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Ethnobiologie et ethnomédecine des Peuples premiers d’Amérique (Cris d’Eeyou Istchee, Parikwene et Pekuakamilnuatsh) : l’impact de l’alimentation et des médecines locales sur la santé et le bien-être des diabétiques
Abstract
Les Peuples autochtones à travers le monde sont disproportionnellement touchés par le diabète. Parmi ces peuples, les Cris d’Eeyou Istchee et les Pekuakamilnuatsh, au Québec (Canada), ainsi que les Parikwene, en Guyane française (France), recourent à leur médecine locale pour soigner cette maladie. En 173 entrevues semi-dirigées, 208 participants venant de ces communautés et/ou travaillant dans leurs services de santé ont décrit ces médecines. Une méthode de recherche mixte, combinant des analyses thématiques à des statistiques multivariées, est développée pour analyser ces descriptions.Ces analyses ont montré que les participants cris, ilnu et parikwene décrivent leurs médecines en lien avec le diabète tant par les différents éléments du monde naturel, que les pratiques et coutumes locales qui en découlent, que les concepts les liant au territoire. Les pharmacopées à base animales et végétales font parties des thèmes les plus discutés. Plus de 381 espèces (109 animaux, 267 plantes, cinq lichens et champignons) lient les systèmes médicinales et alimentaires ensemble via des notions associées au bien-être ou aux propriétés organoleptiques. Au Québec, là où la population autochtone est plus impliquée dans les services de santé, il existe un rapprochement de la description des médecines locales entre le secteur de la santé et ses usagers.De façon générale, la place de l’alimentation dans les médecines locales ne peut être négligée dans le contexte du diabète. De plus, ces médecines sont indissociables du territoire qui offre un espace de guérison, de subsistance, et de continuité culturelle. Cela renvoie, in fine, à des questions importantes sur la reconnaissance des droits autochtones et des droits fonciers.
... Although swidden and fallow agriculture centers primarily around the cultivation of bitter cassava tubers, which is intricately timed with the seasons (66)(67)(68), several dietary plants are also cultivated and harvested on the periphery of fields, which are increasingly and predominantly monospecific (31), and particularly near shelters. These include edible palms like patawa, bacaba and açaí, fruits like mangoes, cashews (Anacardium occidentale L.; Anacardiaceae), papayas (Carica papaya L.; Caricaceae), bananas (Musa paradisiaca L.; Musaceae), pineapples, and several citruses (Citrus spp.; Rutaceae), starchy root vegetables, like dasheen, sweet potatoes and yams, as well as several medicinal plants (69,70). Moreover, swidden and fallow fields act as an access point to secondary and primary forests that provide a number of resources, acquired through wild harvesting, hunting and fishing, which can increase dietary diversity, but also be used for medicinal and technological purposes. ...
... The nutrition and food transition, and some of its aspects, have been previously documented in connection with Parikwene food systems and diet (27,30,31,61,73). Amidst Parikwene narratives linking such transitions to increased consumption of imported and market foods with an increasing prevalence and incidence of diabetes (69), cassava tubers remained the staple food item in Parikwene households, though not unscathed from changes through time. The most notable change reported by Parikwene participants is the historically widespread practice of consuming cassava flatbread, which has now largely been replaced by the transformation of cassava tubers into couac. ...
... The adaptation of couac production in the management of diabetes is grounded in a dynamic Parikwene knowledge system followed with a keen sense of observation. In integrating diabetes to their knowledge system, Parikwene have associated the illness with the following characteristic: (1) sweetness, due to its link with sugar and sweet foods, and (2) heat, due to explanations given to certain symptoms like the evacuation of fluids through polyuria and diarrhea as a consequence of the body overheating and needing to be cooled by replenishing with water, hence polydipsia (69). These sweet and hot characteristics are in keeping with Parikwene medicines that are frequently described based on their organoleptic (i.e., sour and bitter tasting) and caloric (i.e., cold, cool and refreshing) properties (69). ...
Introduction
In the French overseas department of French Guiana, in South America, nutrition therapy for the management of diabetes is based on French guidelines. However, this region is demographically diverse and includes several populations of Indigenous Peoples, Parikwene among others, also called Palikur. Due to socio-economical, cultural, and geographical differences, along with distinctions in the local food system, dietary recommendations, which many consider in the context of post-colonial power dynamics, are not well suited to local populations. In the absence of suitable recommendations, it is hypothesized that local populations will adapt their dietary practices considering diabetes as an emerging health problem.
Methods
Seventy-five interviews were conducted with community members and Elders, as well as healthcare professionals and administrators providing services to the Parikwene population of Macouria and Saint-Georges de l’Oyapock communes. Data regarding the representation of cassava (Manihot esculenta Crantz) consumption and diabetes were collected via semi-structured interviews and participant observation (i.e., observation and participation in community activities), namely via participating in activities related to the transformation of cassava tubers at swidden and fallow fields.
Results and Discussion
Parikwene have adapted the transformation of cassava tubers for their consumption in the management of diabetes.The importance of cassava tubers as a staple and core food to the Parikwene food system was established by identifying it as a cultural keystone species. Narratives illustrated conflicting perceptions regarding the implication of cassava consumption in the development of diabetes. Adaptations to the operational sequence involved in the transformation of cassava tubers led to the production of distinct cassava roasted semolina (i.e., couac), based on organoleptic properties (i.e., sweet, and acidic couac). Preferences for the consumption of acidic couac were grounded in the Parikwene knowledge system, as well as attention to diabetes related symptoms and glucometer readings.
Conclusion
These results provide important insights related to knowledge, attitudes, and practices in developing locally and culturally adapted approaches to providing dietary recommendations in the treatment of diabetes.
... The food system is further enriched by Indigenous swidden-fallow models of cultivation that center on cassava crops [83,[85][86][87], along with game hunting that includes land mammals (e.g., collared peccary (Pecari tajacu (Linnaeus, 1758); Tayassuidae), brocket deer (Mazama spp.; Cervidae) and agouti (Dasyprocta leporina (Linnaeus, 1758); Dasyproctidae)), wildfowl (e.g., black currasow (Crax alector Linnaeus, 1766; Cracidae) and grey-winged trumpeter (Psophia crepitans Linnaeus, 1758; Psophiidae)) and reptiles (e.g., iguana (Iguana iguana (Linnaeus, 1758); Iguanidae) and tortoises (Chelonoidis spp.; Testudinidae)), as well as fishing (e.g., giant wolf fish (Hoplias aimara (Valenciennes, 1846); Erythrinidae), stripped mullet (Mugil incilis Hancock, 1830; Mugilidae) and banded cichlid (Heros efasciatus Heckel, 1840; Cichlidae)) and wild harvesting of dietary plants (e.g., maripa palm (Attalea maripa (Aubl.) Mart.; Arecaceae), açaí (Euterpe oleracea Mart.; Arecaceae), aymoutabou (Moutabea guianensis Aubl.; Polygalaceae); bagasse (Ambelania acida Aubl.; Apocynaceae)) [84,[88][89][90][91][92][93]. Introduced and imported products such as Asian rice are now more consumed than couac (i.e., roasted cassava flour, a staple of the lower Oyapock diet) [84], while chicken and pork from global factory farms have supplanted the consumption of wild game. ...
... Several food profiles distinguished in French Guiana and Guadeloupe reflect populational distinctions as well as similarities due to increasing exposure to a globalized food system [76,77,106]. Along French Guiana's Oyapock River, the Indigenous food profile is characteristically based on the cultivation and consumption of cassava along with meat and fish from hunting and fishing, complemented with plant-based products from wild harvesting [76,89]. This coexists with an Amazonian Creole food profile that, despite the historical influence of Indigenous food systems, shares some similarities with the Caribbean Creole model from Guadeloupe; both are characterized by a predominance of rice over cassava, as well as high consumption of fish, fruits, vegetables and tubers. ...
... Concerns associated with lead poisoning are particularly real among the inhabitants of the villages of the Oyapock [149,150], who still partially depend on hunting and fishing products, as well as cassava-derived products. This is all the truer for the Palikur, who also depend on these modes of subsistence and whose cultivation and consumption of cassava still define their identity [89]. In Guadeloupe, the banana plantation system has long been a source chlordecone input into the ecosystem, persisting in the soil and accumulating in root vegetables grown in family gardens [107,137]. ...
Globalization is transforming food systems around the world. With few geographical areas spared from nutritional, dietary and epidemiological transitions, chronic diseases have reached pandemic proportions. A question therefore arises as to the sustainability of local food systems. The overall purpose of this article is to put in perspective how local food systems respond to globalization through the assessment of five different case studies stemming from an international research network of Human-Environment Observatories (OHM), namely Nunavik (Québec, Canada), Oyapock (French Guiana, France), Estarreja (Portugal), Téssékéré (Senegal) and Littoral-Caraïbes (Guadeloupe, France). Each region retains aspects of its traditional food system, albeit under different patterns of influence modelled by various factors. These include history, cultural practices, remoteness and accessibility to and integration of globalized ultra-processed foods that induce differential health impacts. Furthermore, increases in the threat of environmental contamination can undermine the benefits of locally sourced foods for the profit of ultra-processed foods. These case studies demonstrate that: (i) the influence of globalization on food systems can be properly understood by integrating sociohistorical trajectories, socioeconomic and sociocultural context, ongoing local environmental issues and health determinants; and (ii) long-term and transverse monitoring is essential to understand the sustainability of local food systems vis-à-vis globalization.
... MR conducted this study in the context of his doctoral thesis [100]. AC and DD supervised the work as doctoral advisors. ...
Background
The prevalence of type 2 diabetes (T2D) in the French overseas department of French Guiana, South America, nearly doubles that in its European counterpart, Metropolitan France. This region is demographically diverse and includes several populations of Indigenous Peoples. Although such populations are at particular risk of developing T2D across the Americas, very little is known about their health status in French Guiana, and accurate numbers of diabetic patients do not exist.
Methods
In light of a potential public health crisis, an ethnomedicinal study of diabetes experienced by Indigenous Parikweneh was conducted to provide better insight into the knowledge, attitudes and practices (KAP) related to this quickly emerging disease in French Guiana. Altogether, 75 interviews were conducted with community members and Elders, as well as healthcare professionals and administrators providing services to the Parikweneh population of Macouria and Saint-Georges de l’Oyapock.
Results
Interviews suggest a high incidence of T2D in this population, with cases that have risen quickly since the mid-twentieth century. Parikweneh participants linked the development of the illness to dietary changes, notably through the introduction of new and sweet foods. Recognizing the complexity of diabetes and its symptoms, diabetic patients highlighted the importance of biomedical treatments and follow-ups, though they frequently alternated or used them concomitantly with Parikweneh medicines. With the help of biomedical tools (i.e. glucometer), local medicinal practices mirrored biomedical approaches through dietary adaptation and the use of medicinal animals and plants for glycaemic control and the treatment of complications from the disease.
Conclusion
Parikweneh are appropriating T2D into their knowledge system and adapting their health system in response to this relatively new health concern. A greater understanding of local practices and perceptions relating to T2D among medical staff may therefore be beneficial for meeting patients’ needs, providing greater autonomy in their health path, and improving treatment outcomes.
In French Guiana were detected high lead (Pb) levels in blood of Amerindian people. Lead exposure is a serious hazard that can affect the cognitive and behavior development. People can be exposed to Pb through occupational and environmental sources. Fingerprinting based on stable Pb isotopes in environmental media is often used to trace natural and anthropogenic sources but is rarely paired with blood data. The objective of this study was to determine the main factors associated with high Blood Lead Levels (BLL). Soil, manioc tubers, food bowls, beverages, wild games, lead pellets and children blood were sampled in small villages along the Oyapock River. children BLL ranged between 5.7 and 35 µg dL−1, all exceeding 5 µg dL−1, the reference value proposed in epidemiologic studies for lead poisoning. Among the different dietary sources, manioc tubers and large game contained elevated Pb concentrations while manioc-based dishes were diluted. The isotopes ratios (207Pb/206Pb and 208Pb/206Pb) of children blood overlapped these of lead shots and meals. These first results confirm for the first time, the diary consumption of manioc-based food as the main contributor to Amerindian children’s BLL in French Guiana, but don’t exclude the occasional exposure to lead bullets by hunting activities. This is a specific health concern, since previous studies have shown that these same villagers present high levels of mercury (Hg). These communities are indeed subject to a double exposure to neurotoxic metals, Hg and Pb, both through their diet. The farming activity is based on manioc growing, and explaining that this ancestral practice can induce serious health risks for the child’s development may seriously affect their food balance and cultural cohesion.
Les huit auteurs qui signent le chapitre suivant analysent les perceptions des systèmes de soins dans la région de l’Oyapock. Cette dernière, qui est à cheval sur la Guyane française et l’État d’Amapa au Brésil, est faiblement peuplée et habitée par des populations vulnérables dans des conditions environnementales propices à la diffusion de maladies vectorielles. La mobilité transfrontalière de santé repose comme dans d’autres régions du monde sur des asymétries entre des systèmes de soins (conditions sanitaires et d’équipements). La mise en place d’une démarche participative sur les expériences de santé avec des groupes de discussion met en évidence les difficultés d’accès aux soins qui sont d’autant plus fortes pour certaines populations en condition de vulnérabilité : migrants, femmes, enfants. En dépit d’une volonté de coopération, la puissance des systèmes réglementaires entrave la mobilité transfrontalière.
O artigo reflete sobre o processo de conversão dos Palikur, povo nativo do Estado do Amapá, ao catolicismo romano e, posteriormente, ao pentecostalismo a eles introduzido pelos missionários do Summer Institute of Linguistics (SIL). Resgatando considerações de Arnaud (1984), Capiberibe (2001) e Passes 1998) a respeito e empreendendo esforço de compreensão dos condicionantes que provavelmente contribuíram para a efetivação desse evento, além dos já mencionados pelos autores de base, o artigo propõe, na condição de outro explicador, a possibilidade de escolha como iniciativa dos próprios Palikur, percebendo-se que se mantém um sistema de costumes e crenças integrando a cosmologia palikur, por um lado, e a fé cristã manifesta no catolicismo romano e no pentecostalismo missionário, por outro, evento este que finda por se inscrever na esfera dos processos de hibridização cultural. Nota-se, por fim, que, a despeito disso, as sucessivas intervenções de natureza religiosa impactaram de maneira profunda a cosmologia ancestral palikur em favor de um ideal de evangelização resultado de interpretações unilaterais das narrativas bíblicas.
Palavras-chave: Palikur. Cultura nativa. Cristianismo. Evangelização. Norte do Brasil.
Pour répondre à la complexité des crises socioécosystémiques qui affectent de plus en plus une planète anthropisée et globalisée, l’auteur a conçu et mis en œuvre dans le cadre de l’Institut écologie et environnement (INEE) du CNRS depuis 2007 un dispositif global d’interdisciplinarité : les Observatoires hommes-milieux (OHM, 13 existants en 2019), lauréat du PIA1 par un Labex (DRIIHM) depuis 2012. L’auteur présente ce que signifie dans leur cadre l’interdisciplinarité, en quoi elle se distingue des échanges interdisciplinaires classiquement identifiés, comment elle est conçue et mise en œuvre, du plan théorique au plus pratique. Il donne quelques exemples de réalisations et dans une discussion, positionne ce dispositif et ses principes par rapport aux cadres et dispositifs existants.
French Guiana is a territory located more than 7000 km from France. It is also the largest French territory, with almost 84000 km2 and 90% of it is covered by forest. Some municipalities are isolated due to the scarcity of transportation and the poor road infrastructure. The population is extremely diverse ethnically and culturally, and includes more than thirty ethnic groups. Immigration is high because it is one of the richest countries in the area bordering northern Brazil, Suriname, Guyana, and as a result of socio-economic crises in some other countries such as Haiti, and it has permeable natural borders. Diabetes and obesity, are emerging issues, with double the prevalence of Mainland France, whereas infectious diseases, such as HIV, take second place. Therapeutic and educational management are challenging because they require the adaptation of tools and treatments to the mul-ticulturalism and precariousness often encountered in these populations. The French and European recommendations are unsuited to the needs of the territory and must take into account the epidemiological, sociological and cultural parameters of these populations in order to provide appropriate and graded management of diabetes in the French Amazon.
Star fruit (Averrhoa carambola), a popular fruit in many parts of the world, is considered to have many beneficial nutritional and medicinal effects. However, harmful nephrotoxic and neurotoxic effects have also been described. In this review, we have discussed the reported beneficial effects of star fruit, explored the potential mechanisms for such beneficial effects, and outline factors that may affect the safe level of consumption. The beneficial effects include the following: antioxidant (mediated via L‐ascorbic acid, epicatechin, and gallic acid), hypoglycemic (mediated via high fiber levels and 2‐dodecyl‐6‐methoxycyclohexa‐2,5‐diene‐1,4‐dione), hypotensive (mediated via apigenin), hypocholesterolemic (mediated via micronized fiber), anti‐inflammatory, anti‐infective, antitumor effects, and immune‐boosting effects. The presence of chronic kidney disease, gastroenteropathies, chronic pancreatitis, dehydration, consumption on an empty stomach, and higher concentration of oxalate in fruit/juice consumed predisposes to toxicity. The level of ingestion at which the beneficial effects transition to nephrotoxicity and neurotoxicity is still to be accurately ascertained. Furthermore, the relationship between the amount of star fruit ingested and the severity of toxicity is not certain and warrants further study. The nutritional and medical properties of star fruit include antioxidant, hypoglycemic, hypotensive, hypocholesterolemic, anti‐inflammatory, anti‐infective, and antitumor effects. However, majority of these findings are extrapolated from in vitro or animal studies. On the other hand, star fruit ingestion has also been shown to cause nephrotoxicity and neurotoxicity. Future studies should focus on the level of ingestion and conditions at which the beneficial effects become toxic.
In recent years, many studies of Momordica charantia (MC) in the treatment of diabetes mellitus (DM) and its complications have been reported. This article reviewed the effect and mechanism of MC against diabetes, including the results from in vitro and in vivo experiments and clinical trials. The common side effects of MC were also summarized. We hope that it might open up new ideas for further mechanism exploration and clinical application as well as provide a scientific theoretical basis for the development of drugs or foods derived from MC.
La Première Nation des Pekuakamiulnuatsh (Innus du Lac Saint-Jean), est engagée dans un processus de négociation territoriale depuis plus de quarante ans. Elle travaille présentement avec ses partenaires du Regroupement Petapan en vue de finaliser un projet de traité avec les paliers de gouvernements fédéral et provincial, dans le cadre de la politique sur les revendications territoriales globales. Se situant toujours au fondement de l’affirmation identitaire des Pekuakamiulnuatsh, la notion de territoire demeure indissociable du lien entre langue et territoire, et de la manière dont celui-ci trouve son expression aujourd’hui dans leur langue, le nehlueun, entre autres par l’usage de toponymes, mais également dans les dispositions prévues au projet de traité préparant la voie à l’autonomie gouvernementale pour les générations futures. Le projet de recherche multidisciplinaire Peshunakun, initié par la Première Nation de Mashteuiatsh en 2008, en réponse à un besoin d’affirmation culturelle et politique, met en évidence l’ancrage même de l’identité et de la langue ilnu dans l’espace, à travers une démarche de documentation de l’histoire de l’occupation et de l’utilisation du territoire ancestral. Un éclairage nouveau est ainsi jeté sur la territorialité de cette Première Nation sous l’angle du lien entre leur langue, leurs visions et leurs préoccupations politiques actuelles.
Background:
French Guiana is characterized by a very multicultural population, made up of formerly settled groups (Amerindians, Maroons, Creoles) and more recent migrants (mostly from Latin America and the Caribbean). It is the ideal place to try to understand the influence of intercultural exchanges on the composition of medicinal floras and the evolution of phytotherapies under the effect of cross-culturalism.
Methods:
A combination of qualitative and quantitative methods was used. Semi-directive interviews were conducted in 12 localities of French Guiana's coast between January 2016 and June 2017, and the responses to all closed questions collected during the survey were computerized in an Excel spreadsheet to facilitate quantitative processing. Herbarium vouchers were collected and deposited at the Cayenne Herbarium to determine Linnaean names of medicinal species mentioned by the interviewees. A list of indicator species for each cultural group considered was adapted from community ecology to this ethnobiological context, according to the Dufrêne-Legendre model, via the "labdsv" package and the "indval" function, after performing a redundancy analysis (RDA).
Results:
A total of 205 people, belonging to 15 distinct cultural groups, were interviewed using semi-structured questionnaires. A total of 356 species (for 106 botanical families) were cited. We observed that pantropical and edible species hold a special place in these pharmacopeias. If compared to previous inventories, 31 recently introduced species can be counted. Furthermore, this study shows that the majority of the plants used are not specific to a particular group but shared by many communities. However, despite this obvious cross-culturalism of medicinal plants between the different cultural communities of French Guiana, divergent trends nevertheless appear through the importance of 29 indicator/cultural keystone species in 10 cultural groups. Finally, we have emphasized that the transmission of herbal medicine's knowledge in French Guiana is mainly feminine and intra-cultural.
Conclusion:
French Guianese medicinal flora is undoubtedly related to the multiple cultures that settled this territory through the last centuries. Cultural pharmacopeias are more hybrid than sometimes expected, but cultural keystone species nevertheless arise from a common background, allowing to understand, and define, the relationships between cultural groups.
The ketogenic diet (KD) has gained immense popularity during the last decade, primarily because of its successful short-term effect on weight loss. In the United States, KD is utilized in a variety of patient populations for weight management, despite limited evidence regarding its efficacy and risks. This literature review provides an evaluation of data on the benefits and risks associated with the chronic use of KD, including its metabolic, endocrinological, and cardiovascular effects.
In recent decades, numerous scientific investigations have been conducted to study the antidiabetic effects of Annona muricata L. However, no comprehensive evidence-based systematic review regarding this topic is available. Hence, this study was conducted to systematically evaluate the studies of the efficacy of A. muricata in diabetes management. Six online databases used to search for the related articles. The search terms used were A. muricata/ soursop in combination with diabetes, glucose, and insulin. Seventeen studies were identified that fit the inclusion criteria (1 clinical, 10 in vivo, 4 in vitro, 1 in vivo/ in vitro and 1 in silico). A clinical study showed the positive adjuvant effect of A. muricata to glibenclamide in type 2 diabetes patients. In vivo studies reported beneficial effects of A. muricata in murine models to include decreasing fasting blood glucose level, attenuating diabetes-associated weight loss, increasing serum insulin, improving the lipid profile, normalizing the activity of antioxidant enzymes, and exerting pancreas-protective and hepatoprotective effects. In vitro studies of A. muricata demonstrated its potential for reducing post-prandial glucose level by inhibiting pancreatic α-amylase, lipase, and α-glucosidase and lowering oxidative stress by inhibiting glycation and lipid peroxidation. Additionally, the in-silico study suggested a positive effect of A. muricata in enhancing insulin sensitivity. A. muricata showed a promising effect on the metabolic parameters in diabetes mellitus. Considering that A. muricata is widely consumed worldwide, further exploration of its therapeutic potential is worthwhile.
The overall malaria burden in the Americas has decreased dramatically over the past two decades, but residual transmission pockets persist across the Amazon Basin, where Plasmodium vivax is the predominant infecting species. Current elimination efforts require a better quantitative understanding of malaria transmission dynamics for planning, monitoring, and evaluating interventions at the community level. This can be achieved with mathematical models that properly account for risk heterogeneity in communities approaching elimination, where few individuals disproportionately contribute to overall malaria prevalence, morbidity, and onwards transmission. Here we analyse demographic information combined with routinely collected malaria morbidity data from the town of Mâncio Lima, the main urban transmission hotspot of Brazil. We estimate the proportion of high-risk subjects in the host population by fitting compartmental susceptible-infected-susceptible (SIS) transmission models simultaneously to age-stratified vivax malaria incidence densities and the frequency distribution of P. vivax malaria attacks experienced by each individual over 12 months. Simulations with the best-fitting SIS model indicate that 20% of the hosts contribute 86% of the overall vivax malaria burden. Despite the low overall force of infection typically found in the Amazon, about one order of magnitude lower than that in rural Africa, high-risk individuals gradually develop clinical immunity following repeated infections and eventually constitute a substantial infectious reservoir comprised of asymptomatic parasite carriers that is overlooked by routine surveillance but likely fuels onwards malaria transmission. High-risk individuals therefore represent a priority target for more intensive and effective interventions that may not be readily delivered to the entire community.
Background
Diabetes mellitus is one of the most common todays public health problems. According to a survey by the World Health Organization, this metabolic disorder has reached global epidemic proportions, with a worldwide prevalence of 8.5% in the adult population.
Objectives
The present study aimed to investigate the hypoglycemic effect of aqueous extract of Mangifera indica (EAMI) leaves in streptozotocin-induced diabetic rats.
Methods
Sixty male rats were divided into 2 groups: Normoglycemic and Diabetic. Each group was subdivided into negative control, glibenclamide 3 or 10 mg/kg, EAMI 125, 250, 500, and 1000 mg/kg. Intraperitoneal injection of streptozotocin 100 mg/kg was used to DM induction. The hypoglycemic response was assessed acutely after two and four weeks of treatment. After a 6-hour fasting period, the fasting blood glucose of animals was verified, and 2.5 g/kg glucose solution was orally administered. The insulin tolerance test and plasma insulin levels assessment were performed in the morning after fasting of 12 to 14 hours.
Results and conclusion
The chemical analysis of EAMI showed high levels of phenolic compounds. There was no significant difference in fasting blood glucose between normoglycemic and diabetic groups, and that EAMI did not have an acute effect on diabetes. After two and four weeks of treatment, the extract significantly reduced blood glucose levels, exceeding glibenclamide effects. EAMI was effective in maintaining the long-term hypoglycemic effect, as well as, significantly increased the sensitivity of diabetic animals to insulin and the plasma insulin level.
Pharmacopoeias are, like any kind of cultural production, living and dynamic objects that constantly change and reinvent themselves through continuous contacts and exchanges between different social groups. Medicinal plants are “biocultural objects” (Pordié, 2002) because of the richness and the complexity of relationships that societies develop with them. In French Guiana, especially in its cross-border areas, cultural interactions are common. Plants and associated knowledge circulate among communities, contributing to a permanent renewal and a continuous hybridization of herbal medicines. These material and immaterial flows form the cultural reality of cross-border areas on the Guiana Shield. This paper focuses on the border between French Guiana and Brazil, which is made tangible by the Oyapock River. This border is a relatively recent political construction as it was only established in 1900 after a Swiss arbitration ended a long diplomatic conflict between France and Brazil. Even if a process of “rebordering” (Moullé, 2017) has been observed lately – despite the opening of the Oyapock bridge – the two sides of the River are part of the same dynamic cultural space since both share a relative remoteness from their respective centre. As well, constant social, economic and cultural circulations take place between the French town of Saint-Georges-de-l’Oyapock and the Brazilian town of Oiapoque. In this context, ethnobotanical circulations – namely, exchanges of medicinal plants and associated knowledge – are a fair illustration of the shared cultural dimension between people. Based on interviews with 23 inhabitants of the French town of Saint-Georges-de-l’Oyapock, the paper offers an exploratory description of ethnobotanical flows in the context of the cross-border area. It lists the medicinal plants used in Saint-Georges and analyses the diffusion of associated knowledge between the different communities. Results show that 92% of the 139 identified plants are used by several communities, and 40% of them are used among four to five different social groups. While most of the used plants are exotic species, their use is quite transversal to the socio-cultural components of Saint-Georges population. Nevertheless, the analysis shows that most of the knowledge transmission about medicinal plants happens inside the same community and via inter-generational means. The use of the same species and medicinal knowledge by different groups is therefore the result of a long-term process. Currently, it seems that early-established communities are more likely to share their knowledge with other groups than newly arrived groups, who integrate local uses to their own pharmacopoeias but seldom share their knowledge. Even though inter-community exchanges are discreet, they still contribute to vivid dynamics of local pharmacopoeias, illustrated by current ethnobotanical “interculturalisation” (Tareau, 2019), relocation and juxtapositions of phytotherapeutical practices, as well as new practices based on combinations between treatments from different origins. The cross-border area is therefore a place of cultural hybridization, in a context of intensive circulations of people and goods between two socio-political systems (Map 1). Practices of medical pluralism explain some of the to-and-fro moves of people on the border: while Brazilians come to Saint-Georges’ dispensary for health treatment, French Amerindians and Creoles visit Terras Indigenas villages in Brazil for consulting pajés . The pajés may also come to Saint-Georges to visit their family and treat sick persons. At the regional scale, circulations for access to care contribute to the delineation of a large health circulation area on the border. The latter also acts as an attraction factor for flows of processed medicinal plants, which find in Oiapoque an interface for entering the Guianese health market (see Map 1). Several factors explain this regional export capacity of Brazilian herbal goods: the presence of Brazilian diaspora and the diffusion of its pharmacopoeia in French Guiana along with the marketing strength of Brazilian herbal pharmacies and the presence of herbalists in Oaipoque, although they are not allowed in France. All these contribute to the development of flows of dried medicinal plants and processed herbal items from inner and Southern Brazil to French Guiana, and therefore to the relentless evolution of local pharmacopoeias.
Background:
The border area between French Guiana and Brazil is an active HIV-transmission zone. The aim of the present study was to describe HIV knowledge, risk and the level of stigma among inhabitants of this border area.
Methods:
A cross-sectional study was conducted among 621 inhabitants over 18 years of age in the border cities of Saint-Georges-de-l'Oyapock in French Guiana and Oiapoque in Brazil. It was conducted between October 2017 and February 2018. An anonymous standardized questionnaire was filled out by culturally-trained mediators, then analyzed using STATA 12.
Results:
Almost half (45.9%) of the individuals had a low education level. Participants whose native language was Portuguese or French demonstrated better HIV knowledge than other populations, notably native Amerindian and creole-speaking people. HIV risk behavior was more frequent in men and in younger age groups. People with good HIV knowledge reported having performed more HIV tests in the last year than participants with poor knowledge. The stigma level was high and reported in 74.8% of respondents.
Conclusions:
These results illustrate the need for initiatives to improve HIV prevention among autochthonous populations on both sides of this border area. Cross-border collaboration on health policies could produce common key messages adapted to the education level and multi-linguistic populations who live in this area.
To implement future malaria elimination strategies in French Guiana, a characterization of the infectious reservoir is recommended. A cross-sectional survey was conducted between October and December 2017 in the French Guianese municipality of St Georges de l'Oyapock, located along the Brazilian border. The prevalence of Plasmodium spp. was determined using a rapid diagnostic test (RDT) and a polymerase chain reaction (PCR). Demographic, house locations, medical history, and biological data were analyzed. Factors associated with Plasmodium spp. carriage were analyzed using logistic regression, and the carriage localization was investigated through spatial cluster analysis. Of the 1,501 samples analyzed with PCR, positive results totaled 90 and 10 for Plasmodium vivax and Plasmodium falciparum, respectively. The general PCR prevalence was 6.6% [5.3-7.9], among which 74% were asymptomatic. Only 13/1,549 were positive by RDT. In multivariate analysis, participants older than 15 years, living in a remote neighborhood, with a prior history of malaria, anemia, and thrombocytopenia were associated with an increased odds of Plasmodium spp. carriage. High-risk clusters of P. vivax carriage were detected in the most remote neighborhoods on the village outskirts and two small foci in the village center. We also detected a hot spot for both P. vivax and P. falciparum symptomatic carriers in the northwestern part of the village. The present study confirms a wide-scale presence of asymptomatic P. falciparum and P. vivax carriers in this area. Although they were more often located in remote areas, their geographic distribution was spatially heterogeneous and complex.
Native to Mexico, Persea americana Mill. (avocado) is a fruit tree whose different parts (leaf, bark, roots, and stone) are used in traditional medicine especially against diabetes mellitus. The aim of this study was to investigate the beneficial effects of 28-day treatment with aqueous, ethanolic, and methanolic leaf extracts on glucose homeostasis in type 2 diabetic mellitus using Wistar rats. Type 2 diabetes was induced with nicotinamide (120 mg/kg, i.p.) and streptozotocin (65 mg/kg, i.p.). After 28 days of treatment, histopathological examination of the pancreas, kidneys, liver, and muscle (tibialis anterior) were realized. Biochemical markers were determined and an intestinal absorption test of D-glucose was performed. All extracts (100 mg/kg/day, p.o.) significantly ( p<0.001 ) reduced blood glucose level at the 28 th day of treatment with a more pronounced effect for methanolic extract. The treatments were well tolerated and induced a restoration of T-CHOL and HDL-C levels compared to the control group. Methanolic extract reduced the AIP (atherogenic index of plasma) by 45%. Histopathological analyzes of the pancreas showed regeneration of islets of Langerhans. Methanolic extract was the most effective in preventing intestinal glucose uptake up to 60.90% in relation to metformin. These results justify the use of this plant in traditional medicine against type 2 diabetes. However, other complementary studies should be done to identify the molecules responsible for this activity and their signaling voice.
Hunting sustainability in Amazonian ecosystems is a key challenge for modern stakeholders. Predictive models have evolved from first mostly biological data-based to more recent modeling including human behavior. We analyze here the hunting data collected in French Guiana through a panel of indices aiming at drawing the puzzle of parameters influencing hunting activity and impact in various socio ecological conditions across the country. Data were collected from five different study sites differing in cultural origins and remoteness from market economy, and over a 10 years period. Most indices show an impact on wildlife populations, and using a full set of indicators allowed us to better understand some underlying mechanisms that lead to a community's hunting profile. The results showed that there are noticeable differences between the study sites in the practices and the ways hunters face the changes in environment and resources availability.
Indigenous populations in Canada have experienced social, economic, and political disadvantages through colonialism. The policies implemented to assimilate Aboriginal peoples have dissolved cultural continuity and unfavorably shaped their health outcomes. As a result, Indigenous Canadians face health inequities such as chronic illness, food insecurity, and mental health crises. In 2015, the Canadian government affirmed their responsibility for Indigenous inequalities following a historic report by the Truth and Reconciliation Commission of Canada. It has outlined intergenerational traumata imposed upon Aboriginals through decades of systemic discrimination in the form of the Residential School System and the Indian Act. As these policies have crossed multiple lifespans and generations, societal conceptualization of Indigenous health inequities must include social determinants of health (SDOH) intersecting with the life course approach to health development to fully capture the causes of intergenerational maintenance of poor health outcomes. To provide culturally sensitive care for those who have experienced intergenerational trauma, health care providers should be aware of and understand two key SDOH inequity influencing the Indigenous life course, including the residential school system and loss of socioeconomic status, over time due to colonialism.
Limonoids are phytochemicals with a variety of biological properties. In the present study, we elucidated the molecular mechanism of suppression of adipogenesis in adipocytes by a limonoid, 7-deacetoxy-7-oxogedunin (CG-1) from Carapa guianensis (Meliaceae), known as andiroba. CG-1 reduced the accumulation of intracellular triglycerides in a concentration-dependent manner. The expression levels of the adipogenic, lipogenic, and lipolytic genes were decreased by CG-1 treatment, whereas the glycerol release level was not affected. When CG-1 was added into the medium during days 0-2 of 6-days-adipogenesis, the accumulation of intracellular lipids and the mRNA levels of the adipogenesis-related genes were decreased. In addition, the phosphorylation level of insulin receptor substrate-1 (IRS-1) and Akt in the early phase of adipocyte differentiation (within 1 day after initiating adipocyte differentiation) was reduced by CG-1. Furthermore, insulin-activated translocation of glucose transporter 4 to the plasma membranes in adipocytes was suppressed by CG-1, followed by decreased glucose uptake into the cells. These results indicate that an andiroba limonoid CG-1 suppressed the accumulation of intracellular lipids in the early phase of adipocyte differentiation through repression of IRS-1/Akt-mediated glucose uptake in adipocytes.
The gathering of medicinal plants in French Guiana is a relatively unknown practice, underestimated and often perceived as an anecdotic or insignificant one. However, everyday people can be seen harvesting plants on the road sides, for their own needs or in small proportions, for selling. This paper aims to characterise these medicinal plants’ collection practices, their diversity and their relevance for questioning the functioning of societies, which are subjected to rapid transformations and are therefore designed here as “transitional”. Through two case studies, one on urban collection in Cayenne city and one in the rural area along the lower Maroni River, this paper analyses the connection between societies, nature and urban dynamics. By observing the socio-cultural specificities influencing collection modes, we propose a conceptualization scheme of collection practices, through the explanatory concepts of heterogeneity and purpose.
Introduction
Le repérage des personnes au stade prédiabétique peut contribuer à retarder ou à prévenir l’évolution vers le diabète de type 2. Nous avons exploré la possibilité de recourir à un envoi postal à l’occupant pour effectuer un dépistage des cas de prédiabète et de diabète sucré de type 2 non diagnostiqué dans la population; nous avons également conçu un protocole standard, et avons élaboré et mis en œuvre des programmes communautaires axés sur les habitudes de vie.
Méthodologie
Le questionnaire d’évaluation des risques de diabète à l’intention des Canadiens (CANRISK), constitué de 16 questions, a été envoyé par la poste à tous les ménages de deux collectivités rurales de Nouvelle-Écosse. Au total, 417 participants âgés de 40 à 74 ans et n’ayant pas reçu de diagnostic de diabète ont répondu eux-mêmes au questionnaire CANRISK et se sont prêtés à une épreuve d’hyperglycémie provoquée par voie orale (HPVO) pratiquée deux heures après l’absorption de glucose dans un établissement de soins de santé local. Les individus ayant reçu un diagnostic de prédiabète ont été invités à participer à un programme de modification des habitudes de vie au stade prédiabétique.
Résultats
Le statut glycémique des participants était normal, prédiabétique ou diabétique dans respectivement 84 %, 13 % et 3 % des cas. L’association entre le statut glycémique et le score de risque global selon CANRISK était statistiquement significative. Six éléments du questionnaire CANRISK étaient associés de manière significative au statut glycémique : l’indice de masse corporelle, le tour de taille, les antécédents d’hypertension et d’hyperglycémie, le niveau de scolarité et la perception de l’état de santé. La rétroaction des participants et des médecins à l’égard du processus de dépistage CANRISK a été positive.
Conclusion
Le questionnaire CANRISK est un outil prometteur pour le dépistage au sein de la population.
Este artigo tem como escopo os ritos funerários do povo Palikur-Arukwayene da região do Rio Urucauá no extremo norte do Brasil. Resultado de um trabalho etnográfico, são apresentadas narrativas históricas e míticas sobre a morte e o processo funerário, desde os antigos enterros secundários em urnas de argila, até a incorporação de ritos e práticas cristãs. As transformações e ressignificações relacionados à morte, por sua vez, desvelam o longo processo histórico do contato colonial entre os Palikur-Arukwayene e as sociedades de matriz euro-ocidentais. Ademais, este é um experimento narrativo, justamente porque busca conciliar conhecimentos e vozes heterogêneas, pois é escrito por duas acadêmicas indígenas Palikur-Arukwayene e um autor não indígena. Assim, há uma sobreposição de desafios como por exemplo, diferenças de gênero, assimetrias de conhecimentos, heteroglosia e implicações éticas. Por fim, destaca-se que o registro dessas narrativas e conhecimentos tem importância para o diálogo e discussões acadêmicas, mas principalmente para as jovens gerações Palikur-Arukwayene.
Ethnopharmacological relevance:
In French Guiana, traditional phytotherapies are an important part of self-healthcare, however, a precise understanding of the interactions between local phytotherapies and biomedicine is lacking. Malaria is still endemic in the transition area between French Guiana and Brazil, and practices of self-treatment, although difficult to detect, have possible consequences on the outcome of public health policies.
Aim of the study:
The objectives of this research were 1) to document occurences of co-medication (interactions between biomedicine and local phytotherapies) against malaria around Saint-Georges de l'Oyapock (SGO), 2) to quantify and to qualify plant uses against malaria, 3) and to discuss potential effects of such co-medications, in order to improve synergy between community efforts and public health programs in SGO particularly, and in Amazonia more broadly.
Materials and methods:
This cross-sectional study was conducted in 2017 in SGO. Inhabitants of any age and nationality were interviewed using a questionnaire (122 questions) about their knowledge and habits regarding malaria, and their use of plants to prevent and treat it. They were invited to show their potential responses on a poster illustrating the most common antimalarial plants used in the area. In order to correlate plant uses and malaria epidemiology, all participants subsequently received a medical examination, and malaria detection was performed by Rapid Diagnostic Test (RDT) and Polymerase Chain Reaction (PCR).
Results:
A total of 1566 inhabitants were included in the study. Forty-six percent of them declared that they had been infected by malaria at least once, and this rate increased with age. Every person who reported that they had had malaria also indicated that they had taken antimalarial drugs (at least for the last episode), and self-medication against malaria with pharmaceuticals was reported in 142 cases. A total of 550 plant users was recorded (35.1% of the interviewed population). Among them 95.5% associated pharmaceuticals to plants. All plants reported to treat malaria were shared by every cultural group around SGO, but three plants were primarily used by the Palikur: Cymbopogon citratus, Citrus aurantifolia and Siparuna guianensis. Two plants stand out among those used by Creoles: Eryngium foetidum and Quassia amara, although the latter is used by all groups and is by far the most cited plant by every cultural group. Cultivated species accounts for 91.3% of the use reports, while wild taxa account for only 18.4%.
Conclusions:
This study showed that residents of SGO in French Guiana are relying on both traditional phytotherapies and pharmaceutical drugs to treat malaria. This medical pluralism is to be understood as a form of pragmatism: people are collecting or cultivating plants for medicinal purposes, which is probably more congruent with their respective cultures and highlights the wish for a certain independence of the care process. A better consideration of these practices is thus necessary to improve public health response to malaria.
Ethnopharmacological relevance
Quassia amara L. recently came into the spotlight in French Guiana, when it became the object of a biopiracy claim. Due to the numerous use records throughout the Guiana shield, at least since the 18th century, a thorough investigation of its origin seemed relevant and timely. In the light of the Convention on Biological Diversity (CBD) and the Nagoya protocol, questions about the origin of local knowledge are important to debate.
Aim of the study: Defining cultural biogeography as the dynamics through space and time of biocultural complexes, we used this theoretical framework to shed light on the complex biogeographical and cultural history of Q. amara. We explored in particular the possible transfer of medicinal knowledge on an Old World species to a botanically related New World one by enslaved Africans in Suriname.
Materials and methods
Historical and contemporary literature research was performed by means of digitized manuscripts, archives and databases from the 17th to the 21st century. We retrieved data from digitized herbarium vouchers in herbaria of the Botanic Garden Meise (Belgium); Naturalis Biodiversity Center (the Netherlands); Missouri Botanical Garden, the Smithsonian National Museum of Natural History, the Field Museum (USA); Royal Botanic Gardens Kew (UK); the IRD Herbarium, French Guiana and the Museum National d’Histoire Naturelle (France). Vernacular names were retrieved from literature and herbarium specimens and compared to verify the origin of Quassia amara and its uses.
Results
Our exploration of digitized herbarium vouchers resulted in 1287 records, of which 661 were Q. amara and 636 were Q. africana. We observed that the destiny of this species, over at least 300 years, interweaves politics, economy, culture and medicine in a very complex way. Quassia amara's uses are difficult to attribute to specific cultural groups: the species is widely distributed in Central and South America, where it is popular among many ethnic groups. The species spread from Central to South America during the early 18th century due to political and economic reasons. This migration possibly resulted from simultaneous migration by religious orders (Jesuits) from Central America to northern South America and by Carib-speaking Amerindians (from northern South America to Suriname). Subsequently, through colonial trade networks, Q. amara spread to the rest of the world. The absence of African-derived local names in the Guiana shield suggests that Q. africana was not sufficiently familiar to enslaved Africans in the region that they preserved its names and transferred the associated medicinal knowledge to Q. amara.
Conclusions
Cultural biogeography has proven an interesting concept to reconstruct the dynamics of biocultural interactions through space and time, while herbarium databases have shown to be useful to decipher evolution of local plant knowledge. Tracing the origin of a knowledge is nevertheless a complex adventure that deserves time and interdisciplinary studies.
Timely initiation and titration of bolus insulin can help improve outcomes for patients with type 2 diabetes mellitus.
Aims:
The main aims are: (a) to draw attention to the nature and pattern of recent global and regional prevalence estimates and projections of diabetes in older adults (65-99 years), and (b) to describe the societal health implications of these changes on a global scale.
Methods:
Diabetes prevalences and projections were estimated using a logistic regression method to generate smoothed age- and sex-specific prevalence estimates for 5-year age groups.
Results:
In 2019, it is estimated that 19.3% of people aged 65-99 years (135.6 million, 95% CI: 107.6 - 170.6 million) live with diabetes. It is projected that the number of people older than 65 years (65-99 years) with diabetes will reach 195.2 million by 2030 and 276.2 million by 2045. For the regional distribution, the highest prevalence in 2019 being the North America and Caribbean region at 27.0%. Countries with the highest number of people older than 65 years with diabetes are China, the United States of America and India.
Conclusions:
There is a need for more data from national and regional sources on those aged 65 years and over but the prevailing evidence points to diabetes being a considerable global chronic illness burden in ageing societies.
L’analyse des 209 entretiens semi-directifs effectués durant cette thèse a permis d’obtenir une vision globale et descriptive, autant qualitative que quantitative, des pharmacopées qui s’entrecroisent sur le littoral guyanais. Les usages phytothérapeutiques des 19 communautés culturelles interrogées ont été décryptés de façon à obtenir un panorama actualisé des pratiques ethnobotaniques guyanaises.Cette étude ethnographique a notamment permis de mettre en lumière les principales catégories nosologiques concernées par la phytothérapie sur le littoral guyanais et d’apporter un regard neuf sur les ethnomédecines de ce territoire et, notamment, les représentations du corps et de la maladie qu’elles sous-tendent. Les modes de traitement et les formes d’administration des remèdes en usage aujourd’hui sont finement documentés ainsi que les espèces utilisées (356 espèces identifiées).De façon plus originale, une cartographie des flux ethnobotaniques actuels est réalisée ainsi qu’une analyse de la « répartition culturelle » des plantes médicinales et une réflexion est menée sur les thèmes de la transversalité, de la sélection, de la transmission et de l’interculturalisation des savoirs relatifs aux plantes médicinales. Entre autres sous-thématiques, les rôles joués par la migration, la transfrontalité ou encore l’urbanité y sont largement discutés.
Objective
While national guidelines advocate for earlier diabetes screening in high-risk ethnic groups, little evidence exists to guide clinicians on the age at which screening should commence. The purpose of this study was to determine age equivalency thresholds for diabetes risk across a broad range of ethnic populations.
Methods
This population-based, retrospective cohort study used linked administrative health and immigration records for 592,376 individuals in Ontario, Canada. Adjusted incidence rates by ethnicity, sex and age were used to derive ethnic-specific age thresholds for risk.
Results
Diabetes incidence rates in South Asians reached an equivalent risk as that experienced by a 40 year-old Western European man (3·7 per 1,000 person-years) by age 25. For all other non-European ethnic groups, the equivalent risk was experienced between age 30 and 35. These risk differentials persisted despite controlling for covariates.
Conclusion
We found a fifteen-year difference in age-equivalency of risk across ethnic groups.
Aim:
Nationwide data on the evolution of diabetes incidence and prevalence are scarce in France. For this reason, our objectives were to determine type 2 diabetes prevalence and incidence rates between 2010 and 2017, stratified by gender, age and region, and to assess annual time trends over the study period in adults aged ≥ 45 years.
Methods:
Diabetes cases in the National Health Data System (SNDS), which covers the entire French population (66 million people), were identified. Gender- and age-specific prevalence and incidence rates were estimated. Negative binomial models, adjusted for gender, age and region, were used to assess annual time trends for prevalence and incidence throughout the study period.
Results:
During 2017, 3,144,225 diabetes cases aged ≥ 45 years were identified. Over the study period, prevalence increased slightly (men from 11.5% to 12.1%, women from 7.9% to 8.4%) whereas incidence decreased (men from 11 to 9.7, women from 7.2 to 6.2 per 1000 person-years). In only four groups did prevalence rates decrease: men aged 45-65 years; women aged 45-60 years; women in Réunion; and women in Martinique. An increasing annual time trend was observed for prevalence [men: +0.9% (95% CI: +0.7%, +1%); women: +0.4% (95% CI: +0.2%, +0.6%)] with a decreasing annual time trend for incidence in both genders [men: -2.6% (95% CI: -3.1%, -2.0%); women: -3.9% (95% CI: -4.5%, -3.4%)].
Conclusion:
Further efforts towards diabetes prevention are required to ensure that incidence rates in France continue to diminish, as the disorder continues to represent an important public-health burden.
O presente artigo tem como objetivo discutir a sociabilidade do povo Palikur, habitante da fronteira franco-brasileira a partir da concepção de identidade e de fronteira étnica, de forma a perceber como esses indígenas sofreram e lidaram com as políticas dos Estados brasileiro e francês após o Laudo Suíço de 1900. No tocante ao contato com as políticas dos Estados, os Palikur são obrigados a conviver com fronteiras impostas por não indígenas, que reverberam historicamente em sua sociabilidade, mas que, apesar do fator “identidade nacional”, mantém a identidade étnica Palikur, utilizando as identidades francesa e brasileira justamente para se adaptarem à fronteira geopolítica, e usando os movimentos migratórios como artifício principal.
Résumé Cet article vise à faire un point des connaissances (en économie) sur le rôle de la couverture complémentaire dans le financement de la santé. On commence dans la première partie par définir les différents modes de financement de la santé et leurs forces et faiblesses respectives. Dans une seconde partie, sont passées en revue les connaissances théoriques et empiriques relatives à diverses formes de partage de la dépense de soins entre système obligatoire et système volontaire. Cette partie repose sur des contributions théoriques, mais aussi sur des analyses empiriques du fonctionnement de la complémentaire dans différents systèmes de soins ayant adopté ce type de financement sous des formes diverses : Canada, France, Royaume-Uni, Suisse et USA. La principale conclusion est la suivante : tout système de financement pur (purement obligatoire ou purement volontaire) est rejeté, d’un point de vue normatif (le bien-être social est moindre que dans un système mixte) ou positif (il ne serait pas choisi dans un vote référendaire). Les systèmes mixtes ne sont donc pas seulement la résultante de circonstances historiques chaotiques mais reflètent un arbitrage rationnel entre les défauts des systèmes obligatoires et volontaires.
Aims:
To provide global estimates of diabetes prevalence for 2019 and projections for 2030 and 2045.
Methods:
A total of 255 high-quality data sources, published between 1990 and 2018 and representing 138 countries were identified. For countries without high quality in-country data, estimates were extrapolated from similar countries matched by economy, ethnicity, geography and language. Logistic regression was used to generate smoothed age-specific diabetes prevalence estimates (including previously undiagnosed diabetes) in adults aged 20-79 years.
Results:
The global diabetes prevalence in 2019 is estimated to be 9.3% (463 million people), rising to 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045. The prevalence is higher in urban (10.8%) than rural (7.2%) areas, and in high-income (10.4%) than low-income countries (4.0%). One in two (50.1%) people living with diabetes do not know that they have diabetes. The global prevalence of impaired glucose tolerance is estimated to be 7.5% (374 million) in 2019 and projected to reach 8.0% (454 million) by 2030 and 8.6% (548 million) by 2045.
Conclusions:
Just under half a billion people are living with diabetes worldwide and the number is projected to increase by 25% in 2030 and 51% in 2045.
We investigated the anti-obesity effect of a limonoid 7-deacetoxy-7-oxogedunin, named CG-1 purified from the seeds of Carapa guianensis, Meliaceae, known as andiroba in high-fat diet (HFD)-fed mice. C57BL/6 mice were fed a low-fat diet or an HFD, and orally administered CG-1 (20 mg/kg) for 7 weeks. CG-1 decreased body weight gain and improved serum triglyceride level and insulin sensitivity in HFD-fed mice. The expression level of the adipogenesis-related genes was lowered by CG-1 in visceral white adipose tissue (vWAT). Moreover, the mRNA level of the macrophage-related genes decreased in vWAT following administration of CG-1 to HFD-fed mice. Noteworthly, CG-1 activated brown adipose tissue (BAT) with enhanced expression of uncoupling protein 1 and increased rectal temperature in HFD-fed mice. These results indicate that a limonoid CG-1 decreased body weight gain and ameliorated hypertriglyceridemia and insulin resistance with activation of BAT in HFD-fed mice.
The epidemic of obesity contributes to the burden of type 2 diabetes mellitus (T2DM) in the United States and worldwide. Importantly, obesity is not only preventable but can be treated, particularly with lifestyle modifications to forestall T2DM in those with excess adiposity. The mechanisms linking obesity to T2DM are numerous and involve adipose tissue remodeling as a result of unhealthy behaviors, including unhealthy diet, reduced physical activity (PA) and exercise training (ET), and increased sedentary behaviors. Taken together, these factors markedly reduce cardiorespiratory fitness (CRF), one of the strongest predictors for cardiovascular outcomes and all-cause mortality in the general population, but also in those with T2DM. In this review we describe the mechanisms leading to adipose tissue remodeling resulting in obesity, as well as the mechanisms linking excess adiposity to insulin resistance and, in turn, T2DM. We then present the therapeutic strategies that can be implemented in obesity to prevent T2DM, with a brief discussion on weight loss, and greater emphasis on PA and ET. We finally present the evidence to support the beneficial effects of such strategies in patients with established T2DM and discuss the importance of achieving improvements in CRF in this population to potentially improve clinical outcomes.
In this study, a polysaccharide was extracted from Physalis pubescens L. (named PP). Its antihyperglycemic and antihyperlipidemic activities were evaluated in STZ-induced diabetic mice. Results showed that PP was determined to be composed of rhamnose (Rha), arabinose (Ara), fucose (Fuc), xylose (Xyl), mannose (Man), glucose (Glc) and galactose (Gal) with molar percentages of 4.65%, 17.34%, 1.43%, 6.24%, 5.52%, 45.5%, 19.31%, respectively. The average molecular weight (Mw) was measured to be 20.0 kDa. It had a strong α- glucosidase inhibitory activity in vitro. PP treatment could enhance the oral glucose tolerance, and increase the levels of SOD, GSH, CAT, Vitamin C, Vitamin E, HDL-c, C-peptide, GCK and hepatic glycogen in diabetic mice. Besides, PP treatment could also decrease the levels of MDA, TG, TC, LDL-c, BUN and G-6-Pase. And the regulating effects were stronger in the high dose of PP treatment than those in the low and medium doses treatment. In short, PP played an important role in protecting STZ-induced diabetic mice, and the effect was closely related to its activities in the antioxidation and regulating glucose and lipid metabolism.
O calendário do meu povo Palikur-Arukwayene, sempre segue os sinais e a orientação da natureza para deliberar o período do início e do final do ano. O ano, no nosso território divide-se duas estações designadas digiswiki/muwokwekri (estação das chuvas/inverno) que se inicia no mês que os não indígenas chamam de dezembro e termina no final de junho e kamukwiki/abareswan (estação da seca/verão) entre os meses de julho e novembro. Nas duas temporadas, os períodos são definidos pelos vegetais, animais, peixes e aves abundantes no período, mas se utiliza também a orientação da lua e das constelações para o desenvolvimento das atividades. As estações são essenciais à sobrevivência do meu povo que observa o seu próprio calendário, diferente do calendário dos não indígenas, conforme o nosso modo de vida e a nossa cultura. Mas, também existem outras maneiras de marcar o tempo, por exemplo, por intermédio das festas tradicionais, dos cantos de animais e aves, os quais se associam ao início do período de derrubada, queima, coivara e colocação das roças e, finalmente a colheita; a alteração do nível das águas do igarapé, do rio e do campo indica a possibilidade de caça de alguns animais e aves, favorece a pesca e ainda a coleta de frutos.