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Introduction: Gastric cancer is one of the most prevalent types of cancer worldwide. The World Health Organization (WHO), the International Agency for Research on Cancer (IARC), and the Global Cancer Statistics (GLOBOCAN) reported an age standardized global incidence rate of 9.2 per 100,000 individuals for gastric cancer in 2022, with a mortality rate of 6.1. Despite considerable progress in precision oncology through the efforts of international consortia, understanding the genomic features and their influence on the effectiveness of anti-cancer treatments across diverse ethnic groups remains essential. Methods: Our study aimed to address this need by conducting integrated in silico analyses to identify actionable genomic alterations in gastric cancer driver genes, assess their impact using deleteriousness scores, and determine allele frequencies across nine global populations: European Finnish, European non-Finnish, Latino, East Asian, South Asian, African, Middle Eastern, Ashkenazi Jewish, and Amish. Furthermore, our goal was to prioritize targeted therapeutic strategies based on pharmacogenomics clinical guidelines, in silico drug prescriptions, and clinical trial data. Results: Our comprehensive analysis examined 275,634 variants within 60 gastric cancer driver genes from 730,947 exome sequences and 76,215 whole-genome sequences from unrelated individuals, identifying 13,542 annotated and predicted oncogenic variants. We prioritized the most prevalent and deleterious oncogenic variants for subsequent pharmacogenomics testing. Additionally, we discovered actionable genomic alterations in the ARID1A, ATM, BCOR, ERBB2, ERBB3, CDKN2A, KIT, PIK3CA, PTEN, NTRK3, TP53, and CDKN2A genes that could enhance the efficacy of anti-cancer therapies, as suggested by in silico drug prescription analyses, reviews of current pharmacogenomics clinical guidelines, and evaluations of phase III and IV clinical trials targeting gastric cancer driver proteins. Discussion: These findings underline the urgency of consolidating efforts to devise effective prevention measures, invest in genomic profiling for underrepresented populations, and ensure the inclusion of ethnic minorities in future clinical trials and cancer research in developed countries.

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Introducción: los trastornos mentales comunes pueden tener un impacto significativo en la vida de los indígenas, pueden provocar discapacidad, disminución de la productividad y aumento de la mortalidad. Objetivo: determinar la prevalencia de trastornos mentales comunes en indígenas de cinco departamentos de Paraguay durante el 2022. Metodología: se realizó un estudio observacional, descriptivo de corte transversal en indígenas residentes en los departamentos de Alto Paraguay, Boquerón, Concepción, Caaguazú, Presidente Hayes de Paraguay. Para la recolección de datos se utilizó el Self Reporting Questionnaire (SRQ-20). Este instrumento constó de 20 preguntas de tipo sí/no correspondientes al mes anterior a la entrevista. Resultados: participaron del estudio 779, indígenas de entre 18 a 69 años de edad. El alfa de Cronbach fue de 0,89, la medida de Kaiser-Meyers-Olkin fue 0,88. El SRQ+ fue del 25,80 % (201), el 14,51 % (113) tuvo síntomas de depresión, el 16,17 % (126) tuvo síntomas de ansiedad, y el 12,58 % (98) tuvo síntomas de psicosis. Conclusión: se encontró una alta prevalencia de trastornos mentales comunes, de acuerdo al Self Reporting Questionnaire, siendo el más frecuente al psicosis. Estos hallazgos subrayan la necesidad de mejorar el acceso a los servicios de salud mental para los indígenas de Paraguay.

Introduction: common mental disorders can have a significant impact on the lives of indigenous people, leading to disability, decreased productivity, and increased mortality. Objective: to determine the prevalence of common mental disorders in indigenous people from five departments of Paraguay in 2022. Methods: a cross-sectional, descriptive observational study was conducted in indigenous people residing in the departments of Alto Paraguay, Boquerón, Concepción, Caaguazú, and Presidente Hayes, Paraguay. Data were collected using the Self Reporting Questionnaire (SRQ-20). This instrument consisted of 20 yes/no questions pertaining to the month prior to the interview. Results: a total of 779 indigenous people aged 18-69 years participated in the study. The Cronbach's alpha was 0.89, and the Kaiser-Meyers-Olkin measure was 0.88. The SRQ+ was 25.80 % (201), 14.51 % (113) had symptoms of depression, 16.17 % (126) had symptoms of anxiety, and 12.58 % (98) had symptoms of psychosis. Conclusion: a high prevalence of common mental disorders was found, according to the SRQ, with psychosis being the most common. These findings underscore the need to improve access to mental health services for indigenous people in Paraguay.

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Resumo Este artigo apresenta uma perspectiva da saúde mental a partir do estudo dos efeitos dos conflitos pela terra e da organização comunitária na aldeia Tupinambá da Serra do Padeiro, no sul da Bahia. A luta pela terra com a retomada do território destaca-se enquanto força produtora de saúde, com potência de suplantar as agruras vividas em um contexto de ameaças, violências e traumas. Para isso, diferentes saberes, práticas e atores, indígenas e não indígenas, são continuamente articulados. Os modos de organização da comunidade se inserem como elemento-chave para prevenção e recuperação da saúde mental, evitando agravos nos conflitos territoriais e promovendo condições para reabilitação e inserção social. A espiritualidade, o trabalho, a cultura, a coletividade e o diálogo interétnico são aspectos centrais de proteção e promoção da saúde mental.

Abstract This study offers a mental health perspective based on the study of the effects of conflicts over land and community organization at Aldeia Tupinambá in Serra do Padeiro in southern Bahia. The struggle for land with the repossession of the territory stands out as a force that produces health with the power to overcome the hardships experienced in a context of threats, violence, and trauma. For this, Indigenous and non-Indigenous knowledges, practices, and actors are continuously articulated. The community's ways of organizing itself are inserted as a key-element to prevent and recover mental health, avoid injuries in territorial conflicts, and promote conditions for rehabilitation and social insertion. Spirituality, work, culture, community and interethnic dialogue are central aspects of protecting and promoting mental health.

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Objetivo Este artigo tem como objetivo discutir a abordagem da psicologia indígena no cuidado de estudantes indígenas em contexto universitário. Método Utilizando o método qualitativo, este artigo apresenta um estudo de caso detalhando a trajetória de formação da Rede de Escuta e Desaprendizagens Étnico-Subjetivas, para analisar a aplicação dos pressupostos da psicologia indígena no suporte a estudantes indígenas e seus familiares na Universidade Estadual de Campinas. Resultados Evidenciou-se a necessidade de reconhecer diferentes epistemologias para uma conexão terapêutica respeitosa. Foram observados desafios na aplicação de práticas alinhadas com a psicologia indígena, destacando a coautoria nas sessões, a valorização das perspectivas dos pacientes e as desaprendizagens contínuas. O estudo dos elementos culturais das etnias envolvidas mostrou-se crucial para evitar a patologização das cosmovisões e subjetividades indígenas. Conclusão A psicologia indígena apresenta-se como um vetor de mudança nas disputas de narrativas culturais, destacando a lacuna na abordagem clínica e a necessidade urgente de estudos para desenvolver intervenções personalizadas para o atendimento das diferentes etnias indígenas.

Objective This article aims to discuss the approach of indigenous psychology in the care of indigenous students in a university framework. Method Using a qualitative method, this article presents a case study detailing the formation trajectory of the Rede de Escuta e Desaprendizagens Étnico-Subjetivas (Network of Ethno-Subjective Listen-ing and Unlearning) to review the application of the principles of indigenous psychology in sup-porting indigenous students and their families at Universidade Estadual de Campinas (Unicamp, State University of Campinas), Brazil. Results The study highlighted the need to recognize different epistemologies for respectful therapeutic connections. Challenges were faced in the application of practices aligned with indigenous psychology, emphasizing co-authorship in sessions, valuing patients' perspectives, and continuous unlearning. The study of the cultural elements of the ethnicities involved proved crucial to avoid the pathologization of indigenous worldviews and subjectivities. Conclusion Indigenous psychology presents itself as a tool for the changes in the cultural struggles, highlighting the gap in clinical approaches and the urgent need for further studies to develop personalized interven-tions for the care of the diverse indigenous ethnicities.

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Resumo Os quilombolas são grupos étnico-raciais de ancestralidade negra e tiveram seus territórios consolidados no Brasil em regiões com acesso difícil e distante dos grandes centros. O objetivo desse estudo é conhecer o itinerário terapêutico (IT) adotado por mulheres quilombolas em comunidades tradicionais localizadas no norte do estado de Minas Gerais. Trata-se de um estudo com abordagem qualitativa com o modelo teórico utilizando o sistema de cuidados à saúde de Arthur Kleinman. O estudo se deu em 23 comunidades quilombolas do norte de Minas Gerais. Foram entrevistadas 40 mulheres quilombolas, com idades entre 25 e 89 anos. A análise dos dados foi realizada seguindo os IT. Emergiram unidades de análise que foram agrupadas em três categorias: as mulheres quilombolas e o significado da saúde e do cuidado; o sistema de cuidado profissional nas comunidades quilombolas; e itinerário de cuidados nas situações vivenciadas pelas mulheres. O itinerário terapêutico das comunidades se mostra relacionado principalmente às ações de medicina popular. Foi possível observar ainda que existem fragilidades em relação à atenção à saúde devido a fatores como dificuldade de acesso aos serviços institucionalizados.

Abstract Quilombolas are ethnic-racial groups, of black ancestry, and had their territories consolidated in Brazil in regions with difficult access and far from large centers. The objective of this study is to know the therapeutic itinerary (IT) adopted by quilombola women in traditional communities located in the North of the state of Minas Gerais. This is a qualitative study with the theoretical model using the Arthur Kleinman health care system. The study scenario was 23 quilombola communities in northern Minas Gerais. Forty quilombola women aged between 25 and 89 years were interviewed. Data analysis was performed following the IT. Units of analysis emerged that were grouped into three categories: quilombola women and the meaning of health and care; the professional care system in quilombola communities; and route of care in situations experienced by women. The therapeutic itinerary of the communities is mainly related to the actions of popular medicine. It was also possible to observe that there are weaknesses in relation to health care due to factors such as difficulty of access to institutionalized services.

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Objetivo Em 2021, povos indígenas Pataxó, Pataxó Hãhãhãe e Tupinambá foram atingidos por inundações intensas na Bahia. A situação exigiu respostas imediatas das equipes locais de saúde, contando com a assessoria de especialistas em desastres e emergências em saúde pública. Esse estudo de caso aborda o processo de construção de linhas de cuidado ao Bem-Viver dos povos originários afetados, por meio do trabalho colaborativo entre etnias indígenas e equipes de políticas públicas de saúde. Método Foram analisados registros de reuniões, um curso de formação para profissionais de saúde indígena e três documentos de referência. Resultados Abordou-se possibilidades e desafios no cuidado ao Bem-Viver na fase de resposta pós-desastres e emergências em saúde pública, com a garantia da especificidade e do protagonismo das comunidades atendidas. Conclusão Foram apresentadas considerações para o processo de construção de linhas de cuidado ao Bem-Viver de povos originários, buscando oferecer subsídios à conformação de políticas públicas consoantes às particularidades sócio-histórico-culturais de cada etnia.

Objective In 2021, the indigenous communities Pataxó, Pataxó Hãhãhãe and Tupinambá, in the state of Bahia, Brazil, were hit by intense floods. The situation required immediate response from local health professionals, with advice from experts in public health disasters and emergencies. This case study focuses on the development of lines of care for the "Buen Vivir" of affected original peoples through collaborative work between indigenous ethnic groups and public health policy professionals. Method Analysis of the records of meetings, a training course for indigenous health professionals and three reference documents was carried out. Results Possibilities and challenges for assuring the "Buen Vivir" in the post-disaster and public health emergency response phase were addressed, guaranteeing the specificity and protagonism of the communities served. Conclusion Contributions were presented along the lines of care construction processes for the "Buen Vivir" of indigenous peoples, pursuing subsidies for public policies in accordance with the socio-historical-cultural particularities of each ethnic group.

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Purpose: Thiopurine S-methyltransferase (TPMT) is an enzyme that metabolizes purine analogs, agents used in the treatment of acute lymphoblastic leukemia. Improper drug metabolism leads to toxicity in chemotherapy patients and reduces treatment effectiveness. TPMT variants associated with reduced enzymatic activity vary across populations. Therefore, studying these variants in heterogeneous populations, such as Ecuadorians, can help identify molecular causes of deficiency for this enzyme. Methods: We sequenced the entire TPMT coding region in 550 Ecuadorian individuals from Afro-Ecuadorian, Indigenous, Mestizo, and Montubio ethnicities. Moreover, we conducted an ancestry analysis using 46 informative ancestry markers. Results: We identified 8 single nucleotide variants in the coding region of TPMT. The most prevalent alleles were TPMT*3A, TPMT*3B, and TPMT*3C, with frequencies of 0.055, 0.012, and 0.015, respectively. Additionally, we found rare alleles TPMT*4 and TPMT*8 with frequencies of 0.005 and 0.003. Correlating the ancestry proportions with TPMT-deficient genotypes, we observed that the Native American ancestry proportion influenced the distribution of the TPMT*1/TPMT*3A genotype (OR = 5.977, p = 0.002), while the contribution of African ancestral populations was associated with the TPMT*1/TPMT*3C genotype (OR = 9.769, p = 0.003). The rates of TPMT-deficient genotypes observed in Mestizo (f = 0.121) and Indigenous (f = 0.273) groups provide evidence for the influence of Native American ancestry and the prevalence of the TPMT*3A allele. In contrast, although Afro-Ecuadorian groups demonstrate similar deficiency rates (f = 0.160), the genetic factors involved are associated with contributions from African ancestral populations, specifically the prevalent TPMT*3C allele. Conclusion: The distribution of TPMT-deficient variants offers valuable insights into the populations under study, underscoring the necessity for genetic screening strategies to prevent thiopurine toxicity events among Latin American minority groups.

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Background: Despite improvements in health insurance coverage, out-of-pocket (OOP) health spending remains a public health issue in Peru, and OOP payment has implications for disease treatment in ethnic minorities. We aimed to analyze the ethnic disparities in the OOP payment and estimate the gaps related to observable risk factors in the OOP payment on medicines by ethnic conditions during 2014-2016 in Peru. Study design: cross-sectional study. Methods: We conducted a secondary data analysis using the National Health User Satisfaction Survey. The outcome was the participants' OOP payment in self-reported medications. Ethnic minorities were considered participants who habitually spoke a language other than Spanish at home. Crude and adjusted linear regression models were performed, and the Oaxaca-Blinder decomposition method was used to assess the OPP payment differential by ethnic minority condition, explained by their individual and sociodemographic characteristics. Results: We analyzed 11,346 surveyed, the mean age was 40.78 years, and 57.67 % were women. There was lower OOP payment in medications among ethnic minorities in the adjusted analysis (Beta coefficient [ß]: -0.11; 95 % confidence interval [95%CI]: -0.21 to -0.01; p = 0.043). In the Oaxaca-Blinder decomposition analysis, a gap of 0.19 USD in the OOP payment in medicines among ethnic minorities was found (p < 0.001), and the explained component by the variables measured in this research only represents 40.5 % of the gap (p = 0.001). Conclusion: There was less OOP expenditure on medicines in ethnic minorities. However, the measured variables explain only 40.5 % of these gaps. Therefore, we recommend future research that measures other variables that explain aspects of OOP spending on medicines not identified in this research. Likewise, our findings can be used to establish policies with an intercultural approach that adapt health documents to native languages or are disseminated by trained people from their communities.

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Quilombola communities are descended from African slaves who escaped in resistance to imperial rule in Brazil. Today, these communities suffer from inadequate health care and health promotion programs due to socioeconomic, geographic, and political factors. This generates greater vulnerability among these groups because they have limited information about prevention to improve their quality of life. This research aimed to analyze the sexuality of young quilombola adults and the impact on their quality of life through an observational, cross-sectional, quantitative study with descriptive and inferential analyses. Our study is the first to address these issues among quilombolas in the Eastern Amazon region. The participants were 79 individuals of both sexes, aged between 18 to 35 years, belonging to seven communities in the state of Pará. The questionnaires were designed to assess sexual behavior and satisfaction, values and beliefs about sexuality, prejudice regarding sexual and gender diversity, knowledge about sexually transmitted infections (STIs), beliefs about maternity, and quality of life. Women reported greater sexual dissatisfaction and lower quality of life than men. Men reported no dysfunctions; however, they were highly prejudiced towards sexual and gender diversity. Low education negatively impacts the health of quilombola populations, as knowledge about STIs and values and beliefs influence sexual behavior, exposing individuals to diseases. The research also confirms that, both among quilombolas and other groups, factors such as sexual satisfaction, values and beliefs about reproduction, and affectivity directly influence the quality of life.