Search Results (52)

Background/Objectives: Encephalitis and related acute encephalopathic syndromes represent severe neurological conditions with diverse etiologies and variable clinical outcomes. This study aimed to analyze nationwide hospitalization patterns for encephalitis-related diagnoses in Ecuador between 2018 and 2024. Methods: We used data from the Ecuadorian National Institute of Statistics and Census to estimate age-adjusted hospitalization and mortality rates according to ICD-10 codes. Binary and multinomial logistic regression models were employed to identify sociodemographic factors and diagnostic categories of encephalitis associated with hospitalization and in-hospital mortality. Results: A total of 1560 hospitalizations related to encephalitis-spectrum diagnoses were recorded, with an overall age-adjusted rate of 0.127 per 100,000 inhabitants and 6.0% in-hospital mortality. Unspecified encephalitis and encephalomyelitis were the most common diagnostic categories. Adolescents (10–19 years) were more frequently diagnosed with acute disseminated and bacterial meningoencephalitis, while patients aged ≥70 had higher odds of “other” encephalitis subtypes and the highest mortality risk (aOR = 0.265; 95% CI: 0.116–0.608). Indigenous individuals were more likely to be diagnosed with acute disseminated encephalitis, and Black individuals showed a higher risk for myelopathy associated with human T-cell lymphotropic virus type 1-associated myelopathy. Conclusions: Age and ethnicity significantly influence hospitalization due to encephalitis-related diagnoses in Ecuador. These findings provide epidemiological rates for a lower-middle–income country where the lack of precise diagnosis, age, and ethnicity contribute to the vulnerability of encephalitis. Full article

Background: In the Americas, the number of people living with diabetes is expected to rise from 92 million in 2024 to 120 million by 2050. Indigenous populations may experience distinct biological, environmental, and sociocultural risk factors; however, they are often treated as a homogeneous group in epidemiological research, and consolidated evidence on diabetes prevalence across diverse Indigenous populations remains limited. This scoping review examines the prevalence of diabetes among Indigenous populations in the Americas. Methods: Following PRISMA-ScR guidelines, we conducted a systematic scoping review of population-based studies reporting the prevalence of diabetes among Indigenous adult populations in the Americas. Searches were performed in PubMed and Scopus. Collected data included study location, Indigenous group, population characteristics, diagnostic criteria, and test used and reported prevalence estimates. Results: Sixty documents encompassing 73 studies met the inclusion criteria, representing 45,503 individuals from 16 countries between 1975 and 2025. The total number of ethnic groups represented was 111, and 12 studies did not identify a specific ethnic group. Fasting blood glucose (FBG) was the most frequently used diagnostic method, followed by the oral glucose tolerance test (OGTT). Estimates of the prevalence of diabetes varied widely across populations, regions, and time periods. Five studies—from Brazil, Chile, Colombia, Mexico, and Paraguay—did not identify any cases of diabetes. Among studies reporting cases, prevalence ranged from 1 to 70% in North America, 5 to 14% in Central America, and 1 to 29% in South America. Conclusions: The prevalence of diabetes among Indigenous populations varied widely across the region, with substantially higher estimates reported in North America than in Central and South America. The decline in published studies in recent years suggests reduced research attention to this topic. The marked heterogeneity identified in this review underscores the need for standardized measurement approaches to support population-specific strategies aligned with personalized care and precision public health. Full article

Background: Breast cancer remains a leading cause of morbidity and mortality among women in Latin America. Mammography is the most effective population-based tool for early detection; however, its impact is limited by persistent social, geographic, and structural inequities. Evidence from the region indicates that ethnicity, rural residence, and health system organization play a central role in shaping unequal access to screening services. Methods: We conducted a narrative review informed by a systematic search strategy, following PRISMA 2020 recommendations. Searches were performed in 17 international and regional databases in English and Spanish, covering publications from 2015 to 2025. Eligible studies included non-interventional quantitative designs reporting mammography access, utilization, or coverage among women residing in Latin American countries. Three reviewers independently screened records, extracted data, and classified determinants of inequality into sociodemographic, geographic, and health-system domains. Results: Of 532 records identified, 12 studies met the inclusion criteria, primarily from Mexico, Brazil, Peru, and Chile. Most analyses were based on nationally representative surveys. Mammography coverage ranged from approximately 20% to 60%, with consistently lower uptake among Indigenous women, rural populations, and women without health insurance. Reduced screening was associated with low educational attainment, socioeconomic disadvantages, rural residence, ethnic self-identification, and fragmented health system affiliation. Structural barriers, including concentration of diagnostic infrastructure in urban areas, reliance on opportunistic screening models, and limited capacity for systematic follow-up, were recurrent across countries. Conclusions: Inequities in mammography access and utilization in Latin America reflect deeply rooted social and structural determinants rather than a lack of screening technology alone. Reducing preventable breast cancer mortality requires strengthening organized, population-based screening programs, decentralizing diagnostic services, improving continuity of care, and implementing culturally appropriate strategies tailored to Indigenous, rural, and uninsured populations. Full article

Background: Dementia is an increasing public health challenge in Mexico, yet recent national data on mortality patterns remain limited. This study examines temporal trends in dementia-related mortality and its sociodemographic and ecological characteristics among adults aged ≥65 years from 2017 to 2023. Methods: National mortality records from the General Directorate of Health Information were analyzed. Annual dementia-related mortality rates were calculated based on mid-year population estimates from CONAPO. Trends were assessed with regression analysis, including population offsets, and individual- and state-level characteristics were evaluated. Results: Between 2017 and 2023, dementia-related deaths increased from 761 to 1425, corresponding to an observed rise from 7.9 to 14.6 deaths per 100,000 inhabitants aged ≥65 years. Period trend indicated an average annual expected increase of 18.6% in dementia related mortality. A transient decline occurred in 2020–2021, coinciding with the COVID-19 pandemic. At the individual level, higher education was associated with greater odds of dementia certification, whereas Indigenous ethnicity appeared protective, which may reflect patterns consistent with diagnostic and reporting disparities. Higher state-level life expectancy correlated with higher dementia mortality, while greater population aging was inversely associated. Conclusions: Dementia-related mortality in Mexico shows a sustained upward trend with regional heterogeneity and apparent inequities in diagnosis and reporting. Strengthening mortality surveillance, improving certification quality, and integrating dementia indicators into national non-communicable disease registries are essential to guide equitable policy responses. Full article

Background: Dementia poses a significant health concern among Australia’s First Nations peoples, who experience higher prevalence and earlier onset compared to non-First Nations populations. Despite growing research attention, the overall scope and characteristics of existing literature on dementia in these communities remain unclear. Objective: This scoping review aimed to map and synthesise existing evidence on the burden of dementia among First Nations peoples, focusing on associated risk factors and culturally responsive approaches to prevention, intervention, and care. Methods: Following the PRISMA Extension for Scoping Reviews guidelines, a comprehensive search was conducted across Scopus, EMBASE, PubMed, PsycINFO, CINAHL, the Indigenous Studies Portal, and Google Scholar for English-language studies published between 2004 and 2025. Search terms combined dementia and cognitive impairment with First Nations, Indigenous peoples, and related concepts, alongside terms for risk factors, intervention, prevention, care strategies, and health disparities. Two reviewers independently screened studies and extracted data using a standardised template. Of the 620 records identified, 324 were screened, 130 were assessed in full, and 75 met the inclusion criteria. Data were narratively synthesised to identify key themes and evidence gaps. Results: The review revealed a disproportionate burden of dementia among First Nations peoples, characterised by earlier onset and higher prevalence than in non-First Nations populations. Major modifiable risk factors included social determinants of health, lifestyle behaviours, and inequitable access to healthcare. Studies emphasised the importance of culturally safe, community-led, and multidisciplinary approaches; however, many interventions remain poorly adapted to the diverse cultural contexts of First Nations communities. The review also identified gaps in diagnostic tools, culturally appropriate care pathways, and the integration of traditional knowledge and digital innovations in dementia management. Conclusions: Addressing dementia inequities among First Nations Australians demands transformative, community-driven action that extends beyond descriptive research. Future work should prioritise co-designed, culturally grounded interventions that embed First Nations knowledge systems, strengthen healthcare capacity, and foster long-term community empowerment. Embedding cultural safety within policy and clinical frameworks, and shifting toward preventive, strengths-based approaches, will advance equity in dementia care and provide valuable insights for First Nations health systems globally. Full article

Background: Although China has eliminated indigenous malaria, imported cases, particularly among young and middle-aged workers returning from Africa, constitute a major challenge for current epidemic prevention and control. In contrast, imported malaria in children is extremely rare and often subject to diagnostic delays in non-endemic areas due to atypical clinical presentations. Case presentation: We report a case of a 2-year-11-month-old boy who returned from Sudan, a malaria-endemic region, presenting with fever and diarrhea as the initial symptoms. The case was identified by the laboratory through the blood routine re-examination rules, crucially informed by the patient’s epidemiological history. The diagnosis was ultimately confirmed as Plasmodium falciparum malaria by rapid diagnostic testing and microscopic examination. Conclusion: This diagnostic pathway exemplifies a closed-loop model of “clinical suspicion → targeted laboratory testing → definitive pathogen identification.” It provides a practical framework for the early detection and diagnosis of pediatric imported malaria with atypical presentations in non-endemic areas. Full article

Archaeological surface features on desert pavements, including geoglyphs, are notoriously difficult to assess. Lacking temporally diagnostic artifacts, they may be impossible to place chronologically, limiting their inferential utility. Not surprisingly, controversies have developed in the North American desert west over certain of these features. We describe methods for chronometrically constraining the ages of desert pavement features using three approaches to rock varnish dating: varnish lamination (VML), lead-profile dating, and the cation ratio (CR) as an additional tool. Each of these techniques may be applied to rock varnished cobbles that have been upthrust into areas previously cleared of the original pavement through cultural or natural processes. We use these methods to resolve two archaeological issues: the age of the intaglios (geoglyphs) along the lower Colorado River corridor and whether the Topock (or ‘Mystic’) Maze is the product of Precontact Indigenous or late-nineteenth-century railroad construction. Ethnographic analysis allows us to contextualize these features and to consider two additional issues: the antiquity of the Yuman speakers’ cultural pattern in the lower Colorado River region and the function of the Topock Maze. Full article

Breast cancer is a substantial and growing public health issue in India, with epidemiological data demonstrating distinct and often severe disease characteristics in contrast to Western countries. Contrary to the global trend, Indian women frequently develop the disease at an earlier age and tend to present with more advanced stages, emphasizing important variations in disease pathophysiology. This review compiles and critically evaluates the current literature to describe the specific pathophysiology of breast cancer in the Indian population. We investigate the unique cellular and molecular landscapes, evaluate the impact of specific Indian demographic and genetic features, and highlight crucial gaps in knowledge, diagnostic tools, and therapeutic approaches. The assessment reveals a molecular landscape determined by the incidence of specific tumor subtypes; triple-negative breast cancer, for instance, is frequently diagnosed in younger women, and genetic profiling research suggests variations in its susceptibility genes and mutation patterns when compared to global populations. While this paper brings together recent advancements, it highlights the challenges of adopting global diagnostic and treatment guidelines in the Indian healthcare system. These challenges are largely due to variances and specific demographic and socioeconomic discrepancies that create substantial hurdles for timely diagnosis and patient care. We highlight significant gaps, such as the need for more complete multi-omics profiling of Indian patient cohorts, an absence of uniform and readily available screening programs, and shortcomings in healthcare infrastructure and qualified oncology experts. Furthermore, the review highlights the crucial need for therapeutic strategies tailored to the distinct genetic and demographic profiles of Indian breast cancer patients. We present significant strategies for addressing these challenges, with a focus on integrating multi-omics data and clinical characteristics to gain deeper insight into the underlying causes of the disease. Promising avenues include using artificial intelligence and advancements in technology to improve diagnostics, developing indigenous and affordable treatment options, and establishing context-specific research frameworks for the Indian population. This review also underlines the necessity for personalized strategies to improve breast cancer outcomes in India. Full article

Recent Chilean jurisprudence on Indigenous religious freedom has revealed a profound dissonance between the legal categories applied by the courts and the spiritual conceptions of Indigenous peoples. This gap between formal recognition and the effective protection of sacred sites generates a form of structural violence, understood as the institutional reproduction of inequality under the guise of neutrality. This study proposes to reformulate the notion of structural violence as an operative legal principle capable of activating heightened judicial scrutiny. Through a qualitative approach, it develops a doctrinal and jurisprudential analysis aimed at identifying normative patterns of exclusion and assessing the hermeneutic, normative, and diagnostic functions of the proposed principle. The results show that Chilean law, by translating spiritual practices into liberal categories of property or procedure, neutralizes their religious content and perpetuates relations of subordination. The study concludes that incorporating the principle prohibiting structural violence enables the reinterpretation of legal norms and the correction of historical asymmetries, orienting the law toward a form of structural justice sensitive to the ontological, cultural, and spiritual plurality of Indigenous peoples. Full article

Background:The Rowland Universal Dementia Assessment Scale (RUDAS) is a validated cognitive screening tool for illiterate and low-educated individuals, adaptable across languages and cultures. In Peru, we adapted it for Quechua speakers (Q-RUDAS) to assess cognitive status in older adults. Objective: We aimed to estimate the prevalence of neurocognitive disorders—mild cognitive impairment (MCI) and dementia—among Quechua-speaking older adults in one of the most socially vulnerable districts of Peru using the Quechua version of the Rowland Universal Dementia Assessment Scale (Q-RUDAS), a brief cognitive screening tool validated in Peru. Methods: We studied 511 participants from Puno a region in the southern Peruvian Andes (mean age 65.04 ± 6.73 years; 80.4% females), collecting sociodemographic data and Q-RUDAS scores. After excluding 18 individuals with medical conditions that could affect cognitive performance, such as neurological, psychiatric, or cerebrovascular disorders, 493 completed the test. Results: All Q-RUDAS items were well understood, although over 50% of participants struggled with visuospatial construction. The mean Q-RUDAS score was 26.01 ± 2.71. Of the participants, 446 (90.5%) scored within normal ranges (26.67 ± 1.92), 41 (8.3%) were classified as having mild cognitive impairment (MCI) (21.49 ± 1.92), and 6 (1.2%) as having dementia (17.00 ± 2.71) based on established Q-RUDAS cut-offs. Urban participants scored higher. The prevalence of MCI and dementia combined was 9.52%. Conclusions: The Q-RUDAS is a culturally sensitive tool that can support the identification of cognitive impairment in Indigenous populations. Our findings highlight the need for further cross-validation studies to refine diagnostic accuracy in Quechua-speaking populations. Full article

Introduction: Rheumatic diseases, including spondyloarthritis, systemic lupus erythematosus, Takayasu’s nonspecific aortoarteritis, Behcet’s disease, and Kawasaki disease, are more prevalent among Asian populations. The indigenous Sakha people, who live in the harsh conditions of the North and the Arctic regions, exhibit a unique pattern of health issues. AIM: The objective of the study is to characterize the ethnic characteristics of juvenile idiopathic arthritis (JIA) among children from the indigenous population of the Republic of Sakha (Yakutia) and compare them with Caucasians (Russians) living in the same region. This comparison aims to inform the development of tailored diagnostic and treatment strategies. Methods: The comprehensive, single-center, retrospective cohort study included medical data of all Sakha (n = 168) and Russian ethnic patients (n = 48) with JIA who were examined and treated at the Pediatric Center’s Cardiorheumatology Department at the Republican Hospital No. 1–M.E. Nikolaev National Center of Medicine—between 2016 and 2023. The ethnicity was self-reported. The standard clinical procedures and laboratory assessments, as well as the current treatment regimen, were thoroughly reviewed. Results: It was found that children of Sakha descent had a later onset of juvenile idiopathic arthritis (JIA), which was associated with the enthesitis-related arthritis (ERA) categories (51.2% vs. 18.3%, p = 0.0002). They also exhibited higher prevalence of enthesitis (19% vs. 2.0%, p = 0.003), sacroiliitis (23.8% vs. 2.0%, p = 0.0003), and HLA-B27 antigen positivity (46.3% vs. 14.6%, p = 0.00005). The Sakha population exhibited a notably higher prevalence (41.7%) of ERA, compared to the Russian population (33.3%; p = 0.0003), and they initiated biologic therapy at a later stage. However, remission rates were lower among Sakha children (29.2%) than among Russian children (72.2%, p = 0.002), as was their likelihood of achieving remission (Log-Rank test, p = 0.005), regardless of the JIA categories (p = 0.008). Sakha children had a 64.4% reduced chance of achieving remission on the first bDMARD, compared to Russian children (HR = 0.36, 95% CI: 0.18–0.71, p = 0.004). Conclusions: Distinct variations in the progression and treatment outcomes of JIA were observed between Sakha children and Caucasians. A tailored approach to the care of JIA patients is essential, considering their ethnic background. Full article

Acute respiratory infections and other infectious diseases causing acute febrile syndrome are major public health concerns in Colombia, particularly among vulnerable populations such as the Wayuu Indigenous community in Manaure, La Guajira. To investigate their viral etiology, 55 nasopharyngeal swabs and 58 serum samples were collected from febrile Wayuu individuals in Manaure. RT-qPCR screening identified Coronavirus, Enteroviruses, Adenovirus, and Influenza A/B in respiratory samples, while no arboviruses were detected in serum. Sixteen representative samples underwent metatranscriptomic next-generation sequencing (mtNGS) using the Chan-Zuckerberg ID (CZ-ID) platform. This analysis confirmed RT-qPCR findings and additionally revealed six viral contigs related to Orthopicobirnavirus hominis. Sequencing coverage enabled the reconstruction of a consensus RdRp segment, which was phylogenetically compared with sequences from diverse hosts. The virus clustered within genogroup 1, alongside Colombian isolates linked to severe acute respiratory infection. The absence of strict host-specific clustering suggests possible interspecies transmission. These findings underscore the complementary roles of targeted and unbiased approaches: RT-qPCR detected common respiratory viruses, whereas mtNGS uncovered a virus previously unreported in this community. Overall, mtNGS emerges as a powerful tool to support viral surveillance and provide baseline evidence in indigenous populations, emphasizing the need to decentralize advanced molecular diagnostics and strengthen public health capacity in Colombia. Full article

Rickettsia rickettsii is the most virulent agent of the genus Rickettsia that causes one of the most relevant vector-borne diseases in the Americas (RRSF). RRSF manifests with many non-specific acute clinical symptoms complicating its diagnosis and can lead to death if not treated appropriately. RRSF has been reported in Canada, the United States of America, Mexico, Costa Rica, Panama, Colombia, Brazil, and Argentina. In addition to R. rickettsii, mild and severe spotted fever group rickettsioses (SFGR) have been reported in the Americas; however, the true prevalence of these diseases is unknown. In Panama, RRSF have been reported in four of 14 provinces during two outbreak periods: five cases including two fatalities were identified in 1950–1951, and 23 cases including 17 fatalities between 2004 and 2025. This paper presents the clinical characterization of a fatal case of RRSF in Coclé province and a severe case of SFGR in a mountainous area of the Gnäbe Buglé Indigenous Comarca (GBIC). Laboratory confirmation was performed by molecular analysis of tissues obtained from necropsies in the case of RRSF and by immunofluorescence assay (IFA) in the case of SFGR. Furthermore, this paper identifies existing gaps in the initial clinical suspicion and pertinent to SFGR in Panama, which may be applicable to other countries in the region. In the last 21 years, cases have occurred upon contact with ticks in rural areas (13), urban and suburban locations (7), rural woodlands (2), and forests (1). Provinces with more cases are Panamá (7 of 23, 6 died), Coclé (5 of 23, 5 died), Colón (3 of 23, 1 died), Panamá Oeste (1 of 23, 1 died), and GBIC (7 of 23, 4 died), including a cluster of seven cases in 2019. Therefore, Coclé province is considered one of the endemic areas for RRSF in Panama, while the latest cases from the GBIC since 2019 indicate that mountainous areas are an eco-epidemiological scenario to include in the transmission of these diseases. Although this disease has a low prevalence, patients who present symptoms commonly associated with more common diseases such as dengue, other arboviruses, malaria, and leptospirosis, among others, should be included in the diagnostic suspicion. Without diagnostic suspicion and adequate treatment, the patient can die. Full article

Streptococcus pharyngitis (strep throat) poses a significant health challenge in rural and remote Indigenous communities in Australia, where access to medical resources is limited. Delays in diagnosis and treatment increase the risk of serious complications, including acute rheumatic fever and rheumatic heart disease. This paper presents a proof-of-concept AI-based diagnostic model designed to support clinicians in underserved communities. The model combines a lightweight Swin Transformer–based image classifier with a BLIP-2-based explainable image annotation system. The classifier predicts strep throat from throat images, while the explainable model enhances transparency by identifying key clinical features such as tonsillar swelling, erythema, and exudate, with synthetic labels generated using GPT-4o-mini. The classifier achieves 97.1% accuracy and an ROC-AUC of 0.993, with an inference time of 13.8 ms and a model size of 28 million parameters; these results demonstrate suitability for deployment in resource-constrained settings. As a proof-of-concept, this work illustrates the potential of AI-assisted diagnostics to improve healthcare access and could benefit similar research efforts that support clinical decision-making in remote and underserved regions. Full article

Objectives: The present study aimed to determine the reference intervals for complete blood count and total protein parameters in Greek indigenous Capra prisca goats and to evaluate their associations with parasitic burden, age and reproductive stage. Methods: Two-hundred clinically health goats were grouped by parasite status (gastrointestinal nematodes, Eimeria spp., and lungworm infection), age (3–6-month-old growing kids; lactating non-pregnant goats ≤ 3 or >3 years old) and reproductive stage (non-lactating pregnant goats; lactating non-pregnant goats). Blood samples were analyzed for erythrogram, leukogram and megakaryocytic parameters using an automated analyzer and manual blood smears. Total plasma proteins were measured using refractometry. Results: Gastrointestinal nematode-infected animals (>300 eggs per gram of feces) were associated with a significant reduction in red blood cell counts and hematocrit estimation, and an increase in mean corpuscular hemoglobin and mean corpuscular hemoglobin concentrations, while lungworm-infected animals were associated with decreased red blood cells, red cell distribution width and neutrophils, and increased lymphocytes compared to non-infected animals. Eimeria spp. affected only basophils in growing kids. Age influenced all erythrocytic and leukocytic parameters (apart from neutrophils and monocytes), as well as all megakaryocytic parameters and total proteins, with younger animals showing higher red and white blood cell counts and platelets compared to adults. Pregnant does had elevated hemoglobin, hematocrit, neutrophils and monocytes compared with lactating non-pregnant does. Conclusions: The calculated 95% reference intervals for our demographic groups of animals provide a useful diagnostic framework for assessing Capra prisca health in Greek goat farming. Full article