Indigenous protagonism has historically promoted the visibility of indigenous peoples in Brazilian public policies, and has been fundamental in ensuring rights and guaranteeing access to services. This article presents qualitative research and thematic content analysis. The documents analyzed were narratives written by indigenous students who acted as mediators in the four editions of the Introduction to the Health of Indigenous Peoples course. The course was offered by São Carlos Federal University, with the participation of indigenous and non-indigenous people, leaders, health workers and students from different regions of Brazil. Three experience categories were analyzed: indigenous presence and leadership in the course experience; learning in the encounter of diversities with active teaching-learning methodologies; indigenous university students training for work. The mediators' narratives revealed the potential to provide spaces for indigenous protagonism, while the methodology allowed the course to be constructed in a participatory manner, and can be recognized as symbolic strategies for the permanence of indigenous people in higher education institutions. O protagonismo indígena historicamente promoveu a visibilidade dos povos indígenas nas políticas públicas brasileiras e tem sido fundamental para assegurar direitos e garantir o acesso a serviços. O presente artigo traz uma pesquisa com abordagem qualitativa e análise temática de conteúdo. Os documentos analisados foram narrativas redigidas por estudantes indígenas que atuaram como mediadores nas quatro edições do curso Introdução à Saúde dos Povos Indígenas. O curso foi ofertado na Universidade Federal de São Carlos, contou com a participação de indígenas e não indígenas, lideranças, trabalhadores e estudantes da saúde de diversas regiões do Brasil. Analisaram-se três categorias de experiências: presença e protagonismo indígena na experiência do curso; aprendizagens no encontro de diversidades com metodologias ativas de ensino-aprendizagem; e universitários indígenas em formação para o trabalho. As narrativas dos mediadores revelaram a potencialidade de proporcionar espaços de protagonismo indígena, enquanto a metodologia permitiu a construção do curso de maneira participativa, podendo ser reconhecida como uma estratégia de permanência simbólica para indígenas nas instituições de ensino superior. El protagonismo indígena ha promovido históricamente la visibilidad de los pueblos indígenas en las políticas públicas brasileñas y ha sido fundamental para asegurar derechos y garantizar el acceso a servicios. Este artículo presenta una investigación con enfoque cualitativo y análisis de contenido temático. Los documentos analizados fueron narrativas escritas por estudiantes indígenas que actuaron como mediadores en las cuatro ediciones del curso Introducción a la Salud de los Pueblos Indígenas. El curso fue ofrecido en la Universidad Federal de São Carlos , con la participación de indígenas y no indígenas, líderes de salud, trabajadores y estudiantes de diferentes regiones de Brasil. Se analizaron tres categorías de experiencias: presencia y protagonismo indígena en la experiencia del curso; el aprendizaje en el encuentro de las diversidades con metodologías activas de enseñanza-aprendizaje; universitarios indígenas en formación para el trabajo. The mediators’ narratives revealed the potential to provide spaces for indigenous protagonism, while the methodology allowed the course to be constructed in a participatory manner, and can be recognized as symbolic strategies for the permanence of indigenous people in higher education institutions.
Since the 1990s, Taiwan has promoted genomics as part of its shift to a knowledge economy. However, controversies concerning Indigenous genetics and genomics extend into political, sociocultural, and historical dynamics. This has prompted a movement among Taiwan's Indigenous activists, culminating in legal reforms that made Taiwan the first country to enact legislation mandating collective informed consent for Indigenous peoples in 2016. This article proposes the concept of 'differentiated biological citizenship' to explain how Taiwan's Indigenous peoples have developed bioethics governance. First, the article analyzes the origin, dynamics, and main events of this controversy, arguing that it should be understood in the context of globalization and Taiwan's evolving identity politics. Second, the article traces how different actors (scientists, Indigenous elites, and government officials) negotiate a series of actionable strategies and develop collective informed consent based on the law. Finally, examining such issues as the relationship between trust and distrust and the power inequality between Indigenous and Han peoples, this article also investigates the difficulty in practicing collective consent as a governance model for Indigenous communities.
BackgroundBrazil has recognized the need to investigate the health context of Indigenous Peoples by (a) collecting data on service coverage, barriers, needs, and gaps in access to health care; (b) developing, funding, and implementing plans and strategies for multilingual service delivery (c) reducing gender, social, and cultural inequalities as well as geographical barriers that hinder equitable access to quality health services; and, (d) incorporating an intercultural-intersectoral approach in the development of policies and inclusive-participatory research.PurposePropose an original conceptual framework for action research on the socio-cultural aspects of pregnancy, childbirth, and the postpartum cycle among Brazilian Indigenous women.ResultsAn online consultation with healthcare professionals was conducted (April-June 2024) using audio recorded narratives to gather information about the health of pregnant and postpartum Indigenous women. The Canadian model of population health promotion guided information analysis. Fourteen healthcare professionals with experience working in four Brazilian states and with 11 ethnic groups were consulted. A total of 23 modifiable situations were identified, and an original conceptual framework was developed that encompasses the following health promotion areas as modifiable situations: structure of the healthcare network; administrative barriers in healthcare management; operationalization of care delivery; and clinical and social contexts.ConclusionThis article conceptualizes areas for innovative and socially responsive solutions to amend vulnerabilities in Brazilian Indigenous maternal health. The conceptual framework proposed offers a useful operational foundation for designing future interventions in Indigenous maternal health and for strengthening action research as a transformative methodological strategy in contexts marked by persistent historical and social inequalities.
This study analyzed the temporal trend and factors associated with unfavorable tuberculosis outcomes in Indigenous populations in Brazil during 2013-2022. An ecological and cross-sectional study was conducted on tuberculosis cases among Indigenous people. Prais-Winsten regression was used for temporal trends and logistic regression for factors associated with outcomes using the odds ratio (OR). A total of 7,446 cases among Indigenous people were analyzed; 82.9% were cured, 9.1% abandoned treatment, and 8.0% died. The North region showed a 5.6% (95%CI=3.1; 8.1) annual increase in abandonment and a 1.5% (95%CI=-2.6; -0.4) reduction in cure rates during 2013-2022, along with a 4.5% (95%CI=1.0; 8.2) increase in new cases and a 24.4% (95%CI=18.6; 30.6) rise in deaths from 2013 to 2019. Factors associated with treatment abandonment were insufficient monitoring (OR=14.07; 95%CI=8.25; 23.99) and lack of observed treatment (OR=1.82; 95%CI=1.32; 2.52). Predictors of death were age over 60 (OR=8.35; 95%CI=4.93; 14.15), living in the North (OR=3.25; 95%CI=1.68; 6.27), and insufficient monitoring (OR=42.94; 95%CI=20.75; 88.82). In summary, the temporal trend was unfavorable in all North scenarios, with multiple predictors of abandonment and death identified, particularly insufficient monitoring of cases. Objetivou-se analisar a tendência temporal e os fatores associados aos desfechos desfavoráveis da tuberculose em indígenas no Brasil no período de 2013-2022. Utilizou-se da regressão de Prais-Winsten para tendência temporal e regressão logística para os fatores associados aos desfechos usando a Odds Ratio (OR). Foram analisados 7.446 casos em indígenas, sendo que 82,9% evoluíram para cura, 9,1% abandonaram o tratamento e 8,0% foram a óbito. A região Norte apresentou crescimento do abandono de 5,6% (IC95%=3,1; 8,1) ao ano e redução das proporções de cura de 1,5% (IC95%=-2,6; -0,4) no período de 2013-2022, além de crescimento do número de casos novos de 4,5% (IC95%=1,0; 8,2) e óbitos 24,4% (IC95%=18,6; 30,6) de 2013 a 2019. Os fatores associados ao abandono de tratamento foram: casos com indicador de acompanhamento insuficiente (OR=14,07; IC95%=8,25; 23,99) e ausência do tratamento observado (OR=1,82; IC95%=1,32; 2,52). Os preditores de óbito foram: idade acima de 60 anos (OR=8,35; IC95%=4,93; 14,15), residir na região Norte (OR=3,25; IC95%=1,68; 6,27) e ter indicador de acompanhamento insuficiente (OR=42,94; IC95%=20,75; 88,82). Em suma, a tendência foi desfavorável em todos os cenários no Norte, enquanto múltiplos preditores do abandono e óbito foram identificados como o acompanhamento insuficiente dos casos. Se analizó la tendencia temporal y los factores asociados a los desenlaces desfavorables de la tuberculosis en poblaciones indígenas de Brasil durante el período 2013-2022. Se utilizó regresión de Prais-Winsten para evaluar las tendencias y regresión logística para identificar los factores asociados, utilizando la razón de probabilidades (OR). Se analizaron 7.446 casos: el 82,9% evolucionaron hacia la curación, el 9,1% abandonaron el tratamiento y el 8,0% fallecieron. La región Norte presentó un aumento anual en el abandono del tratamiento del 5,6% (IC95%=3,1; 8,1) y una reducción en las tasas de curación del 1,5% (IC95%=-2,6; -0,4) durante 2013-2022. Además, entre 2013 y 2019, se registró un crecimiento en los casos nuevos del 4,5% (IC95%=1,0; 8,2) y en los fallecimientos del 24,4% (IC95%=18,6; 30,6). Los factores asociados al abandono fueron seguimiento insuficiente (OR=14,07; IC95%=8,25; 23,99) y ausencia de supervisión del tratamiento (OR=1,82; IC95%=1,32; 2,52). Entre los predictores de mortalidad se identificaron: edad mayor a 60 años (OR=8,35; IC95%=4,93; 14,15), residencia en la región Norte (OR=3,25; IC95%=1,68; 6,27) y seguimiento insuficiente (OR=42,94; IC95%=20,75; 88,82). En resumen, la tendencia fue desfavorable en el Norte, y el seguimiento insuficiente destacó como el principal factor asociado a desenlaces negativos.
Biomethane is a clean, renewable, and eco-friendly unconventional natural gas resource that has attracted widespread global attention. However, the differences in biomethane generation and the constraining factors under the drive of indigenous versus exogenous microorganisms remain unclear. To address this, anaerobic fermentation experiments simulating coal‑derived biomethane generation were conducted using two distinct microbial sources: indigenous microorganisms enriched from fresh coal samples from the study area and exogenous microorganisms optimized under laboratory conditions. Five representative coal samples from the Wuguantun and Baode mining areas were used as carbon substrates. The efficiency of biomethane production was evaluated based on gas chromatography and analysis using four kinetic models. By integrating methods including coal petrographic and proximate analyses, 16 S rRNA high-throughput sequencing, and Fourier transform infrared spectroscopy, principal component analysis and metabolic pathway analysis were applied to systematically elucidate the main controlling factors and synergistic mechanisms governing biomethane generation. The results indicate that although both indigenous and exogenous microorganisms follow a similar three‑stage process during coal‑degrading methanogenesis, their gas production efficiencies differ significantly. Bioaugmentation with exogenous microbial consortia systematically optimized the biomethane generation process, increasing the maximum methane potential (A0) by approximately 80% on average, shortening the lag phase (λ) by about 55% on average, and significantly enhancing the maximum methane production rate (µm). Coal chemical structure was identified as the primary factor controlling gas‑production variability, with high H/C, and a high aliphatic structures (Aal/Aar, CH2/CH3), and moderate O/C serving as the most critical predictors, demonstrating excellent bioavailability. Coal physicochemical structure, microbial functional potential, and methanogenic pathway distribution govern biomethane output. The physicochemical structure of coal sets the upper limit of potential; the predicted functional gene abundance of the initial microbial community serves as an indicator of substrate degradation potential; and the distribution of downstream methanogenic pathways ultimately governs biomethane conversion efficiency. This study not only deepens the understanding of the complex biogeochemical process of coal bioconversion but also provides key scientific evidence for refining theoretical models of biomethane generation.
Vaccine hesitancy is a persistent global health challenge. This project explored attitudes towards and utilization of COVID-19 vaccination, as well as suggestions to improve utilization within Indigenous communities in Northwest Territories, Canada. Utilizing a cross-sectional design, this project spanned two phases: 10 communities in Phase 1 (April to November 2021), and 11 in Phase 2 (August 2022-January 2023). Self-identifying Indigenous adults (≥18 years) were invited. Quantitative and qualitative data were collected via a semi-structured interviewer-administered questionnaire. In Phase 1 (n = 124; mean age = 41.6 years; 63.7% women) and Phase 2 (n = 221; mean age = 43.6 years; 66.21% women), 78.2% and 87.2% of participants had received at least one dose, respectively. In Phase 1, 67.2% reported not being concerned about the vaccine, and 61.2% believed the benefits outweighed the risks. In Phase 2, 56.2% of participants agreed all eligible individuals should be vaccinated, and 59.2% agreed the vaccine prevented serious outcomes. Bivariate analyses revealed that negative attitudes towards COVID-19 severity, vaccine safety, and effectiveness were significantly associated with lower intention to receive a COVID-19 vaccine in the future. Qualitative insights revealed factors of vaccination hesitancy, including: concerns about safety, efficacy, and necessity; a need for information; and distrust in government. Reasons for utilization included: trust in vaccine safety; perceived necessity; and employment and travel requirements. COVID-19 vaccine utilization in Indigenous communities is high, yet hesitancy persists due to safety and efficacy concerns, and distrust in government. Culturally safe strategies, improved communication, and equitable access are essential to sustaining confidence and future pandemic preparedness.
Population-based data on the association between genes regulating non-shivering thermogenesis (UCP) and adipose tissue metabolism are fragmentary and yield inconsistent results. The indigenous populations of high-latitude regions have been the least studied. This study aimed to assess the association of UCP1 (rs1800592), UCP2 (rs660339), and UCP3 (rs1800849) genotypes with body mass index (BMI) and lipid profile markers in the indigenous population of northern Western Siberia. The study groups consisted of 12 males aged 27-50 and 39 females 18-64 years old belonging to the Ob Ugrians (ethnic Khanty and Mansi). Blood samples and data on BMI, blood plasma levels of total cholesterol (TC), highdensity lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were collected. Genotyping of genomic DNA isolated from the subjects' blood samples was performed at the polymorphic UCP1 (A/G, rs1800592), UCP2 (C/T, rs660339), and UCP3 (C/T, rs1800849) loci. Data analysis was performed using the Statistica 12.0 software package (StatSoft, USA). For the maximum accuracy of the Hardy-Weinberg equilibrium compliance test in a small sample, we used the HWE exact test (Fisher's method) implemented in the Cog-Genomics/PLINK statistical package. An intergroup comparison of indicators in carriers of different genotypes was carried out using the Mann-Whitney test. When comparing biochemical parameters in groups with different genotypes, the Bonferroni correction for multiple comparisons was used. In carriers of the AA*UCP1 genotype, BMI values (27.2±5.6 kg/m2; n=30) were higher than in individuals with GG+AG genotypes (23.7±3.94 kg/m2; n=21, p=0.015). No associations were found between BMI and UCP2 and UCP3 polymorphisms. Female subjects with the homozygous TT*UCP2 genotype had increased plasma TG levels (p=0.033) and higher TG/HDL ratios compared with C*UCP2 allele carriers. Homozygotes for the C*UCP3 allele differed from carriers of the T* allele (CT and TT genotypes) in having higher LDL-C levels (p=0.036). The study confirmed the association of UCP1 gene variants with BMI and of UCP2 and UCP3 genes with lipid profile parameters in the ethnic Khanty and Mansi studied group. The association of UCP1 with BMI in the subjects of this study does not agree with the conclusions found in the scientific literature about an increased risk of obesity among G* allele carriers in Caucasian samples. The associations between UCP2-3 and lipid metabolism parameters in Ob Ugrians are consistent with those reported in Mongoloid populations. The specificity of the phenotypic manifestations of UCP polymorphism in different racial groups requires further investigation.
Fungi can oxidise pyrite, a process which has potential implications for metal bioleaching and acid mine drainage formation. However, this capacity has been demonstrated primarily using only a few model fungal strains. Diverse fungal communities are known to inhabit pyrite-rich mine tailings but how these indigenous fungi may mediate pyrite oxidation and by what mechanisms remain largely unexplored. Here, we isolated 51 pyrite-oxidizing fungal strains spanning 28 genera from three mine tailings areas in South China. From this native library, we selected three potent pyrite oxidisers, Pithomyces cynodontis DC37, Penicillium janthinellum ZJS52, and Aspergillus niger DBS124, for in-depth mechanistic characterisation. These indigenous strains solubilised 1.2%-1.8% of the total iron from pyrite in fungus-pyrite co-culture systems, exceeding values reported for model fungi under comparable conditions. They also acidified the medium to a pH as low as 2.15, providing dual lines of evidence for their robust oxidative capacity. Further analyses revealed distinct surface erosion features and changes in iron (Fe) and sulfur (S) speciation, confirming fungal-mediated pyrite oxidation. All three strains secreted organic acids (e.g., oxalic and citric acids) and showed peroxidase activity, but they exhibited divergent patterns. By combining hybrid genome sequencing (Illumina and Nanopore) with time-course transcriptomics, we uncovered the genetic basis for these divergent patterns. Genes coding for lignin and manganese peroxidases in P. cynodontis DC37 were co-induced by reactive oxygen species and metal ions released during pyrite oxidation. Furthermore, A. niger DBS124 employed an oxalic-acid-based mechanism upon pyrite exposure, driven by coordinated upregulation of central carbon metabolism and oxalate biosynthesis. Collectively, our findings highlight the underexplored biotechnological potential of mine-tailings fungi and establish a molecular foundation for understanding their roles in Fe- and S-cycling within mining environments and for developing fungal-mediated bioleaching technologies.
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Sleep disorders are rising globally, but their lifestyle causes remain unclear. We recorded sleep-wake patterns via actigraphy from 1039 Orang Asli adults in Peninsular Malaysia experiencing varying levels of market integration, including access to permanent electrical and housing infrastructure, use of digital technologies, and participation in wage labour. We evaluated associations between these lifestyle variables and sleep timing, continuity and quantity, while accounting for relevant demographic and environmental covariates. Access to powerline electricity was associated with delayed and less regular sleep timing, shorter sleep duration and fewer nighttime disruptions. Ambient temperature more strongly influenced sleep onset than offset, resulting in shorter sleep under hotter conditions. Housing structure modestly shaped sleep timing: individuals living in wood or concrete housing woke earlier and showed reduced sensitivity of sleep timing to ambient temperature, indicating that built environments can modify thermal influences on sleep. Participation in wage labour was associated with fewer nighttime awakenings but not with shifts in sleep timing. Age and sex were strong predictors of sleep variation, with older adults sleeping earlier, with more regularity, and with fewer disruptions. These findings show that market integration exerts heterogeneous, context-dependent effects across multiple sleep outcomes.
This study examines disparities in rates and number of telehealth used among Indigenous Medicare mental health services users in Southeast Queensland. We analysed the 2021 Census and Medicare Benefits Schedule data for 298,283 individuals who used MBS-subsidised community mental health services, including 78,048 who used telehealth. Descriptive and regression analyses were conducted. Indigenous Australians were significantly less likely to use telehealth than non-Indigenous Australians (24.66% vs 26.23%, p < 0.001), although difference was small. Video-based telehealth was associated with a significantly greater increase in service use for non-Indigenous Australians than Indigenous Australians (coefficient = -0.76, p < 0.001). Indigenous adults who were female, aged 25-69, or not in the labour force were more likely to use telehealth, while number of telehealth services used was higher among those aged 40+, those who did not speak an Aboriginal language at home, and those receiving psychotherapies or video-based services. Indigenous children aged 12-17 years and those living in the Gold Coast Hospital and Health Service region were more likely to use telehealth, while greater telehealth utilisation was associated with psychotherapies and video services. Compared with non-Indigenous Australians, Indigenous Australians were less likely to use telehealth services, particularly for video services and psychotherapies, more likely to rely on general practitioner-delivered services and phone consultations. These patterns suggest systemic and cultural barriers, including cost, service availability, and preferences. Tailored telehealth interventions are needed to address these disparities and promote equitable utilisation.
The purpose of this article is to introduce the Social Dynamics of Change (SDoC), a framework for institutional transformation, and examine the Canadian Medical Association's (CMA) 2024 Apology to the Indigenous Peoples of Canada as a case study in institutional reconciliation. Converging social, political, and institutional forces exposed the CMA's maladaptive relationship with Indigenous Peoples. Through the SDoC framework, reconciliation involved movement from crisis through denial, resistance, exploration, and commitment. Progress required relational accountability, trust, co-design, and sustained engagement between Indigenous and non-Indigenous leaders. The case highlights the importance of Indigenous leadership in senior governance, as three authors in distinct leadership roles helped create the enabling environment that supported the CMA's reconciliation journey. The CMA case suggests that meaningful institutional reconciliation is achieved when relational alignment precedes transactional milestones. The SDoC framework helps explain how healthcare organizations navigate change and translate reconciliation commitments into lasting shifts in governance and culture.
Worldwide, mental health systems continue to grapple with providing recovery-oriented services as part of broader reform efforts. Critical to the objective of transforming mental health services is the employment of a rights-based, non-clinical lived experience workforce. Vital to undertaking the roles, and supporting this workforce, is a comprehensive understanding of the knowledge and practices of the discipline, particularly in situations where rapid growth may see this workforce developing in an ad hoc way. The aim of this review was to determine how members of the mental health lived experience workforce describe and enact our discipline, by synthesising evidence and illustrations. A narrative review methodology employed searches for international peer reviewed literature and policy documents related to lived experience work. Resources required at least one mental health lived experience author. We used a deductive approach to the categorisation of three designated mental health lived experience role types: service delivery (such as peer support); leadership; and Indigenous. An inductive approach was then taken to identify the knowledge and practices informing the three role types. Relevant texts were allocated amongst the research team, independently read, coded and themed, followed by team discussions to reach consensus where there were conflicts. After full text reading, we identified 25 resources. There were many more resources about the knowledge and practices of lived experience direct service delivery than about leadership roles. Three themes emerged from the knowledge and practices for each role type. For direct service roles knowledge was: having been there; knowing helpful qualities of relationships; and knowing how to use your own lived experience intentionally. Practices for direct service roles were: working relationally, sharing lived experiences in a meaningful way and working in a values and rights-based way. Knowledge required for leadership was: ethical decision-making; being informed by collective/shared history and knowing how to create change. Required practices were: transforming services from within; embedding the lived experience workforce and championing justice. Themes describing Indigenous knowledge were: challenging exclusively Euro-centric modes of treatment, truth-telling and self-determination. Emerging themes on practices of designated Indigenous lived experience workforces were: relational and community approaches, trauma informed, and culturally sensitive and safe practices. Articulation of the knowledge and practices underpinning the lived experience discipline is required for this workforce to be confident in the scope, purpose and history of their roles and for organisations to successfully establish them and provide effective supports. For Indigenous workers in designated lived experience roles, approaches to wellbeing and cultural practices cannot be separated from the way that the roles are carried out. Embedding Indigenous leadership, knowledge and practices would strengthen the human rights, justice-based and non-clinical nature of these roles, is a necessary response to colonial violence and would guide workforce development for other LE staff, mental health professionals, and mental health service development.
Despite growing attention to cultural safety and cultural responsiveness in health professions, no scoping review has focused exclusively on Canadian Speech‑Language Pathology (S-LP) practice across Indigenous peoples and other equity‑deserving groups. Existing reviews often combine S-LP with other rehabilitation professions, focus on either pediatric or adult populations but not both, or limit analysis to a single service‑delivery context. This scoping review protocol outlines an approach to mapping Canadian literature on culturally safe and culturally responsive S-LP practices across populations, contexts, and the lifespan, examining Indigenous peoples as distinct Nations and collective rightsholders rather than grouping them within other equity‑deserving populations. Guided by the PRISMA‑ScR framework, the review will systematically search peer‑reviewed and grey literature describing Canadian S-LP practice. A culturally informed continuum spanning cultural awareness, sensitivity, competence, responsiveness, and safety will guide data charting and synthesis. Terminology such as trauma‑informed will be included as a search concept due to its prevalence in the literature and will be interpreted using strength‑based and culturally safe lenses. The review will produce a descriptive map of how culturally safe and responsive practices are defined and implemented in Canadian S-LP literature, including strategies addressing Indigenous peoples and other equity‑deserving groups, and will identify key evidence gaps. Findings will inform S-LP education, training, and practice by clarifying how culturally safe and responsive approaches are currently described and where further research is needed within Canadian contexts.
Advances in data science and medical artificial intelligence (AI) raise complex philosophical and ethical quandaries about what it means to know a person or a community through data and what kinds of people and societies we are becoming in this era of predictive data science. Drawing on four lightly fictional but reality-informed case studies in mental health, radiology, genomics and environmental public health, we reflect on how AI technologies, largely built on Western biomedical traditions, may conflict with relational, spiritual and Indigenous understandings of health and wellbeing. This may manifest as epistemic friction, algorithmic fatalism and diminished trust in patient-clinician relationships. Besides familiar concerns regarding bias and transparency, this paper advances the discourse on the ethics of medical AI and data science in healthcare by shifting the analysis from epistemology (how AI systems know, classify and predict) to ontology (the study of the nature of being, as reconfigured by data and AI). We argue that AI systems may inflict significant ontological harm by reconfiguring identity, moral agency and imagined futures and advocate for a renewed medical humanism driven by inter- philosophies dialogue, cross-cultural ethics and ecocentric approaches to care. From Bamenda, Cameroon, to Mthatha, South Africa and Toronto, Canada, the future of medical AI must be defined by the moral and philosophical traditions that people already live by. African, Indigenous, Islamic, Buddhist, Confucian and marginalised Western worldviews should not be treated as peripheral critiques, but as constitutive resources for building inclusive, human-centred health technologies. We conclude that bioethics should be recognised as a core infrastructure in global health, on equal footing with data science, medicine, biomedical research and health innovation.
Indigenous communities in the United States have disproportionately high tobacco use and reliance on propane for heating and cooking fuel compared to other demographic groups. Of concern is exposure to air nicotine (AN) and NO2 in indoor environments and their potential impact on respiratory infections. The objective of this study is to assess indoor air pollution and COVID-19 infection outcomes in multigenerational households within the Cheyenne River Sioux Tribe (CRST). The COVID-19 Wayakta He? ("Are you on guard against COVID-19?") Study recruited 290 multigenerational households with two adults at least 9 years apart. All participants responded to a questionnaire on COVID-19 outcomes, housing conditions, and environmental health factors. Households deployed passive AN and NO2 air monitors in their homes for 1 week. Each participant provided saliva samples for COVID-19 serological testing. The geometric mean AN concentration was 0.052 μg/m3 (range: 0.017-5.35); 40.1% of households had AN detected. The geometric mean NO2 concentration was 10.5 ppb (range: 0.65-138). The odds of previous COVID-19 infection were 1.21 (95% CI: 1.01, 1.51) times higher for those exposed to AN; the odds of self-reported long COVID-19 disease were 3.69 (95% CI: 1.11, 16.6) times higher for those exposed to NO2. Indoor air exposures to AN and NO2 increased the odds of having COVID-19 infection and long COVID-19 outcomes. The combination of toxic chemical exposures, increased prevalence of existing chronic diseases, and structural social problems placed Indigenous communities at increased risk of having COVID-19 infections. High exposures to household AN and NO2 and the occurrence of COVID-19 disease highlight the importance of consistently including exposure assessments to design targeted interventions in Tribal communities.
The impacts of agricultural commercialization on nutrition are highly contested. Agriculture-nutrition linkages are complex and context-dependent and may result in trade-offs between different dietary outcomes. This study compared dietary patterns between children in oil palm and non-oil palm-adopting Indigenous households in two oil palm contexts in Indonesia: "plasma" smallholder oil palm in West Kalimantan and oil palm plantation labor in Papua. Using 24-h dietary recall data from children aged between 12 and 59 mo in West Kalimantan (696 children; 963 recalls across two seasons) and Papua (345 children), we compared quantities of foods consumed at the food group level between children in oil palm and non-oil palm Indigenous households. We also compared the probabilities of consuming ultraprocessed foods. Children living in oil palm-adopting households in West Kalimantan consumed lower quantities of cereals and dark green leafy vegetables (DGLVs), more dairy and eggs, and were more likely to have consumed processed meat and sugar-sweetened beverages. In Papua, children living in households engaged in oil palm plantation labor consumed lower quantities of tubers and fish, but more cereals, DGLVs, and legumes. They were also more likely to have consumed ultraprocessed refined grains and bakery products. Associations between agricultural commercialization and children's diets are context-dependent and may reinforce local dietary transitions. These may include increased consumption of some healthy foods in some contexts, but also be associated with diets linked to negative health outcomes, including reduced consumption of some nutrient-rich foods and increased consumption of ultraprocessed foods.
To evaluate how racially diverse, late-adolescent/early emerging adult college students in the American Southeast would describe past-year traumatic events. In Study 1, 165 first-year students provided an open-ended response describing their past-year traumatic experiences (78.8% Black, Indigenous, or Other People of Color, 49.7% women, Mage = 19.1 years, 19.4% lesbian, gay, bisexual, transgender, queer/questionning). Deductive and inductive thematic analysis was used to categorize responses (all cases were team- or dyad-coded with excellent agreement). Thematic analysis on a second independent study of mostly third-year students (N = 98, 67.3% Black, Indigenous, or Other People of Color, 50.0% women, Mage = 21.1 years, 11.2% lesbian, gay, bisexual, transgender, queer/questionning) emphasized descriptive consistency of themes. Twenty-six codes were generated under an umbrella that included direct trauma (n = 13), indirect trauma (i.e., experienced through someone close, n = 3), or collective trauma (i.e., experienced through the larger community, n = 10). In both studies, the most common experiences were in reference to collective trauma (49.1%-52.0%), especially exposure to school/mass shootings (22.4% in Study 1) and other international traumatic events (e.g., Israel-Hamas/Gaza war; 16.3% in Study 2). Students often reported learning about national/international traumatic events via social media. Direct and indirect trauma, especially death or illness/injury of a loved one, were also relevant. Multiple forms of direct and indirect trauma are relevant to late adolescent/early emerging adults in college, though collective trauma may be especially meaningful. Further research is needed to understand its relevance to increasingly common internalizing symptoms among young people. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The value of data continues to increase as new technologies have a seemingly insatiable demand for information. This places Indigenous peoples in the difficult position as both users of diverse data for standard and unique ends and the producers of standard and unique data for diverse ends. In Aotearoa New Zealand, Māori have entered scholarly and policy debates on data with typical relish. Yet our communities are at different stages of understanding and empowerment as the owners, producers and users of data. This article details a co-design process in producing a data framework that originated in the biosecurity space but has wider applications. While we use cultural metaphors to explain and communicate our work with the mundane and sacred, we are committed to providing practical templates for groups wanting to engage in research. But just as our data is linked to our people, so are current and future technologies that are subject to influence through societal laws and regulations. We offer some thoughts on how a safer world might arise through working in a more ethical way with Indigenous peoples and their data.