Navajo Nation Division of Health

To determine the prevalence and factors associated with pain-related disabilities among First Nations people living off-reserve in Canada in 2017. Secondary analysis of the 2017 Aboriginal Peoples Survey, a cross-sectional survey of individuals living in private dwellings throughout Canada. First Nations people living off-reserve aged 15 years and older (n=9115; weighted n=482 066). Pain-related disabilities, defined as pain-related activity limitations lasting ≥6 months. Overall, 22.1% (95% CI 20.9% to 23.4%) of First Nations people living off-reserve reported pain-related disabilities. Prevalence was higher among females (26.1%; 95% CI (24.3% to 28.0%)), increased with age (34.3%; 95% CI (30.3% to 38.5%) among those 45 to 54 years) and was similar across geographic areas (ranging from 21.0%; 95% CI (18.3% to 23.9%) to 22.5%; 95% CI (20.8% to 24.2%)). Pain-related disabilities increased with the number of coexisting disabilities (96.2%; 95% CI (94.3% to 97.5%) among those with >3 disabilities) and was highest among those reporting physical disabilities (ranging from 88.2%; 95% CI (85.6% to 90.4%) for those with mobility disabilities to 91.0%; 95% CI (88.6% to 92.9%) for those with disability related to flexibility). Regression models suggested that individuals with unmet basic needs, housing dissatisfaction, unmet healthcare needs, a history of mental health consultations, part-time or no employment, chronic conditions, residential school attendance or a low sense of belonging were more likely to report pain-related disabilities. Pain-related disabilities are common among First Nations people living off-reserve, and their aetiology may be multifactorial. Continued collaboration with Indigenous partners is required to contextualise findings and to inform culturally responsive clinical and rehabilitation strategies.

The San Juan River, approximately one-third of which flows through southeastern Utah, either borders or passes through the Navajo Nation. In the past, it has served as a boundary between Ute, Anglo, and Navajo factions and deeply colored the history of the region, since it is one of the few significant sources of water in a primarily arid environment. For the Navajo who have depended on its flow, it has served as a lifeline, drawing large numbers of people to the riverine landscape that encouraged agricultural pursuits, grazing areas for livestock, establishment of trading posts, and coincidentally, later, employment in a rich oil field. All of this has given rise to a distinctive lifestyle centered in beliefs and practices of its residents, who are referred to by old traditionalists as the “River Navajo.” Each one of these “blessings” has also led to conflict and problems, many of which are examined in the book.The author, who has written extensively about the Navajo experience in southeastern Utah, interviewed many elders in the 1980s and 1990s about their lives around the turn of the century and thereafter. Chronologically, this book covers approximately the 1850s to 1990s, and geographically the Four Corners area, including Aneth, Montezuma Creek, Bluff, and Tódahidíkáanii. Oral history makes up the text, which serves as a companion piece to Stories from the Land: A Navajo Reader about Monument Valley, a book that discusses the western portion of the reservation in Utah. Unlike other volumes written about this region, which tend to use extensive written documentation, this book relies primarily on the Navajo voice, providing a glimpse into their thoughts framed by a religious worldview. Even when describing some of the most mundane events—crossing the river, shearing sheep, exchanging goods, collecting herbs, planting crops, adopting new technology, and drilling for oil—there is still a religious side that frames every activity through creation stories. This view becomes even more pronounced when discussing land formations, origin accounts, ceremonies, and the training of a medicine person. A chapter is devoted to each of these topics.Even though I have worked for the Navajo Nation Historic Preservation Department for twenty-five years and am now retired, have married a Navajo woman and raised our children with traditional teachings, and understand the power of the ceremonies, there were still a number of things that I either learned or had reinforced by listening to these elders. The two chapters dedicated to the training and teachings of a medicine man were important. David Kindle, an old-time practitioner, shared how the holy people selected him and why he wanted to share his knowledge gained through years of practice. I enjoyed learning about the many ceremonies that have an origin narrative involving the Four Corners area and how they tie in with specific geographic locations, the Bears Ears being one that is often found in the news today. A major strength of the book comes from the elders who speak lovingly and in detail about the land on which they lived. Ever since the time of the Long Walk (1850s and 1860s), this homeland has helped forge the identity and history of those who have chosen to live there. Utes, Paiutes, Mormons, non-Mormons, and transients have also developed their love of this land, one that at times has been buttressed through conflict. But none have surpassed the Navajo in assigning a spiritual understanding to this region. Thus, the land and its elements have intangible powers that are addressed and summoned through prayers that give the people protection.McPherson points out that all of the elders who shared this information are now gone. That is a significant point. Navajo traditional teachings are being diluted, if not lost, with rising generations. Preserving this knowledge is critical, as they pointed out when sharing their teachings and experiences. Nothing was more significant than having their children and grandchildren understand the important things of life. While change is a constant, the past provides an anchor. This book is easy to read, filled with anecdotes, and well documented. It cites additional sources written by the author and centers on traditional teachings. For me, it was a journey back in time well worth taking, a gift of knowledge. There are many books written about the Navajo, but this is one I recommend not only to serious scholars, but also to my traditional family and friends.

BackgroundRecent biomedical research has shown the unusual, multisystem effects of coronavirus disease 2019 in humans. One specific sequela of a primary severe acute respiratory syndrome coronavirus 2 infection is the reactivation of latent viruses in various tissues, such as Epstein–Barr virus. Epstein–Barr virus has been identified in many inflammatory gastrointestinal lesions, such as microscopic gastritides and colitides. One subtype of these diseases is collagenous disease. “Long COVID” may be related to the reactivation of these latent viruses, and the following case describes a patient who developed vague symptoms consistent with “long COVID.”Case presentationA non-Hispanic white male in his 50s, with previous collagenous gastritis and colitis, developed a 10-kg weight loss and diffuse leg cramps over 3 months. The patient had coronavirus disease 2019 about 3 months prior to presentation. He had iron deficiency and tested positive for human immunodeficiency virus antibody. His heterophile antibody was also positive. Confirmatory testing for human immunodeficiency virus was negative, and his Epstein–Barr virus antibody panel was positive for early antigen immunoglobulin G. His Epstein–Barr virus viral load was undetectable. Minimal improvement was achieved with a 4-week course of oral budesonide, and upper endoscopy showed diffuse gastritis. He is now improving with proton pump inhibitor therapy and ferrous sulfate supplementation.ConclusionThis case report explores outpatient management of microscopic gastritides and colitides. The evidence around coronavirus disease 2019 causing reactivation of Epstein–Barr virus, and Epstein–Barr virus’ presence in chronic gastrointestinal inflammatory lesions, is discussed. Practice recommendations include corticosteroid and acid-suppression therapy for patients suspected of having a recurrence of inflammatory lesions.

A reestruturação da matriz logística brasileira e sua eficiência no transporte de cargas estão intrinsecamente ligadas à modalidade de cabotagem. Este meio de transporte não apenas impulsiona o desenvolvimento econômico, fortalecendo as indústrias locais, mas também contribui para a redução de impactos ambientais negativos, como poluição e congestionamentos. No entanto, apesar de suas evidentes vantagens, o transporte rodoviário ainda prevalece no Brasil. O estudo realizado teve por objeto o levantamento e análise das barreiras relacionadas com a baixa oferta de navios para a cabotagem brasileira. A metodologia utilizada foi eminentemente bibliográfica, a partir de pesquisas em livros, periódicos, anais de congressos, teses, dissertações, trabalhos de final de curso de graduação e sítios da internet de órgãos governamentais e de empresas e associações ligadas a área de navegação de cabotagem. Foram identificados três grupos de barreira: 1) Barreiras de custos operacionais, incluindo o alto preço do bunker, o elevado custo do frete, os custos elevados de mão de obra na cabotagem e na indústria naval, os altos custos dos produtos siderúrgicos e navipeças. 2) Barreiras de aspectos legais e regulatórios, como a cobrança do ICMS e a fragilidade da legislação brasileira. 3) Barreiras relacionadas à entrada de novos agentes no mercado, abrangendo questões de financiamento de embarcações e os preços exorbitantes na importação de navios. Espera-se que o estudo possa fornecer subsídios ao poder público e aos armadores de cabotagem para o desenvolvimento e ampliação do modal.

Context:The Healthy Diné Nation Act (HDNA) of 2014 included a 2% tax on foods of little-to-no-nutritious value (‘junk foods’) on the Navajo Nation. The law was the first-ever in the U.S. and any Indigenous nation worldwide with a population at high risk for common nutrition-related conditions. To date, research on community support for food tax legislation among Indigenous nations is entirely lacking.Objective:To assess the extent of support for the HDNA and factors associated with support including sociodemographic variables, knowledge of the HDNA, nutrition intake, and pricing preferences.Design:Cross-sectional survey.Setting:The Navajo Nation.Participants:234 Navajo Nation community members across 21 communities.Outcome Measures:The percentage of participants that were supportive of the HDNA.Results:Participants were 97% Navajo, on average middle-aged, 67% reported an income below $25,000 annually, and 69.7% were female. Half of the respondents said they ‘support’ (37.4%) or ‘strongly support’ (13.0%) the tax, another 35% of people said they were neutral or somewhat supportive; 15% did not support the tax. Participants with higher income (p=0.025), education (p=0.026), understanding of the legislation (p<0.001 for ‘very well’ vs. ‘not at all’) had increased odds of greater support, as did people who believed that HDNA would make Navajo people healthier (vs. not, p<0.001). Age, gender, language and reported nutrition intake (healthy or unhealthy) were not associated with HDNA support, but participants willing to pay 5% or 12–15% higher prices for fast food and soda had increased odds of greater support (p-values range 0.023 to <0.001).Conclusions:The majority of Navajo community members surveyed were moderately supportive of the Navajo Nation tax on unhealthy foods. Higher-income and education and understanding of the law were associated with greater support, but nutrition intake was not.

Onchocerca lupi is a filarial nematode that causes ocular onchocercosis in canines globally including North America and areas of Europe, North Africa, and the Middle East. Reported incidence of this parasite in canines has continued to steadily escalate since the early 21st century and was more recently documented in humans. Whole genome sequencing (WGS) of this parasite can provide insight into gene content, provide novel surveillance targets, and elucidate the origin and range expansion. However, past attempts of whole genome sequencing of other Onchocerca species reported a substantial portion of their data unusable due to the variable over-abundance of host DNA in samples. Here, we have developed a method to determine the host-to-parasite DNA ratio using a quantitative PCR (qPCR) approach that relies on two standard plasmids each of which contains a single copy gene specific to the parasite genus Onchocerca (major body wall myosin gene, myosin) or a single copy gene specific to the canine host (polycystin-1 precursor, pkd1). These plasmid standards were used to determine the copy number of the myosin and pkd1 genes within a sample to calculate the ratio of parasite and host DNA. Furthermore, whole genome sequence (WGS) data for three O. lupi isolates were consistent with our host-to-parasite DNA ratio results. Our study demonstrates, despite unified DNA extraction methods, variable quantities of host DNA within any one sample which will likely affect downstream WGS applications. Our quantification assay of host-to-parasite genome copy number provides a robust and accurate method of assessing canine host DNA load in an O. lupi specimen that will allow informed sample selection for WGS. This study has also provided the first whole genome draft sequence for this species. This approach is also useful for future focused WGS studies of other parasites.

Abstract During the COVID-19 pandemic, Native American communities were not only heavily impacted by the virus but other socioeconomic factors as well. The Navajo Nation was at the forefront, setting an example for the United States and general public on establishing policies and ground efforts to minimize the spread of the virus through Navajo land. However, as the virus spread, it also revealed the interconnectedness surrounding Indigenous communities and Indigenous women. Through the Missing and Murdered Indigenous Women (MMIW) Movement, researchers found a lack of data as reports present unreliable and underreported information involving racial misclassification and data genocide. Data regarding Indigenous community COVID-19 statistics reflect historical trauma, especially in the exclusion of Indigenous communities from data sets and analyses used to make health policy decisions. I conclude this article by emphasizing the necessity of including Indigenous sovereign bodies in the dispersal of gathered data sets and establishing an amicable relationship promoting the well-being of Indigenous communities between social scientists and Native communities.

Abstract Background: Navajo community members face high rates of diabetes mellitus and other chronic diseases. The Navajo Community Health Representative Outreach Program collaborated with healthcare providers and academic collaborators to implement structured and coordinated outreach to patients living with diabetes. The intervention, called Community Outreach and Patient Empowerment or COPE, provides home-based health coaching and community-clinic linkages to promote self-management and engagement in healthcare services among patients living with diabetes. The purpose of this study was to evaluate how outreach by Navajo Community Health Representatives (“COPE Program”) to affected utilization of health care services among patients living with diabetes. Methods: De-identified data from 2010 to 2014 were abstracted from electronic health records at participating health facilities. In this observational cohort study, 173 cases were matched to 2,880 controls. Healthcare utilization was measured as the number of times per quarter services were accessed by the patient. Changes in utilization over four years were modeled using a difference-in-differences approach, comparing the trajectory of COPE patients’ utilization before versus after enrollment with that of the control group. The model was estimated using generalized linear mixed models for count outcomes, controlling for clustering at the patient level and the service unit level. Results: COPE enrollees showed a 2.5% per patient per quarter (pppq) greater increase in total utilization (p = 0.001) of healthcare services than non-COPE enrollees; a 3.2% greater increase in primary care visits (p = 0.024); a 6.3% greater increase in utilization of counseling and behavioral health services (p = 0.013); and a 9.0% greater increase in pharmacy visits (p &lt; 0.001). We found no statistically significant differences in utilization trends of inpatient, emergency room, specialty outpatient, dental, laboratory, radiology, or community encounter services among COPE participants versus control.Conclusions: A structured intervention consisting of Community Health Representative outreach and coordination with clinic-based providers was associated with a modest increase in health care utilization, including primary care and counseling services, among Navajo patients living with diabetes. Community health workers may provide an important linkage to enable patients to access and engage in clinic-based health care. Trial Registration: NCT03326206, registered 10/31/2017, retrospectively registered