Review of health research on indigenous populations in Latin America, 1995-2004.
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OBJECTIVE: To review health research conducted among indigenous populations in Latin America during the period 1995-2004. Material and methods. The search strategy was purposely broad to ensure the identification of all relevant studies indexed in the PubMed and Lilacs databases. RESULTS: Six-hundred ninety citations were included. One hundred fifty-nine (23.0%) papers dealt with indigenous populations in Central America and 509 (73.8%) papers with South American populations. Three hundred two (43.8%) of the studies were quantitative, 39 (5.7%) qualitative, 259 (37.5%) mainly based on laboratory work and 24 (3.5%) dealt with policy analyses. The most common researched theme was human biology with 200 (29.0 %) papers, followed by communicable diseases (150 papers, 21.7 %). CONCLUSIONS: There is a special need for policy studies in the field of indigenous health. An increased commitment to resources and capacity building will be the real challenge for indigenous health research in the nearest future. (+info)
Best practices in intercultural health: five case studies in Latin America.
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The practice of integrating western and traditional indigenous medicine is fast becoming an accepted and more widely used approach in health care systems throughout the world. However, debates about intercultural health approaches have raised significant concerns. This paper reports findings of five case studies on intercultural health in Chile, Colombia, Ecuador, Guatemala, and Suriname. It presents summary information on each case study, comparatively analyzes the initiatives following four main analytical themes, and examines the case studies against a series of the best practice criteria. (+info)
Development of a culturally appropriate, home-based nutrition and physical activity curriculum for Wisconsin American Indian families.
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We designed an obesity prevention intervention for American Indian families called Healthy Children, Strong Families using a participatory approach involving three Wisconsin tribes. Healthy Children, Strong Families promotes healthy eating and physical activity for preschool children and their caregivers while respecting each community's cultural and structural framework. Academic researchers, tribal wellness staff, and American Indian community mentors participated in development of the Healthy Children, Strong Families educational curriculum. The curriculum is based on social cognitive and family systems theories as well as on community eating and activity patterns with adaptation to American Indian cultural values. The curricular materials, which were delivered through a home-based mentoring model, have been successfully received and are being modified so that they can be tailored to individual family needs. The curriculum can serve as a nutrition and physical activity model for health educators that can be adapted for other American Indian preschool children and their families or as a model for development of a culturally specific curriculum. (+info)
Out back and out-of-whack: issues related to the experience of early psychosis in the New England region, New South Wales, Australia.
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CONTEXT: The slow slide into a first episode of psychosis is often difficult to detect and is often described in retrospect as the point at which things were not quite right. A rural setting can add an layer of complexity to detecting early psychosis, with local structural issues and other disadvantages potentially complicating both identification and early treatment. Fewer specialist workers are available in rural communities compared with urban communities, and drug and alcohol usage can mask the early signs of prodrome (early psychosis symptoms). Along with these more predictable contextual issues, family and drought conditions can impact significantly the mental health of vulnerability rural populations. The use of a vignette provides a window to the lived experience of early psychosis in rural communities. This article explores these issues in the context of northern New South Wales, Australia. ISSUES: Embedded rural health workers are uniquely positioned to work with local people. One way to address access issues and the lack of diversity among available healthcare practitioners is by recognising and nurturing generalist health workers in all disciplines in their specialist role as generalist. It is also important to recognise the natural processes of a rural community with regard to a sense of community, structures and networks, and to accommodate these when planning mental health services. LESSONS LEARNED: The development of generalist health workers to undertake supported early identification of psychosis in rural communities is a useful strategy. In practice, a key feature is the availability of a specialist project worker. In addition, it is important to continue to advocate for services to rural communities that aim at preventing psychiatric illness, as well as optimising continuity of care for rural residents. (+info)
Diabetes screening of children in a remote First Nations community on the west coast of Canada: challenges and solutions.
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Type 2 diabetes (T2D) and its precursor, impaired glucose tolerance (IGT), are now reaching epidemic proportions among Aboriginal Canadians. Of particular concern is the appearance and increasing prevalence of T2D and IGT among Aboriginal youth. At the request of three communities in the Tsimshian nation on the northern coast of British Columbia (with which the Department of Pediatrics, University of British Columbia, had a pre-existing partnership) a screening program was undertaken to determine the prevalence of T2D and IGT among the children. The long-term goal was the collaborative development of intervention programs for each community. The challenges of meeting this request included the sociological and ethical issues associated with research in First Nations communities, as well as the pragmatic issues of conducting complex research in remote communities. Three separate visits were undertaken to respect the cultural dynamics and capacity of the community to accommodate a project of this magnitude. The process began with dialogue, listening and presentations to the community. Only then began the planning of logistics and application for funding. Next, the team visited the communities to ensure understanding of exactly what was involved for the community, each child and family, and to be certain that consent was fully informed. For the diabetes screening visit, special arrangements including chartering a Beaver float plane were needed for the transport of the five-member team with all the necessary equipment, including a -20(o)C freezer to safeguard the integrity of blood samples. The 100% consent rate, successful conduct of study, and retention of community support achieved by the process, indicate that population-based clinical research is possible in remote First Nations communities. This is best achieved with appropriate dialogue, care, respect and planning to overcome the sociological, ethical and practical challenges. (+info)
The impact of supply reduction through alcohol management plans on serious injury in remote indigenous communities in remote Australia: a ten-year analysis using data from the Royal Flying Doctor Service.
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AIMS: To assess the impact of supply reduction through Alcohol Management Plans (AMP) on the rate of serious injuries in four indigenous communities in remote Australia. METHODS: An ecological study used the database of the Royal Flying Doctor Service (RFDS) to calculate trauma retrieval rates for 8 years pre- and 2 years post-AMP in four remote communities covering a period from 1 January 1995 to 24 November 2005. All serious injuries in these communities required aero-medical retrieval. Results Serious injury resulted in a total of 798 retrievals during the observation period. One-sided analysis of variance for repeated measurements over the 10 years demonstrated a significant (P = 0.021) decrease of injury retrieval rates after the introduction of the AMP. Similarly, a comparison of linear trends of injury retrieval rates pre- and post-AMP also resulted in a significant decrease (P = 0.022; one-sided paired t-test). Comparisons of injury retrieval rates of just the 2 years pre- and post-AMP also revealed a significant reduction (P = 0.001; paired t-test), with an averaged 52% decline. Identical comparisons of retrieval rates for causes other than injury revealed no significant changes. Conclusion This impact evaluation provides evidence that AMP was effective in reducing serious injury in the assessed indigenous communities. (+info)
Primary care at the Alaska Native Medical Center: a fully deployed "new model" of primary care.
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OBJECTIVES: Beginning in the 1940s health care for Alaska Native people was delivered by the United States Indian Health Service. The transition to Alaska Native ownership was completed in 1998-9 with the transfer of the Alaska Native Medical Center to Alaska Native corporations. METHODS: The Native leaders of Southcentral Foundation made a conscious decision to redesign the medical primary care system around the core premise of optimizing long-term, trusting, accountable relationships. The medical system was reoriented to optimize these relationships, assure whole system intentional and integrated design, and remove barriers to these relationship being formed. RESULTS: . The transformed system allowed Alaska Native individuals and families to choose a primary care provider, enter into long-term trusting relationship with the provider, and partner in the journey towards wellness. It was a fully integrated approach that used every part of the system to best advantage, put the power in the hands of the individual and family, and effectively focused on the underlying determinants of health. CONCLUSIONS: The primary care system created and managed by Southcentral Foundation at the Alaska Native Medical Center demonstrated a system built on similar premises to the "New Model" of family medicine. (+info)
Improved and expanded pharmacy care in rural Alaska through telepharmacy and alternative methods demonstration project.
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OBJECTIVES: To describe innovative use of technology to improve the level of pharmacy care in remote villages in rural Alaska. STUDY DESIGN: Cross-sectional study. METHODS: The Alaska Native Medical Center and outlying health clinics formed the Southcentral Foundation Pharmacy Network to provide pharmacy services to Native and non-Native patients living in the rural Anchorage Service Unit. The Alaska Native Medical Center served as the central pharmacy, purchasing drugs on behalf of the network and dispensing those drugs to patients of the network. In April 2003, four remote pharmacies began a 6 month comparison of two different telepharmacy equipment systems. The systems were assessed for various factors such as hardware and software capabilities and the customer support offered. The program was then expanded to include 12 participating sites. RESULTS: During fiscal year 2006, 22665 prescriptions were processed utilizing telepharmacy and prospective pharmacist review. There were 990 documented pharmacist consultations and interventions (4.4% of all prescriptions processed). CONCLUSIONS: Incorporation of recent technological advancements enabled the pharmacy department of the Alaska Native Medical Center to improve and expand the provision of pharmacy services to rural, isolated communities. Based upon the success of the program, future sites are being targeted for telepharmacy inclusion. (+info)