Access to Indigenous and allopathic medicines: A systematic review of barriers and facilitators

Background: Globally, Indigenous peoples are the victims of social inequalities in health. Their state of health is much lower than the health of the general population. Colonialism, living conditions and access to care are the main determinants of observed health conditions. The scientific objective of this systematic literature review is to study the facilitators and barriers to access healthcare for both, traditional and allopathic medicines. Methods: An inclusive search of electronic databases (e.g ProQuest, Ovid, Medline, CINAHL PLUS, Cochrane Library, ApaPsyNet, PsyINFO and Sociological Abstracts databases) of the past 20 years was performed. We retained studies discussing (1) traditional medicine (TM) or allopathic medicine (AM) or both and occurring (2) within Indigenous population worldwide. We made no distinction between research carried out in rural as opposed to urban areas. Results: A total of 45 studies published between 1996 and 2016 met our inclusion criteria and this speaks to the high interest and contemporary pertinence of accessing both systems of healthcare for Indigenous populations worldwide. Our thematic analysis enabled us to group barriers and facilitators into five categories, namely related to personal, relational, cultural, structural and policy components. As far as barriers and facilitators are concerned, the category that encompasses the most themes is the structural category. Conclusions: Mutual respect, trust and understanding of each other’s modalities is essential to offer the best healthcare options from both AM and TM to Indigenous peoples and hence pave the way to reducing health inequities. Wellness and strength-based approaches must also be favoured

Access to Indigenous and allopathic medicines: A systematic review of barriers and facilitators

Background: Globally, Indigenous peoples are the victims of social inequalities in health. Their state of health is much lower than the health of the general population. Colonialism, living conditions and access to care are the main determinants of observed health conditions. The scientific objective of this systematic literature review is to study the facilitators and barriers to access healthcare for both, traditional and allopathic medicines. Methods: An inclusive search of electronic databases (e.g ProQuest, Ovid, Medline, CINAHL PLUS, Cochrane Library, ApaPsyNet, PsyINFO and Sociological Abstracts databases) of the past 20 years was performed. We retained studies discussing (1) traditional medicine (TM) or allopathic medicine (AM) or both and occurring (2) within Indigenous population worldwide. We made no distinction between research carried out in rural as opposed to urban areas. Results: A total of 45 studies published between 1996 and 2016 met our inclusion criteria and this speaks to the high interest and contemporary pertinence of accessing both systems of healthcare for Indigenous populations worldwide. Our thematic analysis enabled us to group barriers and facilitators into five categories, namely related to personal, relational, cultural, structural and policy components. As far as barriers and facilitators are concerned, the category that encompasses the most themes is the structural category. Conclusions: Mutual respect, trust and understanding of each other’s modalities is essential to offer the best healthcare options from both AM and TM to Indigenous peoples and hence pave the way to reducing health inequities. Wellness and strength-based approaches must also be favoured

Comprehensive Evidence-Based Assessment and Prioritization of Potential Antidiabetic Medicinal Plants: A Case Study from Canadian Eastern James Bay Cree Traditional Medicine

Canadian Aboriginals, like others globally, suffer from disproportionately high rates of diabetes. A comprehensive evidence-based approach was therefore developed to study potential antidiabetic medicinal plants stemming from Canadian Aboriginal Traditional Medicine to provide culturally adapted complementary and alternative treatment options. Key elements of pathophysiology of diabetes and of related contemporary drug therapy are presented to highlight relevant cellular and molecular targets for medicinal plants. Potential antidiabetic plants were identified using a novel ethnobotanical method based on a set of diabetes symptoms. The most promising species were screened for primary (glucose-lowering) and secondary (toxicity, drug interactions, complications) antidiabetic activity by using a comprehensive platform of in vitro cell-based and cell-free bioassays. The most active species were studied further for their mechanism of action and their active principles identified though bioassay-guided fractionation. Biological activity of key species was confirmed in animal models of diabetes. These in vitro and in vivo findings are the basis for evidence-based prioritization of antidiabetic plants. In parallel, plants were also prioritized by Cree Elders and healers according to their Traditional Medicine paradigm. This case study highlights the convergence of modern science and Traditional Medicine while providing a model that can be adapted to other Aboriginal realities worldwide

Circum-Arctic distribution of chemical anti-herbivore compounds suggests biome-wide trade-off in defence strategies in Arctic shrubs

Spatial variation in plant chemical defence towards herbivores can help us understand variation in herbivore top-down control of shrubs in the Arctic and possibly also shrub responses to global warming. Less defended, non-resinous shrubs could be more influenced by herbivores than more defended, resinous shrubs. However, sparse field measurements limit our current understanding of how much of the circum-Arctic variation in defence compounds is explained by taxa or defence functional groups (resinous/non-resinous). We measured circum-Arctic chemical defence and leaf digestibility in resinous (Betula glandulosa, B. nana ssp. exilis) and non-resinous (B. nana ssp. nana, B. pumila) shrub birches to see how they vary among and within taxa and functional groups. Using liquid chromatography-mass spectrometry (LC-MS) metabolomic analyses and in vitro leaf digestibility via incubation in cattle rumen fluid, we analysed defence composition and leaf digestibility in 128 samples from 44 tundra locations. We found biogeographical patterns in anti-herbivore defence where mean leaf triterpene concentrations and twig resin gland density were greater in resinous taxa and mean concentrations of condensing tannins were greater in non-resinous taxa. This indicates a biome-wide trade-off between triterpene- or tannin-dominated defences. However, we also found variations in chemical defence composition and resin gland density both within and among functional groups (resinous/non-resinous) and taxa, suggesting these categorisations only partly predict chemical herbivore defence. Complex tannins were the only defence compounds negatively related to in vitro digestibility, identifying this previously neglected tannin group as having a potential key role in birch anti-herbivore defence. We conclude that circum-Arctic variation in birch anti-herbivore defence can be partly derived from biogeographical distributions of birch taxa, although our detailed mapping of plant defence provides more information on this variation and can be used for better predictions of herbivore effects on Arctic vegetation.Peer reviewe

Circum-Arctic distribution of chemical anti-herbivore compounds suggests biome-wide trade-off in defence strategies in Arctic shrubs

Spatial variation in plant chemical defence towards herbivores can help us understand variation in herbivore top?down control of shrubs in the Arctic and possibly also shrub responses to global warming. Less defended, non-resinous shrubs could be more influenced by herbivores than more defended, resinous shrubs. However, sparse field measurements limit our current understanding of how much of the circum-Arctic variation in defence compounds is explained by taxa or defence functional groups (resinous/non-resinous). We measured circum-Arctic chemical defence and leaf digestibility in resinous (Betula glandulosa, B. nana ssp. exilis) and non-resinous (B. nana ssp. nana, B. pumila) shrub birches to see how they vary among and within taxa and functional groups. Using liquid chromatography?mass spectrometry (LC?MS) metabolomic analyses and in vitro leaf digestibility via incubation in cattle rumen fluid, we analysed defence composition and leaf digestibility in 128 samples from 44 tundra locations. We found biogeographical patterns in anti-herbivore defence where mean leaf triterpene concentrations and twig resin gland density were greater in resinous taxa and mean concentrations of condensing tannins were greater in non-resinous taxa. This indicates a biome-wide trade-off between triterpene- or tannin-dominated defences. However, we also found variations in chemical defence composition and resin gland density both within and among functional groups (resinous/non-resinous) and taxa, suggesting these categorisations only partly predict chemical herbivore defence. Complex tannins were the only defence compounds negatively related to in vitro digestibility, identifying this previously neglected tannin group as having a potential key role in birch anti-herbivore defence. We conclude that circum-Arctic variation in birch anti-herbivore defence can be partly derived from biogeographical distributions of birch taxa, although our detailed mapping of plant defence provides more information on this variation and can be used for better predictions of herbivore effects on Arctic vegetation