Background: Food nourishes us, sustains us, and has the potential to both heal us and make us sick. Among many Indigenous cultures, traditional activities, ceremonies, events and practices often involve or use food, grounding Indigenous peoples within the context of their local, natural surroundings. This suggests that food is important not only for physical health, but also emotional, mental and spiritual health. The relationships that Indigenous peoples have with food can help us to understand the health of individuals, and the communities in which they live. Purpose: The following qualitative study explores how three generations of adults who live in one Labrador Inuit-Metis community experience and understand their relationships to food in a context of global change. Theoretical Orientation: The research is guided by Two-Eyed Seeing. Two-Eyed Seeing acknowledges that there are many different ways of seeing and understanding the world, some of which can be encompassed through a ‘Western eye’ and some through an ‘Indigenous eye.’ If we learn to see through both eyes, we can gain a perspective that looks very different than if we only view the world through a single lens. Methods: For the study, twenty-four people from the south-eastern Labrador community of St. Lewis participated in individual and joint story-telling sessions. A group story-telling session also took place where community members could share their stories with one another. During many of the story-telling sessions, participants shared photographs, which helped to illustrate their relationships to food. Findings/Discussion: Historically, the people of St. Lewis relied almost entirely upon their own wherewithal for food, with few, if any, government services available and very little assistance from the market economy. This fostered and upheld an Inuit-Metis culture that promoted sharing, reciprocity and respect for the natural world. Currently, greater access to government services and the market economy has led to the creation of certain policies and programs that undermine or ignore established social and cultural norms in the community. Conclusions: Existing Inuit-Metis knowledge should work alongside non-Indigenous approaches to policy and program development. This would serve to protect and promote the health of both individuals and communities.

There is a requirement for all services within the New Zealand health system to be accredited with an established quality organisation and to demonstrate an ability to provide a measurable quality service to consumers. For Māori these requirements must make sense in Māori terms. This thesis is based on the view that, for Māori, the concept of health is more effectively expressed as hauora - optimal health and wellbeing for Māori. This thesis makes five contributions to Māori health and Māori health research. First, it identifies a responsive approach to engaging kaumātua effectively in the process of qualitative research. Second, it identifies a fundamental underlying conceptual framework – kaupapa hauora Māori as a means of understanding hauora – expressed in terms derived from kaumātua in Taranaki and Kahungunu. Third, it adapts this conceptual framework into an analytical research framework and then applies it to allow kaupapa hauora Māori (described in terms of worldview, values and ethics) to be identified from a range of data. Fourth, it critically analyses popular models of Māori health – Te Whare Tapa Whā, Te Wheke and Ngā Pou Mana. Finally, it proposes and details post-doctoral research that will translate kaupapa hauora Māori into a quality services framework/tool. “Kaupapa Hauora Māori” is a conceptual framework articulated by kaumātua, and has its origins in te ao Māori, from which the aronga or worldview is developed. The aronga is composed of the kaupapa or values and tikanga or ethics that provide kaumātua with the values base of hauora. These components have been identified by kaumātua and not only inform the concept of KHM but also inform the analytical research framework that is applied to the data. The values have been identified as a core set of values comprising whakapapa, wairua, whenua, whānau, tikanga te reo Māori, tinana, and hinengaro, and the associated tikanga is expressed as behaviour or ethics. These, together, influence the perception and understanding individuals have of their world and of hauora.

Ngā Kairaranga Oranga – The Weavers of Health and Wellbeing is a theory about the health and wellbeing of Māori women. Health data about Māori women indicate that their health status is less than that of the non-Māori population despite the right to experience equality in health outcomes. Māori women’s health and wellbeing influences the nature of their health outcomes, varies across their lifetime. ‘What is happening for Māori women, their health and interactions with ‘mainstream’ health services?’ is the question that guided the research with Māori women. A grounded theory informed by a Māori centred approach was developed that utilised Mason Durie’s Māori-centred concepts of mana Māori (control), whakapiki tangata (enablement) and whakatuia (integration), and integrated Glaserian grounded theory to guide the collection and analysis of the data. Twenty-three women who identified as Māori within the Te Arawa rohe, and who were between the ages of 18 and 80 years were formally interviewed as either a group, pairs or individuals, with a further 15 informally interviewed during the process of theoretical sampling. Semi-structured interviews and field notes were used to collect the data, and the processes of constant comparative analysis, theoretical sampling and saturation were used to generate a middle-range substantive Māori centred grounded theory. Three core categories were identified relating to the health and wellbeing of Māori women: (a) Mana Māori, which describes what is important for their health and wellbeing; (b) The Way It Is, which outlines the resigned acceptance they have of their reality and life circumstances, and the barriers and challenges that are encountered; and (c) Engaging with Health Services, which describes what they require from ‘mainstream’ health services to improve the access and use of these services. The basic social psychological process of ‘weaving health and wellbeing’ integrates these core categories. The interpretations Māori women have of health and wellbeing, and health-related actions are explained by the theory generated. This substantive grounded theory provides a model to guide the education and practice of health care providers working within ‘mainstream’ health services.

Made available in DSpace on 2014-12-17T14:46:47Z (GMT). No. of bitstreams: 1 MariaNFF_DISSERT.pdf: 2703676 bytes, checksum: 0a6535bf05102a424a0070968ed1d915 (MD5) Previous issue date: 2011-05-16 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The desire to research on this subject arisen from the experience as nursing in the indigenous health, where I observed that many professionals from all regions of Brazil chose to work within this zone. It was notorious the nurse s difficult to settle in only one place for a long length of time. Probably due to health care in indigenous zones happens from a cultural confront. This confront materialize because both sides are imbued with their own culture: in one hand the nurse professional with its scientific knownledgment on the other the indigenous with their rituals and peculiars habits. In this context nurses should delineate and negotiate the reality through symbolic representations of life, and then make questions on the new reality. In this way, this study set out with the aim of apprehends the nurse s social representations of transcultural care in indigenous health. This knownledgment is important to avoid possible conflicts, shocks, difficulties and health care incongruence within this context. The data collect was carried out on a range of non structured interview guided by a pre-elaborated questionnaire with four questions and a hand drawing related to nurse s health care in the indigenous health. This research had a sample of 17 nurses from the Indigenous Sanitary District of Manaus in the Amazon State. To interpret data we used the Discourse of the Collective Subject, which findings were presented in three chapters: characterization of participants, discussion on themes prevalent in discourse; social representation of nursing care through infographics. The analysis revealed that the care in the indigenous health is challenging because the native people imbued in its world are perceived and processed according to the nurse s cultural lens, leading to materialize of some strangeness and adaptation difficulties, especially in the first contacts. The Social Representation on nursing practice, in many cases, is projected and contrived on the basis of scattered believes and on perception derived from common sense. The findings shows that representions are essential to mitigating the initial strangeness and help nurses to better situate themselves in the new universe. The nurse s practice in the indigenous health care should merge into each other. From the Social Representations is possible to perceive that assimilation, also comprehension on indigenous health system and its traditional knowledge are important to developing strategies to improve access and quality of care for indigenous peoples. After analysis the nurse s discourses and drawings, it is possible to represent the nurse s practice in the indigenous health as anthropophagism, since nurses should literally consuming its patients culture, digesting it and seize it as means to provide culturally congruent care. We highlight the urgent need for preparation and training of professionals to work more effectively with indigenous peoples / A realiza??o deste estudo surgiu a partir da experi?ncia como enfermeira na sa?de ind?gena, ao observar que muitos profissionais oriundos das mais diversas regi?es do Brasil optavam por esta ?rea de atua??o. Era not?ria a dificuldade que o enfermeiro tinha em fixar-se por muito tempo em um ?nico local de servi?o. Provavelmente porque o cuidado de sa?de na ?rea ind?gena acontece a partir de um confronto de culturas diversas, pois traz o profissional, de um lado, com todo o seu conhecimento acad?mico e cultura pr?pria e, do outro lado, o ?ndio com seus ritos, usos e costumes peculiares. Neste contexto, o enfermeiro deve definir e negociar a realidade atrav?s de representa??es simb?licas da vida, para, em seguida, questionar a nova realidade. Assim, este estudo busca apreender as representa??es sociais sobre o cuidado transcultural na sa?de ind?gena para os profissionais enfermeiros. Conhecimento, este, importante para evitar poss?veis conflitos, choques, dificuldades e incongru?ncia do cuidado nesse contexto. A coleta de dados foi realizada atrav?s de entrevista n?o-estruturada guiada por um roteiro contendo quatro quest?es norteadoras e elabora??o de um desenho que fosse relacionado ao cuidado do enfermeiro na sa?de ind?gena. A pesquisa contou com a participa??o volunt?ria de 17 enfermeiros do Distrito Sanit?rio Ind?gena de Manaus, no Estado do Amazonas. Para o tratamento dos dados foi utilizada a T?cnica de An?lise do Discurso do Sujeito Coletivo, sendo os resultados apresentados em tr?s momentos, a saber: caracteriza??o dos participantes do estudo, discuss?o das categorias predominantes nos discursos e representa??o social do cuidado de enfermagem atrav?s de infogr?ficos. A an?lise revelou que o cuidado na sa?de ind?gena ? desafiador porque o ind?gena e seu mundo s?o percebidos e processados de acordo com a lente cultural dos enfermeiros, levando ao surgimento de alguns estranhamentos e dificuldades de adapta??o, principalmente nos primeiros contatos. A RS da pr?tica de enfermagem na sa?de ind?gena, em muitos casos, ? projetada e idealizada com base nas cren?as disseminadas e nas percep??es originadas do senso comum. Percebe-se, pois, que o trabalho de representar ? essencial em atenuar as estranhezas iniciais e ajudar o enfermeiro a situar-se melhor no novo universo. A pr?tica de enfermagem na sa?de ind?gena deve ser a fus?o das culturas do ind?gena e do enfermeiro. A partir da Representa??o Social reconhece-se que a assimila??o, a compreens?o do sistema de sa?de ind?gena e o uso dos conhecimentos dessas pr?ticas s?o elementos essenciais para o desenvolvimento de estrat?gias que podem melhorar o acesso e a qualidade do cuidado aos povos ind?genas. Ap?s a an?lise dos discursos e desenhos realizados pelos enfermeiros, pode-se representar a pr?tica de enfermagem na sa?de ind?gena atrav?s do antropofagismo, no qual o enfermeiro deve literalmente devorar a cultura dos seus pacientes, digeri-la e apoderar-se dela para prestar um cuidado culturalmente congruente. No entanto, ressalta-se a necessidade urgente do preparo e treinamento desses profissionais para uma atua??o mais eficaz com os povos ind?genas

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2013-10-07T19:35:16Z No. of bitstreams: 1 Diss MP Silvana Cardoso Gomes 2013.pdf: 1625866 bytes, checksum: 748348c0ba807f10c91b5169b3203fb4 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-10-07T19:35:28Z (GMT) No. of bitstreams: 1 Diss MP Silvana Cardoso Gomes 2013.pdf: 1625866 bytes, checksum: 748348c0ba807f10c91b5169b3203fb4 (MD5) / Made available in DSpace on 2013-10-07T19:35:28Z (GMT). No. of bitstreams: 1 Diss MP Silvana Cardoso Gomes 2013.pdf: 1625866 bytes, checksum: 748348c0ba807f10c91b5169b3203fb4 (MD5) Previous issue date: 2013 / Iniquidades no acesso à saúde entre indígenas tem sido um importante problema na organização dos serviços de saúde no Brasil, e uma preocupação recente da literatura especializada, ainda considerada incipiente quanto à produção de estudos empíricos. O presente estudo teve por objetivo avaliar a acessibilidade dos usuários indígenas do DSEI Cuiabá, aos serviços de saúde de média e alta complexidade do município de Cuiabá, em particular, a partir da CASAI Cuiabá, dispositivo voltado para apoio e melhoria da acessibilidade conforme a PNASPI. Foi realizado estudo de caso único na CASAI Cuiabá com abordagem qualitativa. Os dados foram obtidos por meio da observação das rotinas de trabalho da CASAI Cuiabá, entrevistas semi-estruturadas com profissionais e gestores do DSEI Cuiabá e CASAI Cuiabá, análise documental, bem como análise de dados secundários produzidos pelo SIASI sobre utilização dos serviços de saúde de média e alta complexidade em Cuiabá. Para análise dos dados, foi elaborada uma matriz derivada do modelo teórico lógico de acessibilidade e validada por meio do método Delphi a um grupo de especialistas na temática de saúde indígena. Apesar de avanços trazidos pela CASAI na melhoria da acessibilidade indígena, persistem barreiras sócio-organizacionais, culturais e geográficas no acesso à média e alta complexidade do município estudado. Recomenda-se a formulação de estratégias específicas para melhoria da acessibilidade aos serviços de saúde dos povos indígenas mato-grossenses. / Salvador

Submitted by Cristiane de Melo Shirayama (cristiane.shirayama@unifesp.br) on 2018-05-07T21:42:56Z No. of bitstreams: 1 Karine Assumpção.pdf: 4084155 bytes, checksum: a08861e5570fc71384e8e355f5eb49cc (MD5) / Approved for entry into archive by Cristiane de Melo Shirayama (cristiane.shirayama@unifesp.br) on 2018-05-10T19:56:43Z (GMT) No. of bitstreams: 1 Karine Assumpção.pdf: 4084155 bytes, checksum: a08861e5570fc71384e8e355f5eb49cc (MD5) / Made available in DSpace on 2018-05-10T19:56:43Z (GMT). No. of bitstreams: 1 Karine Assumpção.pdf: 4084155 bytes, checksum: a08861e5570fc71384e8e355f5eb49cc (MD5) Previous issue date: 2014-06-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A partir da análise das problemáticas envolvidas nas relações de negociação de cura estabelecidas antes e depois do Subsistema de Saúde Indígena do Sistema Único de Saúde (SASISUS) no Brasil, o foco desta dissertação recai sobre a relação existente, há quase cinquenta anos, entre os profissionais de saúde não-indígenas do Projeto Xingu, Escola Paulista de Medicina (EPM), atualmente parte integrante da Universidade Federal de São Paulo (UNIFESP), e as populações indígenas, principalmente os povos que vivem no Baixo, Médio e Leste Xingu. Assim, através de observações participativas em locais de ação do Projeto Xingu, tanto em São Paulo como na Terra Indígena do Xingu (TIX), além de entrevistas com os protagonistas, foi possível perceber como, no movimento concomitante de acessar seus códigos e incorporar alguns códigos indígenas, os profissionais ligados ao Projeto Xingu ressignificam a biomedicina, as políticas públicas em saúde e a formação biomédica. Ao experimentarem os valores e noções indígenas, se tornando branquígenas, os profissionais não-indígenas há mais tempo envolvidos nessa relação começam a enxergar o limiar entre salvar vidas e salvar (respeitar) a diversidade cultural, transitando de um a outro lado dessa liminaridade através do conceito ampliado de saúde e de bem-estar (cultural). Tornam-se, assim, mediadores políticos especialistas em problemas de comunicação (comunicose), “doença” endêmica em contextos interculturais como o da saúde indígena. / From an analysis of the problems involving healing negotiation established before and after the Indigenous Health Subsystem of the Unified Health System in Brazil, this study focuses on the relationship established nearly fifty years ago among non-indigenous health professionals of the Xingu Project, of the Escola Paulista de Medicina (EPM), currently part of São Paulo Federal University (UNIFESP), and the indigenous people, especially those living in the Lower, Middle and East of Xingu. Thus, through active observations at the Xingu Project, both in São Paulo and in the Xingu Indigenous Land, along with interviews with the protagonists, it was possible to see that, with a concomitant movement of accessing their codes and incorporating some Indian codes, the professionals associated with the Xingu Project resignify biomedicine, the public health policies and biomedical education itself. As the non-indigenous professionals who have been involved longer in this relationship experience the indigenous values and ideas , (becoming branquígenas) they begin to see the threshold between saving lives and saving (respecting ) cultural diversity , moving from one side to another of this liminality through an expanded concept of health and (cultural) wellness. These professionals thus become political mediators, experts in communication problems (comunicose), that is endemic "disease" in intercultural contexts such as indigenous health.

abstract: The health situation of indigenous peoples is comparable to that of the world's poorest populations, but with the additional burdens of social and cultural marginalization, geographic and cultural barriers to accessing health services, and, in some areas, appropriation of land and natural resources. Cultural transmission (the transfer of beliefs, ideas, and behaviors from one culture to another) from outsider health institutions should presumably aid in closing this health gap by transferring knowledge, practices, and infrastructure to prevent and treat disease. This study examines the biosocial construction of the disease ecology of tuberculosis (TB) in indigenous communities of the Paraguayan Chaco with varying degrees of cultural transmission from outside institutions (government, religious, and NGOs), to determine the influence of cultural transmission on local disease ecologies. Using a biocultural epidemiological framework for the analysis of human infectious disease ecology, this study employed an interdisciplinary, mixed methods approach to examine the interactions of host, pathogen, and the environment in the Paraguayan Chaco. Three case studies examining aspects of TB disease ecology in indigenous communities are presented: (1) The effective cultural transmission of biomedical knowledge to isolated communities, (2) Public health infrastructure, hygiene, and the prevalence of intestinal parasites: co-morbidities that promote the progression to active TB disease, and (3) Community-level risk factors for TB and indigenous TB burden. Findings from the case studies suggest that greater influence from outside institutions was not associated with greater adoption of biomedical knowledge of TB. The prevalence of helminthiasis was unexpectedly low, but infection with giardia was common, even in a community with cleaner water sources. Communities with a health post were more likely to report active adult TB, while communities with more education were less likely to report active pediatric TB, suggesting that healthcare access is the major determinant of TB detection. More research is needed on the role of non-indigenous community residents and other measures of acculturation or integration in TB outcomes, especially at the household level. Indigenous TB burden in the Chaco is disproportionately high, and better understanding of the mechanisms that produce higher incidence and prevalence of the disease is needed. / Dissertation/Thesis / Doctoral Dissertation Social Science and Health 2014

abstract: The overarching purpose of my dissertation is to offer one Pueblo perspective about research and health education to contribute to critical dialogue among Pueblo people so that relevant research and health education approaches grounded in Pueblo thinking can emerge. Research was a pebble in my shoe that caused me great discomfort as I walked within academia during the many years I worked as a health educator at a university, and continues to bother me. The purpose of my journal article is to discuss why much mainstream research is problematic from a Pueblo Indian standpoint and to explore considerations for research with Pueblo people. The purpose of my book chapter is to reflect on my experiences as a Pueblo Indian health educator to add to the discussion about the importance of grounding Pueblo health education in local Pueblo knowledge systems and to discuss the limitations of delivering health education primarily grounded in a western biomedical disease model. Finally, my policy brief is an urgent call to action for tribal leaders regarding a recent change to the New Mexico Department of Health's race and ethnicity presentation in health data standard. This change resulted in 39,636 American Indians and Alaska Natives in New Mexico being reclassified as Hispanic. It is my intention to connect my ideas about research and health education with the work of other Pueblo scholars to add to the growing body of Pueblo informed writing to contribute to current and future scholarship that will ultimately benefit Pueblo people. / Dissertation/Thesis / Doctoral Dissertation Social Justice and Human Rights 2015

Submitted by Felipe Bulzico da Silva null (silva.b.felipe@gmail.com) on 2017-04-18T18:32:35Z No. of bitstreams: 1 Dissertação - Versão Final.pdf: 1901991 bytes, checksum: a5798410b74295ebe178a0ceca64a1fd (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-04-18T19:59:00Z (GMT) No. of bitstreams: 1 silva_fb_me_bauru.pdf: 1901991 bytes, checksum: a5798410b74295ebe178a0ceca64a1fd (MD5) / Made available in DSpace on 2017-04-18T19:59:00Z (GMT). No. of bitstreams: 1 silva_fb_me_bauru.pdf: 1901991 bytes, checksum: a5798410b74295ebe178a0ceca64a1fd (MD5) Previous issue date: 2017-03-30 / O último Censo Demográfico realizado pelo IBGE (2010) com a população indígena brasileira revelou uma ampla diversidade étnica e linguística no país, com estimados 305 povos indígenas e 274 línguas faladas. A despeito dessa diversidade, desde os anos 70, os índios brasileiros têm se mobilizado e assumido um papel cada vez mais proeminente no cenário político, tanto a nível local como nacional. Nesse contexto, a Constituição Federal (CF) de 1988 consolidou o direito dos povos indígenas aos territórios que tradicionalmente ocupam e o reconhecimento de suas especificidades étnico-culturais. A CF/88 estabeleceu a base às legislações indigenistas posteriores de saúde indígena e educação escolar indígena, sobre as quais trata a presente pesquisa. Assim, este estudo objetivou examinar a Portaria nº 254/02 do Ministério da Saúde (MS) – que aprovou a Política Nacional de Atenção à Saúde dos Povos Indígenas (PNASPI) – e o Decreto nº 6.861/09 – que organizou a educação escolar indígena em territórios etnoeducacionais (TEE) – sob a perspectiva das contingências de reforço. Com esse exame, o qual tomou como modelo estudos de outros analistas do comportamento que se debruçaram sobre outros textos legais (CARVALHO, 2013; KUBO; BOTOMÉ, 2002; MARTINS, 2009; SANTOS et al., 2009; TODOROV et al., 2004), pretendeu-se ponderar acerca de alguns dos limites e possibilidades desses documentos, no sentido de quão claras eram suas proposições. Reconheço que o comportamento daqueles em condições de aplicar as recomendações da Portaria e do Decreto presumivelmente não está apenas sob controle do que consta nesses documentos. Contudo, esse reconhecimento não deve diminuir a importância da busca por uma maior clareza na redação desses textos, visto que tais textos também constituem fontes importantes de variáveis a exercer controle sobre o comportamento daqueles a quem eles se destinam. Da leitura do primeiro texto foram inferidas 37 contingências, as quais foram agrupadas, depois dessas inferências, em cinco categorias: organização infraestrutural do modelo de atenção à saúde dos povos indígenas; diretrizes concernentes à atuação profissional de membros das Equipes Multidisciplinares de Saúde Indígena (EMSI); relações entre os territórios indígenas e a questão da saúde; ações específicas em situações especiais e responsabilidades institucionais. Do segundo texto foram inferidas 13 contingências, as quais foram agrupadas, depois dessas inferências, em três categorias: organização do modelo da educação escolar indígena; escolas indígenas e financiamento. A partir do exame feito, o qual foi incipiente e não se arrogou a pretensão de esgotar o assunto, argumentou-se que, embora os documentos objeto de exame representassem avanços importantes em seus respectivos campos, a Portaria sistematizando as recomendações das I, II e III Conferências Nacionais de Saúde Indígena e o Decreto propondo uma inovação da organização do modelo de educação escolar indígena, como limites de ambos os documentos, eles são pouco operacionalizados, ocasionalmente carecendo de explicitação dos três termos de uma contingência e empregando termos gerais, vagos e/ou imprecisos, os quais, como ressaltam Santos et al. (2009), podem impor dificuldades àqueles a quem se destinam as orientações. / The last Demographic Census made by IBGE (2010) with brazilian indigenous people revealed a large ethnic and linguistic diversity, estimating 305 indigenous people and 274 spoken languages. Despite this diversity, since the 70’s, Brazilian Indians have been mobilized themselves and assumed a prominent role in the political arena, both in local and national levels. In this context, the Federal Constitution of 1988 has consolidated the indigenous right concerning to the land that indigenous people traditionally occupy and their ethnical specificities. The Federal Constitution of 1988 established the bases for the formulation of later indigenous legislations concerning to indigenous health and indigenous scholar education, themes of this research. In this sense, this research aimed to examine the Ordinance nº 254/02 – which has approved the National Policy of Indigenous Health – and the Ordinance nº 6.861/09 – which organized the indigenous scholar education in terms of ethnoeducational territories – based on contingency analysis. With this examination, which took as a model studies made by other behavior analysts upon other legal documents (CARVALHO, 2013; KUBO; BOTOMÉ, 2002; MARTINS, 2009; SANTOS et al., 2009; TODOROV et al., 2004), it was hoped to consider some limits and possibilities of both documents, in the sense of how clear were their propositions. I recognize that the behavior of those in conditions to apply the recommendations of both Ordinances presumably is not controlled only by what is written on these legal documents. Nevertheless, this recognition is not reason to diminish the importance of legal texts being clear, since these texts constitute important sources of variables which may control the behavior of those for whom these documents are. The reading of the first text allowed infer 37 contingencies, which were divided, after these inferences, into five categories: infrastructure organization of the model of health attention to indigenous people; guidelines regarding the professional performance of members of the Multidisciplinary Indigenous Health Team; relations between indigenous territories and health; specific actions in special situations, and institutional responsibilities. The second text allowed infer 13 contingencies, divided, after these inferences, into three categories: organization of indigenous scholar education in terms of ethnoeducational territories; indigenous schools, and financing. Based on the exam made, which was incipient and did not arrogate the claim to exhaust the subject, it was argued that, despite both documents represent important advances with respect to their respective areas, the Ordinance nº 254/02 systematizing the recommendations of the I, II and III National Conferences of Indigenous Health and the Ordinance nº 6.861/09 presenting an innovative proposal of organization of the model of indigenous scholar education in terms of ethnoeducational territories, nevertheless, as a limit of both documents, they are little operationalized, occasionally lacking the explanation of the three terms of a contingency and using general, vague and/or imprecise terms, which, according to Santos et al. (2009), can impose difficulties on those for whom the guidelines are.

Submitted by Geyciane Santos (geyciane_thamires@hotmail.com) on 2015-07-29T15:11:56Z No. of bitstreams: 1 Dissertação - Hernane Guimarães dos Santos Junior.pdf: 5400873 bytes, checksum: d02469e137c1abc4953ea3993f7731e5 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2015-07-30T19:31:44Z (GMT) No. of bitstreams: 1 Dissertação - Hernane Guimarães dos Santos Junior.pdf: 5400873 bytes, checksum: d02469e137c1abc4953ea3993f7731e5 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2015-07-30T19:38:58Z (GMT) No. of bitstreams: 1 Dissertação - Hernane Guimarães dos Santos Junior.pdf: 5400873 bytes, checksum: d02469e137c1abc4953ea3993f7731e5 (MD5) / Made available in DSpace on 2015-07-30T19:38:58Z (GMT). No. of bitstreams: 1 Dissertação - Hernane Guimarães dos Santos Junior.pdf: 5400873 bytes, checksum: d02469e137c1abc4953ea3993f7731e5 (MD5) Previous issue date: 2011-08-30 / CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico / The Word Health Organization recognizes that the nutritional evaluation is an important key to analyze the health condition of certain territory. During the last decade the world population has been passing through a dietary and nutritional transition. As a result the malnutrition has been decreasing and the overweight rising. Parallel this phenomena, it is also observed an epidemiological transition which consists in the decreasing of infecto-contagious diseases and the rising of chronical and degenerative diseases. However, the first nutritional survey conducted in 2009 among the Brazilian Indigenous Population showed high malnutrition rates when compares to non-indigenous population. There is a lack of nutritional studies which does not allow to determinate the epidemiological status of each different indigenous ethnics groups, municipality or province. Therefore, the objective of the present study was to evaluate the nutritional status of Baniwa indigenous children from the Middle Içana River, located at Rio Negro River Basin, Amazonas, Brazil. This epidemiologic survey evaluated children under 60 months old from the Middle Içana River, assisted by the Indigenous Special Sanitary District of the Upper Rio Negro. It was collected variables weight, height, age and sex in order to obtain the anthropometric index (W/A-weight for age, W/H-weight for height, H/A- height for age, and BMI-body mass index), as recommended by the WHO. The data was analyzed using the WHO – 2006 and the NCHS-1997 reference curves standards. The results indicated high prevalence of low weight-for-age (9.5% and 13.1%), height-for-age (46.3% and 39.5%), weight-for- height (7.1% and 1.2%), for both WHO and NCHS references. The BMI indicated moderate levels of overweight (9.5%). Therefore, the present study findings showed high rate of malnutrition among Baniwa indigenous children which are consistent with other studies that showed national malnutritional rates six times higher among Indigenous Children when compared with nonindigenous children. Thus, these results suggest that there is a need for effective health programs aimed to improve the nutritional status of the Baniwa indigenous children. / A avaliação nutricional é considerada pela Organização Mundial de Saúde como elemento primordial para analise da saúde pública de um determinado território, ao longo das ultimas décadas a população mundial perpassa pelo processo de transição alimentar e nutricional, ocorrendo diminuição da desnutrição e aumento da obesidade. É observado para este mesmo período um processo de transição epidemiológica, tendo a diminuição das doenças infectocontagiosas e aumentando das doenças crônicas degenerativas, no entanto para as populações indígenas no Brasil o primeiro inquérito nutricional nacional realizado em 2009, mostrou em seus resultados um alto índice de desnutrição linear e ponderal, quando comparados com a população não indígena do país. Pela falta de pesquisas mais amplas, não podemos traçar um perfil epidemiológico por etnia, por município ou por estado, levando a uma grande lacuna. Com intuito de contribuir para diminuição desta lacuna, este estudo teve por objetivo realizar o levantamento epidemiológico do estado nutricional de crianças indígenas da etnia Baniwa do médio rio Içana, na microrregião de Tunuí, no Alto Rio Negro – Amazonas. Foram avaliadas crianças menores de 60 meses. As variáveis peso, altura, idade e sexo foram coletadas para a obtenção dos índices antropométricos (P/I, P/E, E/I e IMCI), padrão, preconizados pela OMS. Os dados foram analisados conforme as curvas de referências OMS- 2006 e NCHS-1997. Os resultados obtidos indicam elevadas prevalências do déficit de pesopara- idade (P/I = 9,5% e 13,1%) e estatura-para-idade (E/I = 46,3% e 39,5%); e sobrepeso para os índice peso-para-estatura (P/E = 7,1% e 1,2%), segundo OMS-2006 e NCHS-1977, respectivamente, e ainda, para IMCI, na referência OMS-2006, 9,5% de prevalência de sobrepeso. Os dados evidenciam o alto índice de desnutrição nesta parcela do grupo Baniwa estudado, o que é congruente com outros estudos referentes à situação nutricional das populações indígenas no Brasil, que apontam (nas duas últimas décadas) índices cerca de seis vezes maior de desnutrição infantil indígena, quando comparados com índices de crianças não indígenas. O contexto apresentado nesta pesquisa indica a necessidade de atuação mais efetiva de programas de vigilância nutricional e de maior cobertura do subsistema de saúde indígena, em busca de melhoria das condições nutricionais desta população.