Participation in biocultural diversity conservation : insights from five Amazonian examples

Unidad de excelencia María de Maeztu CEX2019-000940-MThe past three decades have seen the emergence of myriads of initiatives focused on conserving, revitalizing, and maintaining Indigenous and Local Knowledge (ILK) as part of biocultural approaches to conservation. However, the extent to which these efforts have been participatory has been often overlooked. In this chapter, we focus on five prominent ILK conservation initiatives in the Amazon Basin to examine the participation of Indigenous Peoples and Local Communities (IPLCs) in ILK conservation. Our review illustrates several examples of ILK conservation initiatives offering substantial opportunities for meaningful IPLC participation over the long term. Overall, our case studies suggest that the development of robust and inclusive decision-making processes is essential to optimize IPLC participation in ILK conservation, thereby increasing the legitimacy of these initiatives. Our review is not an exhaustive account of the breadth and depth of all initiatives promoting participatory biocultural conservation in this region, but it illustrates that there are many strategies that can help foster IPLC engagement and lead the participatory turn in biocultural conservation

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Prevalência de infecção por Helicobacter pylori em uma comunidade indígena em São Paulo e fatores associados: estudo transversal

CONTEXT AND OBJECTIVE: The prevalence of Helicobacter pylori infection is unevenly distributed among different populations. The aim here was to evaluate the factors associated with Helicobacter pylori infection among children up to five years of age living in a high-risk community. DESIGN AND SETTING: Cross-sectional study in an indigenous community of Guarani Mbya ethnicity, Tekoa Ytu and Tekoa Pyau villages, Jaragua district, city of Sao Paulo (SP), Brazil. METHODS: 74 children aged 0.4 to 4.9 years (mean 2.9 +/- 1.3 yearsmedian 3.1), and 145 family members (86 siblings, 43 mothers and 16 fathers) were evaluated for Helicobacter pylori infection using the validated C-13-urea breath test. Clinical and demographic data were collected. RESULTS: The prevalence was 8.3% among children aged 1-2 years and reached 64.3% among those aged 4-5 years (P = 0.018overall 31.1%). The prevalence was 76.7% among siblings and 89.8% among parents. There was a negative association with previous use of antibiotics in multivariate analysis adjusted for age (odds ratio, OR: 0.0795% confidence interval, CI: 0.01 to 0.66P = 0.02). The prevalence was higher among males (OR: 1.55), and was associated with maternal infection (OR: 1.81), infection of both parents (OR: 1.5), vomiting (OR: 1.28), intestinal parasitosis (OR: 2.25), previous hospitalization (OR: 0.69) and breastfeeding (OR: 1.87). CONCLUSIONS: The prevalence was high among subjects older than three years of age, thus suggesting that the incidence of infection was higher over the first three years of life. Previous use of antibiotics was inversely associated with current Helicobacter pylori infection.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Univ Fed Sao Paulo EPM Unifesp, Escola Paulista Med, Dept Pediat, Discipline Pediat Gastroenterol, Rua Coronel Lisboa 826, BR-04020000 Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM Unifesp, Escola Paulista Med, Dept Prevent Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM Unifesp, Escola Paulista Med, Dept Pediat, Discipline Pediat Gastroenterol, Rua Coronel Lisboa 826, BR-04020000 Sao Paulo, SP, BrazilUniv Fed Sao Paulo EPM Unifesp, Escola Paulista Med, Dept Prevent Med, Sao Paulo, SP, BrazilFAPESP: 2010/51098-2Web of Scienc