“I am an American”: Communicating Refugee Identity and Citizenship

This study examines the messages in a citizenship preparation class being utilized by refugees and instructors. Through an ethnographic study of a citizenship class at an urban community center in a Midwestern city, an examination of these messages reveals assimilationist expectations and norms for refugees adjusting to American society. Responses from the refugees reveal how these messages are being either accepted or resisted as they negotiate new identities. A contradiction was found between what the citizenship class teaches and the perceptions of refugees regarding the meanings of American citizenship. In particular, refugees reported to often face a difficult situation in which their legal status upon becoming American citizens is not readily acknowledged by the perceptions of other Americans

Public Health and Social Desirability in Kazakhstan: Methodological Considerations

Background: As the Republic of Kazakhstan undertakes new public health efforts to promote healthy lifestyles among its citizens, the local perceptions of health and health behaviors need to be examined and understood from the sociocultural and historical perspectives. The primary aim of this study is to examine the association between perception of control on one’s health and engagement in good and bad health behaviors.Methods: Students enrolled in a health communication course surveyed 310 citizens of Kazakhstan on their perceptions of control over their own health and multiple health behaviors (i.e. smoking status, physical activity, etc.). Twenty-seven students were divided into groups and approached every third passerby as a potential participant during common shopping hours in nine popular marketplaces in Astana, Kazakhstan. Perception of control on one’s health was measured using a validated measure of health control: the multidimensional health locus of control scale (MHLC), developed by Wallston and colleagues. The MHLC measures three separate loci of control: internal, chance, and powerful others.Results: Participants perceived themselves as having highest control over their health (MHLC subscale internal: 29.70±0.64), powerful others had second highest control (MHLC subscale power others: 23.72±0.77), and chance had the lowest but still some control on their health (MHLC subscale chance: 20.82±0.85). Most participants rated their current health as very good (18.1%), good (45.0%), or moderate (32.3%). Approximately 23.4% of participants were smokers, and 22.2% consumed alcohol. Physical activity averaged 3.63 days in the past week, and fruit and vegetable consumption averaged 2 servings of each per day.  Tobacco and the powerful others subscale were significantly negatively correlated (r=-0.17, p<0.05). Conclusions: Participant reports regarding personal health behaviors and lifestyle did not reflect the national reports regarding lifestyle behaviors. The relationship between powerful others subscale and tobacco smoking indicate that using healthcare providers may open up avenues to lowering tobacco use through patient education; however, social desirability is a notable concern for public health interventions. More importantly, the surveys uncovered future questions for conducting public health research with the general public, including issues of trust in the healthcare system and social desirability bias. Additional factors such as distrust in healthcare and government also may play a role in the public’s participation in social scientific research. The students who conducted the surveys reported a general skepticism from the public ranging from unfamiliarity with survey research to explicit distrust in the intentions and purpose of the research itself

Evaluation of communication between physicians and patients in Astana City Hospital ?1

Introduction: Communication between patients and health care providers is important for the effective functioning of health care systems. Miscommunication often stems from discrepancies in expectations of both healthcare professionals and patients due to cultural and historical influences. We investigated the degree to which health care providers (doctors and nurses) and patients in Kazakhstan believe that interaction between doctors and patients should be doctor- or patient-oriented.Material and methods: We conducted a cross-sectional study of 163 patients and 176 health care providers (71 doctors and 105 nurses) in a general hospital in Astana, Kazakhstan. The subjects completed a structured questionnaire containing the Patient-Practitioner Orientation Scale (PPOS), and scales assessing life and job satisfaction, effort-reward balance of healthcare professionals, and the patients’ perceptions of communication practices.Results: An overwhelming majority of doctors (81.7%), nurses (88.1%), and patients (92.3%) were doctor-oriented. Among health care providers, PPOS was not associated with age, sex, life and job satisfaction, or effort-reward imbalance. Among patients, PPOS was not associated with age, sex, or specialty of health care provider. However, higher PPOS among patients (indicating preference for patient-oriented interaction) was associated with higher satisfaction with communication with health care providers and, less strongly, with their life satisfaction.Conclusion: The main finding of this study is the very small proportion of doctors, nurses and patients who believe that interaction should be patient-oriented. These results highlight the necessity of improvement of communication among health care providers towards patient-oriented approach in order to decrease miscommunication with patients. The fact that most patients prefer doctor-oriented interaction may reflect historical stereotypes; educational/information interventions among patients may also be needed

Deficits in autonomic indices of emotion regulation and reward processing associated with prescription opioid use and misuse

Prescription opioid misuse and high dose opioid use may result in allostatic dysregulation of hedonic brain circuitry, leading to reduced emotion regulation capacity. In particular, opioid misuse may blunt the ability to experience and upregulate positive affect from natural rewards

Toward Automation of the Supine Pressor Test for Preeclampsia

Preeclampsia leads to increased risk of morbidity and mortality for both mother and fetus. Most previous studies have largely neglected mechanical compression of the left renal vein by the gravid uterus as a potential mechanism. In this study, we first used a murine model to investigate the pathophysiology of left renal vein constriction. The results indicate that prolonged renal vein stenosis after 14 days can cause renal necrosis and an increase in blood pressure (BP) of roughly 30 mmHg. The second part of this study aimed to automate a diagnostic tool, known as the supine pressor test (SPT), to enable pregnant women to assess their preeclampsia development risk. A positive SPT has been previously defined as an increase of at least 20 mmHg in diastolic BP when switching between left lateral recumbent and supine positions. The results from this study established a baseline BP increase between the two body positions in nonpregnant women and demonstrated the feasibility of an autonomous SPT in pregnant women. Our results demonstrate that there is a baseline increase in BP of roughly 10-14 mmHg and that pregnant women can autonomously perform the SPT. Overall, this work in both rodents and humans suggests that (1) stenosis of the left renal vein in mice leads to elevation in BP and acute renal failure, (2) nonpregnant women experience a baseline increase in BP when they shift from left lateral recumbent to supine position, and (3) the SPT can be automated and used autonomously