Brazilian Native Research Articles

Cognitive impairment and COVID‐19 in an urban indigenous community from Amazonas

AbstractBackgroundLike all minority groups worldwide, indigenous populations were most impacted by the COVID‐19 pandemic, especially in low‐middle income countries (LMICs). However, little is known about the relationship between previous COVID‐19 and cognitive performance. This study aimed to identify the prevalence of cognitive impairment and its relationship with previous COVID‐19 in indigenous mid‐aged and older adults.MethodsUsing a cross‐section approach, 134 indigenous people, 50 years and older, from an urban dwelling community located in Manaus, Amazonas, Brazil, were evaluated for cognitive impairment and previous covid‐19 disease. Cognitive impairment (CI) was based on consensus diagnostic guided by the following criteria: 1) scores on Mini‐Mental State Examination (MMSE) ≤ 14 for illiterate subjects and ≤ 19 for literate subjects (mean minus two standard deviations); 2) scores ≤ 8 on verbal fluency or ≤ 7 on delayed recall on the Brief Battery for Cognitive Screening. All those tests and criteria were already used in Brazil’s previously indigenous community and population with a low‐education level.Results30.6% of the urban indigenous community met the criteria for cognitive impairment, among them 48.8% tested positive for COVID‐19 since the pandemic has started. Logistic regression show that low education increases the changes of cognitive impairment (OD = 0.839; 95% CI = 0.748 – 0.942; p = 0.003) while previous COVID‐19 did not (OD = 0.495; 95% CI = 0.224 – 1.094; p = 0.082).ConclusionThe prevalence of cognitive impairment in an urban community of Brazilian indigenous people increased in older adults with lower education levels regardless of previous COVID‐19.

Violence and human rights

The decisions taken by Jair Bolsonaro’s government since the first day of his mandate, in January 2019, have weakened the country’s environmental control policies and contributed to reduced inspection, increased deforestation on public lands and, consequently, the violation of the rights of indigenous peoples. There is a great diversity of contexts for isolated indigenous peoples in Brazil, from small groups to a single individual. These groups are the survivors of successive massacres and are threatened by the spread of disease, and for these reasons avoid contact with other agents at any cost. In addition to the need to ensure that their territories remain protected, the decision itself to live in isolation must be guaranteed in accordance with the already established instruments, including the United Nations Declaration on the Rights of Indigenous Peoples and Convention No. 169 of the International Labor Organization (ILO). Despite the traumatic history of contact, Brazil is the country with the largest number of isolated indigenous peoples in South America, as well as has the oldest public policy in terms of guaranteeing the rights of these peoples to self-determination. The measures presented in this article substantially undermine the protection of the rights of isolated indigenous peoples and obstruct the possibility of advancing or enforcing human rights which are internationally recognised and provided for in domestic law.

Staphylococcus aureus and CA-MRSA Carriage among Brazilian Indians Living in Peri-Urban Areas and Remote Communities.

The emergence of Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections among indigenous populations has been reported. Usually, indigenous communities live in extreme poverty and are at risk of acquiring infections. In Brazil, healthcare inequality is observed in this population. To date, there are no reports of CA-MRSA infections, and no active search for asymptomatic S. aureus carriage has been conducted among Brazilian Indians. The aim of this study was to investigate the prevalence of colonization with S. aureus and CA-MRSA among Brazilian Indians. We screened 400 Indians (from near urban areas and remote hamlets) for S. aureus and CA-MRSA colonization. The isolates were submitted to clonal profiling by pulsed-field gel electrophoresis (PFGE), and selected isolates were submitted to multilocus sequence typing (MLST). Among 931 specimens (nasal and oral) from different indigenous individuals in remote hamlets, S. aureus was cultured in 190 (47.6%). Furthermore, CA-MRSA was found in three isolates (0.7%), all SCCmec type IV. PFGE analysis identified 21 clusters among the S. aureus isolates, and MLST analysis showed a predominance of sequence type 5 among these isolates. Our study revealed a higher prevalence of S. aureus carriage among Shanenawa ethnicity individuals (41.1%). Therefore, ethnicity appears to be associated with the prevalence of S. aureus in these populations.

Prostate-specific antigen test in Brazilian indigenous: a cross-sectional study

We estimated the prevalence of screening for prostate cancer in indigenous people in Brazil. We also studied how ethnicity, age, social conditions, lifestyle, and history of sexually transmitted infections are associated with altered prostate-specific antigen (PSA) values. This is a cross-sectional study with indigenous people, ≥ 40 years old, from Dourados reserve, Mato Grosso do Sul, Brazil. The patients underwent total PSA and rapid tests for syphilis, HIV, and hepatitis B and C. PSA values were compared with sociodemographic conditions, presence of urological symptoms, clinical data on sexually transmitted infections, lifestyle, and family history of cancer. Out of the 498 men invited to participate in the study, 31.53% (157/498) were ≥ 40 years old and were included. The mean (±SD) age was 54.75 (±11.23) years, and 78.3% (123/157; 95% CI: 0.71–0.84) of the population never underwent any preventive examination for prostate cancer. The mean PSA value was 0.081 ng/mL for the 157 participants, and 4.4% (7/157) had > 2.5 ng/mL and 1.9% (3/157) had values ≥ 4 ng/mL. Rapid tests for STIs showed that 5.73% (9/157) of the participants had syphilis and 0.64% (1/157) had HIV, and Hepatitis B and C virus infection. The results showed that most indigenous people ≥ 40 years never underwent any preventive examination for prostate cancer, and 4.4% had an altered PSA exam result. Future studies should assess the factors that hinder adherence to prostate cancer screening, as well as the existence of a pathophysiological correlation between the occurrence of prostate cancer and STIs.

Urbanization and cardiovascular health among Indigenous groups in Brazil

BackgroundWe described the prevalence of cardiovascular risk factors in groups of Brazilian Indigenous people at different degrees of urbanization.MethodsThe Project of Atherosclerosis among Indigenous populations (Projeto de Aterosclerose em Indígenas; PAI) is a cross-sectional study conducted in Northeast Brazil between August 2016–June 2017. It included three populations: Fulni-ô Indigenous people (lowest degree of urbanization), Truká Indigenous people (greater urbanization), and a highly urbanized non-Indigenous local cohort (control group). Participants were assessed to register sociodemographic, anthropometric, as well as clinical and laboratory-derived cardiovascular (CV) risk parameters. Age-adjusted prevalence of hypertension was also computed. Nonparametric tests were used for group comparisons.ResultsHere we included 999 participants, with a predominance of females in all three groups (68.3% Control group, 65.0% Fulni-ô indigenous group, and 60.1% Truká indigenous group). Obesity was present in 45.6% of the urban non-Indigenous population, 37.7% Truká and in 27.6% Fulni-ô participants. The prevalence of hypertension was 29.1% (n = 297) with lower prevalence in the less urbanized Fulni-ô people (Fulni-ô – 18.2%; Truká – 33.9%; and Control – 33.8%; p < 0.001). In the elderly male population, the prevalence of hypertension was 18.7% in the Fulni-ô, 45.8% in the Truká, and 54.5% in the control group. Of the 342 participants that self-reported hypertension, 37.5% (n = 68) showed uncontrolled blood pressure (BP). Uncontrolled BP was more prevalent among Truká people when compared to Fulni-ô people and non-Indigenous participants (45.4%, 22.9%, and 40.7%, respectively; p < 0.001).ConclusionsWe found a higher cardiovascular risk in communities with a higher degree of urbanization, suggesting that living in towns and cities may have a negative impact on these aspects of cardiovascular health.

Urbanization and kidney dysfunction in Brazilian indigenous people: a burden for the youth.

The aim of this study was to investigate whether the degree of urbanization influences the prevalence of chronic kidney disease in Brazilian indigenous people. This is a cross-sectional study conducted between 2016 and 2017 in northeastern Brazil and includes individuals aged between 30 and 70 years from two specific indigenous groups who volunteered to participate in the study: the Fulni-ô people (lowest degree of urbanization) and the Truká group (greater degree of urbanization). Cultural and geographical parameters were used to characterize and measure the magnitude of urbanization. We excluded individuals with known cardiovascular disease or renal failure who required hemodialysis. Chronic kidney disease was defined as a single measurement of an estimated glomerular filtration rate <60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. A total of 184 indigenous people from the Fulni-ô group and 96 from the Truká group with a median age of 46 years (interquartile range: 15.2) were included. We found a chronic kidney disease rate of 4.3% in the total indigenous population, generally affecting an older population: 41.7% over 60 years old (p<0.001). The Truká people had a chronic kidney disease prevalence of 6.2%, with no differences in kidney dysfunction across age groups. The Fulni-ô participants had a chronic kidney disease prevalence of 3.3%, with a higher proportion of kidney dysfunction in older participants (of the six Fulni-ô indigenous people with chronic kidney disease, five were older). Our results suggest that a higher degree of urbanization seems to negatively influence the prevalence of chronic kidney disease in Brazilian indigenous people.

Everyday Communication and Barter between the French and Brazilian Indians in the 16th Century

The article deals with numerous French and Portuguese testimonies on the everyday communication based on the barter between French and the Brazilian Indians in the 16th and the early 17th century. The French presence in Brazil continued for about a century, oscillating between “official” colonies (i.e. sanctioned by the French crown) and some private initiatives. This grassroots presence served for further attempts to consolidate the French positions in Portuguese America. Good relations with the indigenous population were the key to the very possibility to remain in this region. Everyday communication was concentrated on the barter; both French and Indians appreciated and considered it as profitable deal. Such barter engendered its proper rules and a kind of “local etiquette”; both French and Indians paid attention to respect it and to turn it to their profit.

O “paraíso destruído” pela “guerra justa”: O diálogo entre Las Casas e Vitória na ocultação de povos indígenas por colonizadores europeus

Abstract The domination and consequent exploitation of Amerindians did not occur, nor does it occur by chance. It is a continuous process that has come since the arrival of the European in the Americas, who believed that it was possible to explore such indigenous bodies due to their (lack of) humanity and rationality, having as a point of comparison the European being itself. Regarding this process of conquest of the Americas and, therefore, of the Amerindians, which culminated in their domination and concealment, there are two Spanish thinkers who stand out: Francisco de Vitoria and Bartolomé de Las Casas. Thus, the objective of this study is to establish a link between the speeches of the aforementioned authors, seeking to heighten the influence of the same way in which the original peoples were treated and, equally, if their thoughts can still be used as a way of "downgrading - them”, as observed in Brazil. Therefore, a deductive study is carried out by, first, highlighting the thoughts of Vitória and Las Casas, so that the reflections of their opinions on the treatment of Americans today can be stressed. Thus, insofar as the cited authors thoughts serve as a basis for the reflections of the current scenario, the analysis of the objectives follows the descriptive and explanatory method. In the end, through this bibliographical research, it is concluded that the problems presently faced by indigenous peoples in Brazil do derive from the coloniality that remains from the arrival of the European, which insists on concealing native peoples despite the normative instruments existing today that, in fact, are aimed to increase plurality through the recognition of their rights.

Suicide Among Indigenous Peoples In Brazil from 2000 to 2020

Suicide Among Indigenous Peoples In Brazil from 2000 to 2020

Ambiente, saúde e covid-19: da crise global à existência sustentável

Abstract This essay analyzes the socio-sanitary impacts exerted by the environment, incorporating the dynamics brought about by the COVID-19 pandemic and unveiling its repercussions. Countries that failed to prevent the virus spread and to established effective and collaborative intervention measures were hit the hardest. Environmental destruction reached new heights in the pandemic, as have the threats faced by its defenders, further aggravating the crisis. In this scenario one can highlight the risks posed to Brazilian Indigenous peoples and Latin American environmentalists; the emergence of dangerous groups; and the implementation of government policies with critical effects on environmental preservation that put traditional ways of life at risk. It is thus recognized that the planet faces not only a health crisis, but also a socioeconomic and environmental one. To overcome such heterogeneous crisis, efforts must be multifaceted, involving: caring for health and ecosystems; eliminating global poverty and sanitary inequality; reducing environmental risks; protecting traditional ways of life; defending democracies and human rights; and fostering sustainable development policies and international cooperation. These efforts will also affect the years to come, minimizing the risks of new pandemics and acting to preserve the environment.

Measurement properties of the Brazilian version of the Kidney Symptom Questionnaire

The aim of this study was to measure the reliability, internal consistency, and construct validity of the Kidney Symptom Questionnaire for the Brazilian population. This is a cross-cultural adaptation and questionnaire validation study. We included native Brazilians of both sex aged>18 years, as well as hypertensive and/or diabetic patients. All participants were assessed using Screening for Occult Renal Disease, EuroQol 5 Dimensions, 36-Item Short Form Survey, and the Kidney Symptom Questionnaire. We used Spearman's coefficient (rho) to measure the correlations between the Kidney Symptom Questionnaire and other instruments; Cronbach's alpha to measure internal consistency; and intraclass correlation coefficient, standard error of measurement, and minimum detectable change to measure test-retest reliability. The sample was formed by 121 adult participants, mostly female, with systemic arterial hypertension and/or diabetes mellitus. We found excellent reliability (intraclass correlation coefficient≥0.978), adequate internal consistency (Cronbach's alpha≥0.860), and adequate construct validity on the Kidney Symptom Questionnaire domains; besides, we observed significant correlations between the Kidney Symptom Questionnaire and other instruments. The Brazilian version of the Kidney Symptom Questionnaire has adequate measurement properties to assess chronic/occult kidney disease in patients who do not require renal replacement therapy.

Continuity and Disruption of Borders (a Complete Art Performance)

This three-part collection presents the physicality of borders as conceived by Paulo Nazareth (born Brazil, 1977). First, a 2006 series of pamphlets depict migration in ways that may not be realistic or factually realizable, but the point is the intention. In a second step, a photo series capture moments of the artist’s journey on the road of the Americas, traveling through 15 countries on foot and by bus from his native Brazil to the United States. Finally, the poignant 2022 testimony of a cleaning lady working for his gallerist Mendes Wood DM is presented here in the original Spanish, as Florencia Cruz Ramos recounts her journey as an immigrant and the impact of Nazareth’s work on her life.

Amazon Rainforest Deforestation and Indigenous People Movement in Preserving Environmental Conservation

Background: The Amazon forest is one of the areas experiencing the largest deforestation in the world and this causes a decrease in environmental quality that occurs in its region, and Brazil is responsible for half of the deforestation in the Amazon because deforestation in the Brazilian Amazon region has the largest percentage compared to other regions. Objective: In line with the formulation of the problem described above, the purpose of writing this paper is to find out why there is a decline in environmental quality and how the role and efforts of Brazilian indigenous people are to protect the environment in the Amazon Forest region. Method: The researchers used qualitative approach here. The data were obtained from various documents, including journals and news from different platforms. The researcher analyzed the data by reading every document thoroughly and concluding the result. Result: The result of the conversion of forest land in the Amazon is that other lands are easier and faster to evict as well when compared to the first time this exploitation activity was carried out in the 1970s to mid-2000s. Large areas of rainforest in the Amazon were eventually filled with livestock, soybean farming, excavation of dams and minerals, as well as clearing of land for urban projection and colonialization projects. Conclusion: From this writing, it can be concluded that the deforestation that occurs in the Amazon Forest is caused by human activities or irresponsible parties who turn the forest into land for personal gain.

The impact of urbanisation on the cardiometabolic health of Indigenous Brazilian peoples: a systematic review and meta-analysis, and data from the Brazilian Health registry

Indigenous Brazilian peoples have faced an unparalleled increase in the rate of cardiovascular diseases following rapid nutritional transition to more urban diets. We aimed to conduct a systematic review and meta-analysis to evaluate the association between urbanisation (including data from Amazon rainforest deforestation) and cardiometabolic risk factors and outcomes. In this systematic review and meta-analysis, we searched Pubmed, Embase, Web of Science, and Scopus for articles published in any language between the year 1950 and March 10, 2022. Studies conducted in Indigenous Brazilian adults that evaluated metabolic health were included. Data for deforestation was obtained by the Amazon Deforestation Monitoring Project. Cardiovascular mortality was obtained from the Brazilian Health registry. Two independent reviewers evaluated studies for risk of bias, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The main outcomes assessed were the prevalence of obesity and related cardiometabolic risk factors among Indigenous Brazilian peoples and its association with urbanisation. Summary data were extracted from published reports for the meta-analyses. We calculated pooled estimates of the prevalence of each cardiometabolic outcome by using a random-effects model (DerSimonian-Laird method). This study is registered with the International Prospective Register of Systematic Reviews, CRD42021285480. 46 studies were identified, including a total of 20 574 adults from at least 33 Indigenous Brazilian ethnicities. Meta-analyses of the prevalence of obesity showed that there were higher rates of obesity (midwest region: 23% [95% CI 17-29]; and south region 23% [13-34]) and hypertension (south region: 30% [10-50]) in Indigenous peoples living in urban regions of Brazil, while the lowest rates of obesity (11% [95% CI 8-15]) and hypertension (1% [1-2]) were observed in those in the less urbanised (north) regions of Brazil. The prevalence of obesity was 3·5 times higher in participants living in urbanised Indigenous territories (28%) than in those living in lands with >80% native Amazon rainforest (8%). In meta-analyses that evaluated blood pressure level, there was no incremental change in blood pressure with ageing in Indigenous peoples who lived according to traditional lifestyle, in contrast to those living in urbanised regions. For Indigenous men with traditional lifestyles, systolic blood pressure changed from 109·8 mm Hg to 104·4 mm Hg between the youngest (<30 years) and the oldest (>60 years) age groups, and diastolic blood pressure changed from 69·8 mm Hg to 66·1 mm Hg. For Indigenous women with traditional lifestyles, systolic blood pressure was 100·0 mm Hg for the youngest age group with no changes for older age groups, and diastolic blood pressure was 62 mm Hg for the youngest age group with no changes for older age groups. For Indigenous men with urbanised lifestyles, systolic blood pressure changed from 117·3 mm Hg to 124·9 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 72·7 mm Hg to 76·4 mm Hg. For Indigenous women with urbanised lifestyles, systolic blood pressure changed from 110·0 mm Hg to 116·0 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 68·3 mm Hg to 74·0 mm Hg. For the years 1997 and 2019, the cardiovascular mortality rate in individuals living in the southeast region (the most urbanised) was 2·5 times greater than that observed in the north. Conversely, the incremental rise in cardiovascular mortality in the past two decades among Indigenous Brazilians living in the north or northeast (2·7 times increase) stands in stark contrast to the stable rates in those living in already urbanised regions. The macrosocial changes of Indigenous peoples' traditional ways of living consequent to urbanisation are associated with an increased prevalence of adverse cardiometabolic outcomes. These data highlight the urgent need for environmental policies to ensure the conservation of the natural ecosystem within Indigenous territories, as well as the development of socio-health policies to improve the cardiovascular health of Indigenous Brazilians peoples living in urban areas. None.

Apropriação e expropriação das terras indígenas na cidade de São Paulo

Abstract The city of São Paulo has the fourth largest presence of indigenous peoples in Brazil. In this article, we relate the growth process of São Paulo to the historical situation of this city’s indigenous peoples. We focus on the incorporation of these peoples in the colonizing process, accomplished with the expropriation of their lands to ensure occupation and possession of colonial territory. Finally, we analyze the peripheralization of these peoples as a historical symptom, which also emerges as an instrument of state action for the development of the city and its urban apparatuses. This analysis is carried out through a bibliographic review of classical and contemporary authors and of reports that address the theme.

PREVALÊNCIA DE COMPROMETIMENTO COGNITIVO EM INDÍGENAS BRASILEIROS DO AMAZONAS

ABSTRACT. Studies on the prevalence of dementia in the indigenous population are still scarce worldwide. In the few available studies, prevalence evidence varies from low to very high, with early onset of the disease and high mortality rate after the initial diagnosis. Still, little is known about the rate of dementia in indigenous populations from low- and middle-income countries, where the dementia prevalence in the general population is estimated to increase significantly in the next decades. Objective: This study aimed to determine the prevalence of cognitive impairment and associated factors in Brazilian indigenous people of the Mura ethnicity in Amazonas, Brazil. Methods: A total of 217 indigenous individuals aged 50 years and older from Amazonas, Brazil, were submitted to cognitive assessment. Attention, memory, verbal fluency, visuospatial performance, and mood state composed the cognitive impairment diagnosis. Results: The prevalence of cognitive impairment was 43.3% (95%CI 36.6-49.7) and varied according to age [OR=1.03 (95%CI 1.00-1.06)], education [OR=0.74 (95%CI 0.62-0.87)], body mass index [OR=0.91 (95%CI 0.83-0.98)], and income [OR=0.52 (95%CI 0.27-0.99)]. Conclusions: Cognitive impairment had an early onset in an indigenous community, and its prevalence was greater in older individuals with low education and low family income. These findings highlight the importance of implementing public indigenous health policies focusing on health professional training for early cognitive impairment detection.

Soil Management in Indigenous Agroforestry Systems of Guarana (Paullinia cupana Kunth) of the Sateré-Mawé Ethnic Group, in the Lower Amazon River Region

The Sateré-Mawé Brazilian indigenous people cultivate the guarana liana in biodiverse agroforests that incorporate many species, mainly trees, and produce food, medicines, fuel and income. The objective of this study was to evaluate the soil fertility in nineteen indigenous guarana agroforestry systems (AFSs) compared with areas of adjacent forests in the Andirá–Marau Indigenous Land—an ancestral territory of the Sateré-Mawé people. Soils in both locations showed low natural fertility, with levels of most macronutrients below the minimum agronomic reference levels. Higher C and soil organic matter (SOM) content was observed in the forest soils and may be related to greater vegetation cover and higher litter production. However, the maintenance of the average levels of most nutrients in the soil of the AFSs, at the same level as under the forests, suggests that efficient nutrient cycling is taking place. In these conditions, the management of organic matter seems to be essential to maintain the productivity of guarana AFSs since levels of C, SOM and organic N were not considered as low as those of most of the other soil attributes that were evaluated. The high tree diversity in the guarana agroforests, including N-fixing species, may also contribute to efficient nutrient cycling and maintenance of the soil food web. The results suggest that the addition of limestone, green manure practices and the reincorporation of organic residues from guarana processing, among other sources, can be a low-cost alternative to improve soil fertility and increase guarana production in the AFS under study.

P308 Jorge lobo's disease in brazil: a new recognized reservoir?

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMLobomycosis (lacaziosis) is a chronic subcutaneous disease caused by the uncultivated fungus Lacazia loboi. The disease was first described in 1931 by Jorge Lobo in Brazil and has been reported in South and Central America. Lobomycosis is a rare disease that affects certain geographic regions, mainly in countries of low socioeconomic status, but its prevalence among indigenous people in Brazil is exceptionally high. The state of Maranhão is located in the northeast region of the country and there are rare clinical reports of imported cases of the disease in our region. This is the first published series of autochthonous cases of lacaziosis in Maranhão.ObjectiveTo describe seven cases of Lacazia loboi infections in immunocompetent patients in an endemic area for other subcutaneous mycoses.MethodsWe retrospectively reviewed the medical records of all patients who developed Jorge Lobo's diseases in a new area recognized as a potential environment reservoir. An incident case was defined as a patient who developed proven lacaziosis based on the presence of topical fungal elements in the tissue on histopathology or mycologic direct exam. Epidemiological and clinical data of all cases of lacaziosis were collected using a standard clinical form.ResultsIn the period from 2000 to 2021, seven patients were identified. All cases were diagnosed by histopathology and direct mycological examination of the lesions. A total of 6 out of 7 (85.7%) patients were men and the mean age was 57 years (52-70 years). The median time between onset of infection symptoms and diagnosis was ˃2 years in 6 patients, with 15 years of symptoms duration in patient 7. All patients reported having worked with agricultural activities before. A total of 50% of patients were diagnosed with localized lesions and the other half with disseminated lesions. Subcutaneous lesions involved the upper limbs (4/6; 66.6%), ears (2/6; 33.3%), lower limbs (1/6; 16.6%), and trunk (1/6; 16.6%). All patients exhibited nodules as a dominant pattern of skin lesion, sometimes coalescing with the tumor's appearance. Regarding treatment, a combination of itraconazole and clofazimine therapy was added to all patients. Surgical excision was possible only in 2 episodes due to the limited availability of this procedure at the site. Cure was documented in 2 cases, with no recurrence to date.ConclusionThe present series represents the first and largest collection of case studies of lacaziosis in Maranhão state, with all cases classified as autochthonous. Lacaziosis involves mainly adult males with different occupational risks such as agricultural labor, and other workers exposed to contaminated soil and plant materials. Few data are available to support suggested therapy with itraconazole and clofazime. Excision surgery is important for treatment due to the absence of clinical trials in the medical literature. Epidemiological surveillance studies of new cases of lacasiozis in Maranhão are important for mapping this new reservoir and developing public policies for diagnosis and treatment.

Responding to a corruption crisis through disclosure and remedial action: The case of Petrobras

This case study adopts a positivist perspective to examine how Petroleo Brasileiro S.A (“Petrobras”), a high-profile company in its native Brazil with multiple listings including in Brazil and the US, responded to a major corruption scandal arising in 2014. We consider Petrobras's response both in terms of its visible activities – i.e. in relation to anti-corruption and compliance (“ACC”) disclosures in its annual report (AR) and sustainability report (SR), as well as actioned remedial policies that constitute the crisis plan – and how the company went about interacting with stakeholders during and after the immediate crisis period. We conducted a content analysis of ACC disclosures and assessed Petrobras's remedial activities in the eight-year period 2010–2017 as disclosed in its ARs, SRs and press releases. We find firstly that, consistent with legitimacy theory, Petrobras responded by voluntarily and substantially increasing its relevant disclosures so as to regain legitimacy, a finding which mirrors those found elsewhere following corruption and environmental crises. Secondly, the unique corporate governance situation at Petrobras combined with the fact that leadership was allegedly implicated in the scandal, led the post-crisis management team to undertake a series of remedial actions that prioritised the need to take and maintain executive control and independence from the government, whilst at the same time carefully managing the relationship with this influential stakeholder: - actions which argue strongly in favour of stakeholder-agency theory and multiple agency theory interpretations of the nature of stakeholder interactions that transpired during the crisis period of disequilibrium, and which precluded the type of stakeholder dialogue seen in some previous environmental crisis situations. Finally, we show that Petrobras's crisis management response actions align well with models of trust repair and legitimacy management, and suggest the company considered it had successfully regained legitimacy by 2017.

COVID-19 vaccination, incidence, and mortality rates among indigenous populations compared to the general population in Brazil: Describing trends over time

BackgroundChronic social and health inequities faced by indigenous peoples in Brazil foretell the detrimental impact of COVID-19.MethodsWe use de-identified, publicly available data from the Ministry of Health from March/2020 - December/2021 to describe vaccination coverage, cumulative incidence, and cumulative mortality rates due to COVID-19 among indigenous peoples. We also compare vaccination coverage among indigenous peoples with that reported for older adults, who were simultaneously included as a priority group in the vaccination strategy. Finally, we compared COVID-19 incidence and mortality rates in the indigenous population with that reported for the general Brazilian population.FindingsWe found important heterogeneities in vaccination coverage across the 34 indigenous districts, and a lower overall coverage among indigenous peoples compared to older adults. We observed higher COVID-19 cumulative incidence rates among indigenous populations compared to the general Brazilian population. Although mortality rates were seemingly lower, data should be interpreted with caution due to a younger age structure and more frequent underreporting of cases and deaths among indigenous populations. After the beginning of COVID-19 vaccination program, we observed a decrease in both incidence and mortality rates among indigenous peoples in all Brazilian regions.InterpretationThe COVID-19 pandemic has had a heavy toll on vulnerable populations. Although social and geographic isolation challenges the implementation of any vaccination program for indigenous populations, prior experience suggests that the COVID-19 vaccination strategy lacked effectiveness. The absence of a coordinated strategy to reinforce the importance of the vaccine and other prevention methods, to guarantee the access to trustworthy information, and to respond with the necessary resources in extreme situations, resulted in lower COVID-19 vaccination coverage, higher incidence rates, and preventable deaths due to COVID-19 among indigenous peoples in Brazil.FundingThis work was not supported by specific funding.