A randomized controlled trial of interventions to enhance patient-physician partnership, patient adherence and high blood pressure control among ethnic minorities and poor persons: study protocol NCT00123045

Background

Disparities in health and healthcare are extensively documented across clinical conditions, settings, and dimensions of healthcare quality. In particular, studies show that ethnic minorities and persons with low socioeconomic status receive poorer quality of interpersonal or patient-centered care than whites and persons with higher socioeconomic status. Strong evidence links patient-centered care to improvements in patient adherence and health outcomes; therefore, interventions that enhance this dimension of care are promising strategies to improve adherence and overcome disparities in outcomes for ethnic minorities and poor persons.

Objective

This paper describes the design of the Patient-Physician Partnership (Triple P) Study. The goal of the study is to compare the relative effectiveness of the patient and physician intensive interventions, separately, and in combination with one another, with the effectiveness of minimal interventions. The main hypothesis is that patients in the intensive intervention groups will have better adherence to appointments, medication, and lifestyle recommendations at three and twelve months than patients in minimal intervention groups. The study also examines other process and outcome measures, including patient-physician communication behaviors, patient ratings of care, health service utilization, and blood pressure control.

Methods

A total of 50 primary care physicians and 279 of their ethnic minority or poor patients with hypertension were recruited into a randomized controlled trial with a two by two factorial design. The study used a patient-centered, culturally tailored, education and activation intervention for patients with active follow-up delivered by a community health worker in the clinic. It also included a computerized, self-study communication skills training program for physicians, delivered via an interactive CD-ROM, with tailored feedback to address their individual communication skills needs.

Conclusion

The Triple P study will provide new knowledge about how to improve patient adherence, quality of care, and cardiovascular outcomes, as well as how to reduce disparities in care and outcomes of ethnic minority and poor persons with hypertension.     

Breastfeeding practices of ethnic Indian immigrant women in Melbourne,Australia

Background

The health benefits of breastfeeding are well documented in public health and medical literature worldwide. Despite this, global rates of breastfeeding steadily decline during the first couple of months postpartum. Although immigrant women have higher initiation rates and a longer duration of breastfeeding overall, breastfeeding practices are compromised because of a myriad of socioeconomic and cultural factors, including the acculturation process. The objective of this study was to show how acculturation and cultural identity influenced breastfeeding practices among Indian immigrants in Melbourne, Australia.

Methods

Twelve case studies were employed to gather narratives of women’s lived experiences. Ethnographic field research methods were used to collect data, including participant observation, semi-structured interviews, case studies, and life histories. This provided in-depth information from women on various aspects of the immigrant experience of motherhood, including infant care and feeding. Participants were opportunistically recruited from Indian obstetricians and gynaecologists. Women identifying as ethnic Indian and in their third trimester of pregnancy were recruited. Interviews were conducted in women’s homes in metropolitan Melbourne over a 12 month period between 2004 and 2005. Data were coded and analysed thematically.

Results

All women identified as ethnic Indian and initiated breastfeeding in accordance with their cultural identity. Social support and cultural connectivity impacted positively on duration of breastfeeding. However, acculturation (adopting Australian cultural values and gender norms, including returning to paid employment) negatively influenced breastfeeding duration. In addition, the high reliance of recent immigrants on the advice of healthcare professionals who gave inconsistent advice negatively affected exclusive breastfeeding.

Conclusions

For ethnic Indian immigrant women breastfeeding practice is closely linked to acculturation and identity construction, both personal and communal. The lack of social and cultural networks for recent immigrants prevents their involvement in the cultural systems that traditionally support breastfeeding. With this in mind, healthcare professionals should deliver services in a culturally appropriate and sensitive manner where women feel supported as well as empowered.

     

Cultural Transmission of Traditional Knowledge in two populations of North-western Patagonia

Background

Indigenous knowledge has become recognized worldwide not only because of its intrinsic value but also because it has a potential instrumental value to science and conservation. In Nepal, the indigenous knowledge of useful and medicinal plants has roots in the remote past.

Methods

The present study reviews the indigenous knowledge and use of plant resources of the Nepal Himalayas along the altitudinal and longitudinal gradient. A total of 264 studies focusing on ethnobotany, ethnomedicine and diversity of medicinal and aromatic plants, carried out between 1979 and 2006 were consulted for the present analysis. In order to cross check and verify the data, seven districts of west Nepal were visited in four field campaigns.

Results

In contrast to an average of 21–28% ethnobotanically/ethnomedicinally important plants reported for Nepal, the present study found that up to about 55% of the flora of the study region had medicinal value. This indicates a vast amount of undocumented knowledge about important plant species that needs to be explored and documented. The richness of medicinal plants decreased with increasing altitude but the percentage of plants used as medicine steadily increased with increasing altitude. This was due to preferences given to herbal remedies in high altitude areas and a combination of having no alternative choices, poverty and trust in the effectiveness of folklore herbal remedies.

Conclusion

Indigenous knowledge systems are culturally valued and scientifically important. Strengthening the wise use and conservation of indigenous knowledge of useful plants may benefit and improve the living standard of poor people.     

Ethnic differences in use values and use patterns of Parkia biglobosa in Northern Benin

Background

African locust bean tree (Parkia biglobosa) is a multipurpose species used widely in arid Africa by local communities. The present study focused on ethnic differences in use values and use patterns of P. biglobosa in Northern Benin, where the species widely grows. The use values according to the various ethnic groups in the study area have been evaluated in detail for P. biglobosa.

Methods

From 13 ethnic groups, 1587 people were interviewed in the study area using semi-structured questionnaires. Principal Component Analysis was applied to analyze the use value and the use patterns of P. biglobosa for the different ethnic groups.

Results

All interviewees in the study area knew at least one use of P. biglobosa. The various uses identified were medicinal (47%), handicraft and domestic (3%), medico-magic (1%), veterinary (1%), cultural (1%), food (25%) and commercial (22%). The various parts involved in these types of uses were: fruits [shell (2%), pulp (22%) and seeds (36%)], bark (17%), leaves (9%), roots (3%), flowers (1%) and branches (10%). The ethnic group consensus values for P. biglobosa parts showed that the seeds are used the most. The interviewees diversity value (ID) and equitability value (IE) indicated that knowledge concerning P. biglobosa use was distributed homogeneously among the ethnic groups.

Conclusions

P. biglobosa is well-known and used in different ways by the local populations in the study area. Local knowledge on the species is diversified and influenced by ethnic group. Ethnic differences in use values and use patterns of the species were evident in this study.     

Study protocol: The Adherence and Intensification of Medications (AIM) study - a cluster randomized controlled effectiveness study

Background

Each year, worldwide about 530,000 women die from causes related to pregnancy and childbirth. Of the deaths 99% are in low and middle income countries. Obstetric haemorrhage is the leading cause of maternal mortality, most occurring in the postpartum period. Systemic antifibrinolytic agents are widely used in surgery to prevent clot breakdown (fibrinolysis) in order to reduce surgical blood loss. At present there is little reliable evidence from randomised trials on the effectiveness of tranexamic acid in the treatment of postpartum haemorrhage.

Methods

The Trial aims to determine the effect of early administration of tranexamic acid on mortality, hysterectomy and other morbidities (surgical interventions, blood transfusion, risk of non-fatal vascular events) in women with clinically diagnosed postpartum haemorrhage. The use of health services and safety, especially thromboembolic effect, on breastfed babies will also be assessed. The trial will be a large, pragmatic, randomised, double blind, placebo controlled trial among 15,000 women with a clinical diagnosis of postpartum haemorrhage. All legally adult women with clinically diagnosed postpartum haemorrhage following vaginal delivery of a baby or caesarean section will potentially be eligible. The fundamental eligibility criterion is the responsible clinician's 'uncertainty' as to whether or not to use an antifibrinolytic agent in a particular woman with postpartum haemorrhage. Treatment will entail a dose of tranexamic acid (1 gram by intravenous injection) or placebo (sodium chloride 0.9%) will be given as soon as possible after randomisation. A second dose may be given if after 30 minutes bleeding continues, or if it stops and restarts within 24 hours after the first dose. The main analyses will be on an 'intention to treat' basis, irrespective of whether the allocated treatment was received or not. Subgroup analyses for the primary outcome will be based on type of delivery; administration or not of prophylactic uterotonics; and on whether the clinical decision to consider trial entry was based primarily on estimated blood loss alone or on haemodynamic instability. A study with 15,000 women will have over 90% power to detect a 25% reduction from 4% to 3% in the primary endpoint of mortality or hysterectomy.

Trial registration

Current Controlled Trials: ISRCTN76912190 and Clinicaltrials.gov ID: NCT00872469     

Illness-related practices for the management of childhood malaria among the Bwatiye people of north-eastern Nigeria

Background

A wide range of childhood illnesses are accompanied by fever,, including malaria. Child mortality due to malaria has been attributed to poor health service delivery system and ignorance. An assessment of a mother's ability to recognize malaria in children under-five was carried out among the Bwatiye, a poorly-served minority ethnic group in north-eastern Nigeria.

Methods

A three-stage research design involving interviews, participatory observation and laboratory tests was used to seek information from 186 Bwatiye mothers about their illness-related experiences with childhood fevers.

Results

Mothers classified malaria into male (fever that persists for longer than three days) and female (fever that goes away within three days) and had a system of determining when febrile illness would not be regarded as malaria. Most often, malaria would be ignored in the first 2 days before seeking active treatment. Self-medication was the preferred option. Treatment practices and sources of help were influenced by local beliefs, the parity of the mother and previous experience with child mortality.

Conclusion

The need to educate mothers to suspect malaria in every case of febrile illness and take appropriate action in order to expose the underlying "evil" will be more acceptable than an insistence on replacing local knowledge with biological epidemiology of malaria. The challenge facing health workers is to identify and exploit local beliefs about aetiology in effecting management procedures among culturally different peoples, who may not accept the concept of biological epidemiology.     

Nitrate-use traits of understory plants as potential regulators of vegetation distribution on a slope in a Japanese cedar plantation

Background and aims

Plant physiological traits and their relation to soil N availability was investigated as regulators of the distribution of understory shrub species along a slope in a Japanese cedar (Cryptomeria japonica) plantation in central Japan.

Methods

At the study site, previous studies demonstrated that both net and gross soil nitrification rates are high on the lower slope and there are dramatic declines in different sections of the slope gradient. We examined the distributions of understory plant species and their nitrate (NO ₃ ^? -N) use traits, and compared the results with the soil traits.

Results

Our results show that boundaries between different dominant understory species correspond to boundaries between different soil types. Leucosceptrum stellipilum occurs on soil with high net and gross nitrification rates. Hydrangea hirta is dominant on soil with high net and low gross nitrification rates. Pieris japonica occurs on soil with very low net and gross nitrification rates. Dominant understory species have species-specific physiological traits in their use of NO ₃ ^? -N. Pieris japonica lacks the capacity to use NO ₃ ^? -N as a N source, but other species do use NO ₃ ^? -N. Lindera triloba, whose distribution is unrelated to soil NO ₃ ^? -N availability, changes the extent to which it uses NO ₃ ^? -N in response to soil NO ₃ ^? -N availability.

Conclusions

Our results indicate that differences in the physiological capabilities and adaptabilities of plant species in using NO ₃ ^? -N as a N source regulate their distribution ranges. The identity of the major form of available soil N is therefore an environmental factor that influences plant distributions.     

Depredation of domestic herds by pumas based on farmer’s information in Southern Brazil

Background

We can conserve cultural heritage and gain extensive knowledge of plant species with pharmacological potential to cure simple to life-threatening diseases by studying the use of plants in indigenous communities. Therefore, it is important to conduct ethnobotanical studies in indigenous communities and to validate the reported uses of plants by comparing ethnobotanical studies with phytochemical and pharmacological studies.

Materials and methods

This study was conducted in a Tamang community dwelling in the Makawanpur district of central Nepal. We used semi-structured and structured questionnaires during interviews to collect information. We compared use reports with available phytochemical and pharmacological studies for validation.

Results

A total of 161 plant species belonging to 86 families and 144 genera to cure 89 human ailments were documented. Although 68 plant species were cited as medicinal in previous studies, 55 different uses described by the Tamang people were not found in any of the compared studies. Traditional uses for 60 plant species were consistent with pharmacological and phytochemical studies.

Conclusions

The Tamang people in Makawanpur are rich in ethnopharmacological understanding. The present study highlights important medicinal plant species by validating their traditional uses. Different plant species can improve local economies through proper harvesting, adequate management and development of modern techniques to maximize their use.     

Association between -238 but not -308 polymorphism of Tumor necrosis factor alpha (TNF-alpha)v and unexplained recurrent spontaneous abortion (URSA) in Chinese population

Objectives

TNF-alpha is a critical cytokine produced by Th1 cells while altered T helper 1 (Th1)-Th2 balance is found crucial for a successful pregnancy.

Study Design

A cohort of 132 Southern Chinese Han RSA patients and 152 controls constituted the subjects of this study. Two functional polymorphisms -308 and -238 of TNF-alpha were studied by association analysis.

Results

lack of association was found in TNF-alpha -308 SNP yet a significant difference was discovered in -238 polymorphism.

Conclusion

This study suggested that TNF-alpha may be a risk factor in Chinese RSA patients. However the ethnic differences may also contribute to the results.     

Natural variation in iron use efficiency and mineral remobilization in cucumber (Cucumis sativus)

Aims

Iron (Fe) is an essential micronutrient, and plant available Fe is often limited in alkaline soils. Fe deficiency chlorosis decreases plant growth and yield. Identification of germplasm with high and low Fe use efficiency will allow studies to better understand the genetic components for breeding Fe efficient varieties.

Methods

A screen using cucumber (Cucumis sativus) seedlings identified varieties that maintained contrasting levels of chlorophyll under Fe deficiency or limitation. A time course of mineral dynamics in cotyledons was conducted.

Results

The variety Ashley had the highest chlorophyll under Fe deficiency and per unit Fe in the leaf, while the variety Miniature White had the lowest. Ashley also maintained higher chlorophyll when challenged with low Fe or bicarbonate, accumulated greater quantities of Fe, and had higher root ferric reductase activity. Cotyledons accumulated minerals for the first several days, then Fe, P, K, and Cu were remobilized. The Fe use efficient and inefficient varieties remobilized Fe and P on different timescales.

Conclusions

Our results suggest that this screen can identify varieties for systems level studies that could elucidate factors needed for Fe use efficiency and remobilization of minerals. The time course indicated that cotyledon Fe stores did not contribute to seedling Fe use efficiency.     

Long-term effects of organic amendments on the recovery of plant and soil microbial communities following disturbance in the Canadian boreal forest

Background and Aims

Ecosystem recovery following disturbance requires the reestablishment of key soil biogeochemical processes. This long-term 7 year study describes effects of organic material, moisture, and vegetation on soil microbial community development in the Athabasca Oil Sands Region of Western Canada.

Methods

Phospholipid fatty acid analysis was used to characterize and compare soil microbial community composition and development on reclaimed and natural forest sites. Additionally, we conducted a laboratory moisture manipulation experiment.

Results

The use of forest floor material as an organic amendment resulted in a greater percent cover of upland vegetation and placed the soil microbial community on a faster trajectory towards ecosystem recovery than did the use of a peat amendment. The soil microbial composition within the reclaimed sites exhibited a greater response to changes in moisture than did the soil microbial communities from natural sites.

Conclusion

Our research shows that the use of native organic amendment (forest floor) on reclaimed sites, and the associated establishment of native vegetation promote the development of soil microbial communities more similar to those found on natural forest sites. Additionally, soil microbial communities from natural sites may be more resistant to changes in soil moisture than those found on reclaimed sites.     

Some Lithuanian ethnobotanical taxa: a linguistic view on Thorn Apple and related plants

Background

The perception and use of plants correspond with common plant names. The study of plant names may give insight into historical and recent use of plants.

Methods

Plant names in dictionaries and folklore have been evaluated. A etymological analysis of the names is provided. Onomasiological and semasiological aspects have been considered. Therefore, species named with names related to each other have been selected.

Results

Plant names containing the stem dag- or deg- may belong to either of two categories: incenses or thorny plants. Plants named in durn- have been in use as psychopharmaca. The name rymo points not to Rome but to the use of plants as anodyne or psychopharmaca.     

Naukan ethnobotany in post-Soviet times: lost edibles and new medicinals

Background

This study focuses on health-related plant use among speakers of the critically endangered Naukan language (Inuit-Yupik-Unangan family) in the Russian Far East. The Naukan people were forced, in 1958, under Soviet consolidation, to move from their original settlement on Cape Dezhnev, leading to significant changes in spiritual worldview, subsistence, social structure, and language proficiency in the years that followed. Here, we focus on changes that elders report in their edible, medicinal, and spiritual uses of local plant species since their childhood.

Methods

The authors worked from 2014 to 2016 in the villages of Lavrentiya, Lorino, and Uelen, in the Chukotskiy district of the Chukotka autonomous region, directly adjacent to the Bering Strait. We conducted structured interviews, using an oral history approach, along with participant observation and collection of voucher specimens from the local arctic tundra. Those with Naukan names and uses represent 42 species in 25 families.

Results

Participants reported a decrease of 13% in the number of edible species that people currently harvest, from what they recall harvesting in their youth. On the other hand, the number of local species considered to be medicinal has actually increased by 225%. Current and past Naukan medicinal practices diverge in some notable ways from those of neighboring societies on the Alaskan side of the Bering Strait. Most of the spiritual significance of local plants species is remembered by only a few elders.

Conclusions

Naukan elders explained the large increase in use of medicinal plants by noting that their original concept of medicine emphasized prevention and that illnesses were often assigned a spiritual rather than physical cause. Increased integration with ethnic Russians after moving from Naukan led to the adoption not only of new plant uses, but also of an entirely different, more naturalistic way of viewing illness and treatment.

     

Gene-chip studies of adipogenesis-regulated microRNAs in mouse primary adipocytes and human obesity

Background

Research has investigated whether communication technologies (e.g. mobile telephony, forums, email) can be used to transfer digital information between healthcare professionals and young people who live with diabetes. The systematic review evaluates the effectiveness and impact of these technologies on communication.

Methods

Nine electronic databases were searched. Technologies were described and a narrative synthesis of all studies was undertaken.

Results

Of 20,925 publications identified, 19 met the inclusion criteria, with 18 technologies assessed. Five categories of communication technologies were identified: video-and tele-conferencing (n = 2); mobile telephony (n = 3); telephone support (n = 3); novel electronic communication devices for transferring clinical information (n = 10); and web-based discussion boards (n = 1). Ten studies showed a positive improvement in HbA1c following the intervention with four studies reporting detrimental increases in HbA1c levels. In fifteen studies communication technologies increased the frequency of contact between patient and healthcare professional. Findings were inconsistent of an association between improvements in HbA1c and increased contact. Limited evidence was available concerning behavioural and care coordination outcomes, although improvement in quality of life, patient-caregiver interaction, self-care and metabolic transmission were reported for some communication technologies.

Conclusions

The breadth of study design and types of technologies reported make the magnitude of benefit and their effects on health difficult to determine. While communication technologies may increase the frequency of contact between patient and health care professional, it remains unclear whether this results in improved outcomes and is often the basis of the intervention itself. Further research is needed to explore the effectiveness and cost effectiveness of increasing the use of communication technologies between young people and healthcare professionals.     

Minor contribution of leaf litter to N nutrition of beech (Fagus sylvatica) seedlings in a mountainous beech forest of Southern Germany

Aims

Our aims were to characterize the fate of leaf-litter-derived nitrogen in the plant-soil-microbe system of a temperate beech forest of Southern Germany and to identify its importance for N nutrition of beech seedlings.

Methods

¹⁵N-labelled leaf litter was traced in situ into abiotic and biotic N pools in mineral soil as well as into beech seedlings and mycorrhizal root tips over three growing seasons.

Results

There was a rapid transfer of ¹⁵N into the mineral soil already 21 days after tracer application with soil microbial biomass initially representing the dominant litter-N sink. However, ¹⁵N recovery in non-extractable soil N pools strongly increased over time and subsequently became the dominant ¹⁵N sink. Recovery in plant biomass accounted for only 0.025 % of ¹⁵N excess after 876 days. After three growing seasons, ¹⁵N excess recovery was characterized by the following sequence: non-extractable soil N?>>?extractable soil N including microbial biomass?>>?plant biomass?>?ectomycorrhizal root tips.

Conclusions

After quick vertical dislocation and cycling through microbial N pools, there was a rapid stabilization of leaf-litter-derived N in non-extractable N pools of the mineral soil. Very low ¹⁵N recovery in beech seedlings suggests a high importance of other N sources such as root litter for N nutrition of beech understorey.