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Spirometry is the most important tool in diagnosing pulmonary disease and is the most frequently performed pulmonary function test. Respiratory disease is also one of the greatest causes for morbidity and mortality on the Hopi Nation, but no specific reference equations exist for this unique population. The purpose of this study was to determine if population reference equations were necessary for these children and, if needed, to create new age and race-specific pulmonary nomograms for Hopi children. Two hundred and ninety-two healthy children, ages 4-13 years, attending Hopi Nation elementary schools in Arizona, were asked to perform spirometry for a full battery of pulmonary volumes and capacities of which the following were analyzed: forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), FEV1 % (FEV1/FVC), FEF25-75% and peak expiratory flow rate (PEFR). Spirometric data from Navajo children living in the same geographical region as the Hopi children were compared as well as spirometric data from common reference values used for other ethnic groups in the USA. Spirometry tests from 165 girls and 127 boys met American Thoracic Society quality control standards. We found that the natural log of height, body mass and age were significant predictors of FEV1, FVC, and FEF25-75% in the gender-specific models and that lung function values all increased with height and age as expected. The predictions using the equations derived for Navajo, Caucasian, Mexican-American, African-American youth were significantly different (P ≤ 0.05) from the predictions derived from the Hopi equations for all of the variables across both genders, with the exceptions of Hopi versus Navajo FEV1/FVC in the males and Hopi versus Caucasians FEF25-75% in the females. Thus it would appear for this population important to have specific formulae to provide more accurate reference values.

Spirometry is the most important tool in diagnosing pulmonary disease and is the most frequently performed pulmonary function test. Since respiratory disease is the single greatest cause for morbidity and mortality on the Navajo Nation, the purpose of this study was to create newage and race-specific pulmonary nomograms for Navajo children. Five hundred fifty-eight healthy children, ages 6-14 years, attending Navajo Nation elementary schools in Arizona, were asked to perform spirometry to develop population-specific and tribe-specific nomograms for forced vitalcapacity (FVC), forced expiratory volume in 1 sec (FEV1), and FEV1 Ratio (FEV1/FVC). Spirometry tests from 284 girls and 274 boys met American Thoracic Society quality control standards. Lung function values, except for FEV1/FVC, all increased with height. The lower limit of the normal range for FEV1/FVC was 80%. The spirometry reference equations from the healthyboys and girls were developed. Height and the natural log of height were significant predictors of FEV1, FVC, and FEF25-75% in the gender-specific models. The resulting population-specific spirometry reference equations should be used when testing Navajo children ages 6-14 years. However, the use of the NHANES III spirometry reference equations for Caucasian children may not result in significant misclassification in clinical settings providing that a maximal effort is given by the Navajo child being tested.

博士(アメリカ研究) / Doctor of Philosophy in American Studies / 同志社大学 / Doshisha University

Definitions and boundaries of race and ethnicity are socially constructed. They are malleable inventions created by the negotiation of ascribed ideas from outside groups and asserted notions from the inside group's membership. The revitalization of Taíno identity and culture within the Puerto Rican and related communities is a classic case example of this negotiation. Although objective conditions exist to recognize the descendants of these Caribbean aboriginals as an identifiable group, their identities are contested and sometimes ridiculed. Even though Taíno heritage is accepted as an essential root of Puerto Rico's cultural and biological make-up, this group has been classified as extinct since the early 16th century. This thesis analyzes the official newsletters of the Taíno Nation of the Antilles--one of the leading organizations working for revitalization. The content of this material culture was dissected and organized into rhetorical categories in order to reveal patterns of endogamic assertions of race and ethnicity. This thesis will provide a descriptive analysis of the Taíno Nation's rhetorical process of convincing the world that they do in fact exist.

A epidemiologia da saúde bucal dos povos indígenas no Brasil ainda é pouco conhecida. Os dados disponíveis, em geral, são pertinentes às zonas urbanas. As informações sobre a epidemiologia dessas doenças no Parque Indígena do Xingu (PIX) resultam de investigações nas quais foram utilizadas diferentes metodologias de coletas e análises de dados, dificultado assim um adequado panorama epidemiológico. A partir da implantação do Distrito Sanitário Especial Indígena do Xingu (DSEI-Xingu), em 1999, foram realizados três inquéritos epidemiológicos para doenças bucais, baseados na metodologia proposta pela OMS. O presente estudo teve como objetivo analisar a epidemiologia das referidas doenças no PIX, especificamente de quatro aldeias de diferentes etnias, considerando as necessidades assistenciais odontológicas. Para tal, foi realizado um estudo epidemiológico descritivo, utilizando dados secundários colhidos pela equipe do DSEI-Xingu, provenientes de inquéritos realizados em três momentos distintos: 2001, 2003 e 2006. Foram utilizados:o índice CPO-D, para avaliação da experiência de cárie e para aferir a doença periodontal, o índice periodontal comunitário (IPC). A análise dos resultados mostrou que nas aldeias estudadas, o principal problema de saúde bucal é a cárie, atingindo no ano de 2006, 81% da população. Em relação à cárie, nota-se uma queda nas médias do CPO-D para a maioria das faixas etárias no ano de 2006 em relação a 2001 e houve melhora também nos percentuais de pessoas livres de cárie para as idades entre 0 e 19 anos. As médias de ceo-d para o grupo etário de 0 a 3 anos apresentam elevação no período, exceto na aldeia Moigu, que mostrou diminuição de 8,0 em 2001 para 1,8, em 2006. Ao se analisar os componentes do CPO-D e ceo-d, quando comparados os dados obtidos em 2006 e 2001, foi possível verificar que o componente \"cariado\" apresentou redução para a maioria das faixas etárias em todas as aldeias, assim como o aumento dos componentes \"obturados e perdidos\". Observou-se que para a dentição decídua o componente cariado possui grande contribuição no ceo-d em todas as aldeias, variando entre 69% a 86% do índice. Isso traduz dificuldades no acesso dessa população aos serviços odontológicos. O índice IPC mostrou aumento do percentual de pessoas sem doença periodontal em todas as aldeias, queda no percentual de pessoas com algum tipo de bolsa periodontal e cálculo como o principal problema. Em relação às necessidades de tratamento verificou-se que restaurações foram as indicações mais freqüentes e houve um aumento no número de dentes sem nenhuma necessidade. Para a doença periodontal, observou-se que mais de 80% das pessoas acima de 15 anos precisam de tratamento e necessidade de profilaxia; as necessidades por cuidados mais complexos representam apenas 3% . Concluímos que no período de 2001 a 2006,houve uma melhoria nas condições de saúde bucal dessas populações. Uma hipótese explicativa seria a estruturação do programa de saúde bucal nestas áreas. / There is a lack of information about the epidemiology of oral health conditions of the Indian population in Brazil. In general, available data are related to urban regions. Information about the epidemiology of oral health in the Xingu Indian Park (PIX) derive from surveys that employed different methodologies for collecting and analyzing the data, making it difficult to have an adequate picture of the problem. Since the creati of the indian Special Sanitary District of Xingu (DSEIXingu) in 1999, three epidemiologic surveys for oral health were carried out, based on the methodology proposed by the World Health Organization - WHO. The present study analyzed the oral health conditions in four villages of the PIX, considering treatment needs. A descriptive study was performed, using data already collected by surveys carried out by the health team of the DSEI-Xingu, employing the same methodology, in the years 2001, 2003 ead 2006. The DMF-T index was used to avaluate the caries experience, and for periodontal disease, the community periodontal index (CPI). The analisys of the results showed that the main oral health problem in the studied villages was tooth decay, reaching 81% of the population in 2006. In relation to caries, it was observed a decline in the mean of the DMF-T for majority of the age-groups in 2006 in relation to 2001 and an improvement in the proportion of people free of caries for the ages between 0-19 years. The mean of the dmf-t for the 0 to 3 year age-group was higher in 2006, except in the Moigu village, where a decline was observed (from 8.0 in 2001 to 1.8 in 2006). Comparing the DMF-T and dmf-t between 2006 and 2001, it was observed that the component \" decayed\" decreased in most of the age-groups in the four villages, as well as an increase in the component \"filled and missing\". For the deciduous teeth, the component \"decayed\" had greater contribution in the dmft in all the villages. The CPI index showed an increase in the proportionof persons without periodontal disease and a decrease in the proportion of persons with some kind of periodontal pockets in all the villages. Calculus was the main problem. In relation to treatments needs, indication of restoration was the most frequent and there was a increase in the number of teeth without any need. For periodontal disease, more than 80% of the persons aged 15 years or more need treatment and professional tooth cleaning; more complex treatment was required only by 3% of the individuals. We concluded that there was an improvement in the oral health conditions of this population, in the period 2001 to 2006. an explanatory hypothesis for this findings could be the implementation of the strutured oral health program in this region.

A população indígena brasileira compreende mais de 900 mil indivíduos distribuídos por todos os estados da Federação. Diversos estudos têm apontado para a deterioração da saúde bucal dos povos indígenas ao longo das últimas décadas, embora dados epidemiológicos ainda sejam escassos. A transição para um modelo alimentar baseado em uma dieta rica em gorduras, açúcares e alimentos refinados tem sido indicada como um fator contribuinte para o desenvolvimento de doenças como a obesidade e a cárie dentária em diferentes populações. O objetivo deste estudo é analisar o perfil epidemiológico de saúde bucal da população indígena adulta residente na Terra Indígena Guarita, bem como investigar aspectos subjetivos e determinantes sociais relacionados. Buscou-se, ainda, analisar a experiência de cárie dentária nos povos indígenas da América do Sul. Foi realizada uma revisão sistemática da literatura e meta-análise referente à severidade de cárie dentária em povos indígenas que habitam países sul-americanos. Além disso, foram conduzidos grupos focais com as etnias Kaingang e Guarani da Terra Indígena Guarita. Os dados produzidos foram analisados por meio da metodologia Grounded-Theory e interpretados a partir da teoria do sociólogo Pierre Bourdieu. Adultos com idade entre 35 e 44 anos de ambas as etnias foram examinados em relação à experiência de cárie, necessidade de tratamento, e uso e necessidade de prótese dentária. Participantes responderam a Escala Brasileira de Insegurança Alimentar, a versão curta do questionário Oral Health Impact Profile, e a uma entrevista estruturada sobre dados sociodemográficos e uso de serviços odontológicos. Foram observadas altas experiências de cárie entre povos indígenas da América do Sul, contrastantes com a redução da prevalência da doença na população não indígena. Interferências nos sistemas alimentares indígenas afetam aspectos da identidade cultural, da organização social e da saúde das comunidades indígenas Este fenômeno implica em percepções de vulnerabilidades de saúde bucal e tensões entre o modelo biomédico e as práticas tradicionais de cura. Participantes (n = 109) apresentaram média de dentes cariados, perdidos e obturados de 14,45 (± 5,80). Cerca de dois terços do valor do índice foi composto por dentes perdidos. Necessidade de tratamento foi observada em 93% da população. Foram observadas altas frequências de necessidade de prótese e de experiência de perda dentária. Diferenças significativas na prevalência de dentição funcional foram observadas em relação a sexo e tempo da última consulta odontológica. Cerca de 94% dos participantes vivem em domicílios em situação de insegurança alimentar. Maiores pontuações de insegurança alimentar apresentaram associação com o recebimento do benefício Bolsa Família, maior densidade domiciliar e maior percepção dos impactos da saúde bucal na qualidade de vida. A presença de insegurança alimentar severa foi mais prevalente entre indivíduos que vivem em domicílios com mais de 5 moradores e aqueles com maior pontuação no instrumento OHIP-14. Este estudo apresenta dados epidemiológicos importantes para a compreensão das condições de saúde bucal dos povos Kaingang e Guarani, assim como para o planejamento de serviços de saúde culturamente apropriados para as necessidades desta população. / The Brazilian indigenous population comprises more than 900 thousand individuals distributed throughout all states of the Federation. Several studies have pointed to the deterioration of oral health of indigenous peoples over the last decades, although epidemiological data are still scarce. The transition to a food system based on a diet rich in fat, sugars and refined foods has been pointed out as a contributing factor for the development of diseases such as obesity and dental caries in different populations, including native peoples. This study aims to analyze the oral health epidemiological profile of the adult indigenous population living at the Guarita Reservation, as well as to investigate associated subjective aspects and social determinants. It was also intended to analyze the dental caries experience in the indigenous peoples of South America. A systematic review of the literature and meta-analysis regarding the severity of dental caries in indigenous peoples living in South American countries was carried out. In addition, focus groups were conducted with the Kaingang and Guarani ethnic groups from the Guarita Reservation. The produced data were analyzed through the Grounded-Theory methodology and interpreted using the Pierre Bourdieu\'s theory. Adults aged 35-44 years of both ethnicities were examined regarding caries experience, treatment need, and use and need of prosthodontics. Participants answered the Brazilian Food Insecurity Scale, the short version of the Oral Health Impact Profile questionnaire, and a structured interview on sociodemographic data and use of dental services. High caries experiences were observed among indigenous peoples of South America, contrasting with the reduction of the prevalence of the disease in the non-indigenous population. Interferences in indigenous food systems seem to affect aspects of cultural identity, social organization, and health of indigenous communities. This phenomenon implicates in perceptions of oral health vulnerabilities and tensions between the biomedical model and traditional healing practices. Participants (n = 109) presented a mean number of decayed, missing and filled teeth of 14.45 (± 5.80). About two-thirds of the value of the index was composed of missing teeth. Need for treatment was observed in 93% of the population. It was observed a high frequency of prosthodontic need and experience of tooth loss. Significant differences in the prevalence of functional dentition were observed in relation to sex and time of the last dental visit. Approximately 94% of participants live in food insecure households. Higher food insecurity scores were associated with the Bolsa Família benefit, higher household density and greater perception of the oral health impacts on quality of life. The presence of severe food insecurity was more prevalent among individuals living in households with more than 5 residents and those with higher scores on the OHIP-14 instrument. This study presents important epidemiological data for understanding the oral health conditions of the Kaingang and Guarani peoples, as well as for the planning of culturally appropriate health services to the needs of this population.

Objetivo. Nesta investigação, analisa-se a dinâmica demográfica dos índios Kaiabi do Parque Indígena do Xingu (PIX), Mato Grosso, Brasil, no período 1970-1999. Métodos. Análise transversal e longitudinal da dinâmica demográfica, com base em nas informações do registro de eventos vitais da população das aldeias Kaiabi do PIX, gerados pelo programa de saúde da UNIFESP no Xingu, apoiados por levantamento histórico e etnográfico. Resultados. O contato com a sociedade nacional, nas décadas de 1920 a 1950, na região do rio Teles Pires, deu origem à depopulação das aldeias por confrontos e epidemias e à migração de parte dos Kaiabi para o Xingu. Em 1970, havia 204 no Parque e em 1999, 758. O crescimento da população foi de 4,5% ao ano, a taxas bruta de natalidade é alta ( 53,7 por mil habitantes) e de mortalidade baixa (8,1 por mil habitantes). Na população, 56,2% são menores de 15 anos de idade, sendo a taxa de mortalidade infantil de 15,2 por mil nascimentos vivos, em razão de um programa de saúde indígena existente na área desde 1965. A recuperação demográfica desta população se assemelha a do conjunto da população do Xingu, também atendida pelo programa de saúde. Destaca-se a analise da fecundidade por coortes acompanhadas por períodos de 35 anos, e a importância da coleta sistemática de dados demográficos para populações indígenas. / Objective. This study analyses the demographic dynamic of the Kaiabi a indigenous people of the Xingu river, Mato Grosso, Brazil, from 1970 to 1999. Methods. The demographic survey included cohort and period analyse, with vital statistics from the health service of the Xingu Indigenous Park. Results. Contact with Brazilian national society, established in the 1920 and 1950, in the Teles Pires river region, caused a population drop due to clashes and epidemics. In 1952, a part of the Kaiabi group start to migrate to the Xingu region where they live at present. In 1970 there where 204 individuals in the Xingu villages and in 1999, 758. The crude birth rate is higth (53,7 per thousand inhabitants) and the death crude rate low (8,1 per thousand inhabitants). The majority of the population is under 15 years of age (56,2%) and the infant mortality rate is low or moderate (15,2 per thousands live births ), considering indigenous communities on general, because a health indigenous program is installed on the area before 1965. The demographic recovery starts at 1975 and is similar to that others indigenous Xingu groups. The research highlights the importance of a analyse of fertility cohorts about 35 years.

A epidemiologia da saúde bucal dos povos indígenas no Brasil ainda é pouco conhecida. Os dados disponíveis, em geral, são pertinentes às zonas urbanas. As informações sobre a epidemiologia dessas doenças no Parque Indígena do Xingu (PIX) resultam de investigações nas quais foram utilizadas diferentes metodologias de coletas e análises de dados, dificultado assim um adequado panorama epidemiológico. A partir da implantação do Distrito Sanitário Especial Indígena do Xingu (DSEI-Xingu), em 1999, foram realizados três inquéritos epidemiológicos para doenças bucais, baseados na metodologia proposta pela OMS. O presente estudo teve como objetivo analisar a epidemiologia das referidas doenças no PIX, especificamente de quatro aldeias de diferentes etnias, considerando as necessidades assistenciais odontológicas. Para tal, foi realizado um estudo epidemiológico descritivo, utilizando dados secundários colhidos pela equipe do DSEI-Xingu, provenientes de inquéritos realizados em três momentos distintos: 2001, 2003 e 2006. Foram utilizados:o índice CPO-D, para avaliação da experiência de cárie e para aferir a doença periodontal, o índice periodontal comunitário (IPC). A análise dos resultados mostrou que nas aldeias estudadas, o principal problema de saúde bucal é a cárie, atingindo no ano de 2006, 81% da população. Em relação à cárie, nota-se uma queda nas médias do CPO-D para a maioria das faixas etárias no ano de 2006 em relação a 2001 e houve melhora também nos percentuais de pessoas livres de cárie para as idades entre 0 e 19 anos. As médias de ceo-d para o grupo etário de 0 a 3 anos apresentam elevação no período, exceto na aldeia Moigu, que mostrou diminuição de 8,0 em 2001 para 1,8, em 2006. Ao se analisar os componentes do CPO-D e ceo-d, quando comparados os dados obtidos em 2006 e 2001, foi possível verificar que o componente \"cariado\" apresentou redução para a maioria das faixas etárias em todas as aldeias, assim como o aumento dos componentes \"obturados e perdidos\". Observou-se que para a dentição decídua o componente cariado possui grande contribuição no ceo-d em todas as aldeias, variando entre 69% a 86% do índice. Isso traduz dificuldades no acesso dessa população aos serviços odontológicos. O índice IPC mostrou aumento do percentual de pessoas sem doença periodontal em todas as aldeias, queda no percentual de pessoas com algum tipo de bolsa periodontal e cálculo como o principal problema. Em relação às necessidades de tratamento verificou-se que restaurações foram as indicações mais freqüentes e houve um aumento no número de dentes sem nenhuma necessidade. Para a doença periodontal, observou-se que mais de 80% das pessoas acima de 15 anos precisam de tratamento e necessidade de profilaxia; as necessidades por cuidados mais complexos representam apenas 3% . Concluímos que no período de 2001 a 2006,houve uma melhoria nas condições de saúde bucal dessas populações. Uma hipótese explicativa seria a estruturação do programa de saúde bucal nestas áreas. / There is a lack of information about the epidemiology of oral health conditions of the Indian population in Brazil. In general, available data are related to urban regions. Information about the epidemiology of oral health in the Xingu Indian Park (PIX) derive from surveys that employed different methodologies for collecting and analyzing the data, making it difficult to have an adequate picture of the problem. Since the creati of the indian Special Sanitary District of Xingu (DSEIXingu) in 1999, three epidemiologic surveys for oral health were carried out, based on the methodology proposed by the World Health Organization - WHO. The present study analyzed the oral health conditions in four villages of the PIX, considering treatment needs. A descriptive study was performed, using data already collected by surveys carried out by the health team of the DSEI-Xingu, employing the same methodology, in the years 2001, 2003 ead 2006. The DMF-T index was used to avaluate the caries experience, and for periodontal disease, the community periodontal index (CPI). The analisys of the results showed that the main oral health problem in the studied villages was tooth decay, reaching 81% of the population in 2006. In relation to caries, it was observed a decline in the mean of the DMF-T for majority of the age-groups in 2006 in relation to 2001 and an improvement in the proportion of people free of caries for the ages between 0-19 years. The mean of the dmf-t for the 0 to 3 year age-group was higher in 2006, except in the Moigu village, where a decline was observed (from 8.0 in 2001 to 1.8 in 2006). Comparing the DMF-T and dmf-t between 2006 and 2001, it was observed that the component \" decayed\" decreased in most of the age-groups in the four villages, as well as an increase in the component \"filled and missing\". For the deciduous teeth, the component \"decayed\" had greater contribution in the dmft in all the villages. The CPI index showed an increase in the proportionof persons without periodontal disease and a decrease in the proportion of persons with some kind of periodontal pockets in all the villages. Calculus was the main problem. In relation to treatments needs, indication of restoration was the most frequent and there was a increase in the number of teeth without any need. For periodontal disease, more than 80% of the persons aged 15 years or more need treatment and professional tooth cleaning; more complex treatment was required only by 3% of the individuals. We concluded that there was an improvement in the oral health conditions of this population, in the period 2001 to 2006. an explanatory hypothesis for this findings could be the implementation of the strutured oral health program in this region.

This study couples biological data with aspects of material culture and mortuary ritual for several sites within the proposed Coosa chiefdom described by sixteenth-century Spanish accounts to explore how cultural identities were actively constructed and maintained within the region. The primary goal is to examine regional interactions between these communities and their constructions of social identity and sociopolitical dynamics vis à vis their biological affinities. Questions regarding regional interactions between these groups have been a stimulus for archaeological debate. These interactions may have played a crucial role in the construction of separate cultural identities. What is not clear is to what extent differences in cultural identity reflect or are related to differences in biological relationships. The skeletal samples used in this study represent six Late Mississippian archaeological sites assigned to three archaeological phases: the Dallas Phase, Fains Island (40JE1), Cox (40AN19), and David Davis (40HA301) sites; the Mouse Creek Phase, Ledford Island (40BY13) site; and the Barnett Phase, King (9FL5) and Little Egypt (9MU102) sites. Twenty-seven dental and 22 cranial nonmetric traits were recorded for 923 individuals. Biological affinities were calculated using the Mahalanobis D2 statistic for the cranial and dental non-metric traits. Biological Distance measures were compared to a geographic matrix to examine isolation by distance between the sites. Further analysis was conducted by constructing an R matrix to examine levels of heterogeneity. Comparisons between biological distance and geographical distances suggest that the samples used in this analysis do not conform to the expected isolation-by-distance model. Furthermore, East Tennessee groups appear distinct from their North Georgia neighbors suggesting little biological interaction between these groups. The results of the biological distance analysis conforms to differences in material culture and mortuary ritual between these groups. The results suggests that if there was a political alliance within the region for this period it is not associated with biological relatedness nor did it act as a unifying force for individual communities’ cultural identity.