University indigenous students' perspectives on climate change and survival of indigenous peoples in Brazil: a concept mapping study

Introduction

This study aimed to identify what indigenous university students in Brazil perceived to be important and feasible actions to protect the survival of indigenous peoples from climate change-related impacts.

Methods

Concept mapping, which is a participatory mixed methodology, was conducted virtually with 20 indigenous students at two universities in Brazil. A focus prompt was developed from consultations with indigenous stakeholders and read "To protect the survival of the Indigenous Peoples from climate change, it is necessary to…". Students brainstormed 46 statements, which they then sorted into clusters based on conceptual similarity. They rated each statement for importance and feasibility. Quantitative multivariate analyses of clusters and ratings were conducted to produce multiple visual maps of perceived actionable priorities. These analyses used the Group Wisdom TM software.

Results

Students agreed on 8 clusters that reflect the factors that influence the survival of indigenous peoples-preservation of lands 0.16 (SD 0.13), protection of demarcated lands 0.31 (SD 0.10), indigenous health and wellbeing 0.35 (SD 0.14), ancestral customs 0.46 (SD 0.04), global and national actions 0.61 (SD 0.13), indigenous rights 0.64 (SD 0.23), collective living 0.71 (SD 0.21), and respect 0.75 (SD 0.14).

Discussion

The most actionable priorities are related to the respect for their lands and customs, educational initiatives in schools about the importance of indigenous peoples to society, guarantees for basic health rights, and culturally appropriate provision of care, with specific mention of mental healthcare. The findings aligned closely with the concept of indigenous self-determination, which is rooted in autonomy and respect for cultural diversity, and the right to make decisions that impact their lives, land, and resources.

Climate change and mental health of Indigenous peoples living in their territory: a concept mapping study

Background

The alarming increase in annual deforestation rates has had devastating consequences in climate change, and it is affecting Indigenous people, who depend entirely on the land for survival and has also weakened the rainforest's crucial role in stabilizing the global climate. Recognizing and respecting Indigenous people's needs and social, economic, and historical conditions influence health and healthcare. This study aimed to conduct online concept mapping workshops with university students to identify perceived important and feasible actions for improving the mental health of Indigenous people living in their territory in association with climate change.

Methods

Concept mapping, a participatory mixed methodology, was conducted virtually with 20 Indigenous students at two universities in Brazil. A focus prompt was developed from consultations with Indigenous stakeholders and read-"To improve the mental health of Indigenous peoples in their territory during climate change crises, it is necessary to…."

Results

University students organized 42 unique statements in 6 clusters that cover a wide range of topics: family support, 0.68 (SD 0.19); respect and understanding, 0.37 (SD 0.08); improvement actions, 0.52 (SD 0.07); public policies in favor of Indigenous people's mental health, 0.24 (0.09); health actions, 0.15 (SD 0.08); Indigenous training in health and its importance in improving mental health 0.32 (SD 0.07).

Conclusion

These clusters range from community initiatives, public policies, health actions, and strengthening professional services in Indigenous communities. These all provide numerous concrete ideas for developing interventions designed to address mental health challenges associated with climate change.

Safety and costs of blood transfusion practices in dengue cases in Brazil

Background

Dengue is a public health problem, and noncompliance with World Health Organization (WHO) recommendations for blood transfusion components is frequently reported. Moreover, economic impact studies of the WHO recommendations on the use of blood transfusion are scarce.

Methods

We compared the cost and hospitalization time in a prospective observational study, by following hospitalised patients and analysing their medical records from 2010 and March 2016 to December 2017. We divided the patients into two groups: transfused (with or without WHO criteria for transfusion) and not transfused (with or without WHO criteria for transfusion). Generalised linear modelling was performed to identify the variable that could increase the costs and hospital stay.

Results

Among 323 patients, 52 were transfused, of whom 52% without criteria (n = 27), and 271 were not transfused, of which 4.4% (n = 12) with criteria. Hospitalisation costs were 41% higher in the transfused group without criteria than in those with criteria (median US$ 674.3 vs US$ 478 p = 0.293). Patients who were not transfused but met the WHO criteria for transfusion (n = 12) had longer mean hospitalisation time than did those who were not transfused (3.8±3.4 days versus 3.6±3.1 days; p = 0.022). The GLM analysis using hospital stay and costs as the dependent variable explained approximately 33.4% (R² = 0.334) of the hospitalisation time and 79.3% (R² = 0.793) of costs. Receiving a transfusion increased the hospitalization time by 1.29 days (p = 0.0007; IRR = 1.29), and the costs were 5.1 times higher than those without receiving blood components (IRR = 5.1; p< 0.001; median US$ 504.4 vs US$ 170.7). In contrast, patients who were transfused according to WHO criteria had a reduction in costs of approximately 96% (IRR = 0.044; p<0.001; β = -3.12) compared to that for those who were not transfused according to WHO criteria (without criteria).

Conclusion

Transfusion without following WHO recommendations increased the time and cost of hospitalisation.