Asthma is the most frequent chronic disease in children, and its pathogenesis involves genetic, epigenetic, and environmental factors. The rapid rise in the prevalence of asthma registered over the last few decades has stressed the need to identify the environmental and modifiable factors associated with the development of the disease. In particular, there is increasing interest in the role of modifiable nutritional factors specific to both the prenatal and post-natal early life as, during this time, the immune system is particularly vulnerable to exogenous interferences. Several dietary factors, including maternal diet during pregnancy, the duration of breastfeeding, the use of special milk formulas, the timing of the introduction of complementary foods, and prenatal and early life supplementation with vitamins and probiotics/prebiotics, have been addressed as potential targets for the prevention of asthma. In this review, we outline recent findings on the potential role of prenatal and perinatal dietary and nutritional interventions for the primary prevention of pediatric asthma. Moreover, we addressed unmet needs and areas for future research in the prevention of childhood-onset asthma. The role of several dietary factors, including maternal diet and vitamin status, composition of the microbiome, duration of breastfeeding, the use of hydrolyzed formulas and the introduction of complementary foods, has been investigated in recent clinical trials, to identify potential targets for the prevention of childhood-onset asthma , vitamin E, and zinc had a protective effect against early life wheezing in offspring, but not on childhood-onset asthma or other atopic conditions. One recently published study, assessing the impact of pre-pregnancy diet on the risk of allergic outcomes in children  in asthma prevention is still controversial. Two early RCTs showed no significant difference between pHF and eHF in the prevention of allergic diseases in children, including asthma , 42. In In a recent birth cohort study, infants received breast milk only, pHF with or without a hypoallergenic label, or non- hydrolyzed formula. The use of the pHF-with hypoallergenic label, compared to non-hydrolyzed formula, had no protective effect on the risk of asthma up to 2 years of age and was related to a higher risk of wheezing at 1 year in high-risk infants . A recenThe hypothesis that VD status in childhood might influence the susceptibility to childhood asthma and allergy is supported by the evidence on the role of VD as a key modulator of lung growth and innate and adaptive anti-inflammatory immune responses –50. ExpeInterestingly, VD supplementation during pregnancy and infancy has been related to a reduced risk of sensitization to house dust mites at age 18 months .in-utero  or a diet-limited supplementation (control group) showed a 34% reduced risk for recurrent wheezing by 12 months in the intervention group . There iin-utero  and postin-utero , and proin-utero . InterveThere is mounting evidence showing the relationship between the composition of the early-life gut microbiome and the risk of asthma in children , 58, whiIn a 2-year follow-up RCT involving 132 infants at risk of atopy, infants that were fed with a formula containing a mixture of prebiotic oligosaccharides reported a lower incidence for recurrent wheezing compared to the placebo group . In a 1-Taken together, the evidence on the effects of oral probiotics and prebiotics for the prevention of pediatric asthma is so controversial that no definitive recommendation can be made. Differences in the probiotic strain specificity, the population treated, the timing of administration, and the duration of the intervention all contribute to the heterogeneity of the meta-analysis and of RCT outcomes.The supplementation with omega-3 long-chain polyunsaturated fatty acids (LCPUFA) during pregnancy and early life, through the administration of fish oil, has been proposed for the prevention of allergic sensitization and atopic disease, including asthma , 73. LCPConflicting results have been found in studies investigating fish oil supplementation in infants and children for the prevention of allergic sensitization and asthma –67 Tabl. A meta-Recent advances in the field of allergy prevention showed that early 2000s recommendation to delay the introduction of solid allergenic foods to the infant's diet is not an effective approach to reduce the risk of allergic sensitization and atopic diseases in children –88. MoreThe timing of the introduction of fish is of particular interest to the purpose of primary prevention of asthma, given its high content in LCPUFA. Despite the heterogeneity in the methods of analysis and outcome measures, the early introduction of fish has been associated, in many observational studies, with a reduced risk of allergic sensitization , 94. HowThe significant increase in the prevalence of asthma and allergic diseases registered in recent years has promoted research on the identification of modifiable risk factors for the prevention of such disorders. It is well-acknowledged that respiratory health is determined by a complex interaction between genetic factors and environmental drivers that occur during prenatal and early postnatal life, including dietary factors. However, it remains difficult to define the contribution of specific dietary supplements and nutritional food sources to the risk of developing pediatric asthma, due to the heterogeneous pathogenesis of this disease and the limitations of the currently available evidence, in terms of study design, type and duration of interventions and outcomes measures.Further research is needed to accurately identify dietary and nutritional modifiable risk factors for asthma and to address whether the modulation of such factors, either alone or in combination, could contribute to the primary prevention strategies of pediatric asthma.DP, GN, IT, GC, and PC made substantial contributions to conception, design, and acquisition of data. GC, IT, GN, and PC drafted the initial manuscript. DP, EV, ED'A and PC critically reviewed it for important intellectual content. All authors approved the final version of the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Interstitial Lung Diseases (ILDs) are a large family of disorders characterized by inflammation and/or fibrosis of areas of the lung dedicated to gas exchange. In this Special Issue entitled “Clinical and Radiological Features of Interstitial Lung Diseases”, we collected a series of contributions in which a multidisciplinary approach was crucial for the correct diagnostic assessment of ILD. Sharing knowledge between different specialties can significantly improve diagnostic approaches and the management of ILD patients. Interstitial Lung Diseases (ILDs) are a large family of disorders characterized by inflammation and/or fibrosis of areas of the lung dedicated to gas exchange. The impairment of lung parenchyma causes the occurrence of symptoms, and in some ILDs, such as idiopathic pulmonary fibrosis (IPF), it may lead to respiratory failure and death. Some ILDs, including IPF and sarcoidosis, are idiopathic, others such as hypersensitivity pneumonia and drug-induced ILDs recognize specific etiologic agents, some others are instead associated with systemic diseases, as in the case of connective tissue diseases (CTD-ILDs) . ILDs reAll articles of this Special Issue are comprehensive and innovative in their approaches, addressing practical and still controversial or unresolved clinical problems related to the diagnosis, follow-up, and prognosis of ILDs. The two editors, Stefano Palmucci and Sebastiano Torrisi, both have the merit to involve and coordinate in this Special Issue, a number of young clinicians and experts. Looking at the list of authors who contributed to the different articles, it is nice to note the variety of their specialties: Biologists, physicists, immunologists, rheumatologists, radiologists, internists, computer scientists, and pulmonologists have all contributed to the success of this issue dedicated to ILDs. The participation and commitment of young experts to this group of diseases, coming from very different scientific settings, confirm the relevance and the broad clinical interest for this important chapter of the respiratory diseases.


Using the time series of 1 Jan 2020 to 26 June 2020, I employ a machine learning technique, i.e. Least Absolute Shrinkage and Selection Operator (LASSO) to examine the research question for its benefits over the traditional regression methods. This further allows me to cater to the issue of limited data during the crisis and at the same time, allows both variable selection and regularization in the analysis. Additionally, LASSO is not susceptible to and sensitive to outliers and multi-collinearity. The European market is mostly affected by indices belonging to Singapore, Switzerland, Spain, France, Germany, and the S&P500 index. There is a significant difference in the predictors before and after the pandemic announcement by WHO. Before the Pandemic period announcement by WHO, Europe was hit by the gold market, EUR/USD exchange rate, Dow Jones index, Switzerland, Spain, France, Italy, Germany, and Turkey and after the announcement by WHO, only France and Germany were selected by the lasso approach. It is found that Germany and France are the most predictors in the European market.  Specifications tableThe world has seen enough of the catastrophic implication of the COVID-19. Till 27 June, confirmed COVID-19 infections have crossed 10 million and with the loss of 5,02,208 lives around the globe. This had a further devastating impact on the global economy See: . Global The international market integration has been a topic of interest in recent times. The coronavirus has had a significant impact on the global economy. This increased volatility and impact on the world financial market is well documented in the literature The literature on pandemic and financial markets is evolving and currently explores rising volatility due to COVID-19 and uncertainty in the financial markets see .In this study, we analyze the potential European and global markets that shook Europe. To do this, 21 different potential predictors of the European financial market including predictors inside and outside Europe are used. The 21 indicators include indices from countries which got impacted by the COVID-19 the most along with gold, oil and bitcoins. This is done using a machine learning approach named LASSO regression, which allows both the model selection and regularization in the analysis. Germany, France, Gold, the S&P500, Singapore, Switzerland, Spain, Italy, Turkey, the Dow Jones, and the EUR/USD are found to be among the most important predictors of Europe. Germany and France are found to be the top predictors of Europe.The remainder of the article is structured as follows: the following section provides information on data and methods which describe the data sources, the variables specification, and estimation methods. This followed by a detailed discussion on the analysis and discussion on the importance of the predictors found to be important to Europe. Finally, the conclusion section.We employ daily data from 1 January 2020 till 26 June 2020We employ a machine learning technique, known as the Least Absolute Shrinkage and Selection Operator (LASSO) for the default sample and subsample periods. The literature on LASSO provides two main advantages of employing lasso over other methodologies like wavelet or ANN; first, LASSO offers a special feature of coefficient shrinkage, which automates the model selection in linear regression due to the nature of 1-penalty, and while doing so it further removes some variables from the model. It also factors in the the issue of multicollinearity as it is not sensitive to outliers and multicollinearity LASSO combines the least-squares estimator with an extra constraint on the sum of the absolute values of the coefficients. The limited data availability, during the COVID-19 crisis, might be an issue for traditional times series analysis, however, learning from the data, lasso also takes care of this problem and gives the best predictors.Before the pandemic announcement, Gold, EUSDD, DJ, Switzerland, Spain, France, Italy, Germany, and Turkey indices are found to be the most important commodities and indices that impacted Europe. For the third sample, that is after the announcement of the global pandemic by WHO, only France and Germany are found to be impacting Europe. However, no commodity market is found to be impacting Europe. The plausible reason could be that oil prices were falling due to its own dynamics [23]y-axis and the L1 norm is shown on the x-axis. For the default sample, it is found that all the selected predictors shown in To get further insights into the degree of importance of the selected predictors, the coefficient paths obtained from models are plotted in Addressing the nature of the impact of these predictors, these figures suggest that overall, the impact on Europe is (1) negative from Gold, the S&P500, and Singapore. And (2) positive from, along with the indices from, Switzerland, Spain, Italy, Turkey, the Dow Jones, and the EUR/USD. While Germany and France are found to be the top positive predictors of Europe. Though the LASSO selects different variables across different subsamples, the impact of selected variables remains unchanged.We attempted to explore the potential predictors of the European financial market by examining the impact of protentional internal and external determinants. Germany, France, Gold prices, S&P500, Singapore, Switzerland, Spain, Italy, Turkey, Dow Jones, and the EUR/USD are found to be the predictors of the Europe market. Germany and France are found to be the most important determinants of the European market. Though the LASSO selects different variables across different subsamples, the impact of selected variables remains unchanged.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


The authors wish to make the following correction to this paper .Biomolecules [The affiliation of Dr. Anuj Kumar was incorrect in the published paper in olecules .Therefore, this information was changed by the Biomolecules Editorial Office from:School of Chemical Engineering, Yyeongsan 38541, KoreaTo:School of Chemical Engineering, Yeungnam University, Gyeongsan 38541, KoreaWe apologize for any inconvenience caused to the readers. The manuscript will be updated, and the original will remain online on the article webpage with a reference to this Erratum.


The extractionof data from primary studies was performed using an instrument produced bythe authors and which allowed the construction of the categoriespresented.18 publications were included in this review. Among the most studied themesare the difficulties of the teams regarding the continuity of care in thehealth network; the importance of in-service education by themultidisciplinary team; professional unpreparedness; bioethics; thevalidation and application of scales for prognosis and care for somepathologies such as cancer and diabetes; among others.it became evident that palliative care in primary health care has beengradually developed, but it is necessary to consider the organization ofprimary health care and the social policies that support or weaken it, beingconsidered a complex challenge. Currently, PCs are defined as “active holistic care, offered to peopleof all ages who are in intense suffering related to their health, resulting fromserious illness, especially those who are at the end of life. The objective ofPalliative Care is, therefore, to improve the quality of life of patients, theirfamilies and their caregivers”.The most recent definition of Palliative Care (PC) was published in 2018 anddeveloped after a large project involving more than 400 members from 88 countries ofthe International Association for Hospice & Palliative Care (IAHPC), anassociation that maintains close ties and official relations with the World HealthOrganization (WHO).Thus, offering palliative care to people with serious illnesses takes into accountnot only the person, but everyone involved in the care. As a definition, seriousillness is understood as “any acute or chronic illness and/or condition that causesa significant disability and that can lead to a condition of disability and/orweakness for a long period, or even death”.. It is noteworthy that, in the 1980s, the life expectancy of Brazilianswas 62.5 years. Currently, the reality is different, the numbers have increased, bothlife expectancy has risen to 76 years and the number of services that provide palliative care in the country.This increase in life expectancy is the result of investments in public policies bythe State, including the implantation and implementation of the Unified HealthSystem (UHS).In Brazil, isolated discussions and initiatives in PC have been found since the1970s. It is noteworthy, however, that it was in the 1990s that the first organizedservices began to appear. It is .5 years. Curren76 years and the.Until August 2018, after a survey carried out by the National Academy of PalliativeCare (NAPC), 177 palliative care services were identified, distributed in the fiveregions of Brazil. Of these, 58% (103 services) are concentrated in the Southeastregion, 20% (36 services), in the Northeast region, 14% (25 services), in the Southregion, 5% (eight services), in the Midwest region, while only 3% (five services)are located in the North of the country on primary health care (PHC) and PC, held in 2014, aimed to understandthe roles of PHC professionals in palliative care and pointed out that PHC can makea difference to patients and their families by having easy access to them, close tohome, be able to carry out constant management of symptoms and sensitivity to therealities of the community: “Professionals monitor the aging and fragility of theirpatients, the efforts of families to accommodate the new care needs of theirmembers, fears, financial insecurity and, therefore, cannot avoid this moment: it isexactly in situations like this that the full potential of PHC actions and theFamily Health Strategy (FHS) becomes more evident. No other health service can standside by side with these families with such property and face the path of palliationwith constant presence, guidance and welcome”.As a result of the growth in the life expectancy of the population, there is anincrease in the occurrence of Chronic-degenerative Noncommunicable Diseases (CNCDs),which make the demand for PC a contemporary public health problem. An integrativereview on primwelcome”., held in 2015 on palliative care and PHC, aimed to identify, in theview of health professionals, the ethical problems arising from practice in thiscontext. The ethical problems detected were the scarcity of resources, the lack ofknowledge about PC, the lack of communication skills, the difficulty of establishinglimits in the clinical relationship, the work overload and the lack of support fromthe reference services. The authors concluded that, in order to incorporate PCs inPHC, specific norms and training are required, in addition to the culture of sharedand co-responsible care.A systematic review, held ible care.Therefore, in order to know the current panorama of palliative care in PHC andbecause there are no studies like this, which synthesize scientific evidence inrelation to the theme, justifying this study and its importance, it is presented asan objective: to map the available evidence on the main topics investigated inpalliative care in primary health care.. The elaboration of the scoping review followed a process consisting offive stages: a) Identifying the research questions; b) Identify the relevant studiesvalid for the investigation; c) Selection of review studies; d) Mapping of data fromstudies included in the review; e) Confront, summarize and report theresults.This is a scoping review study, carried out based on a set of techniques in order tomap knowledge on certain topics in a research field. It differs from systematicreview because it aims to focus on broader themes and include studies with differentdesigns. The elresults.For this, the PICO strategy was used, acronym for Patient, Intervention, Comparisonand Outcomes, for the definition of the following guiding question: “What evidenceis available about palliative care in primary health care?”. For the construction ofthe aforementioned question and to carry out the search, the PICO strategy wasstipulated as: P for Population, Patient or Problem (what evidence is available); Iof Interest  and Context CO .This review was conducted in the databases Medical Literature Analyzes and RetrievalSystem Online (PubMed/MEDLINE), Latin American and Caribbean Literature in HealthSciences (LILACS), Web of Science, Scopus and Cumulative Index to Nursing &Allied Health Literature (CINAHL). For this, the controlled and indexed descriptorswere used for each of the databases in this review. For the combination of these,the boolean operators OR and AND were used.From the research question, terms were selected in the Health Sciences Descriptors(DeCS) and terms in the Medical Subject Headings (MeSH) containing the appropriatedescriptors for searching the databases. The controlled descriptors used were asfollows: a) PubMed/MEDLINE: palliative care , hospicecare (synonym: hospice program), terminal care, critical illness, primary healthcare (MeSH); b) LILACS: palliative care , palliative care at the end of life , terminal assistance ,terminal care , Primary Health Care ; c) Web of Science; d) Scopus; e)CINAHL: Palliative care , hospice care (synonym:hospice program), terminal care, critical illness, primary health care (MeSH).For the selection of studies, the following inclusion criteria were considered: a)original research articles; b) made available in the full version; c) published inthe period 2009 to 2019, the last ten years; d) Portuguese, French, Spanish andEnglish languages.Exclusion criteria were defined: a) studies whose theme palliative care is presentedas a “recommendation” in the results and conclusions, not being configured as acentral object of the study; b) dissertations, theses, public policies and videos.The search for jobs for primary research took place on April 27, 2019 via advancedform.After identification, primary studies were selected, according to the guidingquestion and the previously defined inclusion and exclusion criteria. This step wascarried out by two reviewers independently. The instrument, designed for the purposeof extracting and analyzing data from the included studies, was composed of thefollowing items: 1- article identification; 2- object and/or question and/orobjectives of the study; 3- type of study/design; 4- data production tools and/ortechniques; 5- year; 6- magazine; 7- participants and/or sample; 8- main results; 9-area; 10- country. The stages of selection of the studies included theidentification, screening, eligibility and inclusion.The categorization was the form adopted for the analysis of the results in which itwas extracted how the PC has been carried out in the PHC. The work of analyzing thestudies consisted of a careful task. There was an interest in knowing andcharacterizing the panorama of the studies according to its investigated object. Forthe presentation of the data, we chose to build sequential figures that sought todemonstrate how the CP theme in PHC was studied by different authors.(-) were relevant for this review, since they met the study question andpre-established criteria, as explained in the analysis flowchart  and from Brazilian authors, five were published in Spanish and three in English. Of the included studies, eight used the qualitative approach and ten, the quantitative. As for the instruments / techniques for data collection/production,questionnaires, interviews, observation, discussion groups and application of scaleswere used. Among the study participants, the following were identified: healthprofessionals; formal and informal caregivers; patients eligible for palliativecare. Two studies, also, had sample of medical records of patients, according toWith regard to language, eleven studies analyzed were published inPortuguese-,-,-26 annish-,-17 annglish,,22. Oht-,- used th; meaning of being a caregiver and on PC for health professionals; evaluation of tumor asthenia; validation and application of a tool for prognosis; identification and characterization of patients in PC andservices; pain evaluation; assessment of dignity at the end of life; difficulties in accessing PCs; the work process in PHC; perspectives of occupational therapists in PC in PHC; ethical problems; comfort of caregivers of patients in PC; relationship between social support, quality of life and depression inPC patients in PHC, the complexity and/or difficulties in palliative care athome, the peculiarities of palliative care with high cost demands -infrastructure, the insufficient number of visits by health professionals, limited multidisciplinary approaches, insufficient professional training, the reduced scientific production in the area, the need to structure PHC for this purpose,the existence of very general care protocols and difficulties in accessing psychological support.The analysis of scientific production has shown that, although there have beenadvances in recent years, palliative care practices in PHC have still been incipientand, when they occur, present limits, as described in the results in ,21, tthome-,23, ttructure, the inssionals, limiteproaches, insuffaining,-21, t purpose,the exirotocols and dif support..Such aspects are related to the organization of care networks and primary healthcare. In Brazil, Family Health teams represented advances in access and healthindicators, but face difficulties of various kinds, such as economics, withunderfunding of health, training of professionals and improvement of networkarticulation, among others.. Perhaps, the incipience of this practice in Brazilian services isdemonstrated by the absence of a public health policy that specifically structuresor guides the development of these actions.An analysis of the current panorama of the PC, carried out in 2018, indicated that,although aware that primary care may be the strategy with the lowest cost andgreatest impact on the health of a population, the provision of palliative care inthe country is centered on hospitals. Perhap actions..A study involving Brazil and France addressed the transition of patients betweenhospital palliative care services and homes and showed that, in both countries,there are difficulties in this transition related, among others, to caregiverfatigue and fear of death. In this study, hospital discharge was also addressed withrationalizing purposes such as the release of beds. addressed the insufficient training of professionals for palliativecare and this theme was also evidenced in research, pointing out that the professionals’ unpreparedness to deal with thedemands and needs of chronic health conditions was present in countries that have anaging population longer than Brazil.The studies,-21 adresearch, pointiDeath, understood as a theme that is part of the daily life of health services,integrates the different phases of the human life cycle, but it is still a topicthat is treated in a reduced way, both in the training of health professionals andin health services, compromising the principle of integrality. it was shown that the request by family members not to reveal thediagnosis to the patient may coincide with the professional’s option, reinforcingtheir own difficulties with the subject. An integrative review of PC in PHChighlighted that the monitoring of the process of death and grief and thecommunication of bad news, among other topics, are rarely addressed in training andhealth services.In the study it was services..In some speeches of the professionals and in their actions, the curative model stillprevails, focused on the disease and the specificity of care. The training ofprofessionals could favor health education for patients and families, especially inrelation to the implementation of PC in PHC,14.. Thus, it is believed that institutionalized spaces that can putprofessional practices in an interdisciplinary way, are essential for the promotionof comprehensive palliative care.In addition, Permanent Health Education (PHE) is considered learning at work, takeseveryday life as an open space and a permanent reviewer of professional practices,as a place of subjectivity and discussions. Thus, However, it is considered that the provision of palliative care in primary care isrelated not only to the professionals’ capacity for the development of palliativecare, but also with universal health systems that are organized in a network andguided by an expanded conception of the health-disease process, taking into accountsocial determinants and social inequalities. “Poor” teams in poor locations thatmaterialize selective primary care are unable to take on the complexity of primaryhealth care and palliative care..Teams without adequate working conditions may, for example, make an insufficientnumber of visits by health professionals to these families. on Primary Health Care in Latin America addressed 12 countries anddiscussed the relationship between the implementation of comprehensive primary careand universal social protection. Certainly, this aspect does not match theimplementation of neoliberal policies and flexibility of social rights, as has beenseen not only in Brazil.A study on PrimThe authors addressed Primary Health Care in full, which considers the family andcommunity focus, the territorial base, the work in multi-professional teams andsocial participation and the expansion of this aspect in Latin America in left andcenter-left governments. Concerns were raised about the current political scenarioin this region of the world. articles brought the association of palliative care and cancer. Anotherfive articles mentioned cancer, but not in isolation, they also pointed outother diseases such as diabetes, Alzheimer’s disease, as well as respiratory andcardiovascular diseases. The expansion of PCs to other diseases appeared in a studyon human rabies and suggested a review of clinical guidelines, proposing theintroduction of PCs for people with rabies in endemic countries.It was observed that five-,-,23 arfive,,-26 arountries..Initially, palliative practice was directed only to cancer patients, but gradually itstarted to be incorporated by other specialties involved in the care of patientswith chronic-degenerative diseases. In its first edition, published in 1995, the“Medical guidelines of the National Palliative Care Organization (NPCO) fordetermining the prognosis in Selected Non-Cancerous Diseases” determined theprognosis of non-cancer diseases and included them in the palliative care programs.The first non-cancer diseases to be included were: Congestive Heart Failure (CHF),Chronic Obstructive Pulmonary Disease (COPD) and Alzheimer’s disease..Subsequently, the second edition, published in 1996, added the following pathologies:Aids (Acquired Immunodeficiency Syndrome); liver and kidney disease; leakage; comaand Amyotrophic Lateral Sclerosis (ALS)..If the association of diseases with palliative care can facilitate the specificity ofthe care to be offered, for Primary Health Care teams, other knowledge needs to bemobilized, such as, for example, the dynamics of family relationships and theproduction of unique therapeutic projects, as pointed out in a study. and the Karnofsky Performance Scale (KPS). Another article proposed the correlation between two scales, the KPSand the ICD-10 classification (ICD-10).The use of scales/instruments to define people eligible for palliative care wasaddressed in six articles, using the Palliative Performance Scale (PPS) and theKPS),,-26. A(ICD-10)., the General Comfort Questionnaire (GCQ), to assess the comfort offormal and informal caregivers, the European Cancer Research and Treatment Organization scale (EORTCQLQ-C15-PAL), to measure patients’ quality of life, the Medical Outcome Study (MOS)scale, for assessing the level of social support, and the Center for EpidemiologicalStudies - Depression (CES-D) scale for identifying symptoms ofdepression.In addition to the scales to identify people’s eligibility for palliative care, otherinstruments, such as the Visual Analog Scale (VAS), were used to assess painintensity, the Geregivers, the Eupression..An article that aimed to develop the Dignity Scale for Palliative Patients (PPDS) andused six other scales is highlighted: the Patient Dignity Inventory (PDI), whichidentifies sources of suffering in patients at the end of life; the Hospital Anxietyand Depression Scale (HADS); the Brief Resilient Coping Scale (BRCS), which measuresresilience; the GES Questionnaire, referring to spirituality; the IBPC C-30 Qualityof Life scale (EORTC-QLQ-C30) and the Duke-UNC-11 Functional Social SupportQuestionnaire, which assesses confidential and affective social support.In addition, it is essential that the primary health care professional knows andknows how to use the main scales used in palliative care, such as the EdmontonSymptom Assessment Scale, the Karnofsky Performance Scale and the PalliativePerformance Scale. Thus, professionals can have tools to help guide the specificcare plan for palliative care.; respect and willingness to understand the meaning attributed by thepatient and their family about death; communication used as a strategy to establish a bond; active and sensitive listening; non-judgment or abandonment of the patient and maintenance ofhope, even about the efficiency of the treatment for symptom relief. Thisdemonstrates that the way of doing, at this moment, emphasizes the ethical andinterpersonal dimensions in the professional-patient-family relationship.Regarding the work process of FHS professionals involved in the care of patients atthe end of the process of living, the following ways of caring can be identified:compassion-empathy-,-19; r death,,21; cning-,,21; n ofhope,19, etionship. publications, this subject was addressed. In one of them, ethics in palliative care was the central theme, includingaspects involving the communication of bad news, such as lack of sincerity andhiding the truth. Another article approached the subject, presenting a brief discussion about otherness,considered one of the references of bioethics.The discussion on bioethics was not a recurring theme in the selected articles and,in only two,21 pu article approacIt should be added that, for the effectiveness and guarantee of palliative care inprimary care, it is assumed that there is articulation between the various healthservices and several other sectors - consequently, other professional categories -such as: transport, to ensure accessibility; social security, guaranteeing socialrights; and justice, to ensure access and equity..In addition, in the intra-sectoral prism of the health system, relations with thevarious medical specialties  must besigned and perpetuated, in addition to different multi-professional categories,areas of epidemiological information and management, among others. articles, with an emphasis on the need for theoretical, scientificknowledge and specific clinical skills in the domain of different professions sothat the integrality of actions in the process of offering palliative care takesplace, thus contemplating the physical, psychosocial and spiritual dimensions of thepatient and their family.The importance of the multi-professional team was mentioned as fundamental infive,,-21 ar.In addition, within its scope, PHC has the potential to develop a set ofinterventions that favor the quality of life and continuity of palliative care,inside and outside the home, and can potentially favor and provide the patient withcare close to the patient family and friends, in addition to reducing the risk ofinfections and suffering from unnecessary hospitalizations,34.In addition, for the PC to evolve in PHC, it is necessary to plan the offer, identifyand meet the needs, the available resources, practice the sharing of informationthrough appropriate communication and define the commitments of the partiesinvolved. This is done in collaborative relationships and practices betweendifferent professionals, families and managers..In line with Resolution No. 41, of October 31, 2018, which provides for guidelinesfor the organization of palliative care, in the light of integrated continuous care,within the scope of the Unified Health System (UHS), it is advised that “thepalliative care should be part of the integrated continuous care offered within thescope of the Health Care Network (HCN)”, with PHC being considered the originator ofcare and territorial action..In order for changes to occur in the scope of management and care, the ability todialogue and problematize the current concepts within each health team is essential.The construction of new pacts, with the approximation of concepts aboutcomprehensive, humanized and quality care, in addition to equity and milestones thatoccurred strongly in the process of reforming the Brazilian health system, areessential for such changes to occur.This study has as its limit the non-problematization of the different health systemswhere the studies were produced, and primary health care is not always developed inits integral aspect, and there is still a strong orientation of health servicesaccording to the hospital logic. In addition, another limitation is the inclusion ofarticles in only four languages , which mayhave limited access to other publications on the topic.It is hoped that the compilation of the findings presented in this review may giverise to new lines of research and encourage other publications, contributing to thescientific advancement of the theme and performing the function of aid and supportfor the restructuring of practices and policies related to palliative care inprimary health care.The evidence and themes investigated relating palliative care in primary health carepoint to the possibility of this care, since these teams work closely with familiesand the territories where they live. Such a process could occur in health systemsthat implement primary care articulated with social policies, which ensure health asa human right, being difficult to implement in non-universal systems and withprimary care teams with few resources and poor articulation in a servicenetwork.The studies point out possibilities of using scales that can assist in theidentification and follow-up of people in palliative care, such as the EdmontonSymptom Assessment Scale, the Karnofsky Performance Scale and the PalliativePerformance Scale. There are also productions that point out aspects of subjectivityas important, highlighting empathy, listening and valuing cultural aspects.There are articles that deal with specific pathologies, with emphasis on cancer,diabetes and several pathologies that participate in the epidemiological anddemographic transition. It is emphasized that specific care needs to be recognizedat the same time that, in primary health care, other knowledge needs to be mobilizedto consider family and social dynamics and thus build unique therapeuticprojects.It was possible to identify, in this review, that there is a concern with the initialtraining of health professionals and on-the-job training, as this is stillincipient. To improve this situation, the insertion of the PC discipline in healthcourses is recommended and the implementation of permanent education and healtheducation actions to bring family members and professionals closer together, takinginto account cultural and social aspects of each family and team.However, it is reaffirmed that the provision of palliative care in primary care is acomplex challenge that goes beyond the preparation of professionals and familymembers, involves changing the logic and the care model that is still centered ondiseases, economic logic and professional practices that compete with each other ina corporate way. This process is also related to social policies that conflict withthe implementation of neoliberal policies and the flexibilization of socialrights.


The article analyzes how approaches to “Living Well” as reflected in the Constitution of the State of Bolivia, the Law of the Rights of Mother Earth, and the American Declaration on the Rights of Indigenous Peoples of the Organization of American States (OAS) contribute to understanding the Andean cosmovision of indigenous peoples of the American continent. To do so, it first studied the most immediate precedents that led to incorporation of the notion of Living Well into Bolivian law. Second, it approached the right to development from the American Declaration on the Rights of Indigenous Peoples, which has as its source the United Nations Declaration of the Rights of Indigenous Peoples. The paper thus proposes reflections on the Bolivian State and the American Declaration that advance understanding of Living Well, a notion comparable in the West to the right to development  that enables the individual and collective realization of the individual. Fullness, understood in terms of well-being, is related to the protection of health and of the environment. Finally, the paper employs a qualitative methodology with a well-documented hermeneutic focus, as well as the tool of a semi-structured interview with a Bolivian scholar familiar on the topic. In 2017, the Economic Commission for Latin America and the Caribbean (ECLAC) counted 826 indigenous peoples, of which 200 live in voluntary isolation. In 2014, Bolivia had the largest proportion of indigenous persons in its total population of any country in the region, 62.2% or over 6 million people. Like Bolivia, other ECLAC countries have large numbers of indigenous inhabitants relative to their total population: Guatemala 41% or 5.9 million, and Peru 24% or 7 million  an inalienable human right by virtue of which every human person and all peoples are entitled to participate in, contribute to, and enjoy economic, social, cultural and political development, in which all human rights and fundamental freedoms can be fully realized.”These are the claims for the individual. In parallel, from the collective perspective, development implies “the right of peoples to self-determination which includes, subject to the relevant provisions of both International Covenants on Human Rights, the exercise of their inalienable right to full sovereignty over all their natural wealth and resources” (Article 1). “The human person is the central subject of development and should be the active participant and beneficiary of the right to development” (Article 2). Various legal instruments on indigenous issues have considered the right to development in their different articles. First, Convention 169 (Articles 7 and 23) of the ILO includes the right of indigenous peoples to take decisions about priorities concerning the process of development and the duty of States to lend their support (Article 7). The Convention also stresses the importance of the traditional activities of indigenous peoples to their development (Article 23) .Second, through the principle of free determination, the UN Declaration on the Rights of Indigenous Peoples recognizes “political, economic, social, and cultural development. And to end all forms of discrimination and oppression, wherever they occur.”These peoples should control the events that affect them and their lands, territories, and resources according to their needs and aspirations (Preamble). States must therefore adopt effective measures such as free, prior, and informed consent concerning these lands and territories (Article 29) .Indigenous peoples have the right to maintain and determine their own priorities with respect to their political, economic, social, and cultural development in conformity with their own cosmovision. They also have the right to be guaranteed the enjoyment of their own means of subsistence and development, and to engage freely in all their economic activities ,6.This right includes the “development of policies, plans, programs, and strategies” for the exercise of their right to development and to implement them in accordance with their legal, political, social, institutional structure and their cosmovisions.Indigenous peoples have the right to be actively involved in developing and determining development programs that affect them and, to the extent possible, to administer such programs through their own institutions and their cosmovision.States shall consult and cooperate in good faith with the indigenous peoples concerned through their own representative institutions in order to obtain their free and informed consent ,53 priorIndigenous peoples have the right to effective measures to mitigate adverse “ecological, economic, social, cultural, or spiritual impacts of the implementation of development projects” that affect their rights. Indigenous peoples who have been deprived of their means of subsistence and development have the right to restitution and, where this is not possible, to fair and equitable compensation. This includes the right to compensation for any harm caused to them by the implementation of plans, programs, or projects of the State, international financial institutions, or private business.The OAS Declaration also materializes the right to development in Article 29. The content of this article is very similar that established by the UN Declaration mentioned above. More specifically, this article includes five situations:It is also important to mention briefly the legal development of the IHR Court on this issue. The IHR Court was a pioneer in expounding the close relationship of indigenous and tribal peoples to the land. Specifically, the IHR Court recognized the right of indigenous and tribal peoples to enjoy the earth without need of a formal title to property. It has decreed the adoption of special measures to guarantee exercise of the right to protection of physical and cultural survival, as in Mayagna (Sumo) Awas Tingni Community v. Nicaragua . SimilarFurther, the IHR Court stipulates indigenous and tribal peoples’ right to property in the case of natural resources discovered in their territories. Without resources, the economic, social, and cultural survival of the peoples is at risk, as demonstrated in the case of Yakye Axa Indigenous Community v. Paraguay . SimilarOn this order of ideas, the IHR Court also identifies the tremendous importance of the right to consultation and prior, free, and informed consent. The right of indigenous peoples to participate and to have their institutions and cosmovision respected includes the definition, demarcation, and allocation of a title to an indigenous or tribal territory, taking into account “traditional law, values, uses, and customs.” This assumption is reflected in Awas Tingniv. Nicaragua . In SaraOn the right to consultation, the Court determined in the case People of Sarayaku v. Ecuador that States have the obligation to consult with indigenous peoples. It based its decision not only on support for this notion in conventional law, but on also on the fact that the law of consultation constituted a general principle of international law that has been incorporated into domestic statutes and the jurisprudence of the great majority of the OAS member States .Finally, it is worth noting that, following the recent promulgation of the OAS Declaration for the International Day of the World’s Indigenous Peoples (August 9), the Court Reporters of the UN and the Inter-American Commission of Human Rights (ICHR) published a joint press release reaffirming indigenous peoples’ right to development, adding that a countries’ development “has been and continues to be driven at the expense of indigenous peoples of the continent.” Ultimately, the right to development, on the one hand, implies the right of all indigenous peoples to define their own development priorities, whether political, economic, social, or culture, according to their cosmovision; on the other, it challenges the States to guarantee that indigenous peoples enjoy their own means of subsistence and development and dedicate themselves freely to their economic activities .The right to development cannot be interpreted in isolation from other rights that complement it and facilitate understanding it as a whole if we seek to equate the right to development to Andean Living Well, which goes beyond the satisfaction of needs for comfort or consumption in monetary terms. Two sets of rights follow. The first set, the rights established in the third Section on Cultural Identity, includes: the right to cultural identity and integrity (Article 13); the right to preserve, use, develop, revitalize, and transmit to future generations their own systems of knowledge, language, and communication (Article 14); the right to education, particularly of indigenous children, at all levels and in all forms, without discrimination (Article 15); the right freely to exercise their own spirituality and indigenous beliefs(Article 16); the right to preserve, maintain, and promote their own family systems (Article 17); collective and individual rights to the enjoyment of the highest attainable standard of physical, mental, and spiritual health;(Article 18); and the right to protection of a healthy environment (Article 19).The second set encompasses the rights in the Fifth Section on Social, Economic, and Property Rights, including: the right to maintain and strengthen their distinctive spiritual, cultural, and material relationship with their lands, territories, and resources(Article 25); the right to remain in voluntary isolation or initial contact, and to live freely and in accordance with their cultures (Article 26); labor rights, such that States shall take all specific measures necessary to prevent, punish, and remedy any discrimination (Article 27); the right to protection of their tangible and intangible cultural heritage and intellectual property, including its collective nature, transmitted over millennia from generation to generation (Article 28); and the right to peace, security, and protection(Article 30).We will now focus on the right to peace, which is linked most directly to the right to development. Previously, the UN Declaration on Development  had asseThe UN Declaration of the Rights of Indigenous Peoples understands the right to peace as the suppression of military activities in lands or territories of indigenous peoples, unless there is a public reason to justify intervention. In any case, the State must consult before using indigenous lands or territories (Article 30.) The OAS Declaration later views this matter similarly to that of its UN predecessor, but includes more extensive content. According to the Preamble of the OAS Declaration, only:“recognition of the rights of indigenous peoples in this Declaration will foster harmonious and cooperative relations among States and indigenous peoples, based on the principles of justice, democracy, respect for human rights, nondiscrimination, and good faith.”In their totality, these factors enable harmonious coexistence, that is, realization of the right to peace. The Declaration also includes this right explicitly in Article 30, under the title, “Right to peace, security, and protection” of indigenous peoples, in which indigenous peoples are subject to protection under law. This formulation differs from the UN Declaration on the Rights of Indigenous Peoples, which considers indigenous persons as the subject of protection.Article 30 also recognizes the right to autonomy of indigenous institutions; the right to protection and security in situations of war , according to international humanitarian law; and the fourth Geneva Convention of 1949 on the protection due civil persons in times of war. In addition, Protocol II of 1977 on the protection of the victims of armed conflicts, which is not international in character, recognizes these rights. In the case of armed conflicts, States must take appropriate measures to protect the human rights, institutions, lands, territories, and resources of indigenous peoples and their communities.Special emphasis is placed on protecting the most vulnerable in the group, such as indigenous children and women, prohibiting their recruitment in the armed forces, providing effective compensation and reparations for the harm or damage caused by an armed conflict, taking special and effective measures to avoid all forms of violence ,simultaneously guaranteeing the right of access to effective justice, protection, and reparation of the damages caused to the victims, and protecting their right not to engage in military activities.Within this scenario, the last report of the Inter-American Commission on the situation of indigenous peoples of the Amazon states that “Indigenous peoples have the right to be protected from forced displacement due to violence, as usually occurs in contexts of armed conflict.” By analogy, forced displacement directly attacks the existence of indigenous peoples due to their bond with their territory, “on which they depend for their physical and cultural survival.” The indigenous population displaced in urban environments is easy prey to poverty and discrimination, labor exploitation, sexual violence, human trafficking, and crime. For these reasons, States should adopt special protective measures, although such measures do not exclude taking measures to enable the return of indigenous people “to their traditional territories safely and with dignity” .Finally, the right to international peace and security are fundamental elements for constructing the right to development. The right to peace and the right to development are closely related to Andean Living Well, which are related to the individual and collective harmony of indigenous persons and their peoples and, above all, to living together in and for peace.As previously mentioned, Bolivia plays an important and critical role in contributing to issues concerning indigenous peoples, and this contribution spans the legal, political, economic, cultural, and environmental spheres. This section focuses on the legal sphere.First, Bolivia has taken an important step in including in its Constitution  the prohThis law originated to remedy the former prohibition of indigenous people and animals from access to public establishments. Specifically, the Framework Law of Mother Earth stipulates that Living Well means that indigenous persons live “in a just, equitable, and solidary society, without material, social, and spiritual poverty” (Article 4. Law 300).A catalog of constitutional rights (Article 30.II).The constitutional and hierarchical equivalence of ordinary and indigenous jurisdiction (Articles 190 to 192).Recognition of rural native indigenous autonomy (Articles 289 to 296).Second, recognition of the following matters in the Constitution of Bolivia  providesIn fact, there must be compatibility and complementarity of “fundamental, civil, political, social, economic, and cultural rights to Living Well” (Article 4. Law 300). This idea includes individual and collective rights and freedoms linked to free determination of rural native indigenous peoples. But the concept is also associated with consultation and consent, natural resources, lands, and territory, which are often the subject of controversy between indigenous peoples and the State. According to Article 349 of the Constitution of Bolivia, natural resources are the property and direct and indivisible domain of the Bolivian people.Third, on the right to development, Article 9 of the Constitution affirms that it is the goal and function of the State to guarantee the development, well-being, security, and equality of persons, nations, peoples, and communities. The State must therefore foster “mutual respect and intracultural, intercultural, and plurilingual dialogue.” Bolivia considers development to be integral, “in harmony and equilibrium with Mother Earth” (Article 1. Law 300), Integral Development for Living Well, understood as:“the continuous process of generating and implementing social, community, citizenly, and public management measures and actions for the creation, provision, and strengthening of conditions, capabilities, and material, social, and spiritual means within the framework of culturally sufficient and appropriate practices and actions” (Article 5. Law 300).Fourth, on the topic of Peace, the Constitution includes in Article 10 that Bolivia is “a pacifist State that promotes the culture of peace and the right to peace, as well as cooperation among the peoples of the region and the World…” (Article 10.I). Article 4 Section 12 of the Framework Law of Mother Earth speaks of the “harmonious, dynamic, adaptive, and balanced relationship” between the needs of Bolivia and Mother Earth. Peace is related to harmony, which means “Living Well amongst ourselves, Living Well with those around us, and Living Well with oneself.”Finally, the influence of the Andean world view is present in the text of the Constitution. As Baldivieso writes: “Primary laws are enriched with rural native indigenous values and principles that generate fundamental and organic laws, but the law also keeps the higher goods inherent in Western culture; an interesting axiological symbiosis that gives rise to the development of Bolivian legal pluralism’’ .Within this conceptual framework, we will now briefly tackle the contributions of the OAS Declaration. This is an international legal instrument, subsidiary to national law, and the State is the main organism responsible for and guarantor of protection of the rights of all of its citizens within its jurisdiction. As with the Constitution of Bolivia, one of the arguments for development of the OAS Declaration revolves around the vindication of indigenous and tribal populations, which were not historically included, but rather, were made victims century after century. The first checks were imposed on this situation at international level, with the OLI’s Convention 107  and Convention 169 [The OAS Declaration recognizes that the vulnerability of indigenous and tribal populations led them to be dispossessed of their lands, territories, and resources, and that this has made it impossible for them to exercise their right to development, understood in terms of economic and social well-being. The Declaration recovers this respect for cultural identity and exercises the right to development according to one’s needs. Finally, it supports development as an essential element to achieve Living Well.On the right to peace, the Declaration recognizes peace, along with security and protection, as a totality, in times of both peace and war or conflict  and draws on other international instruments and humanitarian international law. It seeks to protect its women, children, and adolescents, who are direct victims of conflicts . The Declaration also firmly rejects military activities in territories or lands of indigenous and tribal populations. The only exceptions are public interest and having reached an amicable agreement between the indigenous population and the State.Definitely, the OAS Declaration attempts to equate indigenous peoples’ right to development and peace as integral elements of understanding Andean Good Living. Therefore, the right to development first recognizes the inseparable connection of indigenous peoples to the land, territory, and resources, which are conceived as a pillar of development. Second, the right to peace—defined as peace, security, and protection of indigenous peoples—incorporates essential elements for achieving the right to development. That is, both rights (peace and development) and other connected complementary rights  constitute the condition “sine qua non” to make it possible to speak in terms of equivalents to Andean Living Well. At the same time, these rights are mechanisms to guarantee the protection and defense of indigenous and tribal peoples against State decisions that may go against their economy, politics, culture, environment, or institutions.Finally, the jurisprudence of the IHR Court plays a valuable role, first as the “cement” for establishing and consolidating the edifice of the rights of indigenous and tribal peoples, constructed primarily around the right to development and peace, both of which are intimately related to Andean Good Living. The Court also establishes that control and possession of land, territories, and natural resources are indispensable parameters for the survival and development of indigenous peoples. Further, it consolidates this inseparable association of indigenous populations and the Earth, their territories and natural resources  resources, energy, flora, fauna, etc.) as elements crucial to their economic, political, social, cultural, and institutional development from their Andean cosmovision. Finally, the Court seeks to construct the inseparable synergy between indigenous and tribal peoples and Mother Earth known as “Pacha Mama, Mucane, Tonanzín, Iwi, Nana Tlalli, Gaia” .Appreciating and illustrating this close relationship that indigenous peoples have had historically with the environment and recognizing their rights are essential for the global implementation, monitoring, and fulfillment of the 17 Sustainable Development Goals (SDGs) in the Framework of the UN’s Agenda 2030  along thAt the Inter-American regional level, the Commission and Court for Inter-American Human Rights, as organisms for the protection of the Inter-American Human Rights System, have been working on indigenous issues and the environment. Since 2019, the IHR Court has handed down 24 sentences in favor of indigenous populations. Its legal work on protection of the environment remains, however, incomplete. The Inter-American Commission on Human Rights, in contrast, is already working on these issues and has produced three reports. These are the 2013 report on the situation of “Indigenous Peoples in Voluntary Isolation and Initial Contact in the Americas: Recommendation for the Full Respect of their Human Rights” ; the 2012). This area is considered the most biodiverse in the world, with tremendous cultural and biological wealth. It is also a “source of subsistence for the whole planet because it is a biome that operates as a global climatic stabilizer …and as a reserve of flora, fauna, and genetic diversity.” From the times of our ancestors to the present, this region has been inhabited and has served as the place where indigenous and tribal peoples develop their lives, knowledge, and traditional practices. It is home to around 350 peoples, including those in voluntary isolation and initial contact [We take the example of the Amazon Basin, part of which is located in Bolivia, with the rest distributed across eight other countries: Brazil, Colombia, Ecuador, Guyana, French Guiana, Peru, Suriname, and Venezuela  [The Bolivian Constitution’s Article 390.II states that the country’s Amazon territory includes the departments of Beni , Pando, La Paz , Cochabamba and Santa Cruz , 724,000g (CNPV) , there aBolivia’s domestic law specifically includes the protection and preservation of the Amazon region at a Constitutional level . The State prioritizes the sustainable integral development of Bolivia for its “environmental sensitivity, existing biodiversity, hydric resources, and ecoregions.” The State also administrates this development, fostering the financing of tourism and ecotourism activities in coordination with the rural native indigenous peoples in the region. To do so, it facilitates dialogue through the creation of a special decentralized entity in the Amazon, fostering traditional extractive products. Finally, the State protects against cutting species such as the syringa and chestnut due to their “historic, cultural, and economic value,” declaring them symbols of the Bolivian Amazon. Violating this law leads to criminal punishment except in cases of public interest.It is important to stress that Bolivia protects the environment as a right included in the Constitution (Article 30.II.10) and the laws favor Mother Earth and Living Well. Environmental law is protected by other constitutional clauses dedicated to its enforcement . This right is also linked to the right to health, as the State further promotes “quality of life” free access of the Bolivian population to healthcare and protection of the traditional medicine of indigenous populations (Article 35).These articles are also connected to Title II, on Environment, Natural Resources, Land, and Territory, which holds the State and the population responsible for the duty of preserving, protecting, and sustainably exploiting resources and biodiversity (Articles 342 to 347). To this end, environmental management policies are established, since this heritage is of public interest. There is also a special chapter on Hydric Resources. The right to water is recognized as “a most fundamental right for life” and health, through regulation of its use and integral management .Finally, we value very positively for a society like Bolivia its aspiration to collective and individual well-being of its citizens, reviewed in protection and guarantees of the right to the environment and its care. This strategy will be much more productive, however, if it not only includes national law but also makes the regional agenda of all States a priority, i.e., the agendas of both the American continent and the rest of the world. The first victims in this line of fire are always the most vulnerable, in this case, indigenous populations and those without contact or living in voluntary isolation, who live in harmony with nature and from whom we have much to learn. In fact, their participation and wisdom were fundamental elements in the processes that produced the UN’s Agenda 2030 for Sustainable Development .The Amazon has significantly affected the way of life, culture, and harmony with nature of the Amazonian indigenous peoples, who have been threatened since the twentieth century by increased extraction activities, reflected in increased logging, that accelerated deforestation that have given way to problems with other land uses. In recent times, there have been many changes, at the regulatory level, in State policies and practices aimed at increasing the extraction of natural resources and advancing large infrastructure projects, exerting pressure on indigenous ancestral territories ,63.In this context, there is a debate among States regarding the ratified international legal instruments of the United Nations and the Inter-American Organizations, emphasizing among other duties deriving from these instruments: (a) Design and effectively implementation of an adequate normative framework for the protection of human rights, which may be affected by extractive, exploitative and development activities; (b) the need for a legal framework that adequately addresses the operation of foreign companies within the jurisdiction of a State; and (c) the duty to prevent illegal activities and forms of violence against the population in areas affected by extractive activities, exploitation, or development .Accordingly, the State must adopt the most appropriate legislation and not contradict these rights, for example, environmental protection standards are indispensable in domestic legislation, not to bring before the Court the State for violating the human rights of the affected populations, and for activities that affect the environment . In thisThe great contradiction between theory and practice makes it difficult for legislators to carry out their work and makes legal implementation difficult, in relation to the exploitation and extraction of the natural resources of the Amazon region, with a combination of interests of individuals and the State itself. The lack of regulation or inadequate regulation of the resources of the Amazon, and the excesses in their exploitation and indiscriminate use, is a pending problem not only at the national level, but also at the global level.In the case of Bolivia, legal implementation at the constitutional and legislative levels has been favorable with regard to the protection of natural resources and indigenous peoples. Thus, the aim of the State is “to promote and guarantee the responsible and planned use of natural resources and to promote their industrialization” (Article 9.6). In particular, Title II, entitled “Environment, natural resources, land and territory”, provides for their treatment . In thisThe new Constitution grants ownership of natural resources to the people of Bolivia and is administered by the State in the collective interest (Article 311.II); the State is responsible for the mineral wealth found in the soil and subsoil (Article 369.I). It also deals with biodiversity, forest resources, hydrocarbons, mining, land, and the Amazon (Articles 390 to 392) . In thisThe internal law of Bolivia (Constitution and Laws) is progressive and supports the rights and recognition of the indigenous worldview. This was reflected in different aspects such as identity, feminism and its struggle for equality and justice among different genders, ethnicities, and social classes, with indigenous communities and their traditions. As a result, the cross-cutting “generic, cultural, ethnic, and generational diversity” and the principles of equity, interculturality and non-discrimination are taken into account throughout the constitutional text .First, indigenous identity is one of the essential elements in order for a human community to be considered a native indigenous rural people and nation . In this context, these peoples enjoy, among other rights to their cultural identity, religious belief, spiritualities, practices and customs, and to their own worldview, so that, if they consider it, the possibility of registering it with Bolivian citizenship and other official identification documents (ethno-citizenship) .Second, is feminism and its struggle for gender equality and justice. The Constitution recognizes the equality of conditions between men and women, as well as a series of guidelines and rights in favor of equality in relation to political participation and internal election of leaders ; field of work and wages (Article 48); sexual and reproductive rights (Article 66); vocational and humanistic education (Article 78.IV); and more specific rights directed to women, such as: not to suffer physical, sexual or psychological violence, in the family and in society (Article 15.II); maternity and special care before, during, and after childbirth and in the pre-and post-natal periods (Article 45.V); and in this line, not to be dismissed or discriminated against for any of the above reasons, ensuring their occupational security until the child reaches the age of one (Article 48). Consequently, the State is responsible for promoting policies aimed at eliminating all forms of discrimination against women in access to, tenure in and inheritance of land (Article 402).With regard to indigenous women, according to PilarUriona, “Living Well” is situated “in the context of the recognition and revaluation of the various existing identities”, with the “challenge to secure a permanently shared political gender agenda so that, in practice, the new legislation reflects the rights and claims that women demand and not the opposite of what is demanded” .However,Third, is sethnic groups and social classes. Discrimination against indigenous people and their populations is a challenge to be overcome throughout the world. In Bolivia, the current Constitution (Article14 and other related articles) eliminates all types of discrimination; especially in 2010, with the entry of the Law against Racism and all forms of discrimination,  where ArThe ethnic and cultural diversity of the American continent characterizes some ethnic groups whose ancestors lived in Africa. People of African descent remain ethnically and culturally distinct collectives, sharing a common identity, origin, history, and tradition . Afro-deThe Constitution mentions all the original languages that make up Bolivia, considering the plurinational as part of its commitment to inclusion and social justice, promoting mutual respect and intra-cultural, intercultural and multilingual dialogue (Article 9). The premise is that Bolivia is made up of all Bolivians, the original indigenous peoples, the intercultural, and Afro-Bolivian communities, which together are the people (Article 3).In order to avoid conflicts, the economic, social, political, and cultural rights of the Afro-Bolivian peoples, as provided for in the Constitution for the native indigenous rural nations and peoples, are recognized in all matters of concern to them. The State also provides them with fiscal land that they do not possess or are insufficient, in accordance with State policy, with a policy of sustainable rural development and women’s ownership of land without discrimination on the basis of their civil status (Article 395).Finally, with regard to indigenous peoples in danger of extinction, or in voluntary isolation and not contacted , their iHistorically, the Bolivian people have stood up in 10 marches against the measures and policies of exclusion implemented by various governments, demanding universal vote, agrarian reform, and the participation of the indigenous majority, women, and farmers in the public and political spheres. Subsequently, other marches have taken place, progressively achieving the inclusion and recognition of the rights of excluded groups, such as the native indigenous peasant populations .The political movement also achieved the legal recognition and inclusion of the Afro-descendant community , as wellThe vindication of indigenous persons and their peoples in Bolivia has brought important advances in recognition of their rights and dignity, but it has also revived their hope that they will not return to being excluded and oppressed in an unequal society. The question arises as to whether the protection of Bolivian constitutional law and international law in guaranteeing the rights and worldviews of indigenous peoples is sufficient. It is a collective that has been generationally marginalized throughout history, but, through the United Nations Declaration of Indigenous Peoples, significant progress has been made with the recognition of a number of essential rights  .Later, with the American Declaration on the Rights of Indigenous Peoples, it becomes clear that the States themselves are still the natural guarantors of the rights of their citizens, constituting the OAS protection bodies which promote a series of provisions for the promotion and protection of the rights of individuals, who are considered indigenous, and who are identified as such, among their parts. This represents a major step forward in the development of indigenous peoples’ issues and inter-American jurisprudence. In this area, it constitutes an invaluable contribution to the protection of the rights of the indigenous and tribal peoples of the OAS member States. However, although a legal framework, both international and national  for the protection of indigenous peoples is fully in place , regulatWith the adoption of ancestral knowledges  State policies have given concrete form to a hopeful process of change toward Living Well. These policies have been incorporated in Bolivian national law, bringing favorable changes and reforms to benefit these populations. Living Well is care for “Mother Earth”, for the person as individual being, social being, collective or group being, and spiritual being, and for the environment. Maintaining the equilibrium of these elements involves harmony within oneself, with one’s environment, and with the cosmos, a plenitude that correlates with health . Although approaches to Living Well differ depending on whether one takes an international perspective or an Andean one, there are points of intersection that should be preserved in both dimensions. Specifically, both approaches pursue the protection and guarantee of the rights of indigenous populations, recognizing the unquestionable bond of indigenous populations with their land, their territory, and their natural resources.As a result, the State must respect the rights of indigenous populations, using the law of prior, free, and informed consultation to guarantee peaceful and harmonious coexistence among indigenous persons, their populations, and the State, as well as equilibrium of the environment and natural resources, such as water. Finally, these rights guarantee quality of life, dignity, health, culture, and preservation of their identity, customs, culture, and oral traditions, among other rights. A long road and many unfinished tasks remain to complete this process, the more so because the process is taking place in a framework conditioned by the individual interests of the States, which sometimes either fail to implement sufficient mechanisms or only do so partially, not taking into account the rights of indigenous populations. But this situation transcends not only our generation and any specific territory, but also the political or economic situation of a single country; it goes beyond even current deforestation of the flora and fauna and the impact on the environment and biodiversity. It involves us all, because if we do not do something to protect these indigenous populations and “Mother Earth” as a whole, there will soon be little we can do. We will have destroyed any glimmer of hope for intergenerational equity.Finally, changes are not won in a single day. Promoting transformations of such magnitude requires time, courage, monitoring, and rigor to enable mature evaluation and reveal the aspects that need improvement and strengthening. We must also consolidate and continue the work to make the process of change toward Living Well possible, regardless of who comes to power and who dominates the world in any particular circumstances or at any given moment. Therefore, within the framework of the UN Agenda 2030 of SDGs, we must encourage and protect the knowledge of nature and the hereditary knowledge possessed by the rural native indigenous peoples of Bolivia and of other territories. They are an asset of incalculable value for the adoption and success of this crucial global strategy of humanity. This process will be aided by making a breakdown of data and inclusion of an “indigenous identifier” in the UN’s official statistics on countries’ progress toward fulfilment of Agenda 2030.The survival, dignity, wisdom, well-being, and respect of the rights of the indigenous peoples of Bolivia specifically, and of the whole world in general, constitute an essential foundation for successful dialogue between indigenous peoples and States. But above all, they represent hope for our future generations, for respect for our Mother Earth, for sustainable development, and ultimately for our common future on Earth, in the framework of the Andean vision of Living Well.In the case of the State of Bolivia, its Constitution makes it directly responsible for guaranteeing, protecting, and respecting the rights of indigenous nations and peoples (Article 30.III). It is a good start, that the first guarantor and responsible for a right is the State itself. These policy measures encourage the equal and non-discriminatory treatment of persons, regardless of their original social race, already covered by the Article 2 of the Universal Declaration of Human Rights. However, this does not mean that an ideal situation has been reached in this area. In this country, although the Constitution includes in part different important aspects that have been demanded since the first marches in the last century, there is still much work to be done, not only at the national level, but also at the regional and global levels. The task is not only for the State in question, but for everyone.