 2.76, 95% CI: (1.08 to 7.05)] compared with others. Therefore, health education, particularly regarding hygiene practices and lifestyle changes, is crucial for reducing the burden of intestinal parasitic infections (IPIs) in indigenous Badi communities., Competing Interests: Declarations. Ethical approval: Ethical approval for this study was obtained from the Institutional Review Board (IRB) of the Institute of Science and Technology (IOST), Tribhuvan University (approval no. 23–0066). Initially, each eligible participant was approached, and the study's objectives and procedures were explained. If they agreed to participate, they were asked to sign an informed consent form. Competing interests: The authors declare no competing interests. , (© 2024. The Author(s).)

Arthropod-borne viral diseases are acute febrile illnesses, sometimes with chronic effects, that can be debilitating and even fatal worldwide, affecting particularly vulnerable populations. Indigenous communities face not only the burden of these acute febrile illnesses, but also the cardiovascular complications that are worsened by urbanization. A cross-sectional study was conducted in an Indigenous population in the Northeast Region of Brazil to explore the association between arboviral infections (dengue, chikungunya, and Zika) and cardiac biomarkers, including cardiotrophin 1, growth differentiation factor 15, lactate dehydrogenase B, fatty-acid-binding protein 3, myoglobin, N-terminal pro-B-type natriuretic peptide, cardiac troponin I, big endothelin 1, and creatine kinase-MB, along with clinical and anthropometric factors. The study included 174 individuals from the Fulni-ô community, with a median age of 47 years (interquartile range 39.0 to 56.0). High rates of previous exposure to dengue, chikungunya, and Zika were observed (92.5%, 78.2%, and 95.4% anti-IgG, respectively), while acute exposure (anti-IgM) remained low. The biomarkers were linked to age (especially in the elderly), obesity, chronic kidney disease, and previous or recent exposure to chikungunya. This study pioneers the use of Luminex xMAP technology to reveal the association between cardiac inflammatory biomarkers and exposure to classical arboviruses in an Indigenous population undergoing urbanization.

Indigenous Peoples face inequities in health and healthcare access due to colonial history and systems. To work towards the Truth and Reconciliation Commission of Canada's Calls to Action and the United Nations Declaration on the Rights of Indigenous Peoples, Alberta Health Services has collaborated with a Wisdom Council of engaged Elders and Indigenous community members to tailor programmes for Indigenous Peoples. The Indigenous Support Line (ISL) was created based on the Wisdom Council's advice to provide an Indigenous-specific concerns line, which later expanded into a telehealth line to address any health questions or access issues, including health system navigation and access to Western and Indigenous health and wellness supports. Working from an ethical space guided the process, and Indigenous ways of knowing and Western approaches were respectfully integrated throughout. The percentage of calls answered or abandoned within 10 min was tracked as a key measure for quality improvement, coupled with a patient survey to measure access, accessibility, effectiveness and safety that included several open-ended questions that were treated as qualitative data and analysed using thematic analysis. Between June 2022 and February 2024, 92.7% of inbound calls were answered or abandoned within 10 min. A total of 86 respondents completed the survey, with 100% indicating they were satisfied with the service. Qualitative findings showed respondents felt satisfied with the line and the Indigenous Listeners, were respected during their call, and felt supported to have their concerns addressed. The ISL was successful in increasing Indigenous Peoples' access to care in a culturally safe environment., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background:  Indigenous populations globally face significant health disparities compared to non-Indigenous groups, primarily due to marginalization and limited access to healthcare. In Mexico, which is home to the largest Indigenous population in the Americas, these disparities were further exacerbated by the COVID-19 pandemic, with impacts intensified by factors such as marginalization, discrimination, and inadequate access to essential services., Methods: This study aimed to investigate the COVID-19 pandemic's impact on mortality, vaccination access and uptake, and official birth registration among a predominantly Indigenous population in San Juan Chamula, Chiapas. We conducted an online survey among high school students at the Colegio de Bachilleres del Estado de Chiapas, supplemented with epidemiological and socio-demographic data (N = 107)., Results: The survey revealed that 14% of respondents reported being infected with COVID-19, while national dashboard data indicated only 212 confirmed cases and one death in Chamula between April 2021 and June 2023. Additionally, 79.4% of respondents were unvaccinated, with significant communication barriers and a lack of information in Indigenous languages contributing to low vaccination rates. Additionally, 5.6% of surveyed family members and 4.7% of community residents lacked official birth certificates, significantly impeding their ability to access essential services such as education, healthcare, and vaccinations., Conclusion: Our findings highlight significant underreporting of COVID-19 cases and deaths in Indigenous communities, likely due to inadequate diagnostic resources and medical evaluation. The study underscores the urgent need for tailored public health strategies that integrate local Indigenous languages, cultures, and knowledge systems supported by trusted Indigenous leaders. Investing in education in Indigenous languages is crucial for improving vaccination adherence and overall public health outcomes. These strategies can inform national preparedness and response plans to address the unique challenges faced by Indigenous populations during pandemics and other public health crises., Competing Interests: Declarations. Ethics approval and consent to participate: Our study followed ethical standards, institutional regulations, national laws, and the Helsinki Declaration. This study was based on data with no personal identifiers. Students over 18 could participate by voluntarily signing the informed consent form, while those under 18 were required to obtain their parents’ permission through an informed consent form to participate. The participants’ voluntary completion of the survey and the prior signing of the informed consent form by either them or their parents constituted consent to participate in the study. This study was approved by the Institutional Review Committee of the Colegio de Bachilleres Plantel 57 in Chiapas State. Consent for publication: Students over 18 could participate by voluntarily signing the informed consent form, while those under 18 were required to obtain their parents’ permission through an informed consent form to participate. The participants’ voluntary completion of the survey and the prior signing of the informed consent form by either them or their parents constituted consent to participate in the study. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Most Indian tribes have limited access to healthcare facilities and rely heavily on traditional healing practices. This narrative review aimed to identify the disparities in the implementation of healthcare services and in accessing and availing these services by the indigenous population in India. We also have tried to throw light on the plausibility in strengthening the efficiency and efficacy of the public health system, by utilizing the available resources to its maximum potential, so that there will be a measurable outcome in the health status of these populations in India, coherently with the relevant sustainable development goals (SDG). The evidence from published literatures supports the fact that the disparity exists in the health status of indigenous populations in India as compared to the general populations. It emphasizes the need to address the key determinants such as the lack of knowledge, traditional healing practices and poor utilization of healthcare services provided to them. Various factors such as accessibility to healthcare resources, traditional healing practices, lack of awareness regarding healthcare services and schemes provided by the government, insufficient data regarding their issues and challenges and cultural and language barriers worsen the health status of indigenous people. However, our review reiterates that a well-structured and sustainable policy with reframed infrastructure and administration of healthcare system might bring a positive change in the health status of indigenous population in India., Competing Interests: Declarations Ethics Approval This is a narrative review, and hence, no ethics approval was required. Consent to Participate Not applicable. Consent for Publication Not applicable. Conflict of Interest The authors declare no competing interests., (© 2023. The Author(s).)

This ecological study conducted with secondary data extracted from the Indigenous Health Care Information System (SIASI) analyzed the access to oral health services provided to Xukuru do Ororubá Indigenous peoples from 2017 to 2018. The units of analysis were the Indigenous villages. The services delivered by the oral health teams working in the context were analyzed, verifying access and performance indicators and their parameters. The socioeconomic and demographic conditions, the provision of services, and the spatial components of the territory were characterized. The correlation coefficients between indicators were estimated. The results showed a growing coverage of first dental appointments, the mean number of procedures per capita, the percentage of tooth extractions, the coverage of supervised tooth brushing, and a decrease in the rate of completed treatments. There were better access opportunities for the Xukuru do Ororubá Indigenous people in the period analyzed. However, there is a persistent need to strengthen the continuity of services to complete treatments. The study points to the need for indicators suitable for the context of Indigenous health and the potential of the SIASI for oral health surveillance.

The study evaluates the nutritional and metabolic profile of the adult population of the Xingu Indigenous Territory by gender and base hub. It was developed in 18 villages from 2017 to 2019. Anthropometry and clinical, physical examinations were conducted in loco in individuals over 18. A total of 1,598 Indigenous people were evaluated, with a mean age of 36.7 years. Of these, 50.6% were male, 53.2% lived in the Leonardo Base hub, 22.7% in Diauarum, 12.3% in Pavuru and 11.8% in Wawi. Women had a higher prevalence (p < 0.05) than men, respectively, of underweight (2.0% vs. 0.1%), normal weight (46.1% vs. 37.4%), central obesity (63.4% vs. 21 .8%), low HDL cholesterol (77.7% vs. 72.9%) and Metabolic Syndrome (29.0% vs. 23.5%). In comparison, men had a higher prevalence (p < 0.05) than women, respectively, of overweight (46.3% vs. 37.5%), high triglycerides (34.5% vs. 28.2%) and high blood pressure levels (13.1% vs. 8.6%). The Leonardo and Wawi base hubs had the worst nutritional and cardiometabolic results. Overall, subjects had a high frequency of noncommunicable diseases and cardiometabolic risk. Urgent measures need to be taken to control this situation.

This study aimed to estimate the COVID-19 lethality in the Mexican Indigenous population from 2020 to 2022, considering clinical characteristics and social conditions. Data were retrieved from the Epidemiological Surveillance System of Respiratory Diseases, identifying the COVID-19-positive cases among the Indigenous population. Lethality was evaluated per clinical conditions and vulnerability due to social deprivation. The number of COVID-19-positive cases in the Indigenous population represented 0.7% of the total number of cases. The case fatality rate in the Indigenous population was 9.8% against 4.6% in the non-Indigenous population. Lethality was higher in men. However, the association with diabetes, hypertension, chronic kidney disease, obesity, and smoking was lower in the Indigenous population than in the non-Indigenous population. A greater vulnerability to social conditions was identified among the Indigenous population than the non-Indigenous population, mainly regarding income, education, and access to health services.

This study aimed to analyze the adaptation of prenatal care offered to Indigenous women and its association with maternal characteristics and health services. This is a cross-sectional study, conducted with 461 Indigenous women who gave birth and/or received immediate postpartum care in the municipalities of Mato Grosso do Sul, between 2021 and 2022. An indicator of minimum prenatal adequacy was developed, which was classified as adequate when the woman started prenatal care in the 1st trimester of pregnancy, had ≥7 consultations, and had routine exams recorded. Logistic regression models were used to estimate the adjusted odds ratios and factors associated with prenatal adequacy. It was found that 67.2% began prenatal care in the 1st trimester, 51.8% had ≥7 consultations, and 40.6% had exam results recorded. About 1 in 4 Indigenous women achieved the proposed adequacy; the associated maternal characteristics were ethnicity, region of residence, and place of residence. Prenatal care revealed health inequities, with low adequacy rates in prenatal care and worse rates among women living in villages and settlements in the southern region of the state.

This article aims to characterize Indigenous people aged 18-23 of the Xukuru do Ororubá ethnic group, Pernambuco state, Brazil, regarding the use of dental services, self-perceived oral health, oral hygiene practices and caries experience, and socioeconomic and demographic aspects. This population-based cross-sectional study is nested in a cohort study that started in 2010 and was conducted in the Indigenous territory in 2018. Oral examinations and questionnaires were conducted with 131 Indigenous people. Data were collected using Epi Info software and the SPSS 20.0 statistical program was used for descriptive statistics. R software was adopted to compare the caries experience results obtained with the National Oral Health Survey (SB Brasil 2010). The caries experience verified by the DMFT Index had a mean of 7.4, with the mean Index components corresponding to 22.8 for healthy teeth, 2.4 for decayed teeth, 0.2 for filled/carious teeth, 3.5 for filled teeth, and 1.4 for missing teeth. The oral health condition of Indigenous people is characterized by significant inequality when compared to the results of epidemiological surveys conducted in the country involving other population groups.

Estimating average blood pressure levels and prevalence of arterial hypertension (AH) and associated factors is essential to monitoring health and planning actions to combat noncommunicable diseases (NCDs) in Indigenous peoples in Brazil. This is a cross-sectional study that investigated average blood pressure levels and prevalence of arterial hypertension in 4,680 Indigenous women (aged 18-49 years), using data from the 1st National Survey of Health and Nutrition of Indigenous Peoples (2008-2009) and associated factors, such as through gamma regression and multilevel logistics. The prevalence of hypertension was 10.7%, varying across macro-regions: North, Northeast, Midwest, and South/Southeast. Women who lived in villages without domestic waste collection and in households without stable income were more likely to have AH. Increasing BMI and age were positively associated with the chances of developing high blood pressure. In the model for DBP, unlike education, the variables stable household income, BMI, and age were positively associated. In the model for SBP, there was a negative association with education, in the medium and high strata of the household goods index and in households with no stable income, and a positive association with the housing indicator, BMI and age.

The present article aimed to analyze the association between sociodemographic and hospitalization characteristics with the outcome of indigenous and non-indigenous pregnant and postpartum women, as well as factors associated with deaths among indigenous women hospitalized for Severe Acute Respiratory Syndrome (SARS) due to COVID-19 in Brazil. This is a cross-sectional and analytical study, with secondary data of pregnant and postpartum women of reproductive age, classified into race/skin color (indigenous and non-indigenous), extracted from the Obstetric Observatory, which uses data from the Influenza Epidemiological Surveillance Information System. The outcome variables were analyzed using the chi-square test or Fisher's exact test, and logistic regression was performed for the factors associated with the death of indigenous people. The highest proportion of deaths occurred among non-indigenous women who were in the 2nd trimester of pregnancy (99.7%), who lived in urban/peri-urban areas (99.8%), as well as in the South/Southeast (99.8%) and Northeast (99.5%) regions. Indigenous people who lived in rural areas and in the North and Midwest regions have a greater chance of death when compared to indigenous people who lived in urban areas and in the South/Southeast regions.

This article analyzes the sociodemographic composition of the Indigenous population in Brazil in the 1991, 2000, and 2010 demographic censuses, in addition to investigating inequalities in access to basic sanitation and electricity based on the 2010 Census. A methodology is proposed that classifies households with Indigenous residents as "homogeneous", "mixed" with an Indigenous in the category "household head", and mixed with a non-Indigenous in the category "household head". Regional and situational differences overlapped with differences by type of household and location, with better conditions in urban than rural areas and in the Southeast and South. The North was the region with the least access in general. Regional differences and differences between urban/rural areas were observed, highlighting better urban conditions in the Southeast and South. These inequalities reflect fragmented public policies, economic pressures, and deterritorialization, among other factors. The development of new techniques and critical debate is essential to understanding and addressing racial inequalities in the country and promoting public policies appropriate to Indigenous peoples.

A large body of empirical research has demonstrated that caregiver adverse childhood experiences (ACEs) predict ACEs in one's child, a phenomenon known as the intergenerational transmission of ACEs. Little of this empirical research, however, has focused specifically on Indigenous peoples despite a growing body of theoretical literature and the wisdom of Elders and Traditional Knowledge Keepers that speaks to the presence of this phenomenon within Indigenous communities as well as the protective role of Indigenous cultural identity in preventing the intergenerational transmission of ACEs. The purpose of the current study was to conduct an empirical evaluation of this hypothesis, specifically that Indigenous cultural identity and social support protects against the intergenerational transmission of ACEs among Indigenous peoples and their children in the USA. Participants were 106 Indigenous women caregivers of children ages 10 to 14 in South Dakota who completed surveys. Results showed that Indigenous cultural identity moderated the association between caregiver ACEs and child ACEs. At high levels of cultural identity, there was no association between caregiver ACEs and child ACEs. At low levels of Indigenous cultural identity, however, there was a strong and positive relationship between caregiver ACEs and child ACEs. Social support did not moderate the association between caregiver ACEs and child ACEs. These findings underscore the need for initiatives that enhance Indigenous cultural identity and social support among Indigenous caregivers to prevent the intergenerational transmission of ACEs., Competing Interests: Declarations Ethics Approval The research procedures were approved by the University of Nebraska-Lincoln’s Institutional Review Board (IRB protocol number: 20210921287FB-COLLA) as well as the Great Plains Indian Health Services IRB. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Consent to Participate Participants provided informed consent to participate. Conflict of Interest The authors declare no competing interests., (© 2023. W. Montague Cobb-NMA Health Institute.)

Epidemiological surveys by ethnic groups are scarce in Brazil. The health and nutrition conditions of indigenous peoples who face situations of social inequities and inequalities, negatively influence their health indicators. This study is the widest investigation on the subject ever carried out on the Baniwa ethnic group, one of the most numerous in the country. The survey aimed to analyze the living conditions and nutritional profile of children aged under 60 months and women aged 14 to 49 years of the Baniwa ethnic group, residing in the northwest region of the state of Amazonas, in the Indigenous Land of Alto Rio Negro, an area that serves as a border connecting Brazil, Colombia, and Venezuela. The results show a high prevalence of chronic malnutrition in 52.5% (95%CI 48.9-56.1) and anemia in 68.3% (95%CI 64-5-71.8) of children under 60 months, in addition to overweight in 26.3% (95%CI 18.4-27.0) and anemia in 52.3% (95%CI 43.6-53.6) of the women. The situations of food insecurity observed in this study are linked to poor income and sanitation conditions. The magnitude of these injuries expresses the low effectiveness of primary care actions offered by the health system, with a significant percentage of hospitalizations resulting from injuries sensitive to basic care at the primary care level.

Background: The incidence of discharge against medical advice (DAMA) in emergency departments (EDs) among Indigenous people is a growing concern in Australia. This study aimed to determine the incidence of ED DAMA in public hospitals in Queensland (QLD) from 2016 to 2021 and investigate the disparities in ED DAMA between Indigenous and non-Indigenous patients. The study also assessed the impact of the COVID-19 pandemic on the incidence of ED DAMA., Methods: A descriptive epidemiological study was conducted using aggregated data from QLD public hospital EDs. The data was retrieved from Clinical Excellence QLD, Healthcare Improvement Unit, in the QLD Health Open Data Portal for the period 1 January 2016 to 31 December 2021. Incidence rates and unadjusted odds ratios were calculated and compared using the chi-square test to identify differences between Indigenous and non-Indigenous patients., Results: The annual incidence of DAMA in EDs was 7.7% among Indigenous patients, compared to 4.8% among non-Indigenous patients, with the highest rate (8.9%) reported in 2021 among Indigenous patients. The incidence of ED DAMA was higher for Indigenous patients in major cities (20.0%) than in very remote areas (7.4%). Patients in triage categories 4 (10.0%) and 3 (7.3%) accounted for the vast majority of ED DAMA events among Indigenous patients. The acute group A hospitals had the highest incidence of ED DAMA (10.9% for Indigenous patients and 6.5% for non-Indigenous patients). The COVID-19 pandemic had no impact on the incidence of ED DAMA., Conclusion: Indigenous patients experience a disparity in ED DAMA incidence. Addressing this issue requires collaborative efforts from healthcare providers, policymakers, and community organizations., Competing Interests: Declarations Ethical Approval The University of Queensland Human Research Ethics Committee approved an ethics exemption application for this study (HREC No: 2022/HE001308). Consent to participate is not applicable. Consent for Publication Not applicable. Competing Interests The authors declare no competing interests., (© 2023. W. Montague Cobb-NMA Health Institute.)

Considered an important public health problem among Indigenous peoples in Brazil, obesity is a risk factor for Noncommunicable Diseases (NCDs) and conditions. The present study aimed to describe the occurrence of excess weight, obesity, and associated factors in Xavante Indigenous adults, through a nutritional survey carried out in the population ≥ 15 years of age living in the Pimentel Barbosa and Wedezé Indigenous Lands, Mato Grosso, Central Brazil, during the period of June to August 2011. Eight of the 10 villages in the territory were investigated. Anthropometric, bioimpedance and socioeconomic data were collected. This study counted on 495 participants, corresponding to 94.1% of the target population. The prevalence of overweight and obesity was 65.9% (male: 63.2%; female: 68.6%) and 19.8% (male: 21.3%; female: 18.2%), respectively. In the multiple regression model, the prevalence of excess weight was higher among women, in higher age groups and education levels, in individuals living in group 2 of the villages, and in households with low consumption of farmed foods. An increase in the age group aged 20 to 49 years and in individuals living in households with a low consumption of food from hunting, fishing, and gathering presented the highest prevalence of obesity.

Background: Medication for mental health problems represents a significant proportion of overall medication use and the prescription of psychotropic medicine has increased in many western countries over the last decades. Childhood violence (CV) is strongly associated with mental health problems, which in turn may increase the likelihood of being prescribed psychotropic medication. However, the association between CV and prescription of benzodiazepines (BDZ) and antidepressants is rarely described, and no such study has been performed among the Indigenous Sami people., Methods: Data from the SAMINOR 2 Questionnaire Survey (2012) was linked to the Norwegian Prescription Database. Information on filled prescriptions for BDZ and antidepressants in 2004-2019 was collected for 11,296 persons (55.8% women, 22.6% Sami). Gender-stratified chi-square tests and two-sample t-tests were used to test for differences between groups. Logistic regression was applied to investigate the association between CV and filled prescriptions for BDZ and antidepressants., Results: During the 16-year study period, 16.7% of all women filled at least one prescription for BDZ. The figures were significantly lower among Sami women (14.1%) compared to non-Sami women (17.4%) (p = .003). Among all women, 23.6% filled at least one prescription for antidepressants, with no difference between ethnic groups. Filled prescriptions among men were 10.0% and 14.2%, respectively, with no difference between ethnic groups. During each year, and in total, a significantly higher proportion of women exposed to CV received at least one prescription for BDZ and antidepressants, respectively, compared to women not exposed to CV, with no differences between ethnic groups. Among men, the pattern was similar., Conclusion: A lower proportion of Sami women filled prescriptions for BDZ than non-Sami women. Those who reported exposure to CV filled prescriptions for BDZ and antidepressants more often than those who did not report CV. There were no overall differences between Sami and non-Sami; the dispensing rates of antidepressants and BDZ were similar for Sami and non-Sami, and the effects of CV on the dispensing of antidepressants and BDZ were also similar. This study highlights the importance of preventing CV, and of identifying a history of CV when treating adults with mental health problems., (© 2024. The Author(s).)

A large and growing literature argues that the agricultural labor market is stratified by ethnicity and legal status. However, other markers of distinction, such as indigeneity, may overlap with legal status to reveal additional health inequalities. Our study contributes to this scholarly dialogue by assessing the relation between indigeneity, legality, and health among immigrant-origin farmworkers from Latin America. To this end, we use data from the National Agricultural Worker Survey (N = 21,092) to examine health outcomes among indigenous and non-indigenous immigrants. Results indicate that indigenous farmworkers experience higher rates of pain-but not chronic conditions-than their non-indigenous counterparts. While undocumented farmworkers who are not indigenous exhibit especially favorable health, indigenous workers who are documented are significantly more likely to suffer from pain. Finally, there is limited evidence that differences in insurance coverage can fully explain the patterning between legal status, indigeneity, and health. This project sheds light on the well-being of indigenous migrant laborers in the U.S. food system, a population that experiences pervasive barriers to socioeconomic advancement at home and abroad., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: This study examines maternal mortality among Brazilian indigenous women from 2015 to 2021, contrasting their causes of death with non-indigenous women., Methods: An observational study utilizing Ministry of Health data analyzed maternal deaths' characteristics, comparing indigenous and non-indigenous groups based on death certificates and live-birth records. Variables included age, region, location, time, and cause of death. Maternal mortality ratios (MMR) were calculated with linear regression and outliers identified with Grubbs test. Prevalence ratios compared MMR and causes of death., Results: Between 2015 to 2021, Brazil recorded 13 023 maternal deaths. Among these, with 205 among indigenous women (1.60% of total). Indigenous women had higher MMR (115.14/100 000), than non- indigenous women (66.92/100 000), consistently across years. Hemorrhagic causes notably contributed to the indigenous women's elevated MMR., Conclusion: Indigenous Brazilian women face elevated maternal mortality rates across all causes, primarily due to hemorrhage, contrasting wih national trends., (© 2024 International Federation of Gynecology and Obstetrics.)

Background: Non-village indigenous people may face urban lifestyle influences, impacting their nutritional profile. Therefore, this study aimed to analyze the temporal trends in the nutritional status (2008-2023) and food consumption (2015-2023) of non-village indigenous people in Brazil, using data from the Food and Nutrition Surveillance System (SISVAN)., Methods: In this time series study, secondary data available on the SISVAN online platform were used. All records of non-village indigenous people from all regions of Brazil were evaluated. Nutritional status was assessed using height-for-age (H/A) and Body Mass Index-for-age (BMI/A) for children and adolescents, and BMI for adults and the elderly. Food consumption trends were analyzed using food consumption screeners, based on specific food groups consumed the day before the assessment. An annual percentage change (APC) was calculated using Prais-Winsten regression models., Results: There was a reduction in severe stunting among children aged 2 to 4 years old (APC = -0.80%; p = 0.025) and 5 to 9 years old (APC = -4.02%; p < 0.001). Adolescents showed an increase in thinness (APC = 0.91%; p = 0.016) and obesity (APC = 4.38%; p < 0.001). In adults and the elderly, there was a decrease in underweight (APC = -5.59%; p = 0.002 and APC = -3.12%; p < 0.001, respectively) and an increase in obesity grade 1 and overweight (APC = 3.81%; p < 0.001 and APC = 1.82%; p < 0.001, respectively). There was an increase in vegetable consumption among children, adolescents and the elderly, and a rise in the consumption of hamburgers and sausages across all age groups., Conclusion: There was an improvement in the nutritional status of children and adolescents, with reduced stunting, but a rise in obesity among adolescents, adults and the elderly. Food consumption trends showed increased consumption of vegetables and ultra-processed foods., (© 2024. The Author(s).)

Background: Cervical cancer remains a public health problem despite heavy global investment in health systems especially in low-and-middle-income countries (LMIC). Prophylactic vaccines against the most commonly detected human papillomavirus (HPV) types in cervical cancers are available and decisions on the selection of vaccine design depends on the prevalence of high-risk (hr) HPV genotypes for a particular region. In 2015, Botswana adopted the use of a quadrivalent HPV vaccine as a primary prevention strategy. Secondary prevention includes cervical smear screening whose uptake remains notably low among indigenous and marginalized communities despite efforts to improve access., Aim: To determine the prevalence of hrHPV genotypes and cervical lesions' burden in women from the indigenous and marginalized communities of Botswana., Methods: This prospective survey enrolled 171 non-HPV vaccinated women aged 21 years and older. Face-to-face interviews, Pap smear screening, hr-HPV and Human Immuno-deficiency virus (HIV) testing were carried out. Conventional Papanicolau smears were analyzed and cervical brushes were preserved for hrHPV testing using the Ampfire Multiplex HR-HPV protocol which detects the following genotypes: HPV 16, 18, 31, 35, 39, 45, 51, 52, 53, 56, 58, 59 and 68., Results: In this study, 168/171 (98.6%) of the women consented to HIV testing; 53/171 (31%) were living with HIV and self-reported enrolment on antiretroviral therapy. Among the women examined, 23/171 (13.5%) had cervical dysplasia with most presenting with Atypical Squamous Cells of Undetermined Significance 8/23 (35%), Low-Grade Squamous Intraepithelial Lesions 8/23 (35%), Atypical Squamous Cells-High Grade 4/23 (17%), Atypical Endocervical Cells 2/23 (9%) and Atypical Endocervical Cell favoring neoplasia 1/23(4%). However, no High-Grade Squamous Intraepithelial Lesions (HSIL) or squamous cell carcinoma (SCC) were detected. Overall hrHPV prevalence in this study was at 56/171 (32.7%). The most commonly detected hrHPV genotypes in women with cervical dysplasia were HPV39 (6.25%), HPV51 (14.5%), HPV52 (12.5%) and HPV56 (4%). Notably, HPV 16 and 18 were not found in women with cervical dysplasia., Conclusions: Our study provides valuable insights into the prevalence and distribution of hrHPV genotypes in indigenous and marginalized communities in Botswana, and the need for further investigation of their potential role in cervical carcinogenesis in this population. These results may also serve as baseline data to facilitate future evaluation of the HPV vaccine needs., (© 2024. The Author(s).)

The prevalence of interpersonal violence has been reported at higher levels among Indigenous than non-Indigenous populations worldwide, but has not been thoroughly investigated among the Sámi population in Sweden. The aims of this study were to investigate: (1) the prevalence of emotional, physical, and sexual violence and violence by intimate partners, family members, acquaintances, and strangers among participants identifying as Sámi or Swedish, (2) whether reporting experiences of historical losses and discrimination mediated the anticipated association between identifying as Sámi and reporting experiences of violence, and (3) whether background characteristics were associated with reporting experiences of violence. Cross-sectional questionnaire data collected in 2021 for the "Health and Living conditions in Sápmi" study were used. All adults in an arctic region in Sweden were invited to participate (response rate: 41%). Respondents self-identifying as Sámi ( n  = 375; 24.7%) or Swedish ( n  = 1,144; 75.3%) were included in this study. Sámi respondents of both sexes more often reported violence by an acquaintance or stranger. Likewise, more Sámi than Swedish women reported family violence (16.4% vs. 9.2%), but there was no difference concerning intimate partner violence (13.3% vs. 15.4%). Mediation analyses revealed strong positive indirect effects of historical losses and discrimination on the different types of violence. Being female was the strongest predictor of reporting intimate partner violence, and younger age was associated with violence by all perpetrators except family members. In conclusion, interpersonal violence was more often reported by Sámi respondents, but the association was explained in full by experiences of historical losses and discrimination. The results underline the importance of a life-course and even intergenerational and historical perspectives when investigating interpersonal violence., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

This article aims to systematize and analyze, from a historical perspective, the discussions that permeated the topic of indigenous health in interface with the demography of these populations, based on the political dimension that the quantification of indigenous peoples assumed during the military dictatorship in Brazil. Covering an extensive period that extends from the establishment of the Indian Protection Service in 1910 until the end of the 1980s, this article offers a comprehensive view of the topic. The analysis focuses primarily on the 1970s, highlighting the actors involved in this debate: indigenous leaders, indigenists, academics, health professionals, and missionaries.

Background: Multimorbidity, the concurrent presence of multiple chronic health conditions in an individual, represents a mounting public health challenge. Chronic illnesses are prevalent in the Indigenous populations, which contributes to multimorbidity. However, the epidemiology of multimorbidity in this population is not well studied. This review aimed to elucidate the extent, determinants, consequences, and prevention of multimorbidity within Indigenous populations globally, contrasting findings with non-Indigenous populations., Methods: Adhering to the PRISMA guidelines, this systematic review assimilated peer-reviewed articles and grey literature, focusing on the prevalence, determinants, implications, and preventive strategies of multimorbidity in global Indigenous populations. Emphasis was given to original, English-language, full-text articles, excluding editorials, and conference abstracts., Findings: Of the 444 articles identified, 13 met the inclusion criteria. Five studies are from Australia, and the rest are from the USA, Canada, New Zealand, and India. The study indicated a higher multimorbidity prevalence among Indigenous populations, with consistent disparities observed across various age groups. Particularly, Indigenous individuals exhibited a 2-times higher likelihood of multimorbidity compared to non-Indigenous populations. Noteworthy findings underscored the elevated severity of certain comorbid conditions, especially strokes, within Indigenous groups, with further revelations highlighting their significant pairing with conditions such as heart diseases and diabetes., Interpretation: The findings affirm the elevated burden of multimorbidity among Indigenous populations. Prevalence and risk of developing multimorbidity are significantly higher in this population compared to their non-Indigenous counterparts. Future research should prioritize harmonized research methodologies, fostering insights into the multimorbidity landscape, and promoting strategies to address health disparities in Indigenous populations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: There is an important gap in the literature concerning the level, inequality, and evolution of financial protection for indigenous (IH) and non-indigenous (NIH) households in low- and middle-income countries. This paper offers an assessment of the level, socioeconomic inequality and middle-term trends of catastrophic (CHE), impoverishing (IHE), and excessive (EHE) health expenditures in Mexican IHs and NIHs during the period 2008-2020., Methods: We conducted a pooled cross-sectional analysis using the last seven waves of the National Household Income and Expenditure Survey (n = 315,829 households). We assessed socioeconomic inequality in CHE, IHE, and EHE by estimating their Wagstaff concentration indices according to indigenous status. We adjusted the CHE, IHE, and EHE by estimating a maximum-likelihood two-stage probit model with robust standard errors., Results: We observed that, during the period analyzed, CHE, IHE, and EHE were concentrated in the poorest IHs. CHE decreased from 5.4% vs. 4.7% in 2008 to 3.4% vs. 2.9% in 2014 in IHs and NIHs, respectively, and converged at 2008 levels towards 2020. IHE remained unchanged from 2008 to 2014 (1.6% for IHs vs. 1.0% for NIHs) and increased by 40% in IHs and NIHs during 2016-2020. EHE plunged in 2014 (4.6% in IHs vs. 3.8% in NIHs), then rose, and remained unchanged during 2016-2020 (6.7% in IHs and 5.6% in NIHs)., Conclusion: In pursuit of universal health coverage, health authorities should formulate and implement effective financial protection mechanisms to address structural inequalities, especially forms of discrimination including racialization, that vulnerable social groups such as indigenous peoples have systematically faced. Doing so would contribute to closing the persistent ethnic gaps in health., (© 2023. W. Montague Cobb-NMA Health Institute.)

Skin infections cause significant health burden and affect underserved communities such as the indigenous Negrito communities disproportionately. There is only one study that has addressed skin infections among the Negrito communities, which is the smallest and most isolated indigenous tribe in Peninsular Malaysia, with approximately 6,500 individuals remaining in northern and central Peninsular Malaysia. This study, which aims to update the infection patterns of scabies and tinea among the Negrito communities, recruited 361 participants from eight villages representing all six Negrito subtribes. The results revealed an overall skin infection prevalence of 35.6%, with scabies (11.7%), tinea versicolor (11.3%), and tinea imbricata (7.5%) as major infections, with no co-infection. Notably, infection rates were significantly higher in resettled villages (55.2%) compared to inland villages (24.8%). Scabies and tinea versicolor were more prevalent in resettled villages (21.2% and 23.6%, respectively) than inland villages (6.4% and 4.7%, respectively), while tinea imbricata was more common in inland villages (9.4% vs 3.9%). Furthermore, there exist predisposition of scabies among Kensiu. High prevalence of tinea imbricata was observed among the inland Bateq while prevalence of tinea versicolor was high among the resettled Bateq. Risk analysis revealed specific associations: scabies with Kensiu subtribe (P = 0.002), high income (P = 0.001) and underweight individuals (P = 0.009); tinea versicolor with Bateq subtribe (P = 0.003), resettled villagers (P < 0.001), males (P = 0.040), and overweight/obese individuals (P = 0.015); and tinea imbricata with Bateq (P = 0.011) and smokers (P = 0.004). These findings highlight a complex interplay between environment and lifestyle in skin infection prevalence. Addressing these infections requires targeted interventions, including regular medical care in inland villages and socio-economic support for resettled communities, considering the distinct predispositions in different village types., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

We conduct a synthetic archaeological and ethnohistoric dating program to assess the timing and tempo of the spread of peaches, the first Eurasian domesticate to be adopted across Indigenous eastern North America, into the interior American Southeast by Indigenous communities who quickly "Indigenized" the fruit. In doing so, we present what may be the earliest absolute dates for archaeological contexts containing preserved peach pits in what is today the United States in the early to mid-16 th century. Along with our broader chronological modeling, these early dates suggest that peaches were likely in the interior prior to permanent Spanish settlement in the American Southeast and that peaches spread independently of interactions with Spanish colonizers. We further argue that that eventual spread of peaches was structured exclusively by Indigenous communities and the ecologies produced through long-term Indigenous land management and land use practices, highlighting and centering the agency of Indigenous societies in the socioecological process of colonization., (© 2024. The Author(s).)

Background: In Malaysia, despite a decline in cases, malaria remains a major public health concern, especially among the vulnerable indigenous people (i.e. Orang Asli) in remote areas. Effective preventive and control measures require an evidence-based understanding of their knowledge, attitudes, and practices (KAP) regarding malaria. This study aimed to evaluate the KAP regarding malaria in an indigenous settlement in Peninsular Malaysia., Methods: A household-based cross-sectional study was conducted in March 2024 in six Semai sub-ethnic indigenous villages in Pos Lenjang, Kuala Lipis, Pahang. A structured questionnaire was administered to randomly selected individuals (≥ 12 years old) to collect data on sociodemographic characteristics and KAP. Data were analysed using descriptive statistics and predictors of KAP were determined using logistic regression. A p-value less than 0.05 was considered statistically significant., Results: A total of 267 individuals from 160 households were interviewed. Nearly half had good knowledge (49.4%) and positive attitudes (54.3%) towards malaria, with high practice scores for prevention and control (83.1%). Multivariate logistic regression analysis showed higher odds of good knowledge in those aged 40-59 years (adjusted odd ratio [aOR] = 6.90, p = 0.034), with primary (aOR = 2.67, p = 0.015) or secondary education (aOR = 2.75, p = 0.019), and with previous malaria history (aOR = 5.14, p < 0.001). Higher odds of a good attitude were found in those with secondary education (aOR = 4.05, p < 0.001) and previous malaria history (aOR = 2.74, p = 0.017). Lower odds were observed for the unemployed (aOR = 0.25, p = 0.018) and those collecting forest products (aOR = 0.25, p = 0.049) for attitude and practice, respectively., Discussion: The overall practice level on malaria prevention was high among the Semai Orang Asli in Pahang. However, to ensure sustainability, the low levels of knowledge and attitude regarding malaria must be strengthened through increased health education and continuous community engagement., (© 2024. The Author(s).)

Background: Risk perception varies greatly among individuals, affecting their behavior and decision-making in risky situations. The COVID-19 pandemic affected worldwide, but the role of risk perception related to COVID-19 in ethnic minorities in Mexico is unclear. This study quantifies the impact of COVID-related risk perception (susceptibility and severity) and perceived fear on the utilization of antenatal care services among indigenous women in San Cristobal de las Casas, Chiapas, Mexico., Methods: We conducted a retrospective crossover study between June and December 2021, interviewing 98 women from San Cristóbal de las Casas, Chiapas. In a crossover design, each subject acts as their own control, so we required the participants to have a previous pregnancy experience. A logistic model was used to calculate the odds ratio for the outcome of having an adequate number of antenatal care visits. The analysis considered the period (during or before the pandemic) as well as perceived severity and susceptibility levels as independent variables., Results: COVID-19 reduced antenatal care utilization by 50%. During the pandemic, the adjusted odds ratio for attending health antenatal care services was 0.83 (95% CI: 4.8, 14.5) compared to pre pandemics. Adjusted for fear of contagion, the mother's perception of severity was associated with an increased likelihood of an insufficient number of antenatal visits. OR = 0.25 (95% CI: 0.10, 0.65)., Conclusion: The risk perception for COVID-19 decreased the likelihood of receiving an adequate number of antenatal care visits., (© 2024. The Author(s).)

Introduction: The COVID-19 pandemic has deeply affected Latin American countries, with countless COVID-19 cases and deaths. In countries like Mexico, Brazil, Peru, Colombia and Ecuador, the public health system collapsed and the lack of testing capacity did not allow control of the spread of SARS-CoV-2 during the first year of the COVID-19 pandemic. Moreover, rural and Indigenous communities in these countries, particularly isolated ones like those in the Amazon Basin, were neglected in terms of access to COVID-19 testing and medical aid., Methods: In this study, we retrospectively analyzed the impact of COVID-19 outbreaks among several endangered Amazonian ethnic groups during the first wave of the COVID-19 pandemic in Ecuador. From June to August 2020, 21 Amazonian communities were included in a COVID-19 surveillance led by Indigenous community leaders and non-profit organizations., Results: A total of 853 individuals were tested for SARS-CoV-2 infection by RT-qPCR. A high SARS-CoV-2 infection rate of 54.05% (461 positive individuals) was found. Only one community was COVID-19 free, and the other 20 communities had severe COVID-19 outbreaks with infection rates up to 90%. For the different ethnic groups, the infection rates were 46.0% for Waoranis, 66.15% for Sionas, 49.8% for Kichwas, 54.9% for Kofans and 62.3% for Shuars. Additionally, 29 individuals had SARS-CoV-2 viral load values higher than 108 copies/mL., Conclusion: Our findings confirm that Indigenous communities of Ecuadorian Amazonia were exposed to SARS-CoV-2 community transmission since the early stages of the COVID-19 pandemic, with the potential occurrence of superspreading events. As the COVID-19 national surveillance program was focussed on symptomatic individuals attending hospital facilities, rural and remote Indigenous communities in the Ecuadorian Amazonia, including endangered ethnic minorities, were neglected during the first wave of the COVID-19 pandemic.

Rationale: The Black, Indigenous, and People of Colour populations in the United States are disproportionately affected by the emerging health threat SARS-CoV-2, which causes COVID-19., Aims and Objectives: This paper aims to demonstrate the usefulness of critical systems thinking by using scenario planning based on epidemiological data and tying epidemiology with soft systems methodology to investigate COVID-19 disparities among disproportionately affected Black, Indigenous, and People of Colour populations., Methods: Using a review of the COVID-19 literature and publicly available US COVID-19 data, critical systems thinking is applied in a scenario planning example and a call to link soft systems methodology with epidemiology., Results: According to the four plausible Endgame scenarios, levels of community transmission as well as the current state transmission are based on the driving forces of the scenarios. In addition, soft systems methodology explores the effect on stakeholders and strengthens the picture of disease burden beyond sole reliance on traditional data sources., Conclusion: This analysis underscores employing critical systems thinking to critically assess diverse methods appropriate for the ongoing complexity of global crises. It is argued that critically engaged subjectivity should be given space alongside data-dependent objectivity. COVID-19 disparities are reliant on the social determinants of health's effects as driving forces on disease transmission in Black, Indigenous, and People of Colour populations. It is moreover argued that critical systems thinking is demonstrated by linking epidemiological evidence with scenario planning and soft systems methodology. This in turn supports a critical systems thinking approach to uncover the state of health disparities among minoritized communities under COVID-19., (© 2024 John Wiley & Sons Ltd.)

Objective: To investigate inequalities related to race/ethnicity and socioeconomic status in self-reported positive diagnosis for COVID-19 in Brazilian adults., Methods: Data available from the National Household Sample Survey COVID-19 (PNAD COVID 19) (July/September/November, 2020) were used in this retrospective investigation. The analyses considered the sampling design, primary sampling units, strata and sample weights. Poisson regression with robust variance was used to estimate prevalence ratio (PR) and the 95% confidence interval (95%CI) of the associations., Results: In July, September and November 2020, with regard to the rapid test, indigenous people were 2.45 (95%CI 1.48-4.08), 2.53 (95%CI 1.74-4.41) and 1.23 (95%CI 1.11-1.86) times more likely to report a positive history of SARS-CoV-2 infection, respectively. With regard to the RT-PCR test in November, indigenous people were more likely to test positive for COVID-19 (PR: 1.90; 95%CI 1.07-3.38). It was observed that the indigenous group was 1.86 (95%CI 1.05-3.29) and 2.11 (95%CI 1.12-3.59) times more likely to test positive for COVID-19 in September and November (2020). Income was associated with testing positive for COVID-19: in November, individuals whose income ranged from R$0.00-R$1.044 were more likely (PR: 1.69; 95%CI 1.16-23.06) to test positive using the RT-PCR test; participants whose income was in this range were also more likely to be diagnosed with COVID-19 using blood tests (PR: 1.72; 95%CI 1.43-2.07)., Conclusion: The data presented show an association between race/ethnicity and economic status with a positive diagnosis of COVID-19.