Amazonian Indigenous resilience profile: a post-COVID perspective

If the expression "Indian time" means anything, it should signify this history of temporal multiplicity.

ABSTRACTDespite Indigenous women in the United States experiencing elevated rates of intimate partner violence (IPV), little is known about family resilience and relevant protective factors, particularly those related to family and culture. Using a framework of historical oppression, resilience, and transcendence, the purpose of this research was to uncover family and cultural-level protective factors for Indigenous women who have experienced IPV. Thematic analysis of 49 ethnographic interviews with Indigenous women who experienced IPV and with professionals who work with them indicated the following emergent protective factors: (1) family support through IPV, (2) family affirming nonviolent values, (3) tight-knit extended family unity and connectedness, (4) elders’ instilling Indigenous principles through storytelling, and (5) enculturation fostering nonviolence and ethnic pride. Depending on the family’s response to IPV, families can be protective or risk factors for Indigenous women’s wellness and recovery from IPV.

Background: In the extremely homophobic conditions in Tanzania and other countries in sub-Saharan Africa (SSA), men who have sex with men (MSM) experience disproportionate amounts of both HIV infection and psychosocial health problems, but no research has been conducted to examine the synergistic or additive effects of these adversities on their experiences. While the predominantly deficit-based research approach has identified various HIV risks and vulnerabilities, any naturally occurring protective and resilience factors that these men naturally employ to these health-related adversities remain undetermined. Purpose: This study examined the syndemic effects of psychosocial health problems on HIV infection and HIV risk and simultaneously sought to identify any resilience or protective factors that may buffer against the syndemic production of HIV infection and risk behavior among high-risk Tanzanian MSM. These syndemic health problems were coined as SAVID (Substance abuse during condomless sex, childhood and adolescent sexual abuse, violence, internalized homonegativity and depression) Methods: Cross-sectional data on demographic characteristics and HIV prevalence and risks among Tanzanian MSM residing in Dar es Salaam and Tanga were used to examine whether there is a proportional increase in HIV infection and risk as the number of syndemic conditions increases. Logistic regression analysis was used to test for interactions between syndemic conditions and to identify any potential resilience factors as a way of establishing protection against the syndemic production of HIV infection and risk among these men. At the level of interaction between protective resilience factors (moderators)-support, age visibility- and SAVID syndemic; those that reported high social visibility among Acquaintance have lower odds of contracting HIV infection when compared to those that have lower social visibility among acquaintances Results: The results revealed significant additive associations between increasing numbers of SAVID syndemic components and higher rates of HIV infection and risk. Among a variety of identified potential resilience factors, three-functional socio-support, age at self-awareness of sexual orientation and formal social visibility among acquaintances-were found to directly associated with lower odds of contracting HIV infection. At the level of interaction between protective resilience factors (moderators: functional social support, age at awareness of sexual orientation, and formal social visibility among acquaintances) and SAVID syndemics, only those sampled MSM that reported high social visibility among acquaintances had lower odds of contracting HIV infection when compared to sampled MSM that had lower formal social visibility among acquaintances Conclusion: Harnessing naturally-occurring resilience factors through strength-based research approach and innovatively disseminate them through existing secrete social network may be a cost effective and a novel health promotion strategy suitable for MSM in extreme homophobic environment.

Background: Breast cancer prognosis depends on stage at diagnosis and varies by intrinsic tumor subtype. In the US, the distribution of intrinsic subtypes has been shown to differ between racial/ethnic groups with African American and Hispanic/Latina women more likely to be diagnosed with the more aggressive triple-negative breast cancer (TNBC) lacking expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), compared to non-Hispanic/Latino White women. Hispanics/Latinos in the US are a heterogeneous group originating from different countries with different cultures and ancestral backgrounds. Information about the distribution of tumor subtypes in Latin American regions is lacking. Methods: Data for these analyses come from the Instituto Nacional de Enfermedades Neoplásicas (the Peruvian National Cancer Institute), which diagnoses and treats ~20% of all breast cancers diagnosed in Peru. We have abstracted data from clinical records for 303 patients diagnosed with breast cancer between 2010 and 2015 and who are members of Indigenous American communities from the Andean Mountain region (N=232) or the Amazonian region (N=71). We compared tumor characteristics and survival between the two groups. Comparisons between the two regions were conducted using chi-squared tests, as well as a t-test for age at diagnosis. Breast cancer subtype was defined as luminal A (ER/PR+/HER2-), luminal B (ER+/HER2+), HER2 overexpressing (ER/PR- HER2+), and triple-negative (ER/PR- HER2-) based on immunohistochemistry. Survival analyses were conducted using a Cox proportional hazards model and included region, age at diagnosis, stage, and tumor subtype as predictors. Results: Overall, tumors from the 303 Indigenous American women from Peru included in the present study were 37% luminal A, 20% luminal B, 23% HER2 overexpressing, and 19% triple-negative. Our analyses showed that women from the Amazonian region were diagnosed at a younger age (50 vs. 55 mean age at diagnosis, P value =0.001), later stage (61% vs. 48% stage III or IV, P value=0.06), and more frequently with triple-negative tumors compared to women from the Mountain region (31% vs. 17%, P value =0.013). Women from the Amazonian region had a 70% higher mortality hazard than the women from the Mountain region in a model adjusted by age at diagnosis (hazard ratio 1.73, 95%CI 1.06-2.86, p=0.027). In the full model including stage and tumor subtype, the difference in the mortality hazard was no longer statistically significant (HR 1.20, 95%CI 0.71-2.03, p=0.493). Conclusion: Differences in tumor characteristics and survival between Indigenous American women from the Amazonian and Mountain Range regions in Peru could be due to variation in genetic predisposition to particular subtypes of the disease, variation in environmental exposures, as well as to differences in cancer awareness and access to care between the different groups. The more we learn by analyzing diverse populations and subpopulations and revealing heterogeneity within Latin American women, the better equipped we will be to provide adequate care for all women. Citation Format: Lizeth I. Tamayo, Tatiana Vidaurre, Jeannie Navarro Vasquez, Sandro Casavilca, Jessica Ivonne Aramburu Palomino, Monica Calderon, Garth H. Rauscher, Laura Fejerman. Breast cancer characteristics and survival among Indigenous American women from Peru [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B79.

This study aimed to examine protective factors associated with resilience among unaccompanied refugee minors in comparison to their Norwegian peers and to examine associations between resilience factors and characteristics related to positive outcomes among unaccompanied minors. Data stem from the Pathways to Independence study conducted in Bergen municipality, Norway in 2018–2019 where 81 unaccompanied minors aged 15–20 participated (83.3% male; 80% response rate). An age- and sex-matched control group of 324 adolescents was retrieved from the youth@hordaland study conducted in Norway in 2012. Resilience factors were assessed by the Resilience Scale for Adolescents. Unaccompanied minors reported lower scores on Goal Orientation (d = 0.4), Social Competence (d = 0.4), and Social Support (d = 0.7) compared to Norwegian adolescents. Being male was associated with lower scores on Goal Orientation (standardized mean difference [SMD] = − 0.9) and Social Support (SMD = − 0.9) among unaccompanied minors, while being in frequent contact with family in the home country was associated with higher scores on all resilience factors (SMD range = 0.6–1.1). The number of leisure activities was associated with Social Competence (SMD = 0.22). There were no significant associations between the resilience factors and amount of support in the living arrangements or contact with the child welfare services. Unaccompanied minors reported fewer resilience factors compared to Norwegian adolescents, indicating that they may have different needs compared to other adolescents. Our study also suggests that frequent contact with family in the home country may be important to bolster positive development for unaccompanied minors after settlement.

The incidence of dissociative identity disorder (DID) is strongly correlated with exposure to serious physical and sexual abuse. Although studies of more than 1,000 DID sufferers indicate that severe child abuse is a predisposing factor in 95% to 98% of cases (B. Braun, 1988), abuse alone is not, in fact, predictive of DID (B. Rind & P. Tromovitch, 1997). Disorganized/disoriented attachment style and the absence of social and familial support, in combination with abuse history, best predict DID (D. Howe, 2006; R. Kluft, 1984; K. Lyons-Ruth, L. Dutra, M. Schuder, & I. Bianchi, 2006). Individuals who are securely attached are less likely to develop serious psychopathology in the event of abuse and are more likely to build a strong extrafamilial system of support—also a protective factor against psychopathology (S. Asher & J. Parker, 1989; D. Howe, M. Brandon, D. Hinings, & G. Schofield, 1999; G. Ladd & B. Golter, 1988). Recognition of the significance of secure attachment and familial and social support as protective factors against the development of DID suggests social intervention as an important area of research to mitigate the psychological consequences of insecure attachment, social disconnection, and abuse.

Cervical cancer in Indigenous women: The case of Australia

17P - Distance related outcome in indigenous and non-indigenous breast cancer women of Western Australia

Background: Breast cancer prognosis depends on stage at diagnosis and varies by intrinsic tumor subtype. In the US, the distribution of intrinsic subtypes has been shown to differ between racial/ethnic groups, with African American and Hispanic/Latina women more likely to be diagnosed with the more aggressive “triple negative” breast cancer (TNBC), lacking expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2), compared to Non-Hispanic/Latina White women. Hispanics/Latinos in the US are a heterogeneous group originating from different countries with different cultures and ancestral backgrounds. Information about the distribution of tumor subtypes in Latin American regions is lacking. Methods: Data for these analyses come from the Instituto Nacional de Enfermedades Neoplásicas (the Peruvian National Cancer Institute), which diagnoses and treats 20% of all breast cancers diagnosed in Peru. We have abstracted data from clinical records for 303 patients diagnosed with breast cancer between 2010 and 2015 and who self-reported as members of an Indigenous American community from the Andean Mountain region (indigenous subgroups: Quechuas, Aimaras, N=232) or the Amazonian region (indigenous subgroups: Shipibo-Konibo, Awajún, Ashaninka, Kichua, Ese Eja, Harakbut, Amahuaca, Shawi, Yanesha, Kakataibo, Nomatsigenga, N=71). We compared the distribution of age at diagnosis and tumor characteristics by region. Comparisons between the two regions were conducted using chi-squared tests, as well as a t-test for age at diagnosis. Breast cancer subtype was defined as luminal A (ER/PR+/HER2-), luminal B (ER+/HER2+), HER2 overexpressing (ER/PR- HER2+) and triple negative (ER/PR- HER2-) based on immunohistochemistry. Results: Overall, tumors from the 303 Indigenous American women from Peru included in the present study were 37% luminal A, 20% luminal B, 23% HER2 overexpressing and 19% triple negative. Our analyses showed that women from the Amazonian region were diagnosed at a younger age (50 vs. 55 mean age at diagnosis, P value =0.001), later stage (53.0% vs. 41.7% stage III or IV, P value=0.107) and more frequently with triple-negative tumors compared to women from the Mountain Region (30% vs. 16%, P value =0.115). Conclusion: Differences between Indigenous American women from the Amazonian and Mountain Range regions in Peru could be due to variation in genetic predisposition to particular subtypes of the disease, variation in environmental exposures, as well as to differences in cancer awareness and access to care between the different groups. The more we learn by analyzing diverse populations, subpopulations and revealing heterogeneity within Latin American women, the better equipped we will be to provide adequate care for all women. Citation Format: Lizeth I. Tamayo, Tatiana Vidaurre, Jeannie N. Vásquez, Sandro Casavilca, Jessica I. Palomino, Monica Calderon, Garth H. Rauscher, Laura Fejerman. Breast cancer characteristics among Indigenous American women from Peru [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5275. doi:10.1158/1538-7445.AM2017-5275

Tuberculosis is a disease that requires lengthy treatment. Knowledge of tuberculosis as well as family and social support are considered as important components of efficacy decisions. This study was conducted to analyse the relationship between knowledge, family and social support and self-efficacy and self-care behaviour in patients with pulmonary tuberculosis. The research used a cross sectional design. The population were 77 people and 65 respondents were obtained using a purposive sampling technique. Instruments used were knowledge, family support, social support, self-efficacy and self-care behaviour questionnaires. The data analysis method used was the Spearman rho test with a significance value of ??0.05. There were significant correlations between knowledge (p=0.003) and family support (p=0.000) and self-efficacy. There was no correlation between social support (p=0.106) and self-efficacy. There was a correlation between knowledge (p=0.048), family support (p=0.036) and social support (p=0.022) and self-care behaviour. There was a relationship between knowledge and family support and self-efficacy, whereas social support had no relationship with self-efficacy. There was a relationship between knowledge, family support and social support and self-care behaviour. Future researchers are expected to be able to design quasi experimental research to determine cultural differences (habits) in patients with pulmonary tuberculosis

Indigenous peoples in countries with similar colonial histories have disproportionate burdens of disease compared with non-Indigenous peoples. We aimed to systematically identify and collate studies describing the prevalence of pre-existing diabetes and gestational diabetes, and compare the prevalence of these conditions between Indigenous and non-Indigenous pregnant women in Australia, Canada, New Zealand, and the USA. For this systematic review and meta-analysis, an information specialist did a comprehensive search of eight databases (Ovid MEDLINE, Ovid Embase, Ovid Global Health, CINAHL [EBSCO], Scopus, ProQuest Dissertations and Theses Global, PROSPERO, and the Wiley Cochrane Library) in June, 2019, for studies published between inception and June 25, 2019, without restrictions on language, publication type, or year of publication. Database searches were supplemented by grey literature searches of the Bielefield Academic Search Engine and Google Scholar, and the reference lists of relevant articles were also manually searched. We included observational epidemiological studies comparing the prevalence of pre-existing diabetes or gestational diabetes in Indigenous and non-Indigenous pregnant women in Australia, Canada, New Zealand, and the USA. Two independent reviewers assessed study eligibility and risk of bias. We used a standardised data extraction form to collect information from the published reports of eligible studies, and, if needed, we contacted authors for further information. We did a Mantel-Haenszel random-effects meta-analysis to obtain the pooled unadjusted prevalence odds ratios (PORs) of pre-existing diabetes and gestational diabetes in Indigenous women compared with non-Indigenous women. We stratified meta-analyses by country and type of diabetes. The study is registered with PROSPERO, number CRD42018095971. Our search identified 1348 studies, of which 43 studies with 32 952 441 participants from Australia, Canada, New Zealand, and the USA were included in the systematic review, and 39 of these studies were included in the meta-analysis. 40 of the included studies used a cohort design. Pre-existing diabetes was more prevalent in Indigenous women than in non-Indigenous women, with pooled PORs ranging from 1·81 (95% CI 1·53-2·13) for women in the USA to 3·63 (2·35-5·62) for women in Australia. Similarly, gestational diabetes was more prevalent in Indigenous women than in non-Indigenous women, with PORs ranging from 1·42 (1·24-1·63) for women in Australia to 2·04 (1·46-2·84) for women in Canada. Risk of bias was low in 37·2% of studies, unclear in 34·8% of studies, and high in 27·9% of studies. Heterogeneity between studies was predominantly high (I2=97-100%), with one exception of moderate heterogeneity (I2=48%); however, the magnitude and direction of the PORs from individual studies indicated an association between pre-existing diabetes or gestational diabetes and indigeneity among pregnant women. The prevalence of pre-existing diabetes and gestational diabetes was higher in Indigenous pregnant women than in non-Indigenous pregnant women in four countries (Australia, Canada, New Zealand and the USA) with similar histories of colonialism. These findings have implications for prenatal care services and the monitoring of Indigenous women in industrialised countries. Canadian Institute of Health Research and the Women's and Children's Health Research Institute.

This paper focuses on a series of cookbooks published by Indigenous Australian groups. These cookbooks are typically produced with government funding, and are developed by nutritionists, dieticians, and health workers in consultation with local communities. They are designed to teach Indigenous Australians to cook healthy, nutritious, low-cost meals. In this paper, Fredericks and Anderson identify the value of these cookbooks as low-cost, public health interventions. However, they note that their value as health interventions has not been tested. Fredericks and Anderson question the value of these cookbooks within the broader context of the health disadvantage faced by Indigenous Australians. They argue that the cookbooks are developed from a Western perspective of health and nutrition that fails to recognise the value of traditional Indigenous foodways. They suggest that incorporating more Indigenous food knowledge and food-related traditions into cookbooks may be one way of improving health among Indigenous peoples and revitalising Indigenous knowledge.

The relationships between care environment, resilience, and social factors in orphaned and separated adolescents and youths (OSAY) in western Kenya are complex and under-studied.Survey responses from OSAY living in Charitable Children’s Institutes (CCI) and family-based care settings (FBS) in Uasin Gishu County, Kenya were used to examine the associations between 1) care environment and resilience; 2) care environment and factors thought to promote resilience (e.g. social, family, and peer support); and 3) resilience and these same resilience-promoting factors, using multivariable linear and logistic regressions. This cross-sectional study included 1202 OSAY (50.4% female) aged 10–26 (mean = 16; SD = 3.5). The mean resilience score in CCIs was 71 (95%CI = 69–73) vs. 64 (95%CI = 62–66) in FBS. OSAY in CCIs had higher resilience (β = 7.67; 95%CI = 5.26–10.09), social support (β = 0.26; 95%CI = 0.14–0.37), and peer support (β = 0.90; 95%CI = 0.64–1.17) than those in FBS. OSAY in CCIs were more likely to volunteer than those in FBS (OR = 3.72; 95%CI = 1.80–7.68), except in the male subgroup. Family (β = 0.42; 95%CI = 0.24–0.60), social (β = 4.19; 95%CI = 2.53–5.85), and peer (β = 2.13; 95%CI = 1.44–2.83) relationships were positively associated with resilience in all analyses. Volunteering was positively associated with resilience (β = 5.85; 95%CI = 1.51–10.19). The factor most strongly related to resilience in both fully adjusted models was peer support. This study found a strong relationship between care environment and resilience. Care environment and resilience each independently demonstrated strong relationships with peer support, social support, and participating in volunteer activities. Resilience also had a strong relationship with familial support. These data suggest that resilience can be developed through strategic supports to this vulnerable population. Abbreviations: 95%CI - 95% Confidence intervalAMPATH - Academic Model Providing Access to HealthcareCASSS - Child and Adolescent Social Support ScaleCCI - Charitable Children’s InstitutesCTQ - Childhood Trauma QuestionnaireFBS - Family-based care settingICAST-CH - ISPCAN Child Abuse Screening Tool for Children a HomeMSPSS - Multidimensional Scale of Perceived Social SupportMTRH – Moi Teaching and Referral HospitalMU - Moi UniversityOSAY - Orphaned and separated adolescents and youthsOSCAR - Orphaned and Separated Children’s Assessments Related to Their Health and Well-BeingOR - Odds ratioRS14 - Resilience ScaleSD - Standard deviationSDQ - Strengths and Difficulties QuestionnaireSE - Standard ErrorUG - Uasin Gishu

BackgroundThe present study investigates the role of quality of life (QOL) in enhancing psychological well-being (PWB) among young adults in transitional, collectivist societies, with particular attention to contemporary China. To advance understanding of how diverse support systems nfluence youths’ well-being, this study departs from recent literature that often conflates family support (FS) and social support (SS), and instead hypothetically distinguishes FS as a structural resource rooted in familial relationships while defining SS as a broader interpersonal resource beyond family unit.MethodsThis study empirically examines the distinct mediating and moderating roles of FS and SS in the relationship between QOL and PWB, and also explores the mediating influence of FS over the relationship between SS and QOL in shaping well-being of young adults within the Chinese context. Drawing on responses of 539 young respondents and employing key statistical methods, including reliability analysis, confirmatory factor analysis, and mediation and moderation analyses, this study tests the validity of the four proposed hypotheses.ResultsCurrent results determined that QOL strongly predicted PWB, with both FS and SS acting as significant mediators. As FS accounted for 38% of the total effect, this study advocated for the lasting influence of familial ties shaped by cultural values. SS, while being facilitated through peer networks and digital platforms, compensated for weaker family ties, especially among internal migrant youth. Even in the absence of robust FS or SS, QOL remained a significant predictor of PWB. The combined effects of QOL, FS, and SS explained 52% of the variance in PWB. Notably, QOL remained a strong predictor of PWB even in the absence of robust FS or SS, thereby emphasizing the need for public investment in education, healthcare, and housing. The combined effect of QOL, FS, and SS explained 52% of the variance in PWB.ConclusionsThis study pleads greater public investment in education, healthcare, and housing to support the well-being of young adults in China. Also, this study seeks to develop a youth-centric national well-being index to assist the cross-sectoral policy efforts. Importantly, FS influences PWB indirectly through its impact on SS, rather than through direct moderation. This distinction calls for the necessity of separating immediate familial support from broader societal networks when evaluating PWB in non-Western contexts.

This paper is based upon the findings of a qualitative study of how child protection social workers and social work managers analyse referrals. The study involved interviews with eighteen participants based on four vignettes of children potentially at risk of emotional, physical or sexual abuse or neglect. Three themes in particular are discussed—the balancing of risk, protective and resilience factors; the use of family history and the child's wider circumstances; and ‘known’ and ‘unknown’ unknowns (‘missing information’). These findings are considered in relation to the potential use of actuarial risk assessment tools or Structured Decisions Making tools in child protection social work. The first of two conclusions is that when given adequate space and time the participants tended to be to be reflective and analytical, but that difficulties remained in their ability to analyse the referrals, in particular with the identification of protective or resilience factors and in the balancing of risk and protective or resilience factors in relation to individual children. The second conclusion is that social workers and managers may benefit from assistance in identifying protective and resilience factors (and distinguishing between protective factors and resilience factors) in particular and this may offer a focus for the introduction of structured tools as a way to support current practice rather than to replace it