Search Results (204)

Three models/methods are given to understand the extreme international variation in available and occupied hospital bed numbers. These models/methods all rely on readily available data. In the first, occupied beds (rather than available beds) are used to measure the expressed demand for hospital beds. The expressed occupied bed demand for three countries was in the order Australia > England > USA. Next, the age-standardized mortality rate (ASMR) has dual functions. Less developed countries/regions have low access to healthcare, which results in high ASMR, or a negative slope between ASMR versus available/occupied beds. In the more developed countries, high ASMR can also be used to measure the ‘need’ for healthcare (including occupied beds), a positive slope among various social (wealth/lifestyle) groups, which will include Indigenous peoples. In England, a 100-unit increase in ASMR (European Standard population) leads to a 15.3–30.7 (feasible range) unit increase in occupied beds per 1000 deaths. Higher ASMR shows why the Australian states of the Northern Territory and Tasmania have an intrinsic higher bed demand. The USA has a high relative ASMR (for a developed/wealthy country) because healthcare is not universal in the widest sense. Lastly, a method for benchmarking the whole hospital’s average bed occupancy which enables them to run at optimum efficiency and safety. English hospitals operate at highly disruptive and unsafe levels of bed occupancy, manifesting as high ‘turn-away’. Turn-away implies bed unavailability for the next arriving patient. In the case of occupied beds, the slope of the relationship between occupied beds per 1000 deaths and deaths per 1000 population shows a power law function. Scatter around the trend line arising from year-to-year fluctuations in occupied beds per 1000 deaths, ASMR, deaths per 1000 population, changes in the number of persons hidden in the elective, outpatient and diagnostic waiting lists, and local area variation in births affecting maternity, neonatal, and pediatric bed demand. Additional variation will arise from differences in the level of local funding for social care, especially elderly care. The problems associated with crafting effective bed planning are illustrated using the English NHS as an example Full article

There is a consensus that fire should be actively managed in tropical savannas to decrease wildfire risks, firefighting costs, and social conflicts as well as to promote ecosystem conservation. Selection and participatory monitoring of the effects of fire on cultural keystone species may be an efficient way to involve local stakeholders and inform management decisions. In this study, we investigated the effects of different fire regimes on a cultural keystone species in Central Brazil. With the support of diverse multiethnic groups of local fire brigades, we sampled Hancornia speciosa (Apocynaceae) populations across a vast regional range of 18 traditional territories (Indigenous Lands and Quilombola Territories) as well as four restricted Protected Areas. We considered areas under wildfires (WF), prescribed burns (PB) and fire exclusion (FE) and quantified tree mortality, canopy damage, loss of reproductive structures and fruit production following a simplified field protocol. Areas with H. speciosa populations were identified and classified according to their fire history, and in each sampled area, adult plants were evaluated. We hypothesized that WF would have larger negative impact on the population parameters measured, while FE would increase plant survival and fruit production. We found that tree mortality, canopy damage, and loss of reproductive structures were higher in areas affected by wildfires, which also had the lowest fruit production per plant compared to PB and FE areas, corroborating our hypotheses. However, we also found higher mortality in FE areas compared to PB ones, probably due to plant diseases in areas with longer FE. Considering these results and that the attempts to exclude fire from fire-prone ecosystems commonly lead to periodic wildfires, we argue that the Integrated Fire Management program in course in federal Protected Areas in Brazil—based on early dry season prescribed fires—is a good management option for this, and likely other, cultural keystone species in the Brazilian savanna. Full article

Protected areas (PAs) in the Brazilian Amazon have proven to be critical in preserving the rainforest but face increasing threats. Since 2019, illegal activities and land conflicts involving PAs have escalated due to the weakening of environmental institutions. Therefore, up-to-date research is needed to evaluate agricultural pressures on PAs—including Sustainable Use Areas, Indigenous Territories, and Strictly Protected Areas—given its importance in driving deforestation in the Amazon, and to identify hotspots of concern. We analyzed property registration, deforestation, pasture expansion, and cattle transaction records within 158 PAs in the Brazilian state of Pará, which holds most of the remaining forest and the highest rates of deforestation. Our findings show that nearly a quarter of Pará’s 2019–2022 deforestation occurred within PAs, undermining their effectiveness as conservation tools. Despite prohibitions, we found illegally registered private properties in most PA categories including indigenous territories and over a 100% increase in deforestation within PAs from 2015–2018. Over 90% of PAs contained pasturelands in 2022, but only half of them had registered cattle transactions within their borders, which suggests the presence of clandestine cattle activities in these areas as well. Indirect sales to slaughterhouses coming from PAs increased during the study period, potentially due to efforts by ranchers to obscure such cattle origins from companies that are increasingly monitoring their direct suppliers. Finally, we identified 17 high-risk PAs concentrating most threats. Focusing monitoring efforts on property registries and cattle transactions in these areas could significantly reduce illegal deforestation and illegal cattle ranching. While PAs are considered to be cornerstones of forest conservation efforts, our findings show that current policies fail to prevent cycles of land grabbing, illegal ranching, and deforestation that can eventually lead to the downgrading, downsizing, and degazetting of PAs. Given this context, validating property claims, tracing cattle sales, and penalizing deforestation are urgently needed to halt these cycles that threaten PAs. Full article

Nature prescription programs have become more common within healthcare settings. Despite the health benefits of being in nature, nature prescriptions within the context of Indigenous Peoples have received little attention. We therefore sought to answer the following question: What are circumpolar-based physicians’ and Indigenous Elders’ views on nature prescribing in the Northwest Territories, Canada? We carried out thirteen semi-structured interviews with physicians between May 2022 and March 2023, and one sharing circle with Indigenous Elders in February 2023. Separate reflexive thematic analysis was carried out to generate key themes through inductive coding of the data. The main themes identified from the physician interviews included the importance of cultural context; barriers with nature prescriptions in the region; and the potential for nature prescriptions in the North. Reflections shared by the Elders included the need for things to be done in the right way; the sentiment that the Land is not just an experience but a way of life; and the importance of traditional food as a connection with Nature. With expanding nature prescription programs, key considerations are needed when serving Indigenous communities. Further investigation is warranted to ensure that nature prescriptions are appropriate within a given context, are inclusive of supporting Land-based approaches to health and wellbeing, and are considered within the context of Indigenous self-determination. Full article

Indigenous Peoples throughout the world have been displaced from their ancestral territories through colonial land use management. Indigenous Peoples have pushed settler-colonial governments to shift their policy frameworks to better support Indigenous rights and leadership across land management, but particularly in conservation. In Canada, this has recently involved the development of Indigenous Protected and Conserved Areas. Combined with pressure from international organizations, Canada’s Federal Government has dedicated substantial funds to support the establishment of these areas and to achieve conservation and reconciliatory goals. In Aotearoa New Zealand, Māori groups have shaped new legislation that recognizes legal personality status for natural features, which contrasts with Western understandings of land ownership. Indigenous-led conservation in Canada faces many interrelated barriers grounded in colonial histories that complicate land jurisdictions, reconciliation, and protected area networks. This research reveals some of this complexity by examining how Indigenous-led conservation can contribute to more equitable and consensus-based decision-making frameworks in land use management. Policy and legal analyses of Canadian, Aotearoa New Zealand, and international conservation and human rights documents inform our results. We affirm that Indigenous-led conservation can foster relationships between Indigenous Nations and Crown governments. They can also provide steps towards reconciling colonial injustices, supporting Indigenous self-determination, and advancing more sustainable land use systems. Full article

We used social network analysis (SNA) to identify the types of water-related conflicts between the users and members of the institutional arena of the Rio Mayo Irrigation District (RMID) within the ancestral territory of the Yoreme Mayo indigenous group in Sonora, northeastern Mexico. We combined ethnography with an analysis and visualization of bimodal networks that consisted of 118 users and their connections to the institutional arena’s 30 identified social actors who influence water management. Using a clustering algorithm, we identified four types of conflicts: (1) disputes between small- and large-scale farmers over (i) irrigation water and (ii) payments for water rights and land rental; (2) the struggle by large-scale farmers against the upper level of the water hierarchy, to obtain more water; (3) struggles by rural indigenous women against water providers, to conserve indigenous vernacular systems of managing water for domestic use; and (4) a “conflict” that turned out to be merely a structural remnant of the algorithm. We conclude that land- and water-grabbing in the RMID mainly affect indigenous small-scale farmers and that the combination of SNA and a clustering algorithm can identify the types of natural resource-related conflicts that might go undetected by other methodologies. However, SNA should in some cases be accompanied by a qualitative methodology. Full article

Indigenous traditional land uses, including hunting, fishing, sacred activities, and land-based education at the Red Sucker Lake First Nation (RSLFN) in Manitoba, Canada, are impacted by mining. The Red Sucker Lake First Nation (RSLFN) people want their territories’ land and water to be protected for traditional uses, culture, and ecological integrity. Towards this goal, their Island Lake Tribal Council sought support for an Indigenous-protected and conserved area (IPCA) in their territory, outside of existing mining claims, but without success. The two-eyed seeing approach was adopted in this study. Traditional land use mapping and interviews were undertaken with 21 Indigenous people from the RSLFN, showing that many traditional land uses are concentrated on greenstone belts. The interviews revealed that mining exploration has resulted in large petroleum spills, noise distress, private property destruction, wildlife die-offs, and animal population declines. These issues negatively impact RSLFN’s traditional land use practices, ecosystem integrity, and community health. Governments need to partner with Indigenous communities to reach their biodiversity targets, particularly considering northern Canada’s peatlands, including those in the RSLFN territory, surpassing Amazon forests for carbon storage. The role of critical minerals in renewable energy and geopolitics has colonial governments undermining Indigenous rights, climate stabilization, and biodiversity to prioritize extractivism. Mining at the RSLFN has environmental impacts from exploration to decommissioning and after, as well as the massive infrastructure required that includes roads, hydro, and massive energy supplies, with a proposed multimedia national Northern Corridor to export RSLFN’s resources and other resources to six ports. Full article

(1) Background: Although culturally grounded health interventions (CGHI) have shown efficacy in improving Indigenous health, few CGHI for Queer and Transgender Pacific Islander (QTPI) communities exist to address their health promotion. This study explores QTPI experiences of health for cultural mechanisms to develop CGHI for QTPI health promotion. (2) Methods: Using Indigenist community-engaged research methodologies, we collaborated with the United Territories of Pacific Islanders Alliance of Washington and Guma’ Gela’ to conduct 11 exploratory semi-structured interviews with QTPI community members living in the Puget Sound area of Washington state. These interviews were analyzed using thematic analysis. (3) Results: QTPI well-being was greatly influenced by how settler colonialism impacted their connectedness to their families, communities, and cultures. We also found that inágofli’e’ and alofa, relational values in CHamoru and Sāmoan culture, played essential roles in facilitating QTPI health. Many participants fostered these values through chosen family, community care, and Indigenous mobilities. (4) Conclusions: Our findings indicate a need for CGHI that facilitate inágofli’e’ and alofa for QTPI to combat settler colonialism’s impacts on QTPI well-being. Finally, we present a community-centered conceptual model for culturally grounded health promotion in QTPI communities. Full article

This paper offers paradigmatic insights from an international workshop on Ecological Legacies: Bridge Between Science and Community, in Ecuador, in the summer of 2023. The conference brought together foreign and local scholars, tour operators, village community, and Indigenous leaders in the upper Amazonia region of Ecuador with the goal of developing a vision for a sustainable and regenerative future of the upper Amazon. The conference offered three epistemological contributions to the existing literature in the emergent field of Montology, including addressing issues of (a) understanding the existing linguistic hegemony in describing tropical environments, (b) the redress of mistaken notions on pristine jungle environments, and (c) the inclusion of traditional knowledge and transdisciplinary approaches to understand the junglescape from different perspectives and scientific traditions. Methodologically, the conference bridged the fields of palaeoecological and ethnobotanical knowledge (as part of a wider conversation between science and local communities). Results show that local knowledge should be incorporated into the study of the junglescape and its conservation, with decolonial approaches for tourism, sharing language, methodology, tradition, and dissemination of the forest’s attributes. Our research helped co-create and formulate the “Coca Declaration” calling for a philosophical turn in research, bridging science and ethnotourism in ways that are local, emancipatory, and transdisciplinary. We conclude that facilitating new vocabulary by decolonial heightening of Indigenous perspectives of the junglescape helps to incorporate the notion of different Amazons, including the mountainscape of the Andean–Amazonian flanks. We also conclude that we can no consider Ecuador the country of “pure nature” since we helped demystify pristine nature for foreign tourists and highlighted local views with ancestral practices. Finally, we conclude that ethnotourism is a viable alternative to manage heritagization of the junglescape as a hybrid territory with the ecological legacies of the past and present inhabitants of upper Amazonia. Full article

Background & Aims: Reports of a rise in childhood cancer incidence in Australia and globally prompted the investigation of cancer incidence and survival in South Australia (SA) and the Northern Territory (NT) over a 28-year period, with emphasis on Indigenous peoples. Methods: This cross-sectional analysis of two prospective longitudinal databases, the SA and NT Cancer Registries (1990–2017), included all reported cases of childhood cancers. Poisson regression provided estimates of incidence rate ratios and survival was modelled using Cox proportional hazard models for children aged <5 and ≥5 years. Results: A total of 895 patients across SA (N = 753) and the NT (N = 142) were ascertained. Overall and in the NT, childhood cancer incidence was higher in males compared with females (IRR 1.19 [1.04–1.35] and 1.43 [1.02–2.01], respectively). Lymphocytic leukemia was the most reported cancer type across all locations. With reference to the 1990–1999 era (181.67/100,000), cancer incidence remained unchanged across subsequent eras in the combined cohort (SA and NT) (2000–2009: 190.55/100,000; 1.06 [0.91–1.25]; 2010–2017: 210.00/100,000; 1.15 [0.98–1.35]); similar outcomes were reflected in SA and NT cohorts. Cancer incidence amongst non-Indigenous children significantly decreased from the 1990–1999 era (278.32/100,000) to the 2000–2009 era (162.92/100,000; 0.58 [0.35–0.97]). Amongst 39 Indigenous children in the NT, incidence rates remained unchanged across eras (p > 0.05). With reference to the 1990–1999 era, overall survival improved in subsequent eras in SA (2000–2009: HR 0.53 [0.38–0.73]; 2010–2017: 0.44 [0.28–0.68]); however, remained unchanged in the NT (2000–2009: 0.78 [0.40–1.51]; 2010–2017: 0.50 [0.24–1.05]). In the NT, overall survival of Indigenous patients was significantly lower compared with the non-Indigenous cohort (3.42 [1.92–6.10]). While the survival of Indigenous children with cancer significantly improved in the last two eras (p < 0.05), compared to the 1990–1999 era, no change was noted amongst non-Indigenous children in the NT (p > 0.05). Conclusions: The incidence of childhood cancers has remained unchanged over 28-years in SA and the NT. Encouragingly, improved survival rates over time were observed in SA and amongst Indigenous children of the NT. Nevertheless, survival rates in Indigenous children remain lower than non-Indigenous children. Full article

Multidrug- and artemisinin-resistant (ART-R) Plasmodium falciparum (Pf) parasites represent a challenge for malaria elimination worldwide. Molecular monitoring in the Kelch domain region (pfk13) gene allows tracking mutations in parasite resistance to artemisinin. The increase in illegal miners in the Roraima Yanomami indigenous land (YIL) could favor ART-R parasites. Thus, this study aimed to investigate ART-R in patients from illegal gold mining areas in the YIL of Roraima, Brazil. A questionnaire was conducted, and blood was collected from 48 patients diagnosed with P. falciparum or mixed malaria (Pf + P. vivax). The DNA was extracted and the pfk13 gene was amplified by PCR. The amplicons were subjected to DNA-Sanger-sequencing and the entire amplified fragment was analyzed. Among the patients, 96% (46) were from illegal mining areas of the YIL. All parasite samples carried the wild-type genotypes/ART-sensitive phenotypes. These data reinforce the continued use of artemisinin-based combination therapies (ACTs) in Roraima, as well as the maintenance of systematic monitoring for early detection of parasite populations resistant to ART, mainly in regions with an intense flow of individuals from mining areas, such as the YIL. This is especially true when the achievement of falciparum malaria elimination in Brazil is planned and expected by 2030. Full article

Background: Physical activity (PA) can improve the physical and psychosocial health of individuals with cancer, yet PA levels remain low. Technology may address PA maintenance barriers in oncology, though the intervention effectiveness to date remains mixed. Qualitative research can reveal the nuances of using technology-based PA maintenance tools. The present study aimed to understand the perspectives of individuals with cancer on using an app to support PA maintenance. Methods: Individuals were interviewed after using a self-monitoring app for 24 weeks, asking about their app use, ease of use, and perceived value for supporting PA. Analyses were guided by an interpretive description. Results: Eighteen individuals were interviewed. The participants were 37–75 years old; lived in seven Canadian provinces/territories; identified as White, South Asian, or Indigenous; and had eight different cancers. Four themes were developed: some did not need the app to stay physically active, some valued the app for helping them maintain their PA, the user experience ranged from intuitive to confusing, and the time burden of app use ranged from acceptable to overwhelming. Conclusions: The participants provided insights on using a self-monitoring app to improve PA maintenance in oncology. Work is needed to capture additional perspectives and apply findings to the development of technology-based PA maintenance tools. Full article

Since 2006, the Australian Aboriginal and Torres Strait Islander Health Performance Framework (HPF) reports have provided information about Indigenous Australians’ health outcomes. The HPF was designed, in consultation with Indigenous stakeholder groups, to promote accountability and inform policy and research. This paper explores bridging the HPF as a theoretical construct and the publicly available data provided against its measures. A whole-of-framework, whole-of-system monitoring perspective was taken to summarise 289 eligible indicators at the state/territory level, organised by the HPF’s tier and group hierarchy. Data accompanying the 2017 and 2020 reports were used to compute improvement over time. Unit change and confidence indicators were developed to create an abstract but interpretable improvement score suitable for aggregation and visualisation at scale. The result is an exploratory methodology that summarises changes over time. An example dashboard visualisation is presented. The use of secondary data inevitably invites acknowledgments of what analysis cannot say, owing to methods of collection, sampling bias, or unobserved variables and the standard mantra regarding correlation not being causation (though no attempt has been made here to infer relationships between indicators, groups, or tiers). The analysis presented questions the utility of the HPF to inform healthcare reform. Full article

Despite legal safeguards, the Yanomami community faces challenges such as unauthorized incursions by gold miners, resulting in environmental degradation, particularly from mercury. This jeopardizes the health and food security of indigenous individuals, especially due to the consumption of contaminated fish. Ethnic and racial disparities persist in indigenous healthcare, marked by troubling health indicators such as malnutrition, anemia, and infectious diseases. This cross-sectional study, conducted in October 2022 in the Yanomami Indigenous Territory in the Amazon Forest, Brazil, presented clinical, laboratory, and neurodevelopmental findings in Yanomami children chronically exposed to methylmercury. The results revealed that Yanomami children exhibited weights and heights below expectations (median Z-scores of −1.855 for weight for age and −2.7 for height for age), a high prevalence of anemia (25%), low vaccination coverage (15%), and low IQ (average 68.6). The Total Hair Mercury (Total Hg) levels ranged from 0.16 µg/g to 10.20 µg/g (mean: 3.30 µg/g; median: 3.70 µg/g). Of 117 children tested, 93 children (79.4%) had levels ≥ 2.0 µg/g (had no significant difference between sex). Among the 58 children for whom it was possible to estimate the Total Intelligence Quotient (TIQ), the average value was 68.6, ranging from 42 to 92 points (median: 69.5; standard deviation: 10.5). Additionally, the lowest score on the IQ test was associated with 5 times the risk of having high levels of mercury in their hair, 2,5 fold the risk of having an older age, and almost 8 times the risk of consuming fish, adjusting for nut consumption. Notwithstanding the study’s limitations, results suggest that mercury contamination from illegal mining activities on indigenous lands may negatively impact neurodevelopment in older indigenous children, particularly those fish consumers, despite the inherent benefits of fish consumption. Addressing other socio-environmental concerns is crucial for enhancing the overall health of the population. Full article

In the last two decades, cultural tourism has transformed the aesthetics and the relationship between the actors of the Arauco territories. In the post-COVID context, these transformations could be reinforced, especially considering the actual legal scenario about indigenous rights and the global ecological crisis. In most cases, the indigenous people, with cultural tourism initiatives, highlight their world vision, including the relations with nature. For this reason, we propose to study this scientific problem from the relational ontology perspective. In this study, we describe the situation of cultural tourism in Arauco Province, Chile, where Mapuche people, the Chilean State, and the international market coexist in permanent friction. The main objective is to analyze how the pandemic influenced Mapuche cultural tourism, from the Mapuche cultural perspective and the global conditions for their development. The methods of research mixed historical and ethnographic approaches with a sample of key actors of Mapuche cultural tourism. As results, we can show the Mapuche way of understanding cultural tourism and the new conditions derived from the pandemic and post-pandemic contexts. Full article