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Ghanaian Indigenous Health Practices: The Use of HerbsDarko, Isaac N. 11 December 2009 (has links)
Herbal medicines remain integral part of indigenous health care system in Ghana. Most conventional health medicines are directly or indirectly derived from plants or herbs. Despite its significant role in modern medicine indigenous herbal practices has been on the low light for some time due to perceived antagonistic relationship that exists between practitioners of herbal medicine and their counterpart in the conventional system.
Using an indigenous knowledge discursive framework, the thesis examined the relevance of herbal medicine to the contemporary Ghanaian society. The thesis also examined the tension between the indigenous herbal practitioners and their orthodox counterparts. The thesis noted that for health care system in Ghana to be effective, there is a need for collaborate relations between these two practitioners. Also, it was noted that for health care system to be effective in Ghana, spirituality has to be central in the works of the herbal practitioners.
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Ghanaian Indigenous Health Practices: The Use of HerbsDarko, Isaac N. 11 December 2009 (has links)
Herbal medicines remain integral part of indigenous health care system in Ghana. Most conventional health medicines are directly or indirectly derived from plants or herbs. Despite its significant role in modern medicine indigenous herbal practices has been on the low light for some time due to perceived antagonistic relationship that exists between practitioners of herbal medicine and their counterpart in the conventional system.
Using an indigenous knowledge discursive framework, the thesis examined the relevance of herbal medicine to the contemporary Ghanaian society. The thesis also examined the tension between the indigenous herbal practitioners and their orthodox counterparts. The thesis noted that for health care system in Ghana to be effective, there is a need for collaborate relations between these two practitioners. Also, it was noted that for health care system to be effective in Ghana, spirituality has to be central in the works of the herbal practitioners.
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Chronic heart failure beyond city limits: an analysis of the distribution, management and information technology solutions for people with chronic heart failure in rural and remote AustraliaClark, Robyn A January 2007 (has links)
Chronic heart failure (CHF) is defined as a complex clinical syndrome that is frequently, but not exclusively, characterised by objective evidence of an underlying structural abnormality or cardiac dysfunction. CHF affects up to 3% of the adult population and this rate is consistent throughout the developed world. In spite of the proven efficacy of treatments, there is a common theme of low implementation rates for recommended therapeutic guidelines. In Australia, where access to specialist CHF management is limited, the burden of care, for the 40% of CHF patients living outside capital cities falls predominantly onto community-based general practitioners (GPs). Unfortunately, there are diminishing numbers of GPs in rural and remote regions and this has created an apparent dual deficit in terms of equitable access to primary and specialist care for the CHF population living in these areas. The purpose of this research was to determine, in a series of themed studies, the population distribution, management and potential information technology solutions for CHF in rural and remote Australia. Appropriate methods were utilised for each study and included epidemiological studies, a quantitative analysis of a large practice audit, geo-mapping, a systematic review, a case study review and a qualitative analysis of participant feedback and clinical notes.
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Primary health care: knowledge development and application in Papua New GuineaDavy, Carol January 2009 (has links)
Research into the use of information by health care professionals has generally been conducted in countries dominated by the biomedical model. In these contexts, illness is considered to have a scientifically identifiable physical cause, and treatment practices within the formal health care sector are prescribed and managed in accordance with this definition. Yet there are also contexts where other belief systems inform and guide the way that people think about their health. In comparison to the biomedical model, these contexts have contributed very little to our understanding of how health professionals develop their knowledge. This research investigates how primary health care workers (PHCWs) in one such context, Papua New Guinea (PNG), develop their knowledge about the health services they provide. In order to discover and understand the differing views of these PHCWs, 69 semi-structured interviews were conducted in three culturally and geographically diverse regions of PNG. In explaining the diagnostic and treatment practices they use, these participants provided insights into not only how PHCWs engage with information but also how it informs their professional practice. These data were analysed, interpreted and discussed using a framework consisting of four, primary but interconnecting aspects: the context in which information was provided, the interactions with the sources of information, the processes by which information was understood, and the outcomes realized as a result of the information being used. Findings indicated that the majority of participants in this study acknowledged, if not incorporated, information pertaining to biomedicine, Christianity and Indigenous belief systems into their diagnostic and treatment practices. Even when these belief systems clearly contradicted each other, PHCWs did not in general feel the need to make a conscious choice between them. From their comments it would appear that four factors contributed to this ability to incorporate diverse and often conflicting ideas into the way that patients were cared for. First, all of the belief systems were considered legitimate by at least one group of people connected to the community in which the PHCW worked. Second, although varying in degrees of availability and accessibility, members of these groups were able to disseminate information pertaining to the belief system they supported. Third, the PHCW had no particular affiliation with any one of these groups but instead regularly interacted with a range of different people. Lastly, the PHCW worked in situations where health practices were not generally well supervised by their employers and therefore they were relatively free to choose between various diagnostic and treatment practices. The qualitative interpretive approach adopted in this thesis contributes to the field of human information behavior by affirming that conflict is in the eye of the beholder. When a number of belief systems coexist and all are considered legitimate, information about them is freely available, and the recipients actions are neither constrained by their own dogma, nor imposed upon by others, individuals may quite comfortably embrace diverse beliefs. These findings may also contribute to a better understanding of health management practices in developing countries by suggesting that health professionals are not merely personifications of a biomedical model. Instead, the study demonstrates that multiple belief systems can be combined by PHCWs, and that in turn this benefits the formal health care sector through increased treatment options that are both appropriate and effective in such circumstances.
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The gender of suicideJaworski, Katrina January 2007 (has links)
Suicide holds an ambivalent position in contemporary social and cultural contexts. It questions what it means to live and die, yet provides no clear-cut answers about death or dying, life or living. This thesis explores some of the ways suicide has been understood and represented, to demonstrate that knowing suicide is dependent not only on what suicide means, but also on how meanings of suicide become part of knowledge. Knowing suicide is not a matter of responding to it as self-evident, transparent, neutral and obvious, but rather is implicated in social processes and norms central to how knowledge gains intelligibility. Guided by poststructuralist, postmodernist, feminist and postfeminist philosophies, the thesis takes up gender and gendering as its central focus, to interrogate how knowledge about suicide becomes knowledge. Critically examining a wide variety of textual sources, it argues that suicide is principally rendered as a masculine, and even a masculinist, practice. Knowing suicide today is anchored in suicidology - the study of suicide - and maintained by institutional sites of practice including sociology, law, medicine, psy-knowledge and newsprint media, each of which is analysed here. Suicide as masculine and masculinist practice is invoked through multiple, often-contradictory and inextricably linked readings of gender, even while claiming homogeneity. Its gendered foundations can however be made to appear gender-neutral, even when actually gender-saturated. The twin gender movements of neutrality and repleteness are in fact crucial to the knowing of suicide. The thesis establishes that knowing suicide can never occur outside discourse. Even more importantly, how suicide enters discourse cannot be thought outside gender. The body matters to the production of deeply problematic understandings of agency, intent and violence, on which the production of suicide as masculine and masculinist depends. It becomes clear that such dependence rests not only on gender, but also on race and sexuality, as conditions of its knowing. The thesis suggests that further attention be given to the production and maintenance of highly reductive and limiting homogenous truth claims in suicide - truth claims that validate and privilege some interpretations of suicide, at the expense of rendering others less legitimate and serious. If the processes and practices of interpreting suicide become a site of permanent debate, they are more likely to challenge the ways in which masculinist ways of knowing render, and limit, the intelligibility of suicide.
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Índice de massa corporal e valores de impedância bioelétrica de crianças e adolescentes indígenas Kaingang, Rio Grande do Sul, BrasilBarufaldi, Laura Augusta January 2009 (has links)
Fundamentos: São necessárias avaliações do estado nutricional de povos indígenas, como forma de mensurar influências ambientais e sociais sobre as condições de vida e saúde e fornecer subsídios para intervenções. Este estudo, de base escolar, objetivou descrever o estado nutricional de crianças e adolescentes Kaingang pela antropometria e pela impedância bioelétrica (IBE) e comparar as classificações geradas pelos dois métodos. Métodos: Estudaram-se 3207 indígenas (73,6% dos matriculados) das 35 escolas de 12 Terras Indígenas Kaingang do Rio Grande do Sul, Brasil. Foram mensurados peso e estatura conforme WHO (1995) e parâmetros de resistência (R) e reactância (Xc), em Ohm, mediante impedanciômetro RJL Systems Electrode Placement. O índice estatura/idade e o índice de massa corporal/idade foram calculados e classificados segundo WHO (2007). A composição corporal foi avaliada pela Análise Vetorial de Impedância Bioelétrica (BIVA) conforme Piccoli et al (1994). A comparação entre classificações da antropometria e BIVA foi realizada graficamente, com base nas elipses de tolerância do gráfico RXc. Foram considerados significantes valores de p<0,05. Resultados: A idade média da amostra foi de 10,8 anos (+2,9), sendo 56,8% adolescentes e 50,6% do sexo masculino. Encontraram-se prevalências de déficit estatural (E/I) de 15,5% e 19,9% e de excesso de peso pelo IMC/Idade de 5,7% e 6,7%, respectivamente para crianças e adolescentes. Para ambos os sexos e faixas etárias, a amostra apresentou desvio em direção ao quadrante inferior esquerdo do gráfico RXc, indicando maior proporção de gordura em relação ao tecido não gordo. Para as crianças do sexo masculino a proporção de indivíduos além da elipse de tolerância de 95% foi de 2,7% e a proporção de indivíduos com classificações discrepantes, relativas à antropometria, foi de 94,6%. As mesmas proporções alcançaram, respectivamente, 2,3% e 77,1% para os adolescentes do sexo masculino; 2,5% e 85,4% para as crianças do sexo feminino e 0,6% e 94,8% para as adolescentes do sexo feminino. Conclusão: Aponta-se a transição nutricional entre os Kaingang, caracterizada por prevalências importantes de déficit estatural e excesso de peso. As discrepâncias entre as classificações do IMC/idade e BIVA sinalizam a necessidade de estudos que procurem conciliar maior número de técnicas de avaliação nutricional, como a conciliação da antropometria com a IBE. / Background: Indigenous nutritional status evaluations are necessary, as a way to measure social and environmental influences on health and life conditions and to provide subsidies for interventions. This school-based study aimed to describe the nutritional status of Kaingang children and adolescents by anthropometry and bioelectrical impedance (BIA), and to compare classifications obtained by both methods. Methods: 3207 indigenous (73.6% of the enrolled) of the 35 schools in 12 Indigenous Lands Kaingang of Rio Grande do Sul, Brazil were studied. Weight and height were measured according to WHO (1995) and resistance parameters (R) and reactance (Xc), in Ohm, by impedanciometer RJL Systems Electrode Placement. Height/ age index and body mass/ age index were classified based on WHO (2007). Body composition was evaluated by Bioelectric Impedance Vector Analysis (BIVA) according to Piccoli et al (1994). Comparisons between anthropometry and BIVA classifications were done graphically, based on the tolerance ellipses of RXc graph. Significant p values <0.05. Results: The average age of the sample was 10.8 years (+2.9), 56.8% of adolescents and 50.6% of males. Prevalence of stunting (H/A) of 15.5% and 19.9% and overweight (BMI/ age) of 5.7% and 6.7% were found, respectively for children and adolescents. For both sexes and age groups deviation toward the lower left quadrant of RXC graph was shown, indicating a higher proportion of fat in relation to not fat tissues. For male children, proportion of subjects beyond the 95% tolerance ellipse was 2.7% and proportion of subjects with discrepant classifications, relative to anthropometry, was 94.6%. The same proportions achieved, respectively, 2.3% and 77.1% of male adolescents, 2.5% and 85.4% of female children, and 0.6% and 94.8% of female adolescents. Conclusions: The study points the nutritional transition among the Kaingang, characterized by important prevalence of stunting and overweight. Discrepancies between classifications of BMI/age and BIVA signal the necessity of studies that look for the conciliation of differents nutritional evaluation techniques, as anthropometry and BIA.
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Índice de massa corporal e valores de impedância bioelétrica de crianças e adolescentes indígenas Kaingang, Rio Grande do Sul, BrasilBarufaldi, Laura Augusta January 2009 (has links)
Fundamentos: São necessárias avaliações do estado nutricional de povos indígenas, como forma de mensurar influências ambientais e sociais sobre as condições de vida e saúde e fornecer subsídios para intervenções. Este estudo, de base escolar, objetivou descrever o estado nutricional de crianças e adolescentes Kaingang pela antropometria e pela impedância bioelétrica (IBE) e comparar as classificações geradas pelos dois métodos. Métodos: Estudaram-se 3207 indígenas (73,6% dos matriculados) das 35 escolas de 12 Terras Indígenas Kaingang do Rio Grande do Sul, Brasil. Foram mensurados peso e estatura conforme WHO (1995) e parâmetros de resistência (R) e reactância (Xc), em Ohm, mediante impedanciômetro RJL Systems Electrode Placement. O índice estatura/idade e o índice de massa corporal/idade foram calculados e classificados segundo WHO (2007). A composição corporal foi avaliada pela Análise Vetorial de Impedância Bioelétrica (BIVA) conforme Piccoli et al (1994). A comparação entre classificações da antropometria e BIVA foi realizada graficamente, com base nas elipses de tolerância do gráfico RXc. Foram considerados significantes valores de p<0,05. Resultados: A idade média da amostra foi de 10,8 anos (+2,9), sendo 56,8% adolescentes e 50,6% do sexo masculino. Encontraram-se prevalências de déficit estatural (E/I) de 15,5% e 19,9% e de excesso de peso pelo IMC/Idade de 5,7% e 6,7%, respectivamente para crianças e adolescentes. Para ambos os sexos e faixas etárias, a amostra apresentou desvio em direção ao quadrante inferior esquerdo do gráfico RXc, indicando maior proporção de gordura em relação ao tecido não gordo. Para as crianças do sexo masculino a proporção de indivíduos além da elipse de tolerância de 95% foi de 2,7% e a proporção de indivíduos com classificações discrepantes, relativas à antropometria, foi de 94,6%. As mesmas proporções alcançaram, respectivamente, 2,3% e 77,1% para os adolescentes do sexo masculino; 2,5% e 85,4% para as crianças do sexo feminino e 0,6% e 94,8% para as adolescentes do sexo feminino. Conclusão: Aponta-se a transição nutricional entre os Kaingang, caracterizada por prevalências importantes de déficit estatural e excesso de peso. As discrepâncias entre as classificações do IMC/idade e BIVA sinalizam a necessidade de estudos que procurem conciliar maior número de técnicas de avaliação nutricional, como a conciliação da antropometria com a IBE. / Background: Indigenous nutritional status evaluations are necessary, as a way to measure social and environmental influences on health and life conditions and to provide subsidies for interventions. This school-based study aimed to describe the nutritional status of Kaingang children and adolescents by anthropometry and bioelectrical impedance (BIA), and to compare classifications obtained by both methods. Methods: 3207 indigenous (73.6% of the enrolled) of the 35 schools in 12 Indigenous Lands Kaingang of Rio Grande do Sul, Brazil were studied. Weight and height were measured according to WHO (1995) and resistance parameters (R) and reactance (Xc), in Ohm, by impedanciometer RJL Systems Electrode Placement. Height/ age index and body mass/ age index were classified based on WHO (2007). Body composition was evaluated by Bioelectric Impedance Vector Analysis (BIVA) according to Piccoli et al (1994). Comparisons between anthropometry and BIVA classifications were done graphically, based on the tolerance ellipses of RXc graph. Significant p values <0.05. Results: The average age of the sample was 10.8 years (+2.9), 56.8% of adolescents and 50.6% of males. Prevalence of stunting (H/A) of 15.5% and 19.9% and overweight (BMI/ age) of 5.7% and 6.7% were found, respectively for children and adolescents. For both sexes and age groups deviation toward the lower left quadrant of RXC graph was shown, indicating a higher proportion of fat in relation to not fat tissues. For male children, proportion of subjects beyond the 95% tolerance ellipse was 2.7% and proportion of subjects with discrepant classifications, relative to anthropometry, was 94.6%. The same proportions achieved, respectively, 2.3% and 77.1% of male adolescents, 2.5% and 85.4% of female children, and 0.6% and 94.8% of female adolescents. Conclusions: The study points the nutritional transition among the Kaingang, characterized by important prevalence of stunting and overweight. Discrepancies between classifications of BMI/age and BIVA signal the necessity of studies that look for the conciliation of differents nutritional evaluation techniques, as anthropometry and BIA.
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Política Nacional de Atenção à Saúde Indígena no Brasil : dilemas, conflitos e alianças a partir da experiência do Distrito Sanitário Especial Indígena do XinguAraújo, Reginaldo Silva de 06 February 2012 (has links)
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Previous issue date: 2012-02-06 / Universidade Federal de Minas Gerais / The Brazilian State, in order to start a new political relationship with indigenous communities, implemented, in 1999, the National Policy of Attention to Indigenous Health (PNASPI), through the National Health Foundation (FUNASA) and 34 Special Indigenous Sanitary Districts (DSEIs) located in the national territory. The new health policy for the indigenous areas, structured within the differentiated attention Subsystem and integrated into the Unified Health System (SUS), proposed a participatory model of Civil Society-State comanagement, via council or public policy managers, cooperation agreements with NGOs and other participatory experiences. Just likeit probably occurred in other indigenous territories, the implementation of a new State Agency in the Xingu brought a creative process of political and cultural adaptationto local leaders, generating the possibility of an inter-ethnic negotiation field. It was therefore from this political scenario that the research proposed to understand the indigenous leaders' forms of practice and their representations. Thus, it sought to observe the strategies of the region s representatives who "make pacts" and "negotiate" with the various organizations responsible for the implementation of health public policies (FUNASA, City Halls and NGOs), oriented by constitutional principles that ensure (universal) rights and (differentiated) specificities regarding preventive health care to these and all other indigenous groups within the national territory. The analysis of these forms of organization and political activity also sought to observe how the implementation of the health policy and its institutional arrangements generated a redesigning of the policy practices established between indigenous peoples and the State. Thus, even though indigenous leaders have not articulated a homogeneous position regarding the State's "offer" of partnership through NGOs and management councils,many of which with goals to ensure recognition and political spaces both in the national scene and in their traditional systems of organization, they started a project that pursues the enlargement of the memberships and a change in the organizational structure of the State.The movement, conducted by the leaders of the Alto Xingu, involves a participatory model of comanagement, whose practice does not dispense a few moments of consummation of the identity among the actors who make up this participatory experience. / O Estado brasileiro, visando a ensaiar uma nova relação política com as comunidades indígenas, implantou, em 1999, a Política Nacional de Atenção à Saúde Indígena (PNASPI), através da Fundação Nacional de Saúde (FUNASA) e de 34 Distritos Sanitários Especiais Indígenas(DSEIs)localizadosao longo do território nacional. A nova política sanitária para as áreas indígenas, estruturada no Subsistema de atenção diferenciada integrado ao Sistema Único de Saúde (SUS), propôs um modelo participativo de cogestão Estado-Sociedade Civil, via conselhos gestores ou de políticas públicas, convênios de cooperação com ONGs e outras experiências participativas. Assim como, provavelmente, ocorreu em outros territórios indígenas, a implementação de uma nova agência estatal na Terra Indígena do Xingu imprimiu aos líderes locais todo um processo político-cultural de adaptação criativa, gerando-se as condições de possibilidade de um campo de negociação interétnica. Portanto, foi a partir desse cenário político que a pesquisa propôs-se a apreender as formas de atuação dos líderes indígenas e suas representações. Procurou-se, assim, observar as estratégias dos representantes alto-xinguanos que pactuam e negociam junto aos diversos órgãos responsáveis pela implementação de políticas públicas em saúde (FUNASA; prefeituras; e ONGs), orientadas por princípios constitucionais que asseguram a esses e aos demais grupos aldeados no território nacional, ao mesmo tempo, direitos (universais) e especificidades (diferenciadas) nos cuidados preventivos e de atenção à saúde. A análise dessas formas de organização e de atuação política buscou, ainda, observar como a implementação da política sanitária, com seus arranjos institucionais,gerouum redimensionamento das práticas políticas estabelecidas até então, entre povos indígenas e o Estado. Portanto, mesmo que os líderes indígenasnão tenham articulado uma posição homogênea diante da oferta estatal de parceria por meio de ONGs e conselhos gestores, muitos com objetivos de garantir reconhecimento e espaços políticos tanto no cenário nacional quanto nos seus sistemas tradicionais de organização, deflagraram um projeto que persegue o alargamento das participações e uma mudança na estrutura organizativa do Estado.Esse movimento, realizado pelos líderes do Alto Xingu, envolve um modelo participativo de cogestão, cuja prática também não dispensa alguns momentos de consumação da identidade entre os atores que compõem essa experiência participativa.
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Índice de massa corporal e valores de impedância bioelétrica de crianças e adolescentes indígenas Kaingang, Rio Grande do Sul, BrasilBarufaldi, Laura Augusta January 2009 (has links)
Fundamentos: São necessárias avaliações do estado nutricional de povos indígenas, como forma de mensurar influências ambientais e sociais sobre as condições de vida e saúde e fornecer subsídios para intervenções. Este estudo, de base escolar, objetivou descrever o estado nutricional de crianças e adolescentes Kaingang pela antropometria e pela impedância bioelétrica (IBE) e comparar as classificações geradas pelos dois métodos. Métodos: Estudaram-se 3207 indígenas (73,6% dos matriculados) das 35 escolas de 12 Terras Indígenas Kaingang do Rio Grande do Sul, Brasil. Foram mensurados peso e estatura conforme WHO (1995) e parâmetros de resistência (R) e reactância (Xc), em Ohm, mediante impedanciômetro RJL Systems Electrode Placement. O índice estatura/idade e o índice de massa corporal/idade foram calculados e classificados segundo WHO (2007). A composição corporal foi avaliada pela Análise Vetorial de Impedância Bioelétrica (BIVA) conforme Piccoli et al (1994). A comparação entre classificações da antropometria e BIVA foi realizada graficamente, com base nas elipses de tolerância do gráfico RXc. Foram considerados significantes valores de p<0,05. Resultados: A idade média da amostra foi de 10,8 anos (+2,9), sendo 56,8% adolescentes e 50,6% do sexo masculino. Encontraram-se prevalências de déficit estatural (E/I) de 15,5% e 19,9% e de excesso de peso pelo IMC/Idade de 5,7% e 6,7%, respectivamente para crianças e adolescentes. Para ambos os sexos e faixas etárias, a amostra apresentou desvio em direção ao quadrante inferior esquerdo do gráfico RXc, indicando maior proporção de gordura em relação ao tecido não gordo. Para as crianças do sexo masculino a proporção de indivíduos além da elipse de tolerância de 95% foi de 2,7% e a proporção de indivíduos com classificações discrepantes, relativas à antropometria, foi de 94,6%. As mesmas proporções alcançaram, respectivamente, 2,3% e 77,1% para os adolescentes do sexo masculino; 2,5% e 85,4% para as crianças do sexo feminino e 0,6% e 94,8% para as adolescentes do sexo feminino. Conclusão: Aponta-se a transição nutricional entre os Kaingang, caracterizada por prevalências importantes de déficit estatural e excesso de peso. As discrepâncias entre as classificações do IMC/idade e BIVA sinalizam a necessidade de estudos que procurem conciliar maior número de técnicas de avaliação nutricional, como a conciliação da antropometria com a IBE. / Background: Indigenous nutritional status evaluations are necessary, as a way to measure social and environmental influences on health and life conditions and to provide subsidies for interventions. This school-based study aimed to describe the nutritional status of Kaingang children and adolescents by anthropometry and bioelectrical impedance (BIA), and to compare classifications obtained by both methods. Methods: 3207 indigenous (73.6% of the enrolled) of the 35 schools in 12 Indigenous Lands Kaingang of Rio Grande do Sul, Brazil were studied. Weight and height were measured according to WHO (1995) and resistance parameters (R) and reactance (Xc), in Ohm, by impedanciometer RJL Systems Electrode Placement. Height/ age index and body mass/ age index were classified based on WHO (2007). Body composition was evaluated by Bioelectric Impedance Vector Analysis (BIVA) according to Piccoli et al (1994). Comparisons between anthropometry and BIVA classifications were done graphically, based on the tolerance ellipses of RXc graph. Significant p values <0.05. Results: The average age of the sample was 10.8 years (+2.9), 56.8% of adolescents and 50.6% of males. Prevalence of stunting (H/A) of 15.5% and 19.9% and overweight (BMI/ age) of 5.7% and 6.7% were found, respectively for children and adolescents. For both sexes and age groups deviation toward the lower left quadrant of RXC graph was shown, indicating a higher proportion of fat in relation to not fat tissues. For male children, proportion of subjects beyond the 95% tolerance ellipse was 2.7% and proportion of subjects with discrepant classifications, relative to anthropometry, was 94.6%. The same proportions achieved, respectively, 2.3% and 77.1% of male adolescents, 2.5% and 85.4% of female children, and 0.6% and 94.8% of female adolescents. Conclusions: The study points the nutritional transition among the Kaingang, characterized by important prevalence of stunting and overweight. Discrepancies between classifications of BMI/age and BIVA signal the necessity of studies that look for the conciliation of differents nutritional evaluation techniques, as anthropometry and BIA.
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A influência da ingestão de bebida alcoólica e transtornos mentais comuns não psicóticos na pressão arterial dos indígenas Mura / The influence of alcoholic beverages consumption and common mental disorder on arterial blood pressure of the Mura IndigenousAlaidistânia Aparecida Ferreira 20 February 2017 (has links)
Introdução: A hipertensão arterial é de causa multifatorial, envolvendo hábitos de vida e estilos de vida inadequados como o consumo excessivo de bebida alcoólica que propiciam a elevação dos níveis pressóricos. Além disso, os sintomas relacionados ao transtorno mental comum também podem se associar ao estado de saúde, provocando mais danos ao sujeito com hipertensão arterial. Diante disso, o presente estudo teve como objetivo principal identificar associação entre a ocorrência de hipertensão arterial com o consumo de bebidas alcoólicas e a presença de transtorno mental comum em indígenas das aldeias Muras, residentes em região rural e urbana. Casuística e Métodos: Estudo transversal, de base populacional, com 455 indígenas Mura residentes no município de Autazes, Amazonas, Brasil. Foi aplicada a entrevista semi-estruturada com questões referentes aos dados socioeconômicos e educacionais, hábitos de vida, história clínica, histórico familiar, além dos questionários Alcohol Use Disorders Identification Test (AUDIT) e Self-Reporting Questonnaire (SRQ-20), para avaliar o consumo de álcool e presença de transtorno mental, respectivamente. A pressão arterial foi medida com aparelho automático de braço validado. Foram realizadas três medidas e usada a média das duas últimas medidas. Realizaram-se ainda, medida do peso, altura, circunferência do pescoço, circunferência da cintura, avaliação de bioimpedância; glicemia, triglicérides e colesterol com medida capilar. Na análise bivariada, foi testada a associação entre hipertensos, separadamente, com os dois desfechos: consumo de bebidas alcoólicas e a presença de transtorno mental comum explorando especialmente, os aspectos relacionados à hipertensão arterial. Foi ajustada a regressão de Poisson com variância robusta, para ambos os desfechos, com modelagem em stepwise backward automatizado, tendo como critério de entrada, p<0,20 e de significância no modelo final, p0,05. Utilizou-se como estimativa, as razões de prevalência e respectivos intervalos de confiança de 95%. Resultados: A maioria dos participantes era do sexo feminino (57,8%), com 42,10 (16,74) anos, vivendo com companheiro (74,7%) e cerca de quatro filhos por família, baixo nível de escolaridade Analfabeto/Fundamental incompleto (41,1%) e renda até dois salários mínimos (85,0%). A prevalência de hipertensão arterial foi de 26,6%, tabagismo (20,4%) e ser sedentário/irregularmente ativo (52,8%). O consumo de bebida alcoólica foi de 40,2%, sendo 13,4% classificados como alto risco para dependência alcoólica, e maior na área rural em comparação à urbana (57,3% vs 22,2%) p<0,001. Destacam-se os seguintes aspectos do uso abusivo de álcool: sentimento de culpa/remorso (45,9%); amnésia repentina por não lembrar o ocorrido na noite em que bebeu (31,7%); além de machucar-se ou sentir-se prejudicado por causa da bebida (29,6%); preocupação por parte de parentes, amigos ou profissionais de saúde, que aconselharam o entrevistado a interromper o consumo (51,5%). Não houve associação entre a presença e consumo de bebida alcoólica (23% e 26%). Os indígenas com diagnóstico de hipertensão referida, faziam menos uso de bebida alcoólica (14,2%vs 85,8%, p=0,009), porém nas ocasiões em que bebiam, ingeriam maior quantidade, comparado com os que não referiram hipertensão [55,3(72,2) vs 33,3(62,2) gramas de Etanol p=0,008]. A prevalência de transtorno mental comum foi de 45,7%, com destaque para os seguintes itens: referência de dores de cabeça frequentes (69,5%), sentir-se nervoso, tenso ou preocupado (66,2%), ter se sentido triste ultimamente (56,0%), dormir mal (55,2%) e ter sensações desagradáveis no estômago (42,9%). Além disso, destaca-se que 7,3% referiram ideia de acabar com a própria vida e 4,2% sentiram-se incapazes de desempenhar papel útil. Após análise ajustada a razão de prevalência após análise ajustada (Razão de prevalência, IC-95%), verificou-se associação positiva entre ingestão de bebida alcoólica e sexo masculino (2,72, IC-2,12-3,48), tabagismo (1,29, IC-1,06-1,56) e morar na zona rural (2,09, IC-1,61-2,72). Porém, a ação foi protetora para idade (0,98, IC-0,98-0,99), consumo de alimentos in natura (0,97, IC-0,95-0,99), e ausência de dislipidemias (0,75, IC-0,62-0,9). Entre os que apresentaram transtorno mental comum, a hipertensão arterial identificada esteve presente em 30,3% e o consumo de álcool uma vez ao mês em 22,1%. Após a análise ajustada (Razão de prevalência, IC-95%) verificou-se associação positiva entre o transtorno mental comum e a zona de moradia urbana (1.25, IC-1,02-1,54), não sabia que tinham antecedentes para diabetes (1.56, IC-1,24-1,96) e a ingestão de bebida alcoólica (1.01, IC-1,00-1,02). Porém, foi ação protetora não ter antecedentes pessoais de cardiopatia (0.59, IC-0,48-0,73). Conclusão: Observou-se que a presença de hipertensão arterial, consumo de bebida alcoólica e de transtorno mental comum foram elevados nos indígenas da etnia Mura. Esses achados podem ser decorrentes da aproximação e convivência entre indígenas e não indígenas favorecendo mudanças culturais, especialmente de hábitos e estilos de vida, com aumento do risco de doenças crônicas não transmissíveis. / Background: The arterial hypertension has a multifactorial disorder, including unappropriated habits and lifestyle as the excessive consumption of alcoholic beverages that may increase the blood pressure. Additionally, the symptoms related to the common mental disorder may be also associated with the health status, producing even more damages to the hypertensive subjects. Thus, this study aimed to identify the association of arterial hypertension occurrence with alcoholic beverages consumption and presence of common mental disorder in Indigenous from Mura villages, who live in rural and urban zones. Casuistic and Methods: Its a cross-sectional investigation, with demographic base, conducted with 455 Mura Indigenous from Autazes, Amazon, Brazil. Through a semi-structured interview, we gathered data about sociodemographic and educational profile, lifestyle, clinical records, family antecedents. In this occasion, the Alcohol Use Disorders Identification Test (AUDIT) and the Self-Reporting Questionnaire (SRQ-20) were applied to assess respectively the alcohol consumption and the presence of common mental disorder. The blood pressure was measured with an arm automatic device, validated for this goal, being three measures taken and, from the two last of them, a mean was obtained. Furthermore, we gathered weight, height, neck circumference, waist circumference, bioimpedance, glycemia, triglycerides and cholesterol, capillary measure for the last ones. In the bivariate analysis, we analyzed the association between hypertensive persons and the both outcomes- the alcohol consumption and the presence of common mental disorder, emphasizing the issues hypertension-related issues. The Poison regression, with robust variance, was adjusted for both outcomes, with a modelling in automatized stepwise backward, being p<0,20 the entrance criteria and p<0,05 the significance level for the final model. As estimative, we used the odds ratios and their respective confidence intervals of 95%. Results: Most were females (57,8%), with mean age of 42,2(16,74) years, living with a partner (74,7%), with about four children per family, poor educational level- Illiterate/Incomplete Basic (41,1%) and income of up two minimum wages (85,0%). 26,6% of the sample had hypertension, 20,4% were smokers and 52,8% were sedentary/irregularly active. Alcohol consumption was of 40,2%, with 13,4% showed high risk for alcohol addiction, and the consumption was higher in rural area in comparison with the urban one (57,3% vs 22,2%) p<0,001. We emphasize the following aspects of alcohol abuse: feeling of guilty and remorse (45,9%); abrupt amnesia for not remembering what happened in the night that they had drunk (31,7%); feeling hurt or impaired due to the drink consumption (29,6%); concerns from relatives, friends or healthcare professionals who advised the interviewed to interrupt the consumption (51,5%). There was not association between presence and alcoholic beverages consumption (23% and 26%). Indigenous diagnosed with referred arterial hypertension drank less alcoholic beverages (14,2%vs 85,8% p=0,009), but, when they drank, they had a larger amount than those with referred hypertension [55,3(72,2) vs 33,3(62,2) grams of Ethanol p=0,008]. The common mental disorder was identified in 45,7% of the individuals, being highlighted the following items: reporting of frequent headaches (69,5%), feeling nervous, anxious or worried (66,2%), feeling sad in the last days (56,0%), sleeping badly (55,2%) and having upset stomach (42,9%). Additionally, 7.3% reported the idea of committing suicide, and 4,2% felt themselves unable to play a useful role. We verified positive association between alcoholic beverage consumption and male gender (2.72, CI-2,12-3,48); smoking (1.29, CI-1.06-1.56); and living in rural area (2.09, CI-1.61-2.72). However, the action was protective for the age (0.98, CI-0,98-0,99), intake of natural foods (0.97, CI-0,95-0,99), and absence of dyslipidemias (0.75, CI-0,62-0,9). Among those diagnosed with common mental disorder, the arterial hypertension was found in 30,3% and the alcohol consumption once a month in 22,1%. We observed a positive association of common mental disorder and: living in the urban area (1.25, CI-1,02-1,54); unknowing the antecedents for diabetes (1.56, CI-1,24-1,96); and the alcohol consumption (1.01,CI-1,00-1,02). However, the absence of personal background of heart diseases was not protective (0.59, CI-0,48-0,73). Conclusion: We observed that the presence of arterial hypertension, alcoholic beverages consumption and common mental disorder were high in the Mura ethnicity. This finding may be explained for the approach and interaction among Indigenous and non-Indigenous, which favors cultural changes, especially in habits and lifestyle, increasing the risk of non-transferable chronic diseases.
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