Healthcare Access Experiences Among Indigenous Women in Northern Rural Thailand: A Focused Ethnographic Study

Introduction: Persistent inequities in health and access to healthcare services for indigenous women living in Thailand remain a significant challenge. This study provides narrative accounts of Indigenous women’s experiences accessing healthcare in northern and rural Thailand and explores the complexity of culture and its interaction with multiple intersecting influences on health behaviours.Methods: A focused ethnographic study was conducted to understand and describe the culture of health behaviors and other cultural phenomena. We recruited 21 female participants aged 20-41 years between March and April of 2017. In-depth semi-structured interviews conducted in Thai were used to explore the experiences of the participants living in a northern rural village. Data analysis was informed and guided by Roper and Shapira’s framework for ethnographic analysis.Results: Seven themes presented across three phases of experience (pre-access, making choices, and encountering difficulties) revealed an in-depth understanding of the Indigenous women’s lives, the broader sociocultural context in which they lived, and the challenges they faced when accessing healthcare. Analysis of data showed that the participants did not have equal access to healthcare and often disproportionately experienced discriminatory practices and negative attitudes of mainstream healthcare providers.Conclusions: This is the only study to date that discusses healthcare access challenges experienced by Indigenous women living in a northern rural Thai village. There is an urgent need to focus on citizenship, employment, and general health conditions; gender, familial, and labor roles; specific health conditions, wellness, and cultural practices; the seeking of healthcare services; healthcare provider relationships; the ability to access needed care; and optimization of self-care. Future efforts to improve healthcare access and reduce disease burden might benefit from these findings and allow for the development of more effective strategies, programs, and policies

Osteopontin ablation ameliorates muscular dystrophy by shifting macrophages to a pro-regenerative phenotype.

In the degenerative disease Duchenne muscular dystrophy, inflammatory cells enter muscles in response to repetitive muscle damage. Immune factors are required for muscle regeneration, but chronic inflammation creates a profibrotic milieu that exacerbates disease progression. Osteopontin (OPN) is an immunomodulator highly expressed in dystrophic muscles. Ablation of OPN correlates with reduced fibrosis and improved muscle strength as well as reduced natural killer T (NKT) cell counts. Here, we demonstrate that the improved dystrophic phenotype observed with OPN ablation does not result from reductions in NKT cells. OPN ablation skews macrophage polarization toward a pro-regenerative phenotype by reducing M1 and M2a and increasing M2c subsets. These changes are associated with increased expression of pro-regenerative factors insulin-like growth factor 1, leukemia inhibitory factor, and urokinase-type plasminogen activator. Furthermore, altered macrophage polarization correlated with increases in muscle weight and muscle fiber diameter, resulting in long-term improvements in muscle strength and function in mdx mice. These findings suggest that OPN ablation promotes muscle repair via macrophage secretion of pro-myogenic growth factors

Helix-dependent Spin Filtering through the DNA Duplex

Recent work suggests that electrons can travel through DNA and other chiral molecules in a spin-selective manner, but little is known about the origin of this spin selectivity. Here we describe experiments on magnetized DNA-modified electrodes to explore spin-selective electron transport through hydrated duplex DNA. Our results show that the two spins migrate through duplex DNA with different yield, and that spin selectivity requires charge transport through the DNA duplex. Significantly, shifting the same duplex DNA between right-handed B- and left-handed Z-forms leads to a diode-like switch in spin-selectivity; which spin moves more efficiently through the duplex depends upon the DNA helicity. With DNA, the supramolecular organization of chiral moieties, rather than the chirality of the individual monomers, determines the selectivity in spin, and thus a conformational change can switch the spin selectivity

Healthcare Access Experiences Among Indigenous Women in Northern Rural Thailand: A Focused Ethnographic Study

Introduction: Persistent inequities in health and access to healthcare services for indigenous women living in Thailand remain a significant challenge. This study provides narrative accounts of Indigenous women’s experiences accessing healthcare in northern and rural Thailand and explores the complexity of culture and its interaction with multiple intersecting influences on health behaviours. Methods: A focused ethnographic study was conducted to understand and describe the culture of health behaviors and other cultural phenomena. We recruited 21 female participants aged 20-41 years between March and April of 2017. In-depth semi-structured interviews conducted in Thai were used to explore the experiences of the participants living in a northern rural village. Data analysis was informed and guided by Roper and Shapira’s framework for ethnographic analysis. Results: Seven themes presented across three phases of experience (pre-access, making choices, and encountering difficulties) revealed an in-depth understanding of the Indigenous women’s lives, the broader sociocultural context in which they lived, and the challenges they faced when accessing healthcare. Analysis of data showed that the participants did not have equal access to healthcare and often disproportionately experienced discriminatory practices and negative attitudes of mainstream healthcare providers. Conclusions: This is the only study to date that discusses healthcare access challenges experienced by Indigenous women living in a northern rural Thai village. There is an urgent need to focus on citizenship, employment, and general health conditions; gender, familial, and labor roles; specific health conditions, wellness, and cultural practices; the seeking of healthcare services; healthcare provider relationships; the ability to access needed care; and optimization of self-care. Future efforts to improve healthcare access and reduce disease burden might benefit from these findings and allow for the development of more effective strategies, programs, and policies

Nursing students achieving community health competencies through undergraduate clinical experiences: a gap analysis

Sherpa Romeo yellow journal. Permission to archive final published versionIn Canada, it is widely believed that nursing practice and health care will move from acute care into the community. At the same time, increasing numbers of nursing students are engaged in non-traditional clinical experiences for their community health rotation. These clinical experiences occur at agencies not organizationally affiliated with the health care system and typically do not employ registered nurses (RNs). What has yet to be established is the degree to which nursing students are actually being prepared for community health nursing roles through their community health clinical rotations. In this paper we report the findings of a mixed method study that explored the gap between desired and observed levels of competence in community health of senior nursing students and new graduates. The gap was quantified and then the nature of the gap further explored through focus groups.Ye

Osteopontin ablation ameliorates muscular dystrophy by shifting macrophages to a proregenerative phenotype

In the degenerative disease Duchenne muscular dystrophy, inflammatory cells enter muscles in response to repetitive muscle damage. Immune factors are required for muscle regeneration, but chronic inflammation creates a profibrotic milieu that exacerbates disease progression. Osteopontin (OPN) is an immunomodulator highly expressed in dystrophic muscles. Ablation of OPN correlates with reduced fibrosis and improved muscle strength as well as reduced natural killer T (NKT) cell counts. Here, we demonstrate that the improved dystrophic phenotype observed with OPN ablation does not result from reductions in NKT cells. OPN ablation skews macrophage polarization toward a pro-regenerative phenotype by reducing M1 and M2a and increasing M2c subsets. These changes are associated with increased expression of pro-regenerative factors insulin-like growth factor 1, leukemia inhibitory factor, and urokinase-type plasminogen activator. Furthermore, altered macrophage polarization correlated with increases in muscle weight and muscle fiber diameter, resulting in long-term improvements in muscle strength and function in mdx mice. These findings suggest that OPN ablation promotes muscle repair via macrophage secretion of pro-myogenic growth factors

Toward decolonizing nursing : the colonization of nursing and strategies for increasing the counter-narrative

Although there are notable exceptions, examination of nursing’s participation in colonizing processes and practices has not taken hold in nursing’s consciousness or political agenda. Critical analyses, based on the examination of politics and power of the structural determinants of health, continue to be marginalized in the profession. The goals of this discussion article are to underscore the urgent need to further articulate postcolonial theory in nursing and to contribute to nursing knowledge about paths to work toward decolonizing the profession. The authors begin with a description of unifying themes in postcolonial theory, with an emphasis on colonized subjectivities and imperialism; the application of a critical social science perspective, including postcolonial feminist theory; and the project of working toward decolonization. Processes involved in the colonization of nursing are described in detail, including colonization of nursing’s intellectual development and the white privilege and racism that sustain colonizing thinking and action in nursing. The authors conclude with strategies to increase the counter-narrative to continued colonization, with a focus on critical social justice, human rights and the structural determinants of health.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1440-18002015-09-30hb201

Restoring the blessings of the morning star: childbirth and maternal-infant health for First Nations near Edmonton, Alberta

Open access article.It is not only remote Aboriginal communities in Canada that have poorer maternalinfant health status than Canadian averages; residents of First Nation communities located close to large urban centres also experience this health status gap. Alexander, Alexis, Enoch, and Paul First Nations are located within an hour of healthcare services in greater Edmonton. The narratives of 75 predominantly Cree and Stoney women from these communities were gathered through seven talking circles and five semi-structured interviews. The participants described their experiences of loss and separation as pregnancy care and childbirth moved out of the community and into the hospital over the last two generations. This shift was not only a geographic relocation; it also disconnected the childbirth experience from elders, family and community, traditional teachings, and spiritual meaning. Conversely, the participants’ hospital experiences were characterized by a limited sense of cultural safety. Participants highlighted the urgent need to reintegrate culturally based community support and health perspectives into the childbirth experience. The implementation of such a culturally integrated healthcare model in all Aboriginal communities—remote, rural, suburban, and urban—may be the key finally to closing the gap between Aboriginal and non-Aboriginal maternal and infant health status in Canada.Ye

Morphology, ecology and biogeography of Stauroneis pachycephala P.T. Cleve (Bacillariophyta) and its transfer to the genusEnvekadea

Stauroneis pachycephala was described in 1881 from the Baakens River, Port Elizabeth, South Africa. Recently, it was found during surveys of the MacKenzie River (Victoria, Australia), the Florida Everglades (USA) and coastal marshes of Louisiana (USA). The morphology, ecology and geographic distribution of this species are described in this article. This naviculoid species is characterised by lanceolate valves with a gibbous centre, a sigmoid raphe, an axial area narrowing toward the valve ends, and capitate valve apices. The central area is a distinct stauros that is slightly widened near the valve margin. The raphe is straight and filiform, and the terminal raphe fissures are strongly deflected in opposite directions. Striae are fine and radiate in the middle of the valve, becoming parallel and eventually convergent toward the valve ends. The external surface of the valves and copulae is smooth and lacks ornamentation. We also examined the type material of S. pachycephala. Our observations show this species has morphological characteristics that fit within the genus Envekadea. Therefore, the transfer of S. pachycephala to Envekadea is proposed and a lectotype is designated

An exploration of addiction in adults experiencing early-life stress: a metasynthesis

Objetivo: revisar e sintetizar pesquisas qualitativas sobre os vínculos entre o estresse no início da vida e os comportamentos de dependência na idade adulta. Método: metassíntese para revisar resultados de pesquisa qualitativa com base em procedimentos que descrevem como identificar temas ou construtos através de estudos em uma área específica. Foram realizadas pesquisas abrangentes em múltiplas bases de dados eletrônicas. A pesquisa inicial produziu 1.050 artigos, cujos títulos e resumos foram selecionados para inclusão com base em critérios predeterminados. Trinta e oito textos completos de artigos revisados por pares foram recuperados e avaliados por três revisores independentes. Doze artigos foram elegíveis para revisão completa e avaliados usando as ferramentas do Programa de Competências de Avaliação Crítica (Critical Appraisal Skills Programme, CASP). Resultados: os achados revelaram que existem associações claras entre o estresse no início da vida e comportamentos aditivos na idade adulta, como entre trauma na infância, violência e comportamentos aditivos. Um tema comum nas descobertas indica que os participantes se voltam para substâncias aditivas como uma maneira de lidar estrategicamente com experiências estressantes da infância, independentemente dos efeitos colaterais deletérios ou resultados sociais prejudiciais. Conclusão: pode-se inferir que o vício pode ser visto como uma forma de lidar com a adversidade na infância e que existe uma inter-relação entre vício, violência doméstica e crime.Objetivo: revisar y sintetizar la investigación cualitativa referida a la relación entre el estrés durante la infancia y las conductas adictivas en la adultez. Método: metasíntesis que examina los resultados de investigaciones cualitativas basadas en procedimientos orientados a identificar temas o constructos en diferentes estudios en un área específica. Se realizaron búsquedas exhaustivas en múltiples bases de datos electrónicas. La búsqueda inicial arrojó 1.050 artículos. Sus títulos y resúmenes fueron analizados para determinar si debían incluirse en este estudio en base a criterios predeterminados. Se obtuvieron treinta y ocho artículos completos revisados por expertos que fueron evaluados por tres revisores independientes. Entre ellos, doce fueron seleccionados para una revisión detallada y evaluados mediante las herramientas del Programa de Habilidades de Evaluación Crítica (CASP por sus siglas en inglés). Resultados: los resultados revelaron que existe una asociación clara entre el estrés de la infancia y las conductas adictivas en la edad adulta, al igual que entre los traumas infantiles, la violencia y las conductas adictivas. Un aspecto común encontrado en los resultados es que los participantes recurren a las sustancias adictivas como una estrategia para lidiar con experiencias estresantes de su niñez, independientemente de sus efectos secundarios dañinos o de sus resultados sociales perjudiciales. Conclusión: se concluye que la adicción puede ser vista como una forma de lidiar con la adversidad en la niñez y que existe una interrelación entre la adicción, la violencia doméstica y la delincuencia.Objective: to review and synthesize qualitative research on the links between early-life stress and addiction behaviours in adulthood. Method: metasynthesis to review qualitative research findings based on procedures that outline how to identify themes or constructs across studies in a specific area. Comprehensive searches of multiple electronic databases were performed. The initial search yielded 1050 articles and the titles and abstracts were screened for inclusion based on predetermined criteria. Thirty-eight full text, peer-reviewed articles were retrieved and assessed by three independent reviewers. Twelve articles were eligible for full review and appraised using the Critical Appraisal Skills Programme (CASP) tools. Results: the findings revealed that clear associations exist between early-life stress and addictive behaviours in adulthood, such as between trauma in childhood, violence, and addictive behaviours. A common theme in the findings indicates that participants turn to addictive substances as a way of strategically coping with stressful childhood experiences, regardless of the harmful side effects or detrimental social outcomes. Conclusion: it can be inferred that addiction may be viewed as a way to deal with adversity in childhood and that there is an interrelationship between addiction, domestic violence and crime